LTC med nurses-Are you obeying all of the rules? - page 2

by Blackcat99

5,144 Views | 27 Comments

I just got a bunch of paperwork about meds at my LTC. According to the policy, I am required to check for all allergies each and every time before administering meds. I am also required to check for expiration dates on each med... Read More


  1. 3
    I would like to add that checking for expiration dates is especially critical for insulins, eye drops, inhalers and nebulizers. Surveyors are watching to see if nurses are consciously checking those particular items prior to pouring or administering. Quite a few facilities this year have received IJs for having undated and/or expired insulins on the carts. I have suggested to all the facilities that I audit that the nurses begin checking for dates on the insulins whenever they do their shift to shift narcotic counts. It takes a couple of minutes and gets one into the habit of paying attention to this frequently overlooked area.
    NamasteNurse, Blackcat99, and alika like this.
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    It is easy to tell the nurses, "You must do this, this, and this" and more documentation to boot in order to make sure those things are done. Problem is, the more tasks are dumped on nurses whose time is already stretched to the limit, nurses will inevitably come up with shortcuts. You can blame the nurses for not doing what they're supposed to do, or for taking shortcuts, but what about the faulty system that leads nurses that way?

    People in product marketing or advertising know a lot about human behavior and utilize it well. Supermarkets or malls control consumer behavior by using certain layout, music, lighting, all kinds of things. What if healthcare facilities used a similar approach to "control" nurses' behavior? What I mean is, to make it easier for nurses to do the right thing rather than wrong things? Streamline documentation, adopt EMAR system, design med rooms and supply closet in such a way that nurses don't waste time looking for things. But it seems like a facility's priority is everywhere else but nurses.
  3. 3
    In general, no. However, I have 20 residents and the other floor nurse has 20. For the main part, our residents are long term and get the same meds day after day, sometimes year after year. I know their allergies because I've had them a long time, been in their charts, written new orders and transcribed into the MAR so many times.

    If they get a new med, of course I review everything including allergies because as we all know, doctors don't always do that. If a doc see a res and prescribes something new, I check interactions and allergies and if I find an incompatibility I report it.

    As to expiration dates, when we put a stock med on the cart we label it with the date it is opened and check the expiration date. Probably every couple of months or so I look through and check for expiration again, and sometimes our pharmacy rep comes through and does a check. Of course if we hear the dreaded "State's coming" we do a thorough check and throw stuff out.

    If I float, then yes, I look at the MAR more closely every resident and make sure nothings incompatible. The allergies are right on the MAR as we still have PAPER MARS !

    Bottom line, it's the nurses responsibility to ensure pt safety.
    prettymica, CountyRat, and Blackcat99 like this.
  4. 2
    At my job, the night nurses are responsible for checking for expired meds on the carts once a week. Most do it, some definitely don't. Pay more attention to the stock meds- vitamins/liquid APAP/etc., things that are stock and not used frequently expire and can easily go unnoticed.
    As for all the patients not wearing ID bands- mention this to the unit manager. They should all have them on, perhaps she is unaware they don't. If I pass meds to my patients and they are not wearing one, they get one.
    prettymica and Blackcat99 like this.
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    Im brand new and last night I was given 26 patients on my own, (big surprise) I did not finish med pass by the end of my shift. ( I had a preceptor, so I was not on my own) At the end of the night my preceptor told me she thought part of my problem was that I was checking the med cards against the MAR. We are supposed to do that obviously, but some of the Nurses are so familiar with the meds that the patients are on, they dont even bother looking at the MAR and just pop the pills.

    artsmom, ID bands would be a dream come true for me. Ive only been at my first job for a few days and nobody wears an ID and they are in the hall or out of their rooms most of the time. The other nurses and aides are looking at me like I have 2 heads when I ask for a second person to identify because I just dont know all these people yet.
  6. 5
    Let them look at you then. If the pt can't tell me who they are and I don't know them, I always ask. Telling you not to check the cards against the MAR is terrible. I always check them. This weekend alone I found two cards with the wrong doses. I guess a lot of nurses don't look. You will develop a routine to improve your time, let that routine be a safe one!!
  7. 3
    Anne36:
    I am very familiar with my patients and their meds as I've been on the same floor with a majority of the same patients for years now. By habit I pull their 'normal' meds from the drawer..however, before I pop them out of the pack, I always check them against the MAR. Many times, although they might still be on XYZ med..the dose has been increased or decreased, some have been D/C, new ones added, time of admistration might changed etc. I prefer to be safe and double check my meds against the MAR every patient, every med, every med pass. Like the poster above, I've found many cards with the right drug that the MAR has listed but the dose is higher/lower than what the MAR said (due to doctor changing mg amt). IE: Card-Lasix 40mg, MAR says 20mg twice a day d/t doc changing original order from 1x per day to giving lesser mg 2x per day. Or Card-Lasix 20mg twice a day MAR says 40mg once daily.

    You keep doing what you're doing and being safe.
    Blackcat99, Anne36, and artsmom like this.
  8. 1
    Quote from Anne36
    I know we were taught to do that in clinical but we were taught a lot of things in clinical that are not time effective. If we have 20-30 clients to pass meds on how would you be able to check the exp date on each packet of medication every time? One of the reasons we never got many patients in clinical is because it took forever to do med pass with an instructor. When I started my first job last week I was taking the time to pull meds, dot the entry and then go back and sign it after the med is given like you are supposed to, then I noticed that the experienced Nurses were not doing that, they were initialing when they pulled the med. Now I know why, after I passed meds on 28 clients. Anyway, the case manager for the floor saw me doing it and was not happy, probably because I am new and it is not correct to do so. She knows all the other Nurses are doing it. I also saw other Nurses passing meds that fell on the med cart when we are supposed to pop a new pill if it touchs anything. I am orienting and worry about how slow I am when I do everything by the book. It really increases my stress level. I am also on the ceiling about patient identification in these LTC facilites. There is nothing proper like an ID band, all I have is the word of the closest CNA that Im getting the right patient, because I dont know all the residents yet. There is a picture in the MAR, but it doesnt seem like the best way to make an ID on an elderly client.
    According to NCLEX, ATI and Kaplan a photo is acceptable :/
    Blackcat99 likes this.
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    I know it's hard to check for allergies but here is why: my dad is allergic to aspirin. He had a heart attack a few years ago. Despite having an allergy band on his arm, a RED folder indications an allergy EVERY 6hours they tried to give him aspirin. He finally blew up at a nurse because he was sick of them NOT reading the chart and just handing out meds willy nilly.

    Is this always the case? No. But it scared me enough that as a student I ALWAYS checked allergies before handing out a medication. It ticked some instructors off because it took an extra minute, but once I explained why I did it, they left me alone.
    CountyRat and Blackcat99 like this.
  10. 3
    I work during the shift that gives the most meds. Some residents take 20 meds this shift. We also have to FIND the residents! They could be in their room, someone else's room, the dining room, outside...! With charting, glucose checks, breathing treatments, passing scheduled meds, giving PRN meds, doing other treatments, speaking to family members, residents, the Doctor, doing vital signs, paperwork, etc., there is NO POSSIBLE WAY that we could check each med. We have to rely on the Doctor & Pharmacy to give us the correct meds. With each new med order allergies are included.
    prettymica, AheleneLPN, and Blackcat99 like this.


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