LTC med nurses-Are you obeying all of the rules? - page 3

by Blackcat99 5,297 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


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    Quote from Blackcat99
    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 before administering meds. So how many of you are checking for allergies each and every time you give a med? How many of you are checking for expiration dates each and every time you give a med? I have 30 patients. I certainly do not have time to do it period.
    I have 24-32 residents depending on the unit I am on and always check expiration dates. We get our meds in blister packs so it's easier. As for doing everything taught in clinical....ya right. Staying in compliance is hard enough blazing through the med pass...add everything else and we just hope the state doesn't pop in for a surprise check.
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    As a med nurse in a ltc facility, no I don't check for allergies every time nor do I check for expiration dates. I was never even told this was something that I should be doing. Before they split the floor up I used to pass meds to 40 residents. You're right, we don't have the time to check this EVERY time, especially if we want to stay in compliance with the state. The pharmacy should be checking for allergies before they send the meds, and we only get a 30 day supply of (prescribed) meds so there's no need to worry about expiration date. (Hopefully our educational trainer doesn't see this...she'll be insisting we do this too as part of our med pass! lol)
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    Again, another instance of thinking a regulation or recommendation is silly or time consuming or make work.Giving a resident an expred medication or a medication they are allergic too could have far greater consequences than giving them a daily med an hour late.
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    Having a policy where the nurses have to check the expiration date of every pill before pouring it just isn't going to happen. All that will result in is nurses who lie. We have the third shift nurse do a "sweep" of the med cart once a week. Any med that is close to expiration is removed.
    morte and Blackcat99 like this.
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    I am thinking either you misunderstood, or i am misunderstanding you.....Do you really want me to check MS Smith for an allergy to ea of her meds (16) EVERY morning that i give them? This makes no sense, Any new allergies would (at least should) be passed on in report, and a simple glance at the top of the page should cover for ALL the meds at once. no new allergies, no more checking! [QUOTE=CapeCodMermaid;6979514]Again, another instance of thinking a regulation or recommendation is silly or time consuming or make work.Giving a resident an expred medication or a medication they are allergic too could have far greater consequences than giving them a daily med an hour late.[/QUOTE
    prettymica and Blackcat99 like this.
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    While the pharmacy, prescribing doctor, and nurse writing new orders should be mindful of cross checking the pt's allergies, ID, and correct order that doesn't always happen. I worked in a facility where a pt had a documented allergy to Dilantin. The doctor ordered Dilantin, the pharmacy sent the blister pack, and the nurse wrote the order on the MAR. If it hadn't been for checking the new med against the allergy list I would have given the Dilantin to the pt. I also worked in a facility where we received a pt from a LTC facility and a copy of the MAR was sent with the pt. The receiving nurse updated our med list by this MAR which ended up being for a completely different pt. The pt later ended up in ICU due to med errors. The MAR went through EMS, the receiving nurse, doctor, pharmacy, and floor nurse before figuring out the MAR was for the wrong pt. Bottom line-it is the nurse giving the med who will ultimately be held responsible.
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    It's true that the nurse administering the med is ultimately responsible. But this doesn't change the fact that a med nurse cannot check the expiration date on every bottle/pack of pills before pouring it. If you follow the "ultimately responsible" argument to it's logical
    conclusion, you come up with some pretty absurd scenarios. Is the med nurse responsible if the pharmacy dispensed the wrong pill into the bottle? Is she responsible if another
    nurse transcribed the med order on the wrong MAR two months ago? Is she responsible if the night nurse boxed off the wrong days on a "every third day" med during changeover? Is "best practice" to examine every pill against the picture in the med book before giving it? Should we leave the med cart and look up every newish med in the pts chart to make sure there's an order and no transcription error. Should we dig out last month's MAR to make sure all the little boxed off dates jibe up? Where does it end?
    prettymica, morte, and Blackcat99 like this.
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    Quote from CapeCodMermaid
    Again, another instance of thinking a regulation or recommendation is silly or time consuming or make work.Giving a resident an expred medication or a medication they are allergic too could have far greater consequences than giving them a daily med an hour late.
    Knowing you through your posts here on allnurses leads me to believe that you would never berate a staff nurse for not completing the med pass within the appropriate time frame.Sadly,managers and DON's like you are few and far between.I have witnessed co-workers being literally screamed at in the middle of the hallway for running late with the med pass from H*ll.


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