LTC waking residents for routine Tylenol/Benadryl on nites

[doobiedo]

I have worked LTC in the past years but mostly days and eve.. Just started a very prn nite position after many years in a local facility and would like opinions please.

I have a couple residents who get Tylenol round the clock q6hrs or q 8hrs. I would not necessarily want to be awakened for that medication if I was in their position. These are AAO pts. I am unfamilar with rules when it comes to this. I appears the diagnosis justifying this medication is usually arthritis. What if I don't wake them up and circle it and indicate 'pt sleeping' would this be correct? Would the state have an issue with that?

I also have one resident on Benadryl q8hrs and is always sleeping when I come on shift. She has been on it forever...really needs to probably be reviewed for continuation (in my opinion) but again if she is sleeping could I circle it and say 'pt sleeping'? I am not sure of the rules governing this.

We also have a security system whereby certain residents have arm bands that set off an alarm if they go out a door. Nites is assigned to do a battery check on this band! Why do we need to wake pts up to check a battery? I know it needs to be checked but it is only checked once in 24 hrs and it is assigned to nites....but there is 1 nurse on nites for 60 pts and if I am lucky I have 3 aides and usually only have 2 1/2 (one CNA goes between 2 floors) and I have to do vital signs on anywhere from 6-10 pts usually for various reasons....the CNA's can't do them in this facility

I have to start my med rounds at 430am because I have to give meds to 40-45 pts and most are crushed in pudding so that takes extra time. Most of my meds are Synthroid and Prilosec! with some cardiac meds thrown in but not many. If it is a med that is given once a day it is assigned to nites. I am not opposed to doing things on nites believe me! ... however was just wondering why if there are more nurses on days (2-3) why is nites asked to give so many meds that should not require waking up a pt between 4:30-6am to give them.

Is this a common scenario in the facilities any of you work at? I think that most people think nites needs something to do ...I have so much charting and routine checks (accu chek, narc box, filing etc.) that is assigned to nites I certainly don't sit all nite except to do my charting in the morning. Let alone I barely have time to get to know the pts. Just say good morning and push pills is about the most contact I have with them!

Thanks in advance for any comments.

[leslie :-D]

My suggestion? Have your DON and any of the other chiefs spend three nights at your facility as patients, and see what it is like to disrupt their sleep every night...............seniors need their sleep and it should be uninterrupted as long as possible. Perhaps if they did this, then many of your rules would get changed..................

EXACTLY! Bravo Suzanne!

[CapeCodMermaid, RN]

The earliest we give meds is 6 am and most of the patients are already up. The short term residents who are usually younger just tell their docs to write a specific order which reads "do not wake for meds" or "give synthroid at 9 am"... I am still worried about that facility a few postings back with the round the clock benedryl.

[leslie :-D]

I am still worried about that facility a few postings back with the round the clock benedryl.

especially knowing that benadryl is contraindicated in the elderly....

[jkaee]

FINALLY....other people that realize what I was trying to tell TPTB (on day shift) about the poor residents quality of sleep at nights!

I worked nights on my last job, and like another poster stated, the med pass was so horrible on day shift that instead of re-evaluating the meds and their necessity, or hiring more nurses, they decided to put a whole sh$tload of meds on night shift. I'm not talking Prilosec, or Synthroid, I'm talking me waking a resident up at 5 am to give them their full day's worth of daily meds! Not to mention nights had to give all the suppositories, both the qod ones and the ones that made the BM list (some nights I'd have my fingers up at least 12 rear ends!) Add on the accu checks and AM insulins......all the straight caths and if we had a implanted device we had to draw blood for labs from them, plus weekly VS and skin checks and routine dressing changes. On NIGHT SHIFT! I had to start at 5am at the latest to get done.

So, think about it....the aides were in the rooms at least twice to do rounds (and management wanted them to be done at least 3 times since they thought night shift didn't have enough to do), i'm in there to give midnights and 5 am meds, plus suppositories, vitals, caths.......these poor people hardly got any sleep! It drove me nuts, but management didn't want to hear it!

Sorry for the rant, this just really hit a nerve with me. I'm off nights now, and fortunately, the place I'm at now isn't like that at all. Nothing is done on night shift unless it's absolutely necessary for the resident. And that's the way it should be! We also use a lot less psych meds and narcotics and have a lot less falls than my last job. Go figure.

[Twright49015]

Hello

I too work in LTC as a med tech, here is a suggestion for you as you are right its not right to wake residents at 4:30 am for routine tylenol. Fax or call the Dr. let them know what the current order is, then ask if the order can be changed to q 6-8 hrs prn. That way if the resident wakes up in the night and needs the routine med they can have it, if they don't wake up and need it, they don't get it. That will save you from waking them when not needing too.

We start our meds at 6am mostly actonel, procardia, etc. that must be taken before meals or when resident able to sit upright. My res. all in a assisted living facility therefore many of them are getting up about that time to start getting ready for breakfast.

Theresa

[CoffeeRTC, BSN, RN]

I'm glad others have posted on this topic. We are constantly being told that this is their "home", but do you wake up at 4 am to take a suppository or your pills or a finger stick...no! The 11-7 shift has way to much duties and shoouldn't be used for treatments, body checks or showers or q day meds. We don't to treatments unless necessary, body checks, or daily meds. Our q day meds are given on 3-11 and most of the treatments are done then also. I would kick someone if they woke me up every night! The elderly are like our children (not ment to demean them) in that if we wake our 2 yr old up they get very cranky an will be "off" during the day. oops I forgot...that is why we have psych drugs and dietary supplements. The sad part of this is that working 11-7 and being the only nurse for 40+ residents you DO have to start at 5 am just to get the meds and accu checks and etc done on time!

[flashpoint]

When I worked in LTC moons and moons ago, we were supposed to wake the residents up at 0400 for dietary supplements! About 20 out of our 60 were on Two-Cal and they were suppoed to get 2 ounces every 6 hours RTC. I understand the need for the supplements, but I would be furious if someone woke me up at 0400 to drink a nasty tasting liquid that coated my tounge and teeth! I think that doctors and nurses often forget that sometimes the "medically correct" thing is not the sensible thing to do...

[veteranRN]

I work 2-10pm shift in LTC only part time. I like the high risk for choking patients that get the majority of their once daily meds at HS, long after their asleep. Usually these are assigned by the day nurses because the person does not take meds well. HELLO!!! I wonder why these patients are an aspiration risk. On these patients i usually document "unable to arouse patient to safely administer oral meds d/t to increased aspiration risk, dr's office notified" I don't know if this is ligitimate but if someone is only getting vit E and multivitamin, to me it's not worth the risk :angryfire

[doobiedo, RN]

I'm glad others have posted on this topic. We are constantly being told that this is their "home", but do you wake up at 4 am to take a suppository or your pills or a finger stick...no! The 11-7 shift has way to much duties and shoouldn't be used for treatments, body checks or showers or q day meds.

My point exactly. We are told it is their home. Dont wake me up at 4:30 for meds or accu cheks!

I am not trying to get out of work. I want to do what is right for the patient. But as one poster said..I start my med rounds at 4:30 (need to start then for 40 + pts that need meds out of 60) The CNA's have been in on rounds at least 2-3 times before that. Let alone some of these same people I have to do accu cheks on also so that is another time I wake them up.

Just this weekend I had a pt go down the tubes and needed to assess her, call the doc, call 911, etc...needless to say not a pleasant morning and med rounds were late.. makes me wonder why I keep going back! :>)

Anyway ...Thanks for your replies and suggestions....I think I will talk with charge nurse about getting order to hold meds if asleep...by the way the Benadryl is giving for "itching" supposely...although as I said I think it needs to be revaluated....Thanks again. :)

[obeyacts2]

It is a "joke" around here in LTC, all these old folks with skin problems. The real issue is they want them to sleep and be compliant, and lots of old folks will knock right out on Benadryl, just like a sleeper. Nobody will question an order for itchy skin.

Laura

[CapeCodMermaid, RN]

In Massachusetts, Benadryl is always questioned whether it's for sleep or itchy skin. If they need a sleeper it should be Ambien or melatonin...and for itchy skin some soothing lotion or if it's really bad some atarax

[donmomofnine]

In Massachusetts, Benadryl is always questioned whether it's for sleep or itchy skin. If they need a sleeper it should be Ambien or melatonin...and for itchy skin some soothing lotion or if it's really bad some atarax

It's the same in Pennsylvania. No benadryl! ~whatever the reason.