LTC waking residents for routine Tylenol/Benadryl on nites

  1. 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.
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  2. 26 Comments

  3. by   canoehead
    You have some pretty reasonable concerns I think. I also wonder what the point is of waking residents for routine meds that could be given anytime. Seems unnecessarily cruel to me.
  4. by   txspadequeenRN
    i think any patient that is sleeping should be left alone. with the exception of routine morphine. in my facility they want the patients to be awaken for night med pass which is around 9-10p to give sleeping pills. is there something wrong with this picture. :angryfire :angryfire :angryfire :angryfire
  5. by   Destinystar
    1. residents &/or their responsible party are supposed to be involved in the care planning decision. this issue is not about staff convience. if the resident does not want to be woken up then the med should be given when the resident is awake. if the resident doesnt care than what difference does it make?
    2. what does the pharmacy consultant think?
    3. after first detemining that this is a problem for the resident (not u) then you can go ahead and discuss it with the md and get the order changed at a convienant time for the resident
    4. the last time i looked it is the function of the maintenance department to keep equipement operating. this issue could be take up with the administrator (lots of luck). get a union and refuse to waste your preciouse time on non-nursing matters.
    5. this is definatly a quality of life issue.
    6. start on the lowest level take the issue up with the don and see if something will change

    3.
    Quote from 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.
  6. by   michelle95
    It's kind of weird that QD meds are given that early. At the places that I have worked QD is 0900. If it was something that needed to be given on an empty stomach (fosamax, actonel, etc...) I could see that, but, general QD meds? That just seems kind of wrong to me.

    If I ever go to a nursing home and a nurse tries to come in at 0430 to give me a routine med, I'm gonna be fighting.

    The patients may not feel like they have any control over what times their meds are given.
  7. by   VivaLasViejas
    I once worked nights in an LTC where the resident care manager assigned routine meds/treatments to noc shift just because she thought we didn't have enough to do..... And TPTB always wonder why so many nursing home residents have behavior issues.......well, how would THEIR mental health fare if they were awakened several times a night, every night of their lives? I mean, 'lotion to feet and legs' QD at 0400?! Gimme a break!!

    Seriously, I've always believed that the way things are done in LTC overall is for staff convenience and to even out the workload, not because of any possible benefit to the residents. When I became an RCM, one of the first things I did was get rid of all the routine Tylenol (at 2400 and 0600), the "silver bullet brigade" (if anyone ever came in and tried to stick something up my backdoor at five AM, they'd be lucky to keep their teeth!! :angryfire ), and other unnecessary sleep interruptors I possibly could. It was one thing if the resident wanted it done that way; but as a firm believer in the restorative quality of uninterrupted sleep, I fought to provide residents with as much of it as I could.
  8. by   Blackcat99
    When doctors write orders they should write "Tylenol every 6 hours if awake" I have worked evenings and have seen some noc shift nurses circle a med and write on the back of the med sheet med not given-asleep. I don't know if the state approves of this or not. I am worried that the state might consider it a med error since you have no order to hold it if resident asleep???
    Yes maintenance should be checking the batteries on day shift when the residents are awake. I can understand giving fosamax and actonel on nocs but it is indeed strange to have to give all the daily meds on nocs. Most LTC's give the daily routine meds at breakfast time. Elderly people have sensitive stomachs and shouldn't be taking all their morning pills on an empty stomach.
  9. by   CapeCodMermaid
    Our pharmacy consultant insisted we give the synthroids out at 6 because it is absorbed better on an empty stomach.
    Get your docs to add "hold if asleep or q4 while awake" to cover yourself.
    Don't you have one of those hand held wanderguard checkers? It doesn't beep or alarm...a light goes off so you know it's working.
    Benadryl q 6 in an elderly patient??? We need an act of God to use Benadryl here. It's a horrible drug for elderly patients.
    And, a union won't help you.
  10. by   suzanne4
    Quote from CapeCodMermaid
    Our pharmacy consultant insisted we give the synthroids out at 6 because it is absorbed better on an empty stomach.
    Get your docs to add "hold if asleep or q4 while awake" to cover yourself.
    Don't you have one of those hand held wanderguard checkers? It doesn't beep or alarm...a light goes off so you know it's working.
    Benadryl q 6 in an elderly patient??? We need an act of God to use Benadryl here. It's a horrible drug for elderly patients.
    And, a union won't help you.
    Your pharmacy consultant needs to check things. For over 25 years, synthroid has always been given with morning meds, be it at 9 am or 10 am. This is the first time that I have ever heard this.....if he is insistent on an empty stomach, then why can't they give it when they give the morning insulin? There can't be that many patients on synthroid!
  11. by   CapeCodMermaid
    Quote from suzanne4
    Your pharmacy consultant needs to check things. For over 25 years, synthroid has always been given with morning meds, be it at 9 am or 10 am. This is the first time that I have ever heard this.....if he is insistent on an empty stomach, then why can't they give it when they give the morning insulin? There can't be that many patients on synthroid!
    My consultant is insistent upon it....needs to be given on an empty stomach. Take SYNTHROID as a single dose, preferably on an empty stomach, one-half to one hour before breakfast. Levothyroxine absorption is increased on an empty stomach. That was taken from the synthroid.com web site.What amazes me at one facility I worked at, the AM med pass was horrible...2 nurses for 60 patients...they were never in compliance. So instead of recommending another nurse, they changed many of the QD meds, and meds with parameters to the 3-11 shift. The theory in part was the state is hardly ever watching a 3-11 med pass or something.
  12. by   suzanne4
    Quote from CapeCodMermaid
    My consultant is insistent upon it....needs to be given on an empty stomach. Take SYNTHROID as a single dose, preferably on an empty stomach, one-half to one hour before breakfast. Levothyroxine absorption is increased on an empty stomach. That was taken from the synthroid.com web site.What amazes me at one facility I worked at, the AM med pass was horrible...2 nurses for 60 patients...they were never in compliance. So instead of recommending another nurse, they changed many of the QD meds, and meds with parameters to the 3-11 shift. The theory in part was the state is hardly ever watching a 3-11 med pass or something.
    Yes, an empty stomach is one thing and most hospitals still give it with regular am meds. but to have to give it at 4:30 am, you are not serving breakfast at 6 am....................I think your facility is being totally outrageous with waking every patient up for meds during the nite shift.
    What time is breakfast served?
  13. by   suzanne4
    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..................
  14. by   leslie :-D
    Quote from suzanne4
    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!

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