Med Pass - page 3

Hi all. Although I am working med/surge full time now, I still pick up a shift in a LTC facility 1/wk. PRN, so I working someone else's routine. Last night's 2-10 was a nightmare. Unfamiliar with... Read More

  1. by   linzz
    I sure agree with you guys, I have started my first job and now the facility has changed their policy and wants to float us to other units to pass meds for 55 people with no orientation to the floor. I am almost certain that I will quit. I can comfortably pass meds for 35 people but not 55 with no orientation. I too hope that being an honest and caring person will bring me good karma.
  2. by   weirdRN
    If I knew what the icon was for vomiting, I would use it! No way would I pass meds for 55 people that I had never met and not been orientated to.

    I think that having another nurse to use as a sort of guide to how to approach some of the people in the LTC setting is just as important as the interaction with the resident.
  3. by   morte

    whimsey.....just scroll down the smilies.....about25-30 or so
    i do agency, in fact i just had an assignment of sup and a wing....no orientation....just a brief tour.....typical up here/ NE.....the two hour time limit, in my understanding is DPH driven......need to get orders for anything that deviates from the norm of the facility....if Qd is 9a....then you need an order to give it anything else....have worked places that the "med" nurse did 40-50 patients...you would see the times change about half way thru the med pass, qd became an hour later than the first half, etc...one time i did a day shift (usually do nocs) and started out on the side with the lower numbers, thought qd at 9a was odd......got to the 2nd side and the qd was 8 am......the charge nurse didnt think to tell me this.....so qid cardizem, you guessed it 8,12,4,8 she got the first dose at 10a....didnt get the second one!!! have worked a noc shift...started at 5a, and finished at 0735...that is passing meds....no report no count.....and no answering any lights...which is hard for me, i always try to contribute so the aides arent overwhelmed and see me as an ally not the enemey....good luck
  4. by   jjjoy
    Whimsie, you noted that you asked to be followed on a med pass to see just what they'd say about how you could be faster (without cutting corners that shouldn't be cut). Did that take place? What happened?
  5. by   Spatialized
    This is one reason I am leaving LTC/SNF nursing. Sure, I've gotten to know my residents, am getting more comfortable with the med pass and treatments, but I feel that I put my license on the line every single day I'm out there. I am a new nurse with primarily acute-care experience in school, but needed a job after being unemployed for more than 3 months. It scared me on the first day and every day since to pass meds like this, and I have the "easy" section (1 Tube feeder, 3 IVs, 1 Peritoneal Dialysis...nearly everyone else only has PO meds and maybe 1 g-tube.)
    According to state rules, which were pounded into us last week as they are coming back to re-check on the things they saw last time, we have +1/-1 hour of the scheduled time to pass. But someone in their infinite wisdom scheduled my entire run except for 2 or 3 all at 8am. I try very hard to be anal and protect my license but can't handle it anymore. So I'm gone.

    Good luck to y'all though, I don't know how you do it!
    Cheers,
    Tom
  6. by   weirdRN
    Quote from jjjoy
    Whimsie, you noted that you asked to be followed on a med pass to see just what they'd say about how you could be faster (without cutting corners that shouldn't be cut). Did that take place? What happened?
    Yeah it happened and all I got for my trouble was more anguish and self doubt. I don't cut corners. Period. I wait the full five minutes and longer between inhalers. The full minute between eyedrops. I count pulses and take blood pressures. I don't leave the room until the resident has taken their meds or refused them. I use alcohol wash or I wash my hands for two turns of happy birthday (and they are peeling worse than a dishwashers!)after every resident. I am very consciensious about my infection control procedures. When mixing crushed meds, I stir them slowly with the idea that I won't spill meds or end up with a nose full of Penicillian (I am allergic to this med) Norvasc, Digitek or Atenolol.

    When I was followed, I was told I was just too slow. She said that I was great that I do all the things that I am supposed to do, by the book. Then she said that sometimes the book has to be put to the side so that the job can get done. I hate that! Why can we not do what is in the best intrests of getting people their meds without taking risks that could put my license and thier lives at risk?
  7. by   jjjoy
    Thanks for sharing that, Whimsie. I hate that, too! As if your supervisor would tell you where you are "allowed" to put the book aside... of course not because then if something goes wrong they can say it was you who decided to cut the wrong corners. Sigh! Anyone else have a different perspective on this?
  8. by   morte
    if the person giving this opinion was a nurse, perhaps the BON would be interested? discretely of course,lol
  9. by   Simplepleasures
    [quote=suninmyeyes;1852620]In my LTC facility our am meds take so long that we are ALWAYS outside of the 1 hr before 1 hr after window.

    :smiley_aa In fact it is one giant medfest from 6 am to 2pm.

    /quote]And then WE get railroaded when something goes wrong.
  10. by   Simplepleasures
    Quote from WhimsieRN
    When I was followed, I was told I was just too slow. She said that I was great that I do all the things that I am supposed to do, by the book. Then she said that sometimes the book has to be put to the side so that the job can get done. I hate that! Why can we not do what is in the best intrests of getting people their meds without taking risks that could put my license and thier lives at risk?
    Because the LTC industrys DO NOT CARE about these things until they get sued due to a negligent death, but then they have thier lawyers to get them out of that, although families and THEIR lawyers are becoming much more savvy now a days( hence "nursing home abuse" law firms). Bottom line of the LTC industry is MONEY, and if there were enough staff to do the job safely and ethically, LTC might actually lose a few million here or there. Sadley LTC staff is now being held responsible when tragic mistakes happen because of overwork and understaffing.
    Last edit by Simplepleasures on Dec 7, '06
  11. by   weirdRN
    I am thinking of starting my own Nusing Home. I am really tired of being profit driven.

    I want a better ratio. I want a better standard of care. I want less stress for myself and the other nurses that I work with/for. I want less risk.

    I want clutter free rooms, that are user (Staff AND Resident) friendly. I want larger dining spaces. I want a larger kitchen. I want a larger activities department. I want a larger Re-Hab section. I want an age in place lifestyle.

    Am I dreaming too big?
  12. by   CapeCodMermaid
    Dreaming too big?? Not if you're a multimillionaire who doesn't mind throwing money around and away.
  13. by   withasmilelpn
    At my facility the med pass has always taken over the 'one hour before one hour after' rule. I always tried to make sure that the residents who get hyperglycemics, enzymes, lovenox ect. get them as close to possible to the time they are supposed to. Then my next priorty is any one who gets qid or tid so that I won't be giving them too close together. I try to give them so I'm keeping in mind their intended effects.
    It has happened to me as well having residents insist 'they don't get their meds this time' or 'they get all of them now' or 'your the only nurse who gives me that (routine qid inhaler etc)' since I'm the weekend nurse 7a-7p. Usually I handle issues like early meds by looking at what they are getting and giving in only if there would not be a negative effect. For instance I would never give coumadin early- but I know nurses who had to have done so! Then at some point I'll get the order changed so that everyone is happy and we're all legal!
    That being said it's worked for me for 5 years at this place, a tough, long med pass- but I could live with it knowing I was doing the best I could, keeping in mind the safey and wellbeing of my residents. Now we have a new administration running around enforcing the 'licenced nurses' staying in the dining rooms from start to finish (I always helped before, but could not, would not stay the whole time) and lots of other 'window dressing' that slows us down and makes our job impossible. I'm very frustrated and ready to quit.

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