Med Pass - page 4

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   LargoLPN
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    I just started agency myself. Mostly have been going to the county jail, I did two Nursing home shifts 3-11 and couldn't believe how hard it was. I hadn't finished my 5p meds and they went for dinner. They came back and I finished the 5 pm meds. The other nurse was done a lot quicker, and when It came time to do the 9p med pass she was charting, talking on the phone ect. When I was finished I was getting the treatment book out to start those. She says oh hunny you must be new at this, I should have told you on 3-11 we pass out all our meds at 5p, we give them all at once it saves time. she also said and if they have prns give them then too. then she laughed. I couldn't believe my ears. OK, that was my last shift at a nursing home doing agency. What in the world, has any one else seen this done?
  2. by   CapeCodMermaid
    When I was the ADNS I had to do the 3-11 med pass for 30 patients. I hadn't given meds in a while and still did and do things by the book. I wondered how anyone got through the pass on time...seems the "honey we give everything at 5pm" was not just the home you described. The patients told me they routinely got all their meds at 5. OKAY...the 4's and 6's could be given at 5, but the coumadins and sleepers weren't ordered till 8....it was an eye opener and I ended up calling in the nurse consultant from the pharmacy to do an inservice....the REAL problem is they all take too darn many pills. No 96 year old woman needs 2 drugs for high cholesterol, 2 antihypertensives, 3 vitamins, 2 nasal sprays....
  3. by   Simplepleasures
    Quote from CapeCodMermaid
    When I was the ADNS I had to do the 3-11 med pass for 30 patients. I hadn't given meds in a while and still did and do things by the book. I wondered how anyone got through the pass on time...seems the "honey we give everything at 5pm" was not just the home you described. The patients told me they routinely got all their meds at 5. OKAY...the 4's and 6's could be given at 5, but the coumadins and sleepers weren't ordered till 8....it was an eye opener and I ended up calling in the nurse consultant from the pharmacy to do an inservice....the REAL problem is they all take too darn many pills. No 96 year old woman needs 2 drugs for high cholesterol, 2 antihypertensives, 3 vitamins, 2 nasal sprays....
    Hallelujah, CapeCod Mermaid, for once I agree with you.
  4. by   banditrn
    Quote from CapeCodMermaid
    The few times I've had to pass meds, I've run into the same problem. I go by the book which means the med label on the card must match the MAR, no one gets meds 2 hours early, no one gets an ativan and a percocet and an ambien at the same time and no one gets meds left at bedside. I can't tell you how many times I get told, "but the other nurses....". I am NOT the other nurses. Do things the right way and if they call you anal so what. You HAVE to be anal about the med pass or mistakes will be made.
    Capecod - that's precisely what I tell them when I'm new - I'm NOT the other nurse, and this is the way I do things, altho I will try to get things changed to fit into their comfort zone.
  5. by   banditrn
    Quote from CapeCodMermaid
    When I was the ADNS I had to do the 3-11 med pass for 30 patients. I hadn't given meds in a while and still did and do things by the book. I wondered how anyone got through the pass on time...seems the "honey we give everything at 5pm" was not just the home you described. The patients told me they routinely got all their meds at 5. OKAY...the 4's and 6's could be given at 5, but the coumadins and sleepers weren't ordered till 8....it was an eye opener and I ended up calling in the nurse consultant from the pharmacy to do an inservice....the REAL problem is they all take too darn many pills. No 96 year old woman needs 2 drugs for high cholesterol, 2 antihypertensives, 3 vitamins, 2 nasal sprays....
    Capecod - I agree with you too. In LTC I think they just keep piling the meds on without paying much attention to what they are already taking.

    One good thing about the facility I last worked at was the pharmacy - they did monthly audits of the residents meds, and sent notices to the DON that she had to present to the docs. They were also trying to work out this 'Beers List' plan as related to the residents meds.

    It was crazy, but even my early morning med pass took 1 1/2 hours to complete!
  6. by   mcneillmama3
    Can anyone tell me the trick to completing a med pass within the one hour before/one hour window. I work for a medical staffing company now, so I am filling at LTC facilities on a dime's notice. I always arrive 30 minutes before my scheduled shift to get a walking report on the residents by the off going nurse. However, it difficult to complete a med pass in one hour when you don't know the residents very well and you are trying to be extra cautious. Further more, there are soooo many medications for 30+ residents, coupled with the fact that the majority have dysphagia or dementia. One can't exactly tell the residents to swallow faster because I have to finish this thing in one hour.

    I have been in nursing for 10 years and there are lots of time that I am still working on my 8AM med pass at 1100AM, when it is time to go back down the hall and start getting 1130 AM accuchecks.

    Can someone out there tell me how they really complete their med pass in less than one hour? It think part of the problem is that these LTC facilities expect one nurse to take on too much. I have filled in at a 12 bed Hospice facility and it was easy to complete the med pass in one hour. I think there is a cut off at where a nurse can efficiently and safely administer mass medications. Does anyone agree?
  7. by   mcneillmama3
    Most LTCs do use agencies. I work for an agency and have past experience as a LTC care nurse where I was a permanent staff nurse. I only got one day's orientation at the LTC facility where I was a staff nurse, believe it or not.

    I have worked in staffing now for 3 years and I know to arrive one hour before my shift to go on walking rounds with the off going nurse. What is getting scary is when the off going nurse is an agency nurse as well, and my relief nurse is also from an agency.
    To top that off, one facility I filled in at, there were three of us, all from a staffing agency, on the same unit on the same shift.

    I think day shift is a safer bet because there is more staff and more supervision on day shift than on night. However, there are less meds to pass on the 11pm-7am shift and less chance of maknig a med error. It's the staff I don't trust on night shift= a lot of people sleeping or flat out disappearing on the job!
  8. by   mcneillmama3
    I agree with you. I work for an agency and believe it or not, I feel safer working that way than going permanent at one of these facilities. I can't ever finish a med pass within the one hour time frame and I don't waste time. However, you can't make residents with dysphagia, dementia, Gtubes, or whatever take their meds any faster than they can swallow or flush a slow running Gtube.
  9. by   Lovely_RN
    I am coming to the conclusion that there are plenty of tricks to get the job done but there are NO tricks that will get it done within the correct time frame in the correct way and I feel that anyone who says different is lying.

    All that jazz about time management is BS there is a limit to what the human body can do. No one can make me believe that they are doing things 100% to the T correctly w/o the tiniest bit of a shortcut and getting it all done on time.

    I have 40 patients to pass meds to and I would need two extra sets of arms, eyes, and legs. I would also have to be wearing roller skates and have a jet pack strapped to my back to get everything done on time in the "correct" way.

    Quote from mcneillmama3
    Can anyone tell me the trick to completing a med pass within the one hour before/one hour window. I work for a medical staffing company now, so I am filling at LTC facilities on a dime's notice. I always arrive 30 minutes before my scheduled shift to get a walking report on the residents by the off going nurse. However, it difficult to complete a med pass in one hour when you don't know the residents very well and you are trying to be extra cautious. Further more, there are soooo many medications for 30+ residents, coupled with the fact that the majority have dysphagia or dementia. One can't exactly tell the residents to swallow faster because I have to finish this thing in one hour.

    I have been in nursing for 10 years and there are lots of time that I am still working on my 8AM med pass at 1100AM, when it is time to go back down the hall and start getting 1130 AM accuchecks.

    Can someone out there tell me how they really complete their med pass in less than one hour? It think part of the problem is that these LTC facilities expect one nurse to take on too much. I have filled in at a 12 bed Hospice facility and it was easy to complete the med pass in one hour. I think there is a cut off at where a nurse can efficiently and safely administer mass medications. Does anyone agree?
  10. by   CapeCodMermaid
    There are many things you can do to be in compliance with the antiquated one hour before/one hour after rule.
    Set the time for half the floor at 8, the other half at 9. You won't be any faster, but you will be in compliance.
    Change the times of some daily meds to 12 or 2pm. Once a day is once a day and there is no reg that says daily means 8 or 9 in the morning.
    And lastly, and probably the hardest, work with your pharmacy consultant and doctors to get rid of the useless meds...no 93 year old person needs to take 23 pills in the morning, 10 in the afternoon and 15 more in the evening.
    We try to review all the patients meds at least a few times a year and we really work hard at reducing the numbers of pills these people have to take.
  11. by   mcneillmama3
    Thanks Falon for your reply. I need a mentor, preferably someone who knows about this and has been there, done that. To CapeCod, some facilities do the scheduling trick. The odd rooms are set for 7AM and the even rooms are set for 8AM, but some days it still takes 3 hours to finish up on everybody. I think the acuity of nursing home residents needs to be considered. Patients are leaving hospitals sicker and quicker which puts a burden on the nursing home that has to recover and rehabilitate those patients. Also these patients are taking entirely too many medications. It would help if I could go in a facility and find the Med Cart not in shambles and missing drugs, probably because the permanent staff nurses didn't have time to reorder drugs. I've found empty med cards or med boxes with the reorder sticker still intact, so I know no one pulled it and faxed it to the pharmacy.

    I am to the point that I don't really care about the one hour rule as long as I don't harm a resident. When I leave work, if all of my residents are breathing, have a pulse, and are not in pain or distress, then I feel I have done what I was called to do. I am not going to sacrifice my safety, or the safety of the residents, to be Jeff Gordon or Dale Earnhardt, Jr. with the Med Pass. We aren't driving race cars, we are pushing a medication cart which could be life threatening.
  12. by   Rexie68
    Quote from babynurselpn
    i'm a fairly new nurse. two months new actually.
    i have two patients that request their prns every night
    one gets 2 ultram and a sleeping pill
    the other wants an ativan and a percocet.

    how dangerous is it to give these together? i know it is always done for both patients. the other nurses who give it have been nurses for awhile.

    also, i have a pt. that was getting around the clock vicodin and at 9pm the had a vicodin and 5mg of methadone.. i tried to question this timeing with the hospice dr. mostly attitude was what i recieved and no real answer.
    i wouldn't question this hospice order....we routinely give hospice pts a lot of meds at the same time or in larger dosages than usual. these pts have developed a tolerance to the same thing that would knock most of us out.
  13. by   Rexie68
    on the rare occasion that i pass meds, there's no way i can get done within the one hour before/after time frame. i'm unfamiliar with the way the residents take their meds (crushed/whole/in appleauce/pudding/warm water, etc). no matter how much i want to be in compliance, it isn't going to happen. i don't sweat it, though. i make sure that the meds given more than once a day are given closest to the ordered time as possible. i make sure that pain meds are given asap. i give meds that need to be given before meals on time. anything else....well....that qd baby aspirin might just wait until 10am for its scheduled 8am dose. out of compliance, but not dangerous. changing the scheduled times will just lead to more confusion. we already have each hall scheduled one hour apart, but that still leaves 25 pts with 8, 10, 12, 1 and 2pm meds. no, not all of them gets meds at those times, but some of them do. anyway, i guess my point is that sometimes you do end up doing something out of compliance, but you have to prioritize and do your best. and again, many of our residents take multiple pain medications at the same time. often, at this point in their life, the goal is to keep them comfortable. as long as there are no adverse effects, i don't see a problem with it. thank goodness that we finally take pain seriously and aren't afraid to get strong narcotics prescribed!!

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