Med Pass

[Lfransis]

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 residents on the station, family complaining of AM breathing Tx not being done, no charting, etc.

This could go on, but my main concern/question of the day being.....

Say a Resident has meds at:

1600

1800

1900 (mostly Xanax here)

Obviously,these meds are all being given @ 1700, with "supper".

1600 and 1800 fall into the time frame, but 1900 does not.

So I have alert residents refusing the 1900 med because "they don't get a pill now"( But I went by the mars timeframe)

I understand not wanting to be on the med cart all night, but giving xanax 2hours early seems extreme (and illegal?)

As a new nurse I am trying to practice good habits, as well as what I was taught in school. I double check residents by comparing the picture, asking their name and having it clarified by a staff member, etc. I am already being classified as "a little anal".

Any input?

-Lelu

[weirdRN, RN]

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?

[CapeCodMermaid, RN]

Dreaming too big?? Not if you're a multimillionaire who doesn't mind throwing money around and away.

[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.

[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?

[CapeCodMermaid, RN]

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....

[Simplepleasures]

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.

[banditrn]

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.

[banditrn]

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!

[mcneillmama3, BSN, RN]

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?

[mcneillmama3, BSN, RN]

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!

[mcneillmama3, BSN, RN]

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.

[Lovely_RN, MSN]

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.

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?