Med pass 55+ residents and med error

CapeCodMermaid, RN · May 12, 2016

Speak to your pharmacy consultant about changing times of the medications so you can safely administer meds within the time frame. Many facilities have gone to 'give meds in the morning'....morning is from 6am to 11:59 am.

You can also speak to the MDs to try to get rid of some unnecessary medications. It takes a while, but in the end everyone benefits.

Adele_Michal7, ASN, RN · May 15, 2016

There is absolutely no safe way to pass medications to 55 patients.

CaringGerinurse525 · May 15, 2016

Holy bananas!! I do not think there is any way to safely pass meds to that many patients in that time frame. I work 12 hour shifts and I have between 28-31 residents. I run all shift and usually clock out on time. My meds are actually the least of my workload. It's the treatments and admissions, charting that keep me going.

lindseylpn · May 15, 2016

When I worked LTC I had 55 patients too. The med pass was very hard but, got easier with time. On your report sheet before you do med pass write down who gets meds when, like:

Room 104- Jane Doe 9am, 12pm

Room 105a- John Smith 12pm (crushed)

Room 105b- Bob Jones 9am, 12pm blood sugar

Then cross them out as you give the meds. It'll also keep you from stopping at every room too to look at the Mar. You'll know no one in room 103 gets meds so, you can move on to Jane Doe in room 104 etc. I would go down the hall and do med pass and I would stick a straw in the Mar for the patients who weren't in their rooms so, I could come back to them later. Other nurses would move their Mars up to where they were sticking out of the book or would turn their Mars backwards so, they'd know they haven't given those meds yet but, using a straw as a bookmark was easier for me. Once I did everyone on the hall I would then do the people I missed and I'd already have their Mars marked with a straw.

I usually got done in a little over 2 hours. I burnt out quickly though.

(Sorry if any of that was worded weird, the cursor kept jumping around on my phone)

CapeCodMermaid, RN · May 15, 2016

I wouldn't rely on straws sticking out of the MAR. Suppose a demented resident decides to take them? Or the book falls on the floor? And since most facilities are or are going to be using EMR, it's not a good practice to count on.

lindseylpn · May 15, 2016

I'd always have my report sheet where I checked off whose meds I'd already given, the straws were just there to save time finding the place in the Mar, no problem if something happened to them.

CapeCodMermaid, RN · May 15, 2016

The DPH in Massachusetts would disagree, but you have to get through the med pass any way you can.

Long Term Care Columnist / Guide · May 24, 2016

It'll also keep you from stopping at every room too to look at the Mar. You'll know no one in room 103 gets meds so, you can move on to Jane Doe in room 104 etc.

I disagree with this. You need to be looking at the MAR every time you pass meds because things change all the time. That lady in 103 may just have had new orders written, and Jane Doe might have had some meds switched. NEVER pass meds without looking at the MAR and matching them up with the pills. I know it's hard because time is of the essence, but I've passed meds on a LTC unit and I'd rather be late than make a mistake.

lindseylpn · May 26, 2016

Sorry, Maybe I phrased that confusingly, I didn't mean don't look at the Mar at all. What I was trying to say was at the beginning of med pass go thru the whole Mar and write down who gets meds and cross them out as you go down the hall so, no one is forgotten. Like if med pass is 6:00 then at 5:40-5:45 start going thru the Mar and start making a note of meds, like: room 101- 6am meds (crushed), room 102- 6am meds, finger stick room 103- no meds, finger stick room 104- change tube feeding bag, flush tube room 105- 6am meds (whole in applesauce) etc. Then when giving med pass, you'd have the Mar and your paper, give meds, sign the Mar and then check them off on your paper. If you get to say room 104 and the resident isn't there then don't check that one off and at the end of the hall you look at your paper and can easily see that you still need to give room 104 their meds so, you can go back to them. Op was worried about forgetting people's meds because, they weren't in their rooms during med pass and when I worked in LTC this was basically a double check system (Mar and my own paper) that worked for me. Other nurses had their own systems for remembering who's meds they hadn't given, like turning the Mars backwards or taking the Mars out of the book and moving them up to where they were

sticking out of the book but, that never seemed safe to me.

Long Term Care Columnist / Guide · May 27, 2016

Thank you for clarifying. Made me a little nervous for a minute there. :)

bugya90, ASN, BSN, LVN, RN · May 27, 2016

I used to work LTC as a new grad and I was terrified of med pass. Our MARa were in a 3 ring binder with a divider tab for was resident. Since residents are in and out of their rooms/cafeteria, I would move each of the dividers so they were all sticking out at the beginning and as I went through each resident I would move their divider back. I knew I was done when the dividers were back in place and my binder looked normal again.