Need expert advice on how to pass 39 patients' medication in a 2-hour time frame.

[OneMurse]

Situation: I'm working in a skilled nursing facility and the unit/station I'm in charge of has 39 residents. For AM shifts, all 39 residents have scheduled medications due at 9am. We are using electronic medical records so we are allow to give medication from 8am to 10am, all medication given after 10am will be considered as late.

Problem: the management kept on reminding me that I need to pick up my speed, they don't want my med pass to be late.

So am I lacking a certain skill or is there something essential that I didn't learn from nursing school? If anyone actually bother to do this simple math, to get through 39 patients in 2 hours that's 3 minutes per patient. THREE MINUTES PER PATIENT. Each patient has an average of 8+ medications need to be given. On top of that, 2/3 of the patients requires BP and/or apical pulse check before med administration. Furthermore, because it's a SNF, we get mostly geriatric patients, so these patients need time to take their medication. So yea, if any of you are working or has worked at a SNF with similar situation, I will really appreciate it if you could share your experience on how to handle this.

[MunoRN, RN]

You've clearly done the math, so ask management what their math is. How long have they determined it should take to perform the 5,6 or however many rights there are these days (I think we're actually up to 11), and any assessments that need to be done. My guess is that they don't have any math to compare yours to, at which point you could explain the reality of physical laws that govern time, which may well be beyond their comprehension, so you could ask what they would prefer you not do, ie what would they prefer they get sued over, which preferably should be in writing.

[brillohead, ADN, RN]

Someone needs to construct a machine-gun style Pyxis machine, so you can just rapid-fire shoot the pills down everyone's throats.

Sorry, that's the best advice I have -- this is one of the reasons I have avoided LTC... it's just ridiculous, the expectations they have!

(An actual possibly-helpful thought: Maybe get someone to go through and get the orders changed so that one end of the hall's residents' meds are ordered for 8am and the other end of the hall's meds are ordered for 10am? That way, you could start on one end at 7am and finish at the other end by 11am? Because let's face it, it doesn't REALLY matter what time of day someone gets the vast majority of their once-a-day meds, as long as the timing is relatively consistent!)

[Nola009]

Ask them if they believe it's necessary for you to do the 3 checks of 5 rights you learned in nursing school on these skilled patients. Then ask them how long they think that, medication preparation and administration would take --- for 39 patients. Tell them that they need to be a bit more realistic when it comes to what can be done in a 2 hr. time frame and that they will need to be more respectful of your nursing degree and education. The only way you can make this workload happen in this time frame is to cut corners. What in your estimation, is worth leaving out? I don't think it's worth loosing your license over this.

[CrunchRN, ADN, RN]

Have you asked the other nurses what they do? Seems impossible to me. Old people are sloooooow.

[morte, LPN, LVN]

cutting out some meds, stretching the time frame, and moving some once-a-days to another slot. good luck

[JBMmom, MSN, NP]

Wow, that's crazy. I worked first shift ONCE, and it took me almost 4 hours to complete the med pass for 30 residents. I'm sure you pick up a little speed when you're more familiar with the meds and residents but I still check my paper MAR before giving any pill, and that takes time. I agree you should approach someone with your rational argument about the math and time, and maybe suggest that residents be split between those that get one a days on the first AM med pass and those that get them at the noon or 4pm pass. I'm not saying there aren't nurses that are fast and don't cut corners, but I know there's no way I could do it and not be at risk of a big mistake. Good luck.

[CapeCodMermaid, RN]

1. Have your pharmacy consultant determine if the patients really need all these meds.

2. Stagger the times...half for 8 half for 9 OR

3. Have the daily meds given between 6:45 and 11:45. No one ever suffered because they got a once a day med at 8 one day and 10:15 the next

[RNBearColumbus, BSN]

1. Have your pharmacy consultant determine if the patients really need all these meds.

2. Stagger the times...half for 8 half for 9 OR

3. Have the daily meds given between 6:45 and 11:45. No one ever suffered because they got a once a day med at 8 one day and 10:15 the next

THIS.

Ask management to help you work smarter, not harder.

I work a 33 patient LTC unit. Up until a year ago, we split the med times. Half the unit was scheduled for 8am, and the other half 9AM. This gave me from 7AM until 11Am to complete the entire med pass.

A year ago however, we went a step further and changed to a BID med pass program.

There are now 2 med pass times for day shift:

7:30Am - 11Am and 3:30PM to 5PM. Night shift has a similar schedule.

No more meds popping up at all times during the day.

Another thing you might want to do is talk to your medical director or CNP about getting rid of some of the BP / Pulse parameters. If the patient is stable over a long period of time, there is probably no reason to check the BP / Pulse every single time the med is given. (unless they are getting digoxin of course)

[CapeCodMermaid, RN]

There is no need to check a pulse on a resident on digoxin. We no longer automatically hold it if the AP is less than 60 since, as one of my former medical directors put it, they might need the extra 'squeeze'.

[StarofLifeRN]

We do a BID med pass as well. Unless there is a good reason to deliver a med at a certain time (cardiac, insulin, # hours between admin), AM meds can be given at any time on the day shift, and PM meds can be given at any time on eve shift. We also factor in resident choice - ie they sleep in but want meds before getting out of bed, they want their Miralax in cranberry juice on their way to breakfast and everything else after they eat, they take oral meds while in their recliner after dinner but hold the eye drops until they are in bed. Yes, this is a skilled nursing floor, but the model is that it's their home first, so we cater to their wishes, not corporate needs. Although admittedly this isn't your typical LTC, there are a lot of practices that could easily be adopted by others that would make for happier patients and allow nurses to care for people instead of feeling like clock watching pill pushers.

[Havin' A Party!, ASN, RN]

... my guess is that they don't have any math to compare yours to...

Absolutely right!

Many in management just don't have a clue about the realities involved with the typical med pass, or simply don't care, or know that the two-hour window is just a game.