I have just recently orientated to a nursing home and found that the nurse wasnt even checking the MAR and just punching out meds and said "she knew what they got" I find this irritating. In nursing homes most of the residents may not question how many, what color, shape or how many times they should get something. ITS DOWNRIGHT DANGEROUS . Plus this puts you in a bad practicing habit that you may not be able to repair. Not reviewing the MAR each time you give meds on possible changes that may have occurred or maybe even meds that shouldnt be given anymore is a very serious act. Nurses have forgotten to tell me on report that a med dose was changed or Dc'd and then I find it when I start giving the meds. If there is a good Nurse manager, good aides, good nurses, your report should be ideal and everyday you should be kept up on the constant changes in meds/treatments on every patient. I found that during report, the patients main diagnosis, chronic or acute complaint, tests, recent labs, any hygeine problems, etc should be a list that each nurse goes down over and over each day.....this impales it into your brain, makes you remember and helps you flow a little more faster each day.
This is what I did for myself. took some time....but I kept my own report book that I reviewed before the shift started with each patients name in it. Helped me remember lots of things I would normally forget.. Just the facts were included and any follow ups, pertinent stuff.
I prefer doing rounds with the nurse before me, going to rooms if its possible, I know finding residents at certain times is hard, but if they are in their rooms already, a quick round will help.
I always tried to get my Aides to listen to report. I typed out a special report sheet with the patients names on them, for each one and kept copies so if for some reason they left early they could just give it to me or leave it at the desk. I always kept the aides up to date. This way I didnt have to run and remind them all the time of things I wanted them to do and they didnt have to ask me all the time, They would just report to me.
I would (when and if I had time) flip through the MAR to find out if there were any drugs or treatmetns that were just LINGERING for some strange reason that no one seemed to care about.....colaces that havent been given since the year of the flood, treatments that no one ever does and the patient doesnt need anymore. Usually the pharmacy will alert you on these but to cut down on the strenous eyeball work you already have, omitting unused drugs or drugs that just arent doing anything for the patient and treatments like, raise the head up every 15 minutes to ease back pain when the patient can do it himself or there is no more back pain will relieve you of checking things off that are useless.
I was always striving to make less paperwork, more of a routine, less stress for all and had lined up all my aides at once in a straight line on the floor for 1 minutes (me included) to give a nice neck/shoulder massage. It looked strange but it was a good moral booster on a stressful hectic day. Beleive me they loved it. Sadly, some missed out. But we usually got them the next day.
It may take a little extra effort on your part, but if you want a tight running ship you will dedicate yourself to making your shift run like clockwork, Aides will look up to you, you will love them to death for their outstanding work and the higher ups will commend you. If you spend a little more time to organize your work outside of the nursing home, in the privacy of your own home where its quiet and relaxed hopefully, you can devise a system that you and your aides will feel comfortable with.......and dont forget to talk to them about their ideas that will make your and their jobs easier....this way its a team thing and everyone is a happy camper and feels productive and useful. Good luck, hope I helped.