Pre-setting meds....

  1. Do you pre-set your meds? Why or why not?

    I personally do not pre-set meds and think it's a very unsafe practice. I've worked with a nurse who pre-set meds right in the hallway -- she might have as many as 10-12 cups of meds sitting on top of her med cart at once. Her logic was that it was ok because she never left her cart. My thoughts is that all it takes is for her to turn her back to the cart to give a resident meds, and although she's still right there, it would be way too easy for another resident to grab the pills and take them before she knew what was happening. We have too many wandering, curious, confused residents for that to be safe. Another nurse thinks it's ok to pre-set if she does in the med room. My problem with that is the time you are taking in the med room pre-setting pills for 15-20 residents you are totally oblivious to what's going on outside the med room. While she was in there once pre-setting pills the other nurse was going on her dinner break but had not left the nurses station yet when a CNA called to her that a resident was choking. By the time the nurse that was supposed to be on break got to the resident, she was turning blue and required the heimlich (sp?). The nurse pre-setting the meds --- she didn't have a clue any of this was going on until she came out of the med room and the other nurse told her!! In my opinion there's just too many chances for med errors to pre-set. How do the rest of you feel about it? Our DON doesn't like it, but apparently there's no policy against it --- and I wish there were.
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  2. 24 Comments

  3. by   night owl
    when you have two people to give 259 pills to 60 residents there's no other way but to preset/prepour your meds. i couldn't imagine trying to open those little packets at each residents bedside and it never fails that when i roll that cart out at 4:30am something is bound to go wrong. if my meds weren't prepoured or preset, i'd be s.o.l. i always have my cart in my eye's view and if anyone goes near it i steer them away. i never place cups of pills on top of the cart, especially 10-12 cups! unless i wrote their names on the cups, i'd forget who's is who's and be setting myself up for sure for a great big med error. i always leave the prepoured cups in each residents drawer. the supervisors used to check if we prepoured our meds, but they turn their backs because they know what it was like to be the floor/med nurse and they did the same thing. if an emergency arises, at least i know that the meds won't be that late because i've already pre- poured. all i have to do is give them out and scan them, not dig in the drawers trying to find them and then find out i'm missing two or three meds. too much of a hassle when you're running behind. when my stress level is high, i don't want it any higher! you just have to be very responsible in what you're doing, and always have the cart where you can see it at all times. i've seen nurses take meds out of a drawer leaving big opened bottles of colace, mvt, lactulose, syringes on top of their carts, walk down the hall and give them to a resident in a room. not good. all kinds of things can happen once you leave the cart unattended. you've got to use your brain. it can be an unsafe practice only if you let it be unsafe. through the years you learn to do what's right for you and what works for you. it's when you become lax and over confident that mistakes are made. always think before you leap... if you have to leave your cart even for a few minutes, lock it up with nothing ontop...no harm can be done. when management hires more people to staff our facilities, maybe i wouldn't have to give so many meds out at one time. then and only then will i be able to pass my meds without prepouring or presetting.
  4. by   momrn50
    There just doesn't seem to be anyway around prepouring meds where I work. I've even seen our DON do it. Best bet is to mark the med cups, stick them in the top drawer of the med cart and keep it locked between residents. Its a shame that understaffing makes you have to do this kind of thing, but with treatments, paperwork,families, doctor visits and staff problems, you have to save time somewhere.
  5. by   ShortFuse_LPN
    Pre-setting meds at the LTC facility I work in is grounds for immediate termination.....not to mention against state regulations. I can see how it would help me get off work on time though........
  6. by   jones58
    Sometime I pre- prepare meds, never more than two pts at a time though. I don't know if is allowed where I work. My med pass always runs over so maybe I should try this more.
    I'm always thinking of time saving techniques.
  7. by   michelle95
    I work on a SNF unit and everybody does this. We don't have medicine carts like in LTC. Our medicine dispensers (pyxis machines) are in the med room.

    I guess it's ok here....no one has ever said anything about it. However, we only have up to 12 patients and I always write the room number and name on the cup.
  8. by   Tookie
    Unsafe and illegal here
  9. by   canoehead
    Seems like if the cup is in the residents drawer and the cart is locked when unattended it would be OK. But if I had to write names on the cups to make sure it got to the right person not sure how much time it would save.
  10. by   Abbysmama
    where i work we have to prepour our meds for the morning med pass or else have them 1 to 1 1/2 hr late. There are over 500 pills to pass. There's just no way around it.
  11. by   GPatty
    Guilty here also.
    I preset them, and mark their names on the cups and keep them locked in the drawers. If I didn't, I couldn't pass them all in time.
    I personally think that it saves mistakes sometimes because if I didn't, at 6:30am, I would be in such a hurry, with feeds to do, and insulin to give, and blood sugars to take, that I may make a med error. Now, to me...that's unforgivable. Especially if I can prevent it by taking more time and presetting them.
  12. by   Nurse Ratched
    I agree with those who wonder how you could possibly get around it in LTC with the sheer volume you're passing. If you didn't pre-set your meds, you'd have technical med errors on most people simply d/t them not getting them in a timely fashion.

    I do agree that having them all on top of the med cart is a bad idea.
  13. by   robinrdrn
    Hmmmmmmmm...........okay here is reality........you ain't suppose to do it.....but, when working a shift where I happen to have 20+ of the same meds suppose to be given at 6:30 am and your have to check blood sugars too.....well lets just say I label, label, label, and pull up everything earlier in the shift when I'm more awake. I certainly don't make a habit of it when "State," is around. Call it nursing judgement or stupidity.....luckily I don't often have to work those shifts.
  14. by   2amigos
    I'm not in the Nursing Program yet, but when I worked as a PCA in a group home with four residents, we would do their meds up early in the shift when it wasn't so busy and mark the cups and lock them up. It was against policy, but I don't know anyone that didn't do it....it was just a necessity and actually was safer than having to do it with all the distractions. We usually worked by ourselves and rarely double staffed. Just my 2 cents.
    Cheryl Moore

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