Ques. about presetting up of meds

  1. Hey all. I'm an RN who works the night shift at a 60 bed LTC facility. Of course, I'm the only nurse there during those hours and have a 22 bed RCF to oversee as well. I don't have many 0600 meds, but that seems to be the worst time for my shift. Can't we legally preset meds as long as we have cards with the med names on them and dosages and resident's names??? Just wanted to know, mondk
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  2. 26 Comments

  3. by   Fudo
    I'm not sure of the legality, but I can say that from a practical point of view, if you don't set up early you will never make it at the end of the shift. If anyrthing goes amiss you will not be able to get done by shift change. At 0600 I routinely give meds to 31 residents. There's no way I could do that without setting up early

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    The thorn defends the rose,yet it is peaceful and does not seek conflict
  4. by   night owl
    mondk,I'm not sure what you mean when you say preset. Is it the same as prepour? Practically speaking, yes prepouring does save time with that dreded 6am med pass, but where I am you also cannot prepour your meds. I guess it all depends what type of med system you use. We use the BCMA system where all the meds are in individually wrapped packets with the name of the med, the dosage, and a bar code. Each med is scanned as you open the packet and pour it into the cup. We are however allowed to pull all 6am meds to the front of the resident's med drawer before hand. That way if there are any missing meds we have time to go to the Doc-u-med cabinet which contains many meds and obtain the ones we need. There is nothing worse than having something missing in the drawer in the middle of a med pass and having to retrieve it because the Doc-u-med is on another floor! On the other hand we cannot open any packets and put the meds into the cup until we are at the bedside. The supervisor will come around and check periodically around 4am to see if anything was prepoured and you never know when that'll happen. If you get caught prepouring, it's considered a med error and of course an incident report has to be made out and it goes in your file...At the moment we have a resident who has sooooo many meds stuffed into two drawers that he actually needs a whole cart for himself! it takes at least 10 minutes to find the seven meds he receives at 6am.(he used to get 13! and all on an empty stomach??? Pheeeeeeeeeew!!!
  5. by   duckie
    Where I work at, presetting is absolutely not allowed and if you're caught doing it more than once, you're terminated. They have said it has to do with state regulations.
  6. by   nursenel
    I'm not a lwayer but where I'm from you cannot preset anything. If state sees it it's mega fines for the facility and probably the end of your job. Yes I know that there's way too much to be passed at 6 am, that's why we stay in compliance and start passing at 5 am. more and more the day shift puts meds on the night shift , I'm told it's so that THEY can stay in compliance...however, if your'e not in compliance, whether nights or days, your'e still, not in compliance. My old manager, had us time our med pass, daily for a week, and she then informed the powers that be, that we needed more staff. Of course, my old manager was an ANGEL compared to most.
  7. by   mondk
    Actually, I was referring to the geriatric setting in a non-skilled long term care facility. I know in our state we used to be able to do this at one time as long as we had these little cardboard cards with the med names and res. names and dosages on them on this certain little tray specifically designed to hold several med cups and keep them from spilling. I know of an RN that I worked with a couple of years ago that preset all of his meds up, pills, not liquids, with this tray thingie and cards, and that was in a skilled facility. I just wondered; a couple of my co-workers had asked me and I was curious. Thanks!!!!!! :-)
  8. by   CriticalCareOnc
    i work in a skilled nursing facility. pre-pouring medications (pills or liquids) is a real no-no. you get writted up the first offense. third is bye-bye time. i know how it feels to finish the 6am med pass ASAP (plus all the fingersticks that we need to do). the state, as far as i know, allows the one hour before and one hour after allowance time. like if u need to pass meds sceduled at 6am, you can start at 5 and end at 7. i hope this helps.
  9. by   night owl
    Question: Do any of you still pass meds with one of those aluminum trays that has holes in it for the med cups and med tickets that you stick into the slits above the hole in the tray??? OMG! That seems sooooo long ago...Now I see what you mean about presetting the meds. I think the last time I used that system, it was...I can't even remember that far back! That's because it IS that far back, say 20 years back!?!?! Holy sh*#iver me timbers. It was a Great BIG no-no then. Don't tell anyone, but shhhhhhh (whispering)we did it any ways. No one said anything and no one looked for it. Today, I'm sure it is still a no-no...
  10. by   mondk
    Night Owl: yes, that was the tray thingie I was referring to. The only meds I preset up now are my narcs since I can't leave my cart to go back to the med room and get them between each res; we have a lot of res. that get them on sched. at 0600. I do start my passes at 0500 sometimes 0530 and pray nothing goes wrong so I can be done by 0630 so the next shift can have the carts and start their 0700 pass. The main thing I hate is giving pills in bed; it takes me forever to wake ppl up, then to wake up enough to swallow the pills without aspirating them. At our facility, breakfast is late, around 0800 so a majority of our res. don't get up until the day shift gets there at 0630. Sometimes I feel like the bosses don't understand that yes, you can get your meds passed within that hour and a half, provided nothing goes wrong, like sick ppl, falls, call-ins, etc. The thing is that most places don't allot time for stuff to go wrong and about 7 times out of 10 it does. I have sent more res. to the hosp. on my nights shift than any other shift. Does it seem this way to anyone else??
  11. by   nursejanedough
    The majority of the meds also need to be crushed and mixed in apple sauce or something...or if they are able to swallow pills they take each one (there are 10 pills at least), "Now what is this one for?" (They have asked this every morning for 2 years). Everyone knows in LTC that if you don't preset, you'll never get done.
  12. by   night owl
    I would like to know the reasons behind not being allowed to preset your meds. If I'm going to pass them, then why can't I preset them? What's the big deal all about?
  13. by   kjmta57
    Big issue where I work but per your licening board here in california the answer is no.but we pass meds to someimes 3-400 inmates in 2 hours our question is how are we to do it then?No one has given us a answer yet.
  14. by   Heather Plate
    WE USE THE OPUS SYSTEM. THIS IS WHERE YOU HAVE A WEEKS WORTH OF MEDICATION IN ONE CASSETTE AND 1 SLOT FOR EACH DAY. IT IS COLOR CO-ORD. FOE THE TIME OF DAY. ie.PINK IS 8AM, YELLOW IS NOON, GREEN IS 4PM, ORANGE IS SUPPERTIME MEDS AND GRAY IS HS MEDS. THERE ARE A FEW EXCEPTIONS BUT YOU GET THE OICTURE. THIS HELPS BUT IT HAS ITS DEMONS TOO. YOU CAN GET A LITTLE TO COMFORTABLE WITH THIS SYSTEM. HOWEVER IT DOES HELP WITH TIME MANAGEMENT AND WE ALL NEED THAT.

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