Rehab needs to get a clue

Specialties Geriatric

Published

This might be something of a vent, but I am very tired of rehab people thinking they are the be all and end all of skilled care. I have rehab staff interrupt the med nurses for a variety of reasons and get ***** if the nurse doesn't drop what they're doing.

We have rehab people walk down the hall and say to the nurse , who is in the middle of a med pass, that the lady in room 15 has leg pain. They then stroll away without even making sure the nurse has heard. THEN they complain that the nurse did nothing with the information.

Really? Do any of them have a clue about the concentration needed to pass meds to 20 residents who take an average of 15 meds each?? One break in that concentration and a huge med error could occur. Our rehab manager seems to enjoy trying to throw the nurse under the bus. He only backs down when I intervene. I think I've had enough of this.

After reading these posts I feel so very lucky. I worked in a hell hole LTC care facility - the administration and staff were wonderful, the company that owns it is godawful - I have worked for them twice in different parts of the country and I can say it will never happen again. I had up to 24 rehab patients plus 7 LTC patients, on 12 hour day shifts. I was responsible for everything - meds, treatments, calling docs with labs/med issues/pt problems, etc., drawing labs i.e stat labs or Vanc troughs, getting paperwork ready for out of facility appointments, handling orders when they returned (and God knows rehab pts have a ton of offsite appts often with many different providers), dealing with pharmacy, admissions, discharges, families, wound care, pts going to and from dialysis (at one time had 5), blood sugars and insulins, care conferences, you name it I was responsible for it. I was expected to be in the dining room at all meals helping pass trays and feeding residents (no not complaining just a fact). We were so short of CNAs, if I was lucky I would have one CNA for the 24 rehab patients and my 7 LTC would be picked up by the CNA in that hall. On other days we would have one CNA for a LTC hall of about 17 and ALSO the hall of 24 rehab pts. God forbid somebody fell but as you can see from this staffing of course they did and we would have fall charting and up to 4-5 patients on neuro checks.

Our rehab team was the bomb, I have no idea what we would have done without them. They hated to have to tell me anyone needed anything as they knew I was over my head swamped, but they still needed to tell me things. They helped us so much, they would be in tears right along with the nursing staff because nobody was getting even basic care let alone good care. They would run so far behind schedule because they were helping us. They toileted people they weren't working with, they changed beds, cleaned rooms, they got the pts water/snacks/coffee, they helped in the dining room, they helped with family and pt requests/problems that had absolutely nothing to do with rehab. Because we were so understaffed on the rehab hall, we worked as a team. All I can say after reading the above threads is 'God bless them' and I am sorry the rest of you have not had such a wonderful group of people to work with. I knew I appreciated them but now know just how much!

I work med/surg and I only had a limited experience with LTC/REhab but I never understood why there isn't more "prep" done in LTC for things like meds. For example if a patient is on the same meds everyday why not use a pillbox to organize the meds? Yes the nurse should check the meds and pt etc before giving it but just having it laid out in an organized matter would seem to help so much. Instead of having to spend so much time every gathering things together, pulling it out of omni/carots/pixis. What if you just did it once a week and then made prn changes to the draws from there.

Also as a few others have said if a patient is in rehab and can't get the pain medication they need to participate then that is a major problem. Others have commented that it's not feasible, but that still doesn't mean it's acceptable. Something somewhere has got to change. Bring in an extra nurse to do PRNs. Pie in the sky I know.

The problem with using preset pillboxes is that it would most likely result in one nurse having to administer meds that were set up by a different nurse. That's something I would flat out refuse to do. Plus it would take more time to verify all the pills in the box are the right ones than it would to just pop them out of the blister packs yourself. And then there's some residents who get their medications altered at least a few times a week.

Now, what I think does work is for nurses in LTC to preset their own meds just before med pass and then administer them. Let the med nurse cloister himself away in the med room for a couple hours (a supervisor can cover the floor for a couple hours, covering the floor is cake when you dont have meds to pass) and set up each resident's medications. Have a med cart with a labled drawer for each resident he can put their meds in and then he's ready to pass meds. I don't care what anybody says, this will not increase the risk for med errors. Trying to pour and set up and administer meds "on the go" is the biggest recipe for errors possible.

It's mind boggling that our highly educated, "evidence based" policy makers claim that the only safe way to administer medications is by pushing a cart down the hall and trying to pour the medications with a million distractions. It would be so much safer for the nurse to prepour the meds in a quiet, isolated room, organize them in a clearly labeled medcart and then go out and pass them.

Specializes in Gerontology, Med surg, Home Health.

Sounds like you want to take the WayBack Machine to the 1950's when the nurses put the meds into little cups with little cards and carried them on a little tray.

Nah, the nurse would still be pushing a med cart. But it would be a med cart that had a labeled drawer for each resident, and each drawer would have the resident's meds already set up in a pill cup in the drawer. Unlock the cart, give mrs smith her cup of pills, lock up the drawer and keep moving. Crushed meds could sit in their drawers in little cups with lids on them so they don't spill. Grab whatever eye gtts, miralax, inhalers, whatever from another drawer. Med pass time would be lightning fast. And the nurse isn't trying to pull 15 different pills in the hallway with a dozen distractions for every resident.

The only hitch in this plan would be the facility would have to schedule the nurse a couple hours of "off the floor" time he can spend locked away setting up the cart. I know this is easier said than done, cause another nurse will have to be out on the floor while the first nurse prepares the meds. But the med pass will become so much faster, safer and efficient, I'm betting the facility would break even finically.

Of course the biggest hurdle would be regulations against presetting. But anyone with a shred of common sense can realize that's it's wildly dangerous to try and pour meds in the midst of all the chaos on the floor. And if the pills are locked away in a locked med cart with clearly labeled drawers, I'm at a loss as to how it's a med error risk.

Specializes in Gerontology, Med surg, Home Health.

Brandon,

You must know by now there is no such thing as common sense in the regulatory world of LTC. We haven't allowed smoking or lighters or matches inside in at least 15 years, but we'd still get tagged if someone had supplemental oxygen in their room without a "NO Smoking, Oxygen in Use" sign at the door.

Specializes in LTC.

Brandon,

The only issue that I can think of that could come up based on your scenario is that say a res has BP meds, BP is taken and falls below parameters and the nurse either didn't know what the BP meds looked like and failed to remove them or gave all of the meds without bothering to search for them in haste. Any med with parameters would be subject to being given in error if the person administering them didn't take the time to search for that med or they would waste time heading back to the med room to figure out which med/meds to remove. I suppose the quick fix to that problem would be to put parametered meds in a separate cup and label them accordingly. So, nevermind, problem solved. :)

Brandon - you can't pre-pour medications. If the facility were on survey, that would be HUGE ding.

Brandon - you can't pre-pour medications. If the facility were on survey, that would be HUGE ding.

I know, that's why I said the biggest problem would be the regulations.

They're wrong about pre-pouring medications. Under the right conditions, it is way safer than trying to pour as you go. As long as the nurse who set up the meds also passes them, and the meds are separated in clearly labeled drawers..... what's the problem? Seriously, can someone, anyone, explain to me how that's unsafe? Like bluegee said, put the digoxin or other parameter-only meds in separate, labeled cups. There aren't that many. Only dumb facilities write parameters for every single BP med. (that's a topic for a whole other thread)

Absolute, worst case scenario for this method, you're resident has some change in condition where your nursing judgement tells you to hold a medication, or they refuse a particular pill. Maybe they've been having loose stools and you need to hold their colace. Well, in these cases the nurse could always discard the pre poured pills and start from scratch. Stop and think about it, and realize this really doesn't happen too often, and only would need to occur in scenarios where the pill in question isn't easily identifiable (and the majority are, but I agree if even slightly unsure, all the pulls must be discarded and pre poured from scratch).

The people who make the rules and regulations are not always right. Their evidence can be flawed, as their research takes place in some theoretical vacuum rather than the real world. Regulations change.

+ Add a Comment