Speedy med pass - page 2

by sbostonRN 24,582 Views | 52 Comments

I am a new grad and I've been working on a subacute rehab unit at a LTC facility for 2 months now. I really love it and I'm well supported by my coworkers. On a typical day, my unit has about 36 patients (up to 40), 2... Read More


  1. 0
    It gets better! One thing I would always try to do was get meds to the pts that go to therapy early, that way you don't have to hunt them down for their meds. I also carry a clipboard around with me where I keep track off odd time med, who needs their BS and how often, what said BS and coverage if given for report, also keep track of my vital on my clipboard as well. Try to run thru you cart at the begginning of your shift to make sure you have everything you need, stock meds, insulin syringes, tape, alcohol preps, med cups ect, to prevent having to make a 100 trips back and forth during your med pass. Efficeny and speediness comes with time and experience. Eventually you will find a rountine that works for you! I'm about to be starting a new job myself so I will have see what kind of rountine works for myself again as well. Good Luck!
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    Some people who do too speedy of a med pass are NOT doing to correctly... do not forget that.

    I worked somewhere where the other med nurse was done with 20 residents by 8 am after starting at 7. There is no way this could have been possible with everyone she had, when I took over the cart on the next shift I would find MANY med errors and the residents that were with it would ask me when I worked her cart on her shift days off "Why do you give me two insulin injections when the other nurse only gives me 1?" etc.
    LTCangel likes this.
  3. 5
    I pass meds to 22 residents, after passing the same meds to the same residents for a few months, I began to memorize them.. I still look at the MAR but it is just quicker now because I already know what meds I am giving to who. I found that in the beginning most of my time was spent reading the meds and comparing them to the MAR.
    You will get faster too, but remember faster isnt always a good thing, more mistakes can happen if you do not take the time to do your 3 checks.. and many nurses don't.
    dallet6, itthybitthythpider, tyvin, and 2 others like this.
  4. 2
    One tip I learned from a seasoned nurse: Go ahead measure and pour all your Miralax powder before you start passing meds. Then just stack the cups inside each other. If you know that you will have 8 pts taking mirilax then you dont have to waste time pouring. Just grab a cup and fill with water/gatorade. :-)
    Juryizout and davisdoll like this.
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    Quote from CrazyGoonLPN
    One tip I learned from a seasoned nurse: Go ahead measure and pour all your Miralax powder before you start passing meds. Then just stack the cups inside each other. If you know that you will have 8 pts taking mirilax then you dont have to waste time pouring. Just grab a cup and fill with water/gatorade. :-)
    Isn't that considered pre-pouring? What's the difference if you have a bunch of ativan in one wing or everyone takes the house multivitamin ... could you stack em up?
    ricksy likes this.
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    Quote from tyvin
    Isn't that considered pre-pouring? What's the difference if you have a bunch of ativan in one wing or everyone takes the house multivitamin ... could you stack em up?
    Yeah it probably is considered pre pouring but it makes things a lot quicker. There is no need to be so dramatic. I never pre pour pills. Especially narcs!! There is a difference.
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    Quote from CrazyGoonLPN
    Yeah it probably is considered pre pouring but it makes things a lot quicker. There is no need to be so dramatic. I never pre pour pills. Especially narcs!! There is a difference.
    Dramatic ... would it be dramatic if a new nurse lost a job because they took advice from this board that guided them to do things that aren't right? This board has great influence on those people who come and read these posts. I take it very serious and don't want anyone walking away thinking it's OK to pre-pour anything; of course unless the facility, JCAHO, and state inspectors have changed their minds about the subject. So yea, I guess it could be considered a little dramatic when I believe in guiding young nurses in correct procedures concerning a med pass and actually take it serious.
    Last edit by tyvin on Aug 24, '11
    Nola009, ricksy, beatrice1, and 2 others like this.
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    Quote from PollyWolly
    Some of the speed comes with experience and organization. The other thing I have found is often the nurses that pass meds the fastest are not giving OTCs, eye drops, or other meds where it is more difficult to catch than if it is coming out of a bubble pack. It is easy to see who does this when you follow them. It sounds like the nurse that helped you had some great advice and helpful tricks for you - and thankfully was kind enough to share them!
    just keep at it and do what is right
    I see other nurses that finish their med pass hours before I do. And I know that if they have done it by the book, and given all the meds and checked all the BPs before giving BP meds, and done everything the way I would do it....There is NO way that they could get done that fast.

    I only act as a nurse, in a manner that I can sleep with at night, AND I can defend in a court of law.

    I keep my stereoscope around my neck
    I keep my wrist BP cuff on my wrist, so that it is always with me (my DON always comments on my stylish bracelet)
    I actually wear a watch on my wrist (the same one with the BP cuff) LOL
    I keep my scissors and pen light in my pocket at all times
    I stock my cart, with everything BEFORE I start
    I change the battery in my netbook after each med pass (even if the battery is not dead, because it will go dead during my next pass)
    I use spoons for crushed pills with pudding, instead of the wooden paddles (I can usually get it all in one bite this way)
    I have learned my residents, the ones that will take 2 hours to eat their lunch...I make sure they get their noon meds & breathing tx before the meal tray is passed, otherwise I am going into that room 10 times to see if they are done yet
    I keep my cart organized, with residents in order, meds in order.
    When I change out OTC meds/get a new bottle: I put the old lid on the new bottle (because I have been looking at that color of sharpie, that handwritting, etc)..It cuts down on time searching the drawer


    I hope this helps

    I worked in a facility for over a year on the same unit with 64 skilled beds all to me! My supervisor always said it took me twice as long as other nurses. And she was hateful and said I needed to do better.

    I always said, if they can do it faster, it is because they are leaving something out! They make it look good on paper, go look at the residents that they have "cared" for in such a hurry. And it does show. Keep your chin up!
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    Quote from supervisorhatchet
    just keep at it and do what is right
    I see other nurses that finish their med pass hours before I do. And I know that if they have done it by the book, and given all the meds and checked all the BPs before giving BP meds, and done everything the way I would do it....There is NO way that they could get done that fast.

    I only act as a nurse, in a manner that I can sleep with at night, AND I can defend in a court of law.

    I keep my stereoscope around my neck
    I keep my wrist BP cuff on my wrist, so that it is always with me (my DON always comments on my stylish bracelet)
    I actually wear a watch on my wrist (the same one with the BP cuff) LOL
    I keep my scissors and pen light in my pocket at all times
    I stock my cart, with everything BEFORE I start
    I change the battery in my netbook after each med pass (even if the battery is not dead, because it will go dead during my next pass)
    I use spoons for crushed pills with pudding, instead of the wooden paddles (I can usually get it all in one bite this way)
    I have learned my residents, the ones that will take 2 hours to eat their lunch...I make sure they get their noon meds & breathing tx before the meal tray is passed, otherwise I am going into that room 10 times to see if they are done yet
    I keep my cart organized, with residents in order, meds in order.
    When I change out OTC meds/get a new bottle: I put the old lid on the new bottle (because I have been looking at that color of sharpie, that handwritting, etc)..It cuts down on time searching the drawer


    I hope this helps

    I worked in a facility for over a year on the same unit with 64 skilled beds all to me! My supervisor always said it took me twice as long as other nurses. And she was hateful and said I needed to do better.

    I always said, if they can do it faster, it is because they are leaving something out! They make it look good on paper, go look at the residents that they have "cared" for in such a hurry. And it does show. Keep your chin up!
    While I agree for the most part, I do take exception to the time part, as the most crucial adjustment is change the times of the medications due, to match what is being done, and that means not all the meds are set at 0800, I also am very skilled and proficient at organizing my med pass to accomodate, as you do, the residents so that I hit the bulk of them, before breakfast, after breakfast, before lunch etc and in some cases, all the am meds are moved to 1200 or 5 pm, especially for dementia residents. I then review the MAR and get those pulses and b/p's changed to weekly and monthly as there is no data that says we need to do BID B/P's for people who have taken those B/P meds for years without B/P issues. A lot of stuff on the MAR, when it gets to the LTC part is left over hospital "best practice" for new medications. THe only one you cannot and should not alter would be of course apical on Dig, and some of the "hold for b/p lower than" but if the person has been stable for 6 months, with bid B/P's it makes sense to save the patient the annoyance of so many B/p's as well as reduce med administration times, if ok with MD/Family and facility. A lot of changes can be made to the MAR that affect nursing time, a lot of eye drops, in elderly, unless for specific eye diseases, may be unnecessary. A good example: a patient has dry eyes, gets eye drops or lubricant prescribed, refuses them, over a course of 2 years, when I arrive, those eye drops have been consistently refused for months, why not get an order to d/c? Patient has a right to refuse, d/c unnecessary med.
    Look at those OTC's, are they really necessary to get 8 vitamins, maybe a Multi-Vitamin wiht Minerals/Iron will substitute nicely at BID, and d/c all the rest of the seperate vitamins.
    Doss BID can be Doss QD. There are lots of ways to skin the cat, gotta whittle the meds down to focus on the patient, quality of life, shoving pills down elderly is not always the best course.
    psychgeribuff, fairyluv, milfordmom, and 2 others like this.
  10. 1
    I do agree with previous post, about cleaning up the MAR. I am working on that now on my med pass. But our medical director is horrible. He is the PCP for 90% or our residents and he won't change anything. He won't d/c meds on a resident that has not put a pill in his mouth in over 4 years! Now isn't that crazy.

    And as far as checking BPs, we have a ton of them at our facility that do have orders to check BP and/or HR prior to, and hold med if ....It is time consuming...

    And when I said, I knew some nurses weren't doing it. I really do know that they are not doing it. During my orientation, one nurse actually had the nerve to say to me "I don't have time for that. Make something up"
    And that is why I always act in a manner that I can sleep with at night, AND can defend in a court of law.

    Just saying....For the original post....

    It will get better, it just takes time. And learning your peeps is part of it.
    Good night all!
    Nursemarymary LPN likes this.


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