Speedy med pass - page 3

by sbostonRN

23,391 Views | 51 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. 3
    Quote from supervisorhatchet
    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!
    My question is,...as nurses...and as nurse managers...and DON's, we KNOW nurses aren't doing these things.....yet we do not act on FIXING the problem. If the medical director won't d/c meds, I would have the DON speak to him. IF the MAR is NOT what we are really doing/giving the resident?.....Scary nurse practices. The golden rod is...what would a prudent, reasonable nurse do in any given situation? My second question is...why are we bothering our LTC clients to take B/P twice daily, or pulse twice daily, or supposedly HOLDING meds based on paramaters that we aren't "really using"...when this problem can be easily fixed? The second advocate is the consultant pharmacist, get him/her to put the reccomendations in the pharmacist monthly report, the MD will/should and /or the DON will follow-up for all the unnecessary nursing time used for no quality of life for the resident.
    dallet6, ktwlpn, and supervisorhatchet like this.
  2. 4
    I don't know how helpful this will be, but it is what I have been doing for years. Each day when you get home, think over your shift. Deciede on one thing that you could do faster. It might only be a few seconds faster, but it is faster. Then implement that. a few seconds faster on each pt can transulate into minutes. It might be with med pass, or it might be with charting, or gathering supplies, dressing changes, tube feeds, iv's, trachs, ect. Over the years it really adds up.

    When I first started nursing, I followed a nurse who was retiring, she was in her mid seventies and had a pronounced limp. - I couldn't keep up with her no matter how I tried. I knew the reason was I wasn't experienced, and she was. So, I have made it my business to become like her.
  3. 5
    When I started, I was passing 9am meds for 38 residents because I was the only one WORKING on my unit while the other 3 nurses stood around doing nothing and calling it "supervising", arguing about who had what administrative position. It was pure hell. But I did pick up a few tricks that are legal and cause no errors.

    1. Pre-pour waters: set up like 4 or 6 cups of water at a time so you're not constantly pouring and you don't forget to pour water. Just don't forget to pitch the cups after they drink from them.

    2. Do those with PT first and premedicate if appropriate (say on someone with an amputation who's going to be working with a prosthesis). That way you're not faced with a lot of PRNs at once, and keep it in your mind who's likely to ask for their PRNs as soon as they can have them (ie "clock watchers").

    3. Figure out who's a fingerstick and highlight your census so everyday you know exactly who to get and when (I used to use orange for only 8am, blue for 11am, and green for 8am and 11am).

    4. Do all your blood pressures/pulses/temps first so you know gets b/p meds and ABTs and you'll be able to assess who you may need to monitor closely for falls and possible calls to the physician that way you can prevent incidents from interrupting your pass.

    5. Make sure you have EVERYTHING you'll need on the cart. You'd be surprised how much time it eats up to run get supplements, OTCs, thickener, thermometers and other equipment.

    6. EAT BREAKFAST!! Seriously. When I first started on the floor, I never ate breakfast and by 8:30 I was sluggish and moving and thinking slower.

    Also, don't gauge how fast you are by how fast other nurses get it done. It has been my experience in my year of nursing that those who get the most praise for being efficient aren't really giving all their meds. I have come behind nurses who signed that they gave eye drops from unopened bottles, meds that were unavailable, signed for uncommon meds for days and not a single pill was popped out of the packs. I've seen nurses write in O2 Sats when there wasn't an oxymeter in the building, so I don't doubt some of them make up vitals and write them in. I try to practice nursing as if it were my loved one or myself I am caring for. I would rather give them all their scheduled meds late, but safely without lying or making errors than for them to not get some or any or receive them in an unsafe manner (like getting B/P meds when their B/P is too low).

    It really does get faster with experience. Just try to avoid bad habits like prepouring. I won't lie and say I've never done imperfect things and we're all human. But I have made errors before doing those types of things, including wrong med to wrong patient. Personally, whether harm results or not, I always regret those kinds of things and feel terrible when I make a mistake like that. You'll get it. Just stay at it.
  4. 0
    I love your reference to the administrative staff standing around arguing about who will be in charge, it is so true, when I was passing meds, I would half-listen and watch what the "managers" were doing, and it was tremendously ridiculous. Often, they did nothing. I remember as a new grad, working eve charge Medicare, state surveyors walked in at 7 pm 3 of them. I called the powers that be, they all came in, a few dragging, it was summer, it was late. 2 of them stood at the nursing station, didn't address the ringing phone, the ringing doorbell or follow any of the surveyors. It was the least pro-active manager team we ever had, and although the survey wasn't that bad, it seems odd to me that they wouldn't address the ringing phone or door.
  5. 2
    I take my census sheet and, in red, write who needs their meds crushed and mixed (abbreviated C/M for myself), GT feeders, and I put little red boxes on the right side for FSBS. If I don't know who has FSBS or not, I go through the entire MAR before I begin my med pass. I also use that time to get a "snapshot" or who I have. I look for BP meds and anything else with a parameter. I also put little boxes for GT feedings. All that kind of thing gets put in red so I can see it easy.

    I use blue for when I'm receiving report. Again, it's so I can easily see what the nurse before me said I needed to be aware of, but isn't routine, everyday things.

    After I'm done with the med pass for one resident, I mark the right side with a large X for the first med pass, and XX if both med passes are done. This lets me see at a glance who I still need to give meds too. Everything that happens in my shift is in black pen.

    Each part of my census sheet is used for something specific, so I know where to look for what. BPs are written in one spot, ATB in another, FSBS in another. I call it my brain, cause without that paper, I'd be lost! It really does help, no matter how you set up your "brain", to do it in the same way every time.

    Also, know what you can deligate. Let your CNAs know who needs BPs done for the first med pass, and they can do them when they get vitals done at the beginning of the shift and report them to you.

    It does get easier. I used to cry because I was so frustrated at being slow and I felt I would never get it! But eventually you pick up little tricks here and there. Always be safe, though, because the frustration you feel at being slow is nothing compared to the fear of harming a resident cause you went too fast. I've seen too many good nurses make too many mistakes because they got frustrated and went too fast.

    Hope this helped and good luck!
    spiderslap and psychgeribuff like this.
  6. 1
    You are so lucky!!! I am a new grad in LTC and I have 36 pts in a skilled unit with treatments, new orders and three med passes and 11 a and 4p FS! And this is prn on a new floor q d!!!
    spiderslap likes this.
  7. 0
    Quote from davisdoll
    You are so lucky!!! I am a new grad in LTC and I have 36 pts in a skilled unit with treatments, new orders and three med passes and 11 a and 4p FS! And this is prn on a new floor q d!!!
    You work 12s? That's rough! You don't have noon FSBS?
  8. 0
    Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!
  9. 1
    Quote from davisdoll
    Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!
    I hate the idea of working off the clock. I wish I could get admin and the "money men" to see that do give proper patient care, we need more nurses on the floor! Not more time clock monitors
    svdbyGrace0976 likes this.
  10. 0
    Quote from davisdoll
    Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!

    I work 12s too, but my patient load is smaller on average. On the skilled unit I have between 9 and 25 patients depending on which hall and the census... the LTC end of the building, the pt. load is more like 30 patients, but on that end they have a treatment nurse/CMA who helps with applying all the butt creams, ace wraps, dressing changes/bandaids/skin checks/incident reports for when someone bumps their knee;.... on the skilled end we don't have any of those- just four nurses, (and often I'm the only RN) to take care of our own hall's dressing changes, meds, treatments, orders, admissions, and whatever else comes up. Every once in awhile when the census is high we get a 5th nurse to help with admissions- but that happened for about the first month I was working at the facility, and then it stopped.

    Our facility takes vent patients, and it's quite crazy if one gets scheduled on a vent hallway- I don't get scheduled on those very often though. One of the vent patients has a patent dislike for new nurses, and won't let me care for him, which makes everything crazy for the other nurses if i can't manage my whole hallway!


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