Speedy med pass - page 4

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

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    How long it should take to complete a med pass on 2nd shift in a long-term facility on a dementia floor with about 35 residents? I wonder if I should take this job if I am offered it. Thanks for your input.

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    That's my shift and load of patients...depends on what kinda hall your working. On the memory care unit 8 pm med pass takes 7 pm to 9:15 pm, trying to get it under 9 but I have to help the understaffed aides at times. This is assisted memory care though so we have no tx's, no g tubes, no iv's. my 5 p pass only takes about an hour. On the actual long term care side I have residents on 8 and 9 p meds so I start my tx's directly after dinner at 6 pm those usually take me an hour, then start my 8's at 7 p and finish my 9'a right at 10 usually so 3 hours if all goes to plan. This includes my g tubes, assessing their bowel sounds etc. my 3 skilleds right now stay up late so I do my 2 complete assessments from 10 to 11 then I do the other before at 4 pm right before dinner. I give report around 11:15 then do charting till about 11:45...have to detail chart on skilled with full vitals as i am sure you are familiar! Day goes by fast in the blink of an eye. I actually like second shift over any other.
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    As many have said - the nurses that get done extremely fast aren't doing their job and it is so easy to tell once you follow them. Another thing I have noticed - many facilities write the time the med is due on the card - and so many nurses just go by that, they don't use their MAR, don't give all or sometimes any of their OTCs, do not catch new orders, give meds that have been DC'd or dosages changed, the list goes on.

    You will get faster with time, and with better organization - I don't know any two nurses that do things exactly the same, they all find what works the best for them. I do not like to take shortcuts or do things that I would not do if the state surveyors were monitoring my medpass, that way when they are there, or when I am orienting a new nurse, I don't have to change what I normally do.

    There is an easy way to set up the Miralax ahead of time - say there are 8 residents that get it with each breakfast. Take a plastic med cup for each of them, labeling it with their name, their room number, and the med (Miralax 17 gm). Don't pour the Miralax directly into the med cup, but place a new empty cup inside of each labeled cup and put the Miralax in there. That way they are ready to go, labeled with the pt name and the med.

    Do you have an easy way to track who you have already given meds to? Some nurses highlight on their report sheet once morning meds are given, then once noon meds are done, etc. This works for me at some facilities, but at others I have found that it is easier to take a plastic med cup for each resident, writing their name and room number on a cup. I place them in alphabetical order and then place an empty plastic med cup inside. I can fill the cup with their meds, pull out the unlabeled cup and take it to the resident, and stack the labeled med cups upside down. That way I know that I still have to give meds to anyone that has a labeled cup still sitting on the top of the cart. You may not need this with the E-mar system that you have.

    Just do it right, always always always compare your med to the MAR, and do your best. Accuracy is the most important thing.
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    Although I'm not new to LTC and med passes there are good quick days and bad slow days, it all depends on what is happening on the unit. Don't compare yourself to others, everyone has their own "system" and as long as you are not violating any regulations, I say go with what works for you.
    A couple useful tips:
    If you work with med punch cards, arrange each persons in the order they appear on the MAR, makes it quicker.
    If you use a preprinted census sheet, put the BP, blood sugar and SPO2 readings in preprinted blanks, that way you never forget to record info and makes it easier for charting.
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    Quote from wyogypsy

    As many have said - the nurses that get done extremely fast aren't doing their job and it is so easy to tell once you follow them. Another thing I have noticed - many facilities write the time the med is due on the card - and so many nurses just go by that, they don't use their MAR, don't give all or sometimes any of their OTCs, do not catch new orders, give meds that have been DC'd or dosages changed, the list goeos on.
    Not necessarily true.
    SuzieVN likes this.
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    Wow I have nothing to complain about. I normally have 18 residents and when we are short I have about 33 and I think that's awful. There are no IVs, Gtubes, or any other speciality care. There is one bad wound dressing that needs to be done daily and it takes me about 2-2 and a half hours for the night med pass. It all depends on what CNAs I have too. If I don't have good ones I end up answering a lot of call lights, taking people to the bathroom, and hearing about how water didn't get passed. All in all every day is different. It also changes by if I have a lot of orders to do, if I need to call the on call doctor etc.

    If you really want my opinion I think 35 people is a lot to take care of but that might be average for where you are IDK. At least they told you that up front at my place of work they would tell you that you have about 20 and then you realize that is if we are full staffed, surprise you now have 30+!
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    Quote from BrandonLPN
    Not necessarily true.
    I had to laugh a little. When I read the post, I immediately thought of you, Brandon because I've seen you post this so many times. I knew someone was going to say something eventually. While many nurses skip things to get done fast, it can be insulting to say ALL fast nurses do. I wish I could orient with you. I'd pick your brain and learn as much as I could from you. What made no sense to me was with my first nursing job, the ADON paired me up to orient with nurses who, just days later, were suspended for taking MAJOR short cuts. How about pairing me with a nurse you TRUST? But no, that's too logical.
    BrandonLPN likes this.
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    I've never heard of so much staff, as listed by the original post. Am I hallucinating, that a 40 bed unit has 3-4 nurses, including two med/tx nurses? Aside from that, yes- some people are giftedly structured enough to be able to pass meds in the time allowable. And yes- there are plenty of others that sign meds they do not give, don't follow protocol, and the like- but eventually, they will be fired, or even worse: have to pass meds with a surveyor in attendance, then that's all she wrote. Then bye bye license. I have a few tips, that can save you hours, every day:

    *Receive your report from offgoing nurse (most will despise you for requesting this) with the med book in hand, as you go page to page- make sure each page is numbered, and if there are new orders ask the status of them- was it ordered? Is it available? If meds from the prior shift were not signed, ask why- was the med not available? Did you order it? Where is it? Did you inform the MD, etc. that you didn't give it? One other biggy- if parameters require being called in and followed up (high sugars, low sugars, weird BP, etc.) ask if that was done. Don't allow yourself to be dumped on. And if lab results require being posted, or meds are based on labs- be sure they have been obtained and recorded. Seem impossible? Not really- 20 minutes of good report time will save you two hours of hell, per day. Also take note of narcotics- were they given, when, why, and did you record them on the count? Thank me later, if you don't believe me?
    *After report, and count (don't ever skimp, you'll regret it- even if you are getting report from your DON!). Make sure there are enough remaining for your shift- if not, ask why not, and request the prior shift to deal with the consequences of calling MD, getting signatures to the pharmacy, and the like. Another hour of time saved.
    *After count- scan the cart for needles, supplies, insulin, anything that is usually missing that you have to go fetch. If there are no supplies, ask the offgoing nurse- Hey, there are no needles in this cart- how did you give 25 insulin shots? Trust me, things will slowly but surely improve when you require accountability. Time saved? Unknown. Depends on if you have a sharp central supply employee, or have to beg, borrow, or steal from other units.
    *After this is all done- make rounds, talk to your people, determine who may be leaving/have appointments, be in immediate pain, be on the floor bleeding, or expired, or whatnot (deal with right away, to prevent your med pass form being stalled constantly)- and tell your people about what time you can expect to be at their room for their meds= this alone can prevent about 100 call lights per shift. Yet another hour saved.

    Yes, Virginia- it is possible, with the correct planning, to get a med pass completed, on time properly.
    xiaobear007 likes this.
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    Round 2: How to save another SIX hours a day on a med pass in a LTC place:

    *During narcotic count- how many of those drugs have been expired for...years? Are the patients even still alive? How long have you been counting meds, day after day, for patients that are long gone, every day? Keep a dynamic list of meds that need DC'd, and get them out of the cart. Inform the pharmacist. Be consistent, and insistent- your DON may hesitate, since it is a LOT of time and regulatory paperwork to clear out a junked up med cart. And if meds turn out to be missing after the fact? Hmm. You do not want to go there. Get rid of them, ASAP.

    *How many PRN meds are being used so often as to be used daily? Get them changed to routine to prevent the exra documention required of PRN meds. Especially for pain, blood pressure and glucose- how many times a shift are MD calls made for those issues?

    If you are energetic, and have the will to survive? LTC CAN be an option.
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    Second shift: Don't have to go to bed at night, don't have to get up in the morning. You have all day to work out, take care of personal business. And? The managers leaves at 5PM, so the pace is relaxed? Heavenly, if single. Hellish, if you are not?

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