Speedy med pass

Specialties Geriatric

Published

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 med/treatment nurses, 1 charge nurse and 1 to do admissions and discharges. So I'm typically responsible for the morning med pass for about 18 patients. I'm curious how other med nurses arrange their morning schedule to gain speed. I come in at 7, generally start my pass around 7:30 (after getting count, stocking my cart and getting any blood sugars), and I finish around 10 or 10:30. So it takes me about 3 hours to do a med pass. I've seen others at my facility finishing their med pass at 9...how is this possible when each resident takes 10-15 meds?

Please, if anyone has tips or tricks for time management, it would be much appreciated. Since I'm on a rehab unit, I do have therapists coming at me constantly wanting to take my patients down to therapy, so I would love to start finishing earlier than I have been!

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.

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.

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.

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?

Specializes in Hospice / Psych / RNAC.

Setting up miralax as mentioned previous is pre-pouring. You could also say if so many residents have colace or vit c why not just put all that in cups and stack; like the miralax? All that patient labeling of cups is a major no no...would you do that if state survey were there?

I've never found prepouring to save time, but it can get you in trouble. Other than the M&Ms, etc. I normally pass out with the other meds, I mean. I keep those in a prepoured cup.

Thanks for the tips! I am not able to pretty up the MAR (but that would be very useful as I'm a visual person) because we use computerized MAR. Basically when a med is due it highlights green, when it's past due it comes up yellow. I have highlighted my cheat sheet with med times and any 0730's, or other nontraditional med times. I work with the same group of pts for 2 weeks before switching so I do get used to their routines, but it still seems like I'm slower than all the other nurses.

Also we are not allowed to write on the caps of stock meds...their reasoning is that caps can be switched too easily and a med error could occur. We can write on the side of the upper edge of the bottle which I might try with a red Sharpie.

Thanks again!

Apparently we have the same program at my facility. We also have computerized MAR due meds are highlighted in green and past due comes up yellow. Also, we are not allowed to write names in stock meds only the opened date.
Specializes in LTC,Hospice/palliative care,acute care.

This thread was started in 2011,I wonder how sboston is faring? I hope she is not pre-pouring ANYTHING-not even miralax....I don't even prepour glasses of water-if I do that then something WILL get spilled and then I have a big mess that takes even more time to clean up. BUMP

Specializes in Pediatrics and geriatrics.

I currently work in a SNF with a patient census of 42 {there are 2 nurses}. I am taking up to 2.5-3 hours to complete the medpass. We have computerized EMAR. Shift starts at 7am, sometimes it is almost 8am before I can get report from the 11-7 nurse, so that puts me behind from the get go! I do my Diabetic patients first. Most of my patients are on ALOT of meds. There are constant interuptions despite the fact that I took the initiative to put a notebook on my medcart asking people to please write down the non-emergent issues for me. Our admin is huge on customer service, so he thinks that the nurse can be constantly interrupted during the medpass and it is ok! I have been a nurse for 7 years, and this medpass is something else!! I have only been working at this facility for almost a month, and everyday I get so frustrated. I have tried cleaning and organizing the medcart, but it is always in a shambles when I return. I seem to be the only nurse who restocks and orders meds. Anyone have any tips or pointers for me? They also leave narcs from discharged patients sitting in the cart too! On my 2nd day in orientation, a whole card of 30 Percocets went missing! I was on the first cart not the cart when the narcs went missing. The DON drug tested a bunch of nurses, so I don't know what became of it..... Although I was told by a nurse that this isn't the first time narcs have gone missing. So for the sake of my license, when I accept narcotic delivery from pharmacy, I have a 2nd nurse cosign with me when I place the narcotic in the narc box!

I have been a nurse for almost a year. 2nd career. I remember a nursing instructor saying it takes a year of full time work to begin feeling like you know what you're doing. I have never worked more than 2 shifts a week other than my initial orientation. I AM SO SLOW at my med pass...STILL. I rarely take a lunch break. Never a regular break. It's very frustrating and I worry that I'll get fired. I go home and think about what I can do differently. I have gotten better but I don't see how I can get it all done. I'm still 8 pts behind before my electronic MAR goes red as in late. I always leave late becuz I do my documentation at the end of shift. I only have 23 pts but they r on a ton of meds that need to be crushed. I waste a lot of time looking at the MAR and punching out the med one at a time. I'm afraid if I do it any other way that I'll commit a med error. I do everything by the book. When I try to delegate simple tasks I get resistance so I end up doing it myself. Often times meds or treatments r missing/out of stock so I have to go hunting. CNAs/therapy taking pts away before I've given them meds. Pts whom want meds at a specific time. I've tried going by room number, by time, by addressing the pts in my immediate vicinity, by giving meds to my pts with the least meds, the most meds, I've even tried getting all the vitals out of way first and I STILL CAN'T GET IT TOGETHER. So frustrating. Today almost all of my pts were on full vital signs! By the time I'm done with my 1st med pass it's 11. Then I start treatments. Then it's the second med pass which isn't too bad. I can't wait to feel good about my job:(

Specializes in home health, developmental disabilities.

I have 32 residents. I start pouring meds at 545 and have all my pills passed by 730am.

I have been a nurse for almost a year. 2nd career. I remember a nursing instructor saying it takes a year of full time work to begin feeling like you know what you're doing. I have never worked more than 2 shifts a week other than my initial orientation. I AM SO SLOW at my med pass...STILL. I rarely take a lunch break. Never a regular break. It's very frustrating and I worry that I'll get fired. I go home and think about what I can do differently. I have gotten better but I don't see how I can get it all done. I'm still 8 pts behind before my electronic MAR goes red as in late. I always leave late becuz I do my documentation at the end of shift. I only have 23 pts but they r on a ton of meds that need to be crushed. I waste a lot of time looking at the MAR and punching out the med one at a time. I'm afraid if I do it any other way that I'll commit a med error. I do everything by the book. When I try to delegate simple tasks I get resistance so I end up doing it myself. Often times meds or treatments r missing/out of stock so I have to go hunting. CNAs/therapy taking pts away before I've given them meds. Pts whom want meds at a specific time. I've tried going by room number by time, by addressing the pts in my immediate vicinity, by giving meds to my pts with the least meds, the most meds, I've even tried getting all the vitals out of way first and I STILL CAN'T GET IT TOGETHER. So frustrating. Today almost all of my pts were on full vital signs! By the time I'm done with my 1st med pass it's 11. Then I start treatments. Then it's the second med pass which isn't too bad. I can't wait to feel good about my job:([/quote']

Did I take an Ambien and sleep write this? I feel your frustrations to the bone.

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