Speedy med pass

  1. 0 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!
  2. Visit  sbostonRN profile page

    About sbostonRN

    sbostonRN has '2.5' year(s) of experience and specializes in 'Med/Surg, Rehab'. From 'Boston metro area'; Joined Jun '08; Posts: 524; Likes: 335.

    52 Comments so far...

  3. Visit  demylenated profile page
    9
    It. Takes. A. Long. Time to learn and get a routine going. You WILL get there. Just be as efficient as possible, and think of thinks you can do to make it go faster.

    Good luck
  4. Visit  nola1202 profile page
    5
    One nurse has given me a lot of ideas. He went through and labled the names and room numbers clearly with a sharpie and index tags that stick out a bit further than the traditional ones. he has found green friendly clip tags wtih bright colors. AM pass is green, Aft pink..and so on. Scheduled blood sugars for noon or am, Single scheduled narcotics or meds that need to be given alone or at 7:30 a different color. At first it seemed confusing and time consuming to set up so I had my doubts, but as he flipped through he just popped em in.
    It's a real help when someone has to step in (like relieving for lunch or helping out while he does an admission or deals with a fall or sudden illness requiring an RN. The other thing he did was use a sharpie to clearly label seperate stock meds or individual pt meds. He uses a label maker for the caps that have the raised bumpy printing on them, or in a pinch silk tape. I know he has to spend a lot of down time doing this, but he says he just did one or two things at a time.
    When stock meds run out the next nurse just peels the label and sticks it on the new bottle. Thanks to him, life is soooo much better. Oh yeah, he also writes the Pt's name in Sharpie pen on top of the med cards so it's easily spotted in a crowded drawer, and has clearly marked room numbers on the dividers, broken ones are retired. A wrist and manual BP cuff are in the bottom drawer with an extra stethoscope.
  5. Visit  PollyWolly profile page
    6
    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!
    spiderslap, LockportRN, AtheistRN, and 3 others like this.
  6. Visit  tyvin profile page
    3
    Quote from nola1202
    One nurse has given me a lot of ideas. He went through and labled the names and room numbers clearly with a sharpie and index tags that stick out a bit further than the traditional ones. he has found green friendly clip tags wtih bright colors. AM pass is green, Aft pink..and so on. Scheduled blood sugars for noon or am, Single scheduled narcotics or meds that need to be given alone or at 7:30 a different color. At first it seemed confusing and time consuming to set up so I had my doubts, but as he flipped through he just popped em in.
    It's a real help when someone has to step in (like relieving for lunch or helping out while he does an admission or deals with a fall or sudden illness requiring an RN. The other thing he did was use a sharpie to clearly label separate stock meds or individual pt meds. He uses a label maker for the caps that have the raised bumpy printing on them, or in a pinch silk tape. I know he has to spend a lot of down time doing this, but he says he just did one or two things at a time.
    When stock meds run out the next nurse just peels the label and sticks it on the new bottle. Thanks to him, life is soooo much better. Oh yeah, he also writes the Pt's name in Sharpie pen on top of the med cards so it's easily spotted in a crowded drawer, and has clearly marked room numbers on the dividers, broken ones are retired. A wrist and manual BP cuff are in the bottom drawer with an extra stethoscope.
    This is golden or you could figure out a system of your own. Either way after you've prettied up the MAR (with your DONs approval) brainstorm about how to consolidate your steps. Can you bring something with you that you usually break stride to go get, are all the supplies on the med cart before you start, know who's going out for xray/PT and when and will they need prn pain meds before PT. Know the CNAs ways ... when are they showering, feeding, etc... And pick it up a little ... you'll see in time you'll be as fast as the rest of them.
  7. Visit  sbostonRN profile page
    1
    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!
    virgo,student nurse likes this.
  8. Visit  tyvin profile page
    0
    Quote from sbostonRN
    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!
    Do you like the computerized better and are the meds in the rooms or do you have cows with meds in them?
  9. Visit  sbostonRN profile page
    0
    I do like the system but since this is my first job I don't have anything to compare it to. The computerized system is very fast and the EMAR loads quickly on the screen (it is internet-based). When something is due, it flags, but it also allows me to change the administration time so you can always appear to be in compliance with med times.
  10. Visit  payang0722 profile page
    4
    I'm a new grad too, just barely 4 months in a LTC. It takes me 3-4 hours to finish my med pass during the first few weeks. I'll start at 7 am, then finish at almost 11 am...I almost gave up. I went here to gather support from the wonderful nurses, and they said to hang in there that it will get better - and it did! It'll come naturally because I learned to get myself organized and had my routine. I still start at 7 am and usually done by 9-9:30 am! that was 1 1/2 hour less than when I was starting (of course it's different when something happens - skin tears / fall / c.o.c . You might think that it's because I have the same set of residents and "memorized" their meds, but no...I'm still a floater and jumping from one station to another station, morning or evening shifts whenever they need me.
    So, as what everybody have said, just hang in there. I'm also a new one, but I promise to you that it will get better.
    Good luck!
    spiderslap, AtheistRN, username33, and 1 other like this.
  11. Visit  sbostonRN profile page
    0
    Oh, and we have med carts with the meds in them, with the computer attached to the top. The med room is for old meds (patients that are no longer there), a refrigerator for insulin and IV Abx, and other random supplies like needles, saline flushes and emergency kits.
  12. Visit  sweetsleep28 profile page
    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!
  13. Visit  AZMOMO2 profile page
    1
    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.
  14. Visit  tainted1972 profile page
    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.

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