There's a Mousetrap In My Med Cart - page 2
As some classmates in our RN nursing program gathered around in a small group this morning, I sided up and listened to a story that quickly carried me back in time when I was a newly licensed... Read More
Mar 14, '09Quote from pagandeva2000"They need to be shot!"OF COURSE we are ALL giving medications outside of the parameters sometimes in our lives! It is a horrible thing to have to decide whether to please a time clock or to SAFELY administer medications to people. Reasons like this make nurses leave the bedside by the droves, or why some medications are flushed down the toilet by desperate nurses. They need to be shot!
Sorry no time for shots...continue with the med pass....heheh
Mar 15, '09Towards the end of the 1st med pass, you realize your entering the next med pass time, and guess what? What's a few more pills? Put em all together. We didn't create this trap.
No one listens when we say its impossible to pass pills to 20-40 pts, take people to the BR, replace dressings that need to be changed, answer phone calls, talk with concerned pts, talk to concerned family members, and help with a work problem the cna's are having.
Then the superviser comes to tell us " it is important that we keep busy" because management is watching us.
Mar 15, '09:chuckle I cannot even begin to tell y'all how much I am laughing and smiling at this moment. Some things never change.
For years, I worked agency for those LTC facilities and did many a med pass. The greatest fun was when folks that had no arm bands needed meds and having to trust staff to identify them would go against the grain of everything you were taught. Or when a facility was doing construction and moving folks all over the place and the permanent staff would not help locate the resident, resulting in your DON at the agency scolding you for missing the insulin. There was always a solution to these incidents ---DOCUMENTATION!!!!!!!
The writer of this story deserves credit. Well written and realistic indeed.
Now, how do we participate in controlling this insanity as health care providers. Many ways, I say. Many ways!
1. Assure that all patients that you identify during the med pass, if they do not have proper identification, have it implemented immediately. VERY IMPORTANT !!!!!
2. Be a patient advocate and med nurse advocate at all times while you are identifying the ways that help the patient receive the medication. DOCUMENT IT ON THE MAR!!! This allows the next nurse to not have to struggle through, loose time, and will increase resident compliance.
3. Here is a very important one... START USING YOUR PHARMACOLOGICAL/CLINICAL PARTNERSHIP KNOWLEDGE as a nurse in a very aggressive manner with the intent of outcome adjustment. Ask yourself from a clinical perspective in your assessment of that resident and their health status if all these Rx are necessary and start weening them off the MAR via Pharmacist, MD conversations and orders.
For the older folks reading this. Think about what time in life does an individual start increasing the medications in their daily routine. It usually begins for some, when they are in their 50s and continues. It is no different for the geriatric population. "Prescribing drugs to take care of side effects from another drug is common".
The Mice are the drugs.
The CATs to take care of that mouse is the Pharmacist and Doctor.
The Mousetrap in the med cart is the NURSE. She/He has the power to eliminate all the bad mice.
Mar 16, '09:wink2:What a super article! You have done such a service to the new Nurses on ANY med unit.
I certainly can well relate to everything that you have said.
You must have had a wonderful spuervisor that day. Just what we all could have used at one time or another.
Thank you so much for sharing.
You Are a wonderful Nurse. I can tell from what you wrote.
Mar 16, '09Thanks for this great article. I pass to 29 patients, 2 with Gtubes, some combative several hospice, the usual difficulties. One of of my shift is taken to monitor meals (dinner, since I work 3-11). I've managed to move some of the meds to the 9 pm med pass so that I can be on time to dinner, but that means that sometime I have to wake pts up to get their hs meds - esp those who go to bed right after dinner. I've met quite a few nurses who solve the problem by doing one big med pass with exceptions for insulin. Haven't reached the point in my career where I can do that, but it does sound lovely, since they get out on time and I never do, and will likely lose my job over it.
Mar 17, '09As I read this I have thought about how many times I have been in tears or near it passing meds. It is sometimes scary and difficult, but somehow we get it all done. Most of the time without incident. (By the grace of God)
Kudos to you and all of us that try our best!
Mar 18, '09I challange any nurse to actually pass 100% of the meds on days in +/- 1 hour in LTC. This is impossible. Especially the nurses that have never worked LTC and complain about their "impossible" load of 5-6 pts. Working LTC is the hardest work you will ever love, but this is but one of the millions of reasons that nurses are leaving the profession. Why is it that the state regulates the ratio of children to daycare workers (6:1 when I last looked) and they think that 25-50:1 for the elderly and frail is fine? Count me out of LTC, I've done my time.
Mar 18, '09I can't adequately express my appreciation for both the article and the comments. I appreciate knowing I'm not alone in this. Thank you.
Mar 18, '09Quote from Valerie SalvaWhere I worked we had 28, lots of diabetics with glucometer checks, lots of G tubes. I was PRN casual so I never had a good handle on the meds, and it took longer. I started at one end, went to the other end, went back to the first room and started again. Most of the shift was spent giving meds. I know I was out of compliance, but I tried to spread them out safely, and combine what I could to save trips. You are not supposed to give meds while they are eating, which adds to the problem. You either are out of compliance or you are taking dangerous shortcuts or completely ignoring any request for anything from a patient.I think that there are tens of thousands of LTC nurses who are giving their meds outside of the time parameters every day. Some meds passes are so huge, there is no way humanly possible to get the meds out "on time."
We pretend we give them on time, and mgmt pretends to not know how it really works- that is the reality of LTC.
I remember when I was a student. My instructor decided to have us practice giving meds for the whole team so we could get skilled at med passes. Well, that included 18 patients and with her there quizzing me and going back to the desk to check things, etc., I ended up still doing the morning meds at lunchtime. This was on an acute care med surg unit. I think she was so sorry that she ever thought this idea up that she never said a word about giving 9 am meds at noon.
Mar 18, '09I've been an LPN for 3 1/2 short years and I've been employed at a LTC facility for those 3 1/2 years and my patient load is 28-29 residents. Yeah I'd agree with the Mousetrap theory!! However I do love my residents but due to the time issue often are in a "hurry" throughout the day and feel like I am not giving my residents the special love and care they so very badly need.
Mar 18, '09I guess my first response is Why is a nursing student giving meds to 17 patients at all? This is almost impossible under the best of
circumstances with a experienced nurse. Why are we trying to run nurses out of nursing before they're even out of school?