There's a Mousetrap In My Med Cart - page 4

by 99percentangel

47,508 Views | 86 Comments

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 practical nurse (LPN) just learning... Read More


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    OK. So. What I keep coming back to is; when TPTB who come up with the number for the time limit in which you need to complete a med pass, how come the other half of the equation never crosses their bean-counting little minds? Ie; how many PATIENTS is it reasonable for one nurse to medicate in that given time frame?? That also would depend on how many med each pt has, and as in the story, how many need to be crushed, or depend on getting a new set of vital signs first, or if you need to do teaching about why they're taking a new med, etc, etc. Where is it that they say you need to do a med pass in x minutes or hours and that it should be reasonable-and SAFE- to accomplish this if the number of patients does not exceed X patients with Y meds each? The time limit is loud and clear; I seem to have missed them voicing any concerns about reasonable expectations or safety...
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    I just started a job at a LTC facility. My last night of orientation ended up being my first night on the floor, because the nurse didn't show up. This article expresses exactly how I felt. Another nurse had to do my treatments and charting because all I did was pass meds. Last night, I had a new admit, and that is all I was able to do. Oh, and his roommate decided to meet a friend to smoke and they had vodka. How the aide who is supposed to be watching the smokers let that happen, I have no idea. (We are one of the rare LTCs that allows smoking, if you can believe it). Thank you for your article. I sent it to my family to try to explain what I feel like at work. Stephani
    spiderslap likes this.
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    Quote from kellyskitties
    I agree, even the 1 hour before and after is a rat race with as many patients as a nursing home med nurse has to medicate. I work med/surg and they just determined we have had too long to pass our meds (TOO LONG!). CMS apparently has a 30 before and after standard and we have lost an hour of our med pass time. That doesn't sound undoable - except we all know how short staffed med/surg is, and I understand from nurses from other areas we have some very demanding patients in our area. So you always start out behind, try to catch up and can't.

    I suggested moving the BID's to 10 and 10 instead of 9 and 9 and was told that it was JAHCO (sp?) But I know other hospitals I have heard mentioned at a conference did make that change. I don't know who they were or I would call and ask them myself.

    Anybody know anything about this that could help me at our hospital?
    One hospital I worked at had this !/2 hour standard, and we had one med cart for each side of the hallway that 3 nurses had to share!!! It was awful and even though we were not allowed we used to put the meds in souffle cups on trays and carry them around. Now they have the meds at the bedside in the rooms, but it is so easy to get interrupted and behind.

    In the home patients don't do this, they take them when they can- morning, evening, with meals, the times change with whenever it works out best for that day. The reality is that most of the time it does not matter, unless they are drugs that have to be timed around meals, or have multiple doses during the day. Too bad they can't give us orders that say Q PM, Q AM, Q 4-6 hours, Q 6-8 hours, etc. Or maybe we could have medminders at the bedside for patients who are alert enough. The alarm sounds, and the comparment opens for the patient to take their own pills.

    I know, I am delusional. Hey, I can dream can't I??? Who comes up with some of these regs anyway? Hospitals should rebel against JCAHO and all their hoops to get accreditation. Patients don't care, and they still have a million regs to make sure they are safe- OSHA, DOH, CMS, etc.
    spiderslap, NutmeggeRN, and Brie80 like this.
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    Where I work, the DON staggered our med times.
    We care for approx 130 people. One half's med times are 7-11-3-7.
    The other half is 8-12-4-8.
    So you can start your med pass at 6am for the 7am time, then proceed on to the 8am med pass which can start at 7am thru until 9am. It works for us and helps alot as it gives an extra hour.
    So maybe some of you on here who are in management could help out your medication nurses by implementing some staggered med times.
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    This is exactly how I felt giving out meds this morning. In the midst of it all, I remembered your article and it made me smile!
    spiderslap likes this.
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    Hey, wonderful idea! Thanks for your comment.
    ~Linda
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    As an LPN in a long term care facility I could relate to so many parts of this story, it was nice to know I am not the only one. I must say I am lucky many of our meds are timed to be am and pm, but it is still tuff to keep up. Thanks I might pass this one on....
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    I feel for you. Where I work we each have 30 patients, lots of eye drops, patches, crushes, nasal sprays, diabetics, g-tubes, foleys...then there's the doctor's orders, treatments, inservices...it never ends. How is this nurseatient ratio legal?? WHY is this legal?
    PS: anyone else get tachycardic at work from the stress?
    spiderslap likes this.
  9. 2
    I've worked in LTC for the past 14 years...each shift I am responsible for 28 residents! Talk about time management! I work 3-11 which means on our 56 bed floor I have a partner responsible for the other 28 residents; this could be another RN or an LPN; 6 CNA's for whole floor, no ward clerk, a supervisor mon-fri (why would one be needed on the wkend?) that has to divide herself to three other units(200 bed facility). With the increase in acuity levels in LTC after 14 yrs I still have to race to get the meds out on time. Accu's and insulins, BP's, HHN-which by the way have to be monitored for the 10-15 min of giving them per new regs, and around 200 meds to pass. Crazy! There is never ever a dull moment! Add falls, IV's,catheters,dressing changes, family members(good and bad), hospice care, physicians doing rounds and record numbers of admit/discharges and it is a wonder the nurses can get the meds out at all! I've never understood why LTC nurses don't get more respect from other nurses!?! I love it but is isn't for the faint of heart! I love that this is in this week's topic list.
    spiderslap and ~MIA~ like this.
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    the amount of pills our patients get in LTC is quite ridiculous. add to that the low level of nursing coverage allowed by fed standards...quite a quagmire. i find it quite difficult to give quality 1:1 care and pass pills, check blood sugars, monitor vitals that are med related, blah blah blah, within the 2 hour window.

    peace


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