Time Limit/UnderStaffing

bluegeegoo2, LPN · Nov 8, 2016

First and foremost, it's a 2 hr window to pass meds: 1 hr before and 1 hr after they are due. Second, what shift do you work? A 0800 med pass is a far cry different than a 2000 med pass.

All of the nurses that I work with everyday, including myself are "out of compliance" with med pass times. In other words, multiple med errors are made daily as they are given beyond state and federally regulated times of administration. Unfortunately, it's a fact of life working in a LTC.

Regardless of time issues, ALL MEDS SHOULD BE GIVEN. We do not possess the licensure to declare that Mrs. Smith, Mr. Jones, and Mr. Man will not receive their meds just because "Sorry! I ran out of time." Try running that by the M.D...

LTC is in a sad state of affairs as MCR/MCD continues to cut reimbursement while increasing the documentation requirements to receive the now reduced rates. Because of that, we can expect being "short" staffed will become the new norm as we struggle to produce more with fewer people to protect the bottom line. The message there is don't expect being short to get better. I fear it's the sign o' the times.

In summary, there is no way that I'm aware of to pass meds to 40 residents within the allotted 2 hr window. And if management has a problem with that, kindly hand them the keys and ask to be shown how it's done.

mtjoanna · Nov 10, 2016

At my previous facility, I was the only nurse in the building from 1800-0600 and had up to 54 residents at one time. The 1800-2100 med pass was brutal as most of the residents had multiple meds and there were a lot of diabetics with BGs and sliding scales, and all that goes on with a typical LTC med pass. I was kinda the primary noc nurse for awhile, so I did some rescheduling of meds. Down one hall, they were all ordered for 1900 (this was the special care unit; when I passed meds in that unit, I was giving the CNA there her 30 minute break, so would do that hall first); down another hall all meds were 2000, and down the 3rd hall, 2000-2100; most of the meds were ordered as "HS," not at a specific hour of day, so I had that freedom. It permitted me to stay on time most days. I could even, usually, deal with a fall or two and still have most of the meds done on time.

purplegal · Nov 13, 2016

I just keep giving medications until they are all done. I honestly can't think of a single shift where 100% of my medications were given on time. It's simply the reality that comes when you're the solo nurse for so many patients. Yes, the number of patients per nurse should be limited, but generally, facilities do not care and will keep admitting people as long as there is room. I'm honestly not overly concerned about giving medications late, as I would rather do it safely than try and rush it. It's better to be an hour or two late than to make mistakes or not give the medications at all. Plus, sometimes the residents do not want the medications at the time they are ordered, so that is another factor as to whether or not they are late.

Macropsia · Dec 24, 2016

I'm in a similar situation; 47 residents. I asked a surveyor about the time constraints and was told she/they realize the magnitude of the task with most facilities cutting staff and they don't really look at it. It is only a concern if it causes or generates a "sentinal event" where a res. was harmed or died directly due to receiving meds. late.

After a few weeks I navigated my routine to get through but is it 100% proper? Probably not. Now I'm training a brand new nurse and it is impossible to do everything as if state is surveying and fit it into 8 hours. All I'm told is do the best you can.