I work in a hospital clinic, so medications for me is different. The first nurse that arrives has to check the crash cart, wheelchairs, stretchers and oxygen tanks. If the oxygen is low, we call respiratory therapy and request new tanks, stat. When the next nurse arrives, we check narcartics and narcartic prescription pads. Each physician has a PCA (similar to nursing assistant, but can also draw blood, do clerical work, and EKGs). If the patient requires nurse counseling ( this will consist of new patients, those to be medicated, and specific patient teaching), it will be indicated on the folder. Our charts are computerized, so, I have to pull up the information and check the nursing order. We administer vaccinations, do PPD implants, regular insulin, give clonidine (a medication that lowers blood pressure quickly) for the hypertensive patients, administer nebulizer treatments, arrange for admissions to the emergency room, vitamin B-12 injections, administer Lovenox on rare occasions in the Coumadin CLinic and do a great deal of patient teaching. We teach about how to mix insulin, self administer injections, how to use the glucometer, metered dose inhalers, as well as educate the patient on their particular ailment, may it be ulcers, diarrhea, weight loss, diabetes, you name it. We give out more meds than what I mentioned, but forget which ones. We have a hospital intranet where we can provide fact sheets on the above mentioned things plus more. I still keep a patient teaching manual and drug book that I personally purchased for my own use for quick references. The RNs in the clinic do the same, plus, they triage telephone and walk in patients to assess if they can be seen the same day, go to the ER or to return on another day. Essentially, I am medicating all day long. It is alot of running around, but I prefer that to the floors, personally.
At my home care assignment, the client has the medication administration record and emergency equipment there, and I have to check it each time I arrive, and make sure that the medication is there, and all administered medication is on the MAR, check the expiration dates or I cannot give it. If the medication is running low, I call the pharmacy to reorder and also tell the parent (I have a 4 year old child that I care for on Saturdays). If the physician gave a new order, I either have to see the original prescription or the client or in this case the mother has to include a copy of the prescription before it is filled included in the book that the agency provided with the MAR and assessment sheets on it. I have to fill out the assessment sheet with the vital signs, check the trach, see the last time it was changed, fill out an intake/output sheet, pain assessment, and it goes through the systems...which makes me "assess" the patient. The physicians phone number, hospital and agency number is on there, and if there are any changes, I have to call the doctor and the agency. Primarily, I am there to ensure that the child is medicated and safe. I am not really responsible for providing ALL of her entertainment, so to speak, but, I take her out when the weather permits, and play with her when she wants my attention, but there are usually others in the house and a cousin that is the same age that play with her. But, I do spend whatever time the child wants. Many times, there, I am more of a babysitter than a real nurse, which can make it peaceful, in a sense. If the whole family is out, it is me and my little charge, and we see what we can get into that is safe for her. I document on her every two hours, and the family will usually tell me what to heat up for her if they are not home to feed her. I usually wind up taking her to the store to get her something she likes and can eat, such as certain fruits and she loves ham and cheese sandwiches, so, her mother told me that I can treat her to that if I want to. At the moment, I would say that the home care is safer in the sense that there is less of a chance of medication errors since it is only one person. The fearful thing is that you are on your own to sustain the client until the ambulance comes if something does happen. Therefore, I make sure that I am current in my CPR knowledge and ensure that her safety equipment is available and working before the mother leaves the house.