Please Help..what is the routine at SNF's

  1. I am acute care experienced and have recently taken some jobs at skilled nursing. In California you can have 30+ in the world are nurses passing meds on time for this many patients and especially when you don't know them and they are scattered allover the unit? I felt absolutely overwhelmed..not to mention trying to do treatments as well....
    So what are your tips?
    Thank you!!
  2. 8 Comments

  3. by   TheCommuter
    Let's assume the morning medication pass is due at 9 o'clock.

    You can legally start passing your meds one hour prior to the documented start time. Additionally, you can legally finish passing meds one hour after your medications are due. If a med pass is due at 9 o'clock, start at 8:00 and be finished by 10:00 so that you'll have a two-hour window to pass the meds. In my experience two hours has been plenty of time to accomplish a typical medication pass with 30 residents in a SNF.
  4. by   geniann
    Like the Commuter said, you have that 2 hour window for the med pass. Another thing is to be prepared ahead of time. As soon as you get report and count your narcs, go thru the MAR and TAR. Stock your cart and have everything ready by 7:45am (for the 9 am pass, for example). By looking over the MAR you can see your accuchecks and know who will need BP or pulses- therefore you will need yor stethescope and cuff- You will also see if anyone needs meds before they go to the dining room for breakfast and who can wait until after they eat. Some nurses flag thier MARs- and some hightlight their report sheets. You will find your niche. What shift will you be working? How acute is the setting? This can help with prep too- I am here to help. Also by looking over the TAR you may be able to knock out some of the quick treatments with your med pass. Have fun!
  5. by   rehab nurse
    this is what i used to do, and i worked between 3-11:30 and depending on what unit i was on had 10to 30 pts.

    on subacute, i had 10 pts.
    when i first come in, i get report, count narcotics.
    when i'm done with that, i check the chart rack for orders. i will do as many as i can, then leave ones that are not stat, now, or essential (like labs for the am) in the rack for later.
    at 4pm, i start meds. first i do all my accuchecks. then i go back and do meds.
    i usually finish around 5pm. then i finish my charts, do any admissions that come in, start their paperwork especially to order their meds.
    when dinner comes up i help pass trays, help feed if necessary, and monitor.
    i then go to lunch, sometime between 6 and 7pm.
    after lunch, i start my charting, finish orders, check my charts for missed orders.
    at 8pm i start my evening med pass.
    when i'm done, i finish my charting, do my treatments.
    if docs come in (and they do during the entire shift) i do rounds, process their orders, start IV's, hang others iv's if they don't know or are agency (policy), draw bloods, collect specimens of all types, call docs for clarifications of orders or to relay lab reports, assess pts that require it for c/o CP, SOB, etc, supervise the aides, hang the tube feedings, help other units who ask for my help, answer the phones (no secretary), answer family questions, answer patient questions, finish morning admissions, try to finish afternoon admissions, write out report on 24 hour sheet.
    all shifts have their own "duties" to do in addition to the above. like midnights has to check to coagucheck machine, and the glucometer. they also are responsible for all routine blood draws, perform all the daily INR's.
    Dayshift has to do all the discharges (usually) and also reports INR's to MD.

    it's very busy!!! especially until you know your unit, and your pt's. ask the nurse to point out unknown people, make sure you check their armbands (even then they are sometimes not on), ask CENA's to point out people.

    when getting report, ask how everyone takes their meds. it helps if you know little things about the pt's, like one only drinks cranberry juice with their meds, etc.
    walking rounds are the best, and make sure you eyeball everyone of your pt's. this helps when you gotta do medpass.
    30 people is a lot of people, too many, in my opinion. but, that's how these places are run.
    it does get easier as you learn the flow of the unit, but it takes time. maybe a couple weeks.
    it also helps to come up with a unit specific sheet to cross off what you've done.
    ask also if your unit has a shift responsibility sheet. this helps you know what the aides and you are resonsible for.
    remember safety is number one. if you don't think you can handle the assignment, refuse it.
    make sure you get a good orientation, and ask for more time if you need it.

    we have a lot of acute care nurses come through to work part-time or PRN. they tell me it's very different!!!
    good luck!!!
  6. by   jamangel
    It really is about establishing a routine as you can see by everyone's response. I did the same thing. After a while it so routine you can do it with your eyes closed.
  7. by   txspadequeenRN
    Not everyone has a 1 hour window. I have worked at places with a 30 min window and it makes the job 100% harder.
  8. by   Fiona59
    Yup, in my part of the world its 30 minutes either side of the scheduled time (in theory). We did our best, but in the end everyone got their meds but lets not talk about times.

    But as an older nurse once told me, how many people take their meds at exactly the same time every day?
  9. by   pagandeva2000
    That is what scares me about working at nursing homes...the amount of patients. It is literally too many. I am a new nurse, and recently signed up for the agency to be a flu nurse. The agency asked me if I wanted to do nursing homes, and I told them 'no'. Not sure until I have my skills more together. Good luck. It does seem that I can use these suggestions myself.
  10. by   dcoffee
    Let me know how you end up developing a routine....I too am a new nurse in a private facility in Southern California. I was stressed when I had to pass meds to our 36 residents, do orders, answer the phone and do treatments! Well, now I'm doing it for 46 residents in that same facility! It's obscene, and with an hour window on each side of 9a, Do you really think I'm finishing by 10a??? Oh yeah, each resident takes a minimum of 6 meds, some take like 15!!!! Makes me laugh that nurses complain about having 6 or 7 patients, I have 46 mostly full code residents, and no they are not that stable, I had to 911's nearly at the same time one day, I guess if I can do this job, I can do anything right???? Feel free to share your insight!!!!!!