How do you pass meds?

[mitral]

It's such a simple thing, but I am finding it hard to do this very quickly. When you are doing a set of say, 15 oral meds, do you open each one and put them all in the cup just outside patients room, then give it to patient? This is how we were taught to do it, but it gave me a little dilemma the other day, when pt wanted me to tell her what each one was, and then to take one out. Also, how to speed up the process if the patient wants to take. Only one at a time, by themselves? (ie, slow and shaky) do you read them each medication as they're taking it? So what is your system? Tia!

[Nurse Kyles, BSN, RN]

Our system requires the bedside scan as well. This is how I arrange my meds. At the beginning of my shift I pull up the eMAR. I print a "snapshot" of the next 8 hours of meds for each patient. The snapshot is a summary of the med, time, dose, route & allergies for each patient. I then pull out my meds for the individual patient on the pyxis using my snapshot list of meds (since we do not have a computer with eMAR right next to the pyxis). This helps me ensure that I have all the meds the first time. IF the patient has NG or needs pills crushed I crush them in the packaging while in the med room (so that I can still scan them at the bedside). When in the patients room I scan each pill and explain it as I am trying to get it out of the packaging. I usually start any given med pass about 1 hour early (or window is 1 hr before or after) so that I can ensure I have all meds done on time. Even though I print the snapshot I do have to check the eMAR often, because meds can change.

[Are-En-Fla]

We also have a scanning system (which saves soooo much time!) so meds are opened at bedside. I check each med against the MAR while pulling them from the Pyxis. At bedside I scan the patient's ID bracelet asking them their name and date of birth. I then scan each med while telling them what they are getting and what it is used for. With new meds, I tell them what the side effects are as well. Before I open the meds, I ask if they have any questions. I then open all meds and put them in a cup and give to the patient however way they take them (with applesauce, one at a time, crushed, etc.).

[DolceVita, ADN, BSN, RN]

With meds consider at the shift start asking how they take them...all at once, with water etc. I used to get murdered on time management when, inevitably, I did not ask and the pt had 15 meds (each requiring identification, inspection, swallowing etc.). I do my 1st check at Pyxis (med storage place), 2nd at computer outside room where they go into a large cup (still in sealed packets). 3rd at bedside - to be scanned, removed from packet and administered.

I have also been known to identify new meds wayyyyyyyy before administration time. Hovering with a pill in my hand is not the ideal time to teach. So I try to find a few minutes earlier in the shift to make sure they understand what any new meds are about.

Everyone else had great remarks too.

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[Band]

After checking the order on the pixis, I take the meds and put them on the little cups that's labeled, unopened. When I'm putting the meds back I recheck if they're the correct rooms/patients. I knock, go into the patient's room, use the purell, go up to her bedside (with the laptop), good afternoon mrs _ this is _ for your _. I check and scan her wristband, scan the medication, giving a cup of water with the medication, I open it in front of her into the litlte cups, and explain to swallow or chew etc. I watch her take her med, finalize with the laptop, take her cup, ask if she needs anything else, go out, use purell, onto the next room.

[SoCalCrystal, CNA]

I believe fully in opening them at the bedside. I did clinicals at Kaiser and I believe this solves med error issues. Kaiser also has a scanning system so once you take them out of the pyxis you take them to the bedside with a COW and scan the pt's braclet and then scan each med.

I also fuly believe in explaining each med to the patient, that is of course unless they say they already know what they are taking or dont want to know.

[minnymi]

find out how the pt prefers to do it and go from there. "i have your meds here....do u have any questions?" if not.....into the cup they go and done.

if they make a request like the one you mentioned, it isn't too late.

MOST patients will just take the med cup and swallow....unless it's a new thing for them and they're actually interested in being educated...which is great.

now for the suspicious side of me, were there narcotics or benzos involved? it may have been as simple as she wanted to make sure she got her lortab or xanax or whatever it was. i usually get those out of the way first and the questions are few.

[rnin0513]

Dispensing at bedside is part of our mandatory 3-check system. The first check is the MAR to the PIXIS screen. The second check is the meds from the PIXIS drawer to the MAR. The third check is when we dispense at bedside from the package. I always do a 4th check as well by looking at the blister packs, etc. before throwing them away. Medication errors are my biggest fear! I'd rather get yelled at for being slow than accidentally give K+ instead of Lasix or something horrible like that. Halfway through the program and I'm STILL nervous about passing meds.