How do you pass meds?

RLtinker, LPN · May 26, 2012

The way they teach us to open them up at the pyxis. I may do that if it was only 3 or 4 but not if it was 15. Honestly, at clinicals, I never saw a nurse open the package before entering the room. This was a geriatric floor, so it wasn't unusual for a patient to have 10-15 meds or more. I would just open the packages at bed side and open the next one as the patient is taking each med. Other wise you will have to remember what each pill is and that could be a problem if say 4 out of the 15 are the same color and shape. If the patient wants to take one med at a time there isn't much you can do about that.

allnurses Guide · May 26, 2012

It depends.

The first time I ever give any of my alert and oriented patients meds, I always open them in front of the patient and I discuss them as we go down the line, "Okay, next I have your Xyz, 10mg, this is for abc."

I also split pills right there and I also explain why 2 tabs of this and blah blah blah.

This gives the pt the opportunity to ask questions or correct me.

Also, I have many very very paranoid and suspicious pts and I need to earn their trust.

Sometimes, my pts even want to take the pills and open them themselves and insist on scrutinizing the labels.

My confused pts, especially those who get their meds crushed, will get them already open and crushed.

I won't do that in front of them.

I am especially careful to check and re-check because the pt will not be able to stop me if something doesn't seem right.

(If I have blood pressure meds, I will not crush those with the rest of the meds unless I know their BP. You can't take it out once you crushed it in all together!).

Bottom line is open as you give is best, but it totally depends on your pt and you always have to check, check and re-check.

mmc51264, BSN, MSN, RN · May 26, 2012

We were taught to open them at the bedside, explaining what each one was. I have had pt refuse meds and if they are not opened, can be returned. Also with narcs, if you don't open them, you don't have to waste.

psu_213, BSN, RN · May 26, 2012

I open mine at the BS. First, if they want to know what each one it, I don't have to keep a med cup full of pills straight. Second, walking through the hall with a cup of unpackaged pills is not such good form. If for some reason you have to put the med cup down or step into another pt's room on the way to your "target" pt's room--you are less likely to give the meds to the wrong pt (though still remember your 5 rights). Third, some pt's are paranoid about their pills (or about everything!) and that way you can assure them that the pill you are giving them is, in fact, their medication.

RNGriffin · May 27, 2012

The best way to give medications in a timely fashion is to label the cups of the pt. After you are done labeling( if using blister packs) you can take a med cart with you or you take your cheat sheet, which should be your MR. This will assist you with know which medication the patient is taken, and if you have a difficult patient who would like to know which medication is which you can detail. it's particularly difficult to memorize each medication in physical form, but knowing what the patient is taking is a little bit more reassuring to a difficult patient.

Do a pre-pull for each floor you are attending( if in a LTC/SNF). You'll learn your patients and which one has reassuring needs as you go on. But, remember pre-pulls in an facility is technically illegal, at least in NYC. This is for the purposes of what you just experienced. A patient has been D/C from certain medications and you have yet to receive the D/C order...SMH...

loriangel14, RN · May 27, 2012

I take them all out and then at the counter in the med room I take them out of the packaging and put them in the cup.Then I give them.If they need crushing then I do that in the med room too.

Katie71275 · May 27, 2012

We usually open them at the bedside. The reason for that is 1)they are labeled 2)you can tell the patient what it is and 3)if they decline a certain med, you haven't just wasted it, and you don't have it all mixed with the others and have to wonder which one it is.

tyvin, BSN, RN · May 27, 2012

Evenutally once you're familiar with the meds you will be able to know what they are just by looking at them. It takes time but after awhile it becomes second nature. It's also best to know what a med looks like to avoid any errors that could arise.

Double-Helix, BSN, RN · May 28, 2012

When I used a Cerner (computer charting) during nursing school, this is how we had to do it:

1. Use electronic MAR to identify which mediations to remove from the Pyxis. Take them out, but leave them in the packaging.

2. Bring the medications and the computer into the patient's room. As you open each medication and place it in the cup, verify the dose and medication again with the E-MAR, explain to the patient what medication you are giving (give the patient a chance to refuse the medication at that time) and sign it off in the E-MAR. (That way, you make sure that you have all the medications that you need to give.)

3. Give the medications to the patient as they prefer (all at once, or one by one, etc.) If you are unable to give a pill (patient vomits after 1st pill, pill falls on the floor, etc.) go back in the E-MAR and correct the medication notations that were not given.

It didn't really make sense to me to do it this way, since I was signing that I had given a medication before the patient had actually taken it. However, it was very useful to insure that I had pulled all of the necessary medications from the Pyxis. And it was the policy at the facility.

I also asked the patient initially how they preferred to take their pills. If they preferred 1 by 1, I would open the medication, explain it, give it, sign it off, and then open the next one. If they wanted them all in one gulp, I'd follow the steps above.

dudette10, MSN, RN · May 28, 2012

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!

We have unit dosing packages for oral meds. I get them out of the cart but take them into the pt's room still in the packages, along with my paper MAR and a couple of med cups. While the patient is taking one pill, I'll sign the MAR for that med, and get the next pill ready with an explanation, assembly line style. Make sure you have a full cup of water available for med pass to that patient.

Slow med-takers should be included in report so that the next nurse can figure out for herself how she wants to prioritize and handle med pass.

FineAgain · May 29, 2012

We have to scan the meds at the bedside, which cuts down on med errors. So...you can't open the meds until you have scanned them. What I do is to pull them from the pyxis, which is one check. Then I take them to the room with the computer, and tell the patient each one while I scan it and what it is for. After they are scanned, I take them out of the package and give them to the patient. Crushing is done at the bedside.