Med Administration - Somatic??

[CNA_Timmy]

Ok... I currently work for (although as of today only PRN) a community mental health center. I work in both the inpatient unit and a group home for seriously mentally ill adults. The clients who live in the group home are all diagnosed with schizophrenia (or a derivative of it), bipolar disorder, and one with a dx of dissociative disorder NOS (yes she is a fun one). The group home is entirely staffed my unlicensed staff (mostly HS diploma or GED) 1 or two per shift (usually one). Well the clients obviously take many kinds of psych drugs, and TONS of meds to manage other problems (COPD, diabetes, hypertension, etc.) The client's medications are all kept in a locked cabinet in the staff office, and the clients come down during med times (mostly 8am, 4pm, and 10pm) to get their meds. The clients take the pills out that they need to take, show the staff member the blister packs, and then when all the pills on their med sheets were taken out they read them again one by one as they open the blister packs and put the pills in a med cup. (ok mind you this is the way it is supposed to go, however I do believe that not all the staff are following this procedure). All of the clients take between 6-16 pills are the 8 and 10 pass, and only a few take 1-4 at 4. I am being called to a meeting with the nurses and medical director of the company for an exit interview. Apparently this is not the norm, and my immediate supervisor said she had never heard of this happening. I got an email today from the director of operations (also an RN) and she told me that the reason for the interview is to hear my suggestions on streamlining the medication times.

The clients all have horribly slow reflexes and limited motor control, many have EPS and TD from yeas of taking typical antipsychotics. It can take forever when a client with severe Parkinson like tremors is attempting to pour out 20mL of valporic acid into a small cup, not to mention the spills and what not, it can take up to 15 minutes and 100mL of the med on the floor before it is in the clients mouth. It can take quite a while for a client with limited sensation in their extremities to open a blister pack of Zyprexa. Clients in the midst of an active hallucination or paranoid thought are very hard to keep focused while staff had to keep a close eye on their clozapine tablets, not to mention where they go (you would think down the throat, but not usually). This has been a struggle for a while, and I have brought it up at many staffing with the psychiatrists, and some things have been done, but not much, they seem unwilling to listen to staff concerns. My ideas... 1) hire a damn nurse to work in the group home!! (really unrealistic, and I assume they have already given that consideration. 2) Have the nurse from the center come in once a week to package medication in those weekly pill organizers (however I have been told by my mom (a nurse) this is unlikely because many would not be willing to sign their name to something they only see once a week (which I understand). 3) NOTHING... Any mental health nurses out here have any suggestions, anything that has worked well for you?? If you need any more info let me know and I will answer it if I know it.

[txredheadnurse, BSN, RN]

Depending on your state BON regs you might be able to have an RN delegate the administration of these meds to unlicensed personnel. Here in Texas there has to be patient specific training with each unlicensed staff person, periodic monitoring of the process, annual re training and any new medications have to have the initial dose given by a nurse.