Advice for med pass

Kuriin, BSN, RN · Mar 13, 2014

Are you given the names of your drugs beforehand? If so, do these have parameters that must be adhered to? (Ex: If SBP is >140 give metoprolol...), if so, do the parameters first. Glucose check in the meantime. I think I'm also a little confused. Is this on an actual patient, mannequin, or are you talking through the process with your meds in front of you in a SIM lab? Are you able to take a little measuring cup to place your meds in?

What is your process in all of this? What do you think is the reason you bombed it?

smf0903 · Mar 13, 2014

This sounds like a classroom med pass? The most important thing with med passes is knowing your parameters, which was already stated (I always go into my patients' rooms and get a set of vitals before I pull meds, no matter what) and doing your checks. I always try to pull meds in the order they come on the MAR (first check) and then after I get them all pulled I do my second check. I do my third check at the bedside, after IDing the patient. Some times you don't really have a lot of room to maneuver and spread stuff out, so you need to find a good way to keep them together, like in med cups or whatever. It also comes with time and practice :) Like anything else, you get your own groove the more you do it! Good luck!!

ambitiousBSN · Mar 13, 2014

Some times you don't really have a lot of room to maneuver and spread stuff out, so you need to find a good way to keep them together, like in med cups or whatever.

Oh man, this so much! I'm in my second semester and we're finally giving meds in clinical, and there's little to no space at the bedside. I've found that when I did the third check at the bedside, I just made a small pile of the pill packets and had a small medicine cup and each time I opened one and explained the pill to the patient, I'd place each individually into the cup for the patient to take. I've seen nurses put all pills into the cup, but my instructor has us pass each individually. I feel like space should be the least of your worries as parameters and checks are most important. As long as I have a small place on the edge of the bedside table, I'm good.

Good luck! :-)

Kuriin, BSN, RN · Mar 13, 2014

Your instructor makes you pass meds individually? As in, having the patient take pills one at a time? Ugh, lol. I get that it's great experience in education (more for the student), however, it's not patient-centered unless the patient is unable to take more than one pill at a time.

Smouldering lotus · Mar 13, 2014

Thanks so much for all of the comments. To clarify it is medication for an actual patient who is unable to orient, cannot eat or ambulate on their own but it is all given orally crushed and mixed with a drink. I know I bombed because the medical records were a mess and kind of all over the place, I had to verify the chart with the MARS then the MARS with the medicine in the cart and then once more in front of the instructor with each individual card and pill in a separate cup. I didn't even have the space in my working area to open both the MAR and the chart at the same time to compare them. Consequently, I missed one med. . .(an acetaminophen). The thing is after that happened my instructor found a medical error in the file that occurred 5 months previous in the facilty unrelated to me. . .the on-staff nurse had said she had been administering meds the same way I had them set up for those five months. . .but since part of the exercise was we find ALL inconsistencies it fell on me. Also our shift normally ends after lunch is fed to our patients, so I assumed I was finished passing meds then. . . but their was one more med pass after our shift normally ends, after that so I totally missed it. My instructor was really pretty nice but I am so afraid now because it was such a horrible day. I am going to evaluate my process from the text book step by step and make notes about how each step could go better. I am going to know the parameters of the meds before clinical day (again), and I am going to workout and eat a good breakfast before I go in. I have two full weeks to prepare for it. so hopefully it goes better but I feel so overwhelmingly inadequate that part sucks. . .The good news is I don't think I could have made a bigger mess so next time I will have to do better than yesterday.

Kuriin, BSN, RN · Mar 13, 2014

I don't know what individual cards are. I'm assuming you have a physical chart, as well as a MAR, with no computer? If that's the case, I can definitely understand the lack of room. I would recommend you make a little "care plan" in the morning with your meds. Time on the far left on when they need to be given, name, dose, and any parameters.

Smouldering lotus · Mar 13, 2014

You are awesome that is a great idea!

The cards are punch cards with medication in them they are about 7"x 9" and the contain individually sealed doses that you punch out as prescribed. The two books I need to verify information in between measure approximately 12"x18" and then just a standard binder plus almost all of my meds were in those cards. All of our work right now is done with hard copies and paper. . .no computer. The space I had to work in was probably in truth about 15"x16" because of the other people also prepping their meds. Yikes!

smf0903 · Mar 13, 2014

Well it sounds like the whole thing was just a hot mess LOL. My advice to you is to not fret over what happened...it sounds like things were already jacked up when you came on the scene. That being said, it's always prudent to check things for yourself (I'm not sure what the issue was that had been going on for 5 months?) and I have a good story from an instructor with regards to that; I learned that one of the things I do when I introduce myself to my patient is to check any IVs running for rate AND for what's running. Our instructor told us about a patient who had had the wrong bag hung...4 days prior...and the nurses kept hanging that same wrong bag, shift after shift, because they went off of report and not off of the MAR. So for 4 days that patient received the wrong IV. Anyhoo, like I said, not sure what exactly the issue was where you were at, but I would chalk this up as a good learning experience. Some of those times when you feel like NOTHING went right and you think "oh my gosh, I am never going to get this!" are the times you learn the most. Figuring out your system of handling the med pass will come with time and practice. Just remember the things you learned from this experience, bad as it may have seemed to you. Good luck!

smf0903 · Mar 13, 2014

I don't know what individual cards are. I'm assuming you have a physical chart as well as a MAR, with no computer? If that's the case, I can definitely understand the lack of room. I would recommend you make a little "care plan" in the morning with your meds. Time on the far left on when they need to be given, name, dose, and any parameters.[/quote']
I totally agree with this...I write these on my report sheet so I know what's coming up (and also double-check the chart when I get in so I catch any changes in med orders). It helps, really.

nursegreene · Mar 13, 2014

Take your time and relax. Don't let yourself get flustered. Each med pass will get easier. You'll find your rhythm and it will go smoother.

Good luck!

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Smouldering lotus · Mar 25, 2014

Thanks so much! I do my next medpass tomorrow I am nervous but I know I am prepared. I really appreciate the positive comment!