Advise about med pass & CBG's

[lcarlson3355]

I'm a new lpn who's a charge on noc shift (2230 to 0630). My problem is that I have to do the 6 am med passes and cgb's for both wings. I begin them at 0500. I'm so afraid of having a med error that I do my 3 checks but it's taking me about 1 hr 35 mins (yes, I actually timed myself) to do them and the cbg's and one of the on coming nurses has been getting upset over me giving report 15 mins late. It seems like everything starts happening when I'm doing that med pass like pt's wanting prn's, a low cbg, pt having complications or taking their time waking up. After that on coming nurse scolded me about needing to give report to her sooner, the next day (knowing she would be the nurse coming on that morning) I changed my attitude -- I walked by call lights, told pt's I would get someone else to help them even though I could have easy put the bedpan under them myself, rather than saying "good morning", I say "here's your meds" as I put them up to their mouth and rushed in and out of rooms like a madman and marked refusal if the patient did open when I tried to give them rather than try again. Basically, I became the cold nurse I didn't ever want to be.

Well, I gave report on time but left feeling like a horrible nurse just there to do a job. Is that how I should be doing it? I've done med passing during day shift without problems but I also had the 2 hour window (1 hr before and 1 hr after med due time). I'm so frustrated and don't know how to balance getting the meds passed before end of shift and not being a cold nurse. I also don't understand how cbg's can be done 1 1/2 hrs before insulin is given. At my facility, cbg's are scheduled at 0500 (noc shift) and insulins at 0600 (day shift) but never get done until after 0630 due to report. Mind you, change of shift is 0630. In addition, my facility requires I do narc count with CMA 1st before giving report.

Any advise?

Also curious how long other nurses take to do med passes?

[makes needs known]

What time is breakfast? Most of our am glucoscan checks get done 30 min before breakfast. Is this using a sliding scale or is a maintenance dose of insulin being given by the oncoming nurse?

[lcarlson3355]

I usually begin cbg's around 0530 on one side and 0615 on the other side.

They begin getting insulin around 0645

And they eat around 0730.

One Levemir and the rest are sliding scale.

[srmoon]

Could they schedule a med aide to come in at 0500? I know its just pushing the issue off on someone else, but that was the solution we used and it worked well. We could count the med cart at 0500 and the med aide didnt have to rush the residents like I had to. Plus the residents are already familiar with her. And day shift recieves report on time. Just an idea...

[NurseHopefulInOH]

I know how you feel. Day shift is always pressuring you to hurry and rushing around like mad women. Ive been chewed out several times for being late d/t resident issues that could not have been forseen! I'm talking not even "late" but just not there to count at the earliest time they can clock in. How long have you been doing this med pass? It does get easier and faster the longer you do it. You learn the resident quirks.. who needs a straw who likes it in applesauce etc. One thing you could do is pre-pull your meds if they are individually wrapped with the name of the med on them. Put them all in a cup in the residents drawer then all you have to do is check again and give them. Ive never heard of doing cbgs so early I would be afraid some ppl may not eat breakfast or decide to fall back asleep in that time. I like to give insulin on their way to a meal lol.

[xtxrn, ASN, RN]

Do you still have the 1 hour before and 1 hour after on nights? And if not, why? :)

[Cat_RN, ASN, BSN, RN]

During the med pass you need to focus on meds only. Your CNA can't pass meds for you so she needs to be the one toileting the pt. If she has too many pt's and is struggling to catch the call lights, bed alarms, and toilet people at this time then she needs to prompt people to toilet earlier. Have her get the ones who always ask to go when you wake them up, starting at 4-430am with the prompting. It works. I've had this problem too.

I know it sucks to be the nurse who says, 'Sorry, I'll put the call bell on for you', or, 'Let me get the aide', but it also is part of your job to delegate and manage your time and get the meds out in compliance with the time they're scheduled. Of course, you can help where you can, if you have someone who you absolutely know will wet the bed if they aren't taken immediately to the toilet or bedpan then you have to do what you have to do. But you can't feel bad for not toileting everyone! That's part of the CNA's last round and it takes just as long if not longer for them do that as for you to give out your meds.

[tyvin, BSN, RN]

I know how you feel. Day shift is always pressuring you to hurry and rushing around like mad women. Ive been chewed out several times for being late d/t resident issues that could not have been forseen! I'm talking not even "late" but just not there to count at the earliest time they can clock in. How long have you been doing this med pass? It does get easier and faster the longer you do it. You learn the resident quirks.. who needs a straw who likes it in applesauce etc. One thing you could do is pre-pull your meds if they are individually wrapped with the name of the med on them. Put them all in a cup in the residents drawer then all you have to do is check again and give them. Ive never heard of doing cbgs so early I would be afraid some ppl may not eat breakfast or decide to fall back asleep in that time. I like to give insulin on their way to a meal lol.

In my state pre-pouring is against protocol.