Am I freak for charting meds as I pull them?

tyvin, BSN, RN · Jul 21, 2011

Why would you sign something off if it had not been given yet?? What if the resident refuses one med or another, or has a emergency before you give.. Would you then have to back track??
I can see signing soon after giving but not before. You must forgive me, I don't work LTC though.

If it's refused for whatever reason it still needs to be signed and then circled in the manual MARs. Circling will indicate the med wasn't given. Then on the back of the MAR there is a place to document why. So no matter what, there can be no holes in the MAR, it all needs to be signed. You're going to sign one way or another.

LoveMyBugs, BSN, CNA, RN · Jul 21, 2011

If it's refused for whatever reason it still needs to be signed and then circled in the manual MARs. Circling will indicate the med wasn't given. Then on the back of the MAR there is a place to document why. So no matter what, there can be no holes in the MAR, it all needs to be signed. You're going to sign one way or another.

I inital as soon as a pop the pill into the cup, you can never have any holes in the MAR, if there is a hole it is considered a med error. If the patient refuses you need to sign and circle and document the refusal.

Izzy11, NP · Jul 21, 2011

Thanks for the replies. I initial when I pop the pills and then if they are refused or not given for some reason, I circle and chart it. I can't keep track of what I've pulled if I don't initial as I do them.

Someone mentioned saving the wrappers, but I don't have any to save. The prescription meds are in bubble sheets, so you pop them out and return the sheets to the drawer, and the OTC meds are in bottles of 100 or whatever.

turnforthenurse, MSN, NP · Jul 21, 2011

Why would you sign something off if it had not been given yet?? What if the resident refuses one med or another, or has a emergency before you give.. Would you then have to back track??
I can see signing soon after giving but not before. You must forgive me, I don't work LTC though.

My thought exactly. Or if orders have been changed?

I don't know if you utilize an EMAR or if you just have a MAR, but when I pull meds, I always bring the MAR with me to check them. Then I bring the meds to the patient's room and sign them off as they take them and I make sure they're down (or given if it's something else, like a patch or Lovenox or IV med or something) before signing them off.

Roxyann57 · Jul 22, 2011

I work in LTC with 30 residents in my hallway. I read the mar and pull the med as i read the mar. i lay my meds out next to the mar and double check. i open the meds, and give to the resident, then i go back and sign. You do not sign BEFORE you give the med thats illegal. what if the resident spits it out or refuses?? I've never prepoured or presigned and I get everything done on time. Your speed comes with doing the same job over and over. You will make mistakes if you keep doing it illegally and will lose your license.

tyvin, BSN, RN · Jul 22, 2011

I work in LTC with 30 residents in my hallway. I read the mar and pull the med as i read the mar. i lay my meds out next to the mar and double check. i open the meds, and give to the resident, then i go back and sign. You do not sign BEFORE you give the med thats illegal. what if the resident spits it out or refuses?? I've never prepoured or presigned and I get everything done on time. Your speed comes with doing the same job over and over. You will make mistakes if you keep doing it illegally and will lose your license.

I was lead to believe that when a resident spits it out or refused you need to sign anyway and then circle it to indicate waste of some sort and document on the back of the MAR. So you have holes or unsigned areas in your MAR?

Roxyann57 · Jul 22, 2011

I was lead to believe that when a resident spits it out or refused you need to sign anyway and then circle it to indicate waste of some sort and document on the back of the MAR. So you have holes or unsigned areas in your MAR?

We just had the state in our facility doing the yearly inspection. As per state you have to sign after you give the med, presigning is considered a short cut and you are not allowed to do this. If the resident spits out the med you sign and circle and write on the back of the mar what happened. but you don't sign before you give then go back and try to circle your signature. I am just going by what is the correct way to do it. There are a lot of short cuts I see being taken in LTC and I try not to be one of the people participating in those short cuts.

tyvin, BSN, RN · Jul 22, 2011

We just had the state in our facility doing the yearly inspection. As per state you have to sign after you give the med, presigning is considered a short cut and you are not allowed to do this. If the resident spits out the med you sign and circle and write on the back of the mar what happened. but you don't sign before you give then go back and try to circle your signature. I am just going by what is the correct way to do it. There are a lot of short cuts I see being taken in LTC and I try not to be one of the people participating in those short cuts.

I think it's wonderful that you don't have to take short cuts with your load of people. But do not be so to quick to judge the ones that have to. I was in a facility where if you didn't you didn't finish until noon. When you must take the vitals on nearly every one, crush the meds and mix, attempt to feed the meds to at least 10 non-compliant individuals and also chase the people because the CNAs won't work with the nurses then perhaps you can muster up a little empathy. Does anyone think these nurses like doing it that way?

How long are you allotted for your med pass?

yooperPN · Jul 27, 2011

I just started working in a LTC facility and it's my first job out of school. It's taking me a long time to do the morning med pass, although I'm getting better at it. The nurse who oriented me said she saves time by signing out the midday meds at the same time she does the morning meds. Another nurse I worked with said he doesn't sign any meds out until the end of the shift because if you do it as you pull them then you have gaps, and you save a lot of time that way. And both of them pull the meds by memory and don't really look at the MAR.
Am I freak for actually signing out each med as I pull them?

No way! When I trained in LTC, I saw many seasoned nurses doing the same thing as you described. I've only been there a year, but still sign out meds as I pull them. In the beginning it took me a long time to get my med pass done, but I've gotten a lot quicker now.

On a side note though, there has been discussion on which is the correct way to sign out meds. Sign them out as you pull them, or sign them out after you give them? On the "sign them out after you give them" side, the argument is what if your resident refuses the med; then it shouldn't be signed out. In those instances, I go back to the med that is signed out and put a "*" over my initials.

Brea LPN · Jul 29, 2011

In my facility u are supposed to sign meds right after giving them not before. A nurse almost got fired for signing out before and got written up for false documentation.

CapeCodMermaid, RN · Jul 29, 2011

Again, I only know the Massachusetts regs but there are two accepted ways of giving meds:

Pop, chart, give OR Pop, give, chart. The surveyors allow either way. If you pop chart give, it is expected you immediately sign your initials before going on to the next resident.

Pop chart give........do you think we can get Julia Roberts to do a sequel of Eat Pray Love?

Forever Sunshine, ASN, RN · Jul 29, 2011

Again, I only know the Massachusetts regs but there are two accepted ways of giving meds:
Pop, chart, give OR Pop, give, chart. The surveyors allow either way. If you pop chart give, it is expected you immediately sign your initials before going on to the next resident.
Pop chart give........do you think we can get Julia Roberts to do a sequel of Eat Pray Love?

What a frightening movie that would be. lol :eek: