avoid interruptions

[nhlpn546]

I am a LPN in a nursing home, responsible for 40 residents (average approx 5-10 skilled care)- accuchecks, meds, notifying md of changes, labs, take orders, etc., etc.... so we are VERY busy ALL day long. Time management is crucial. I am not a new nurse, this is not a new job.. It is just driving me NUTS at how many interruptions we get while on a med pass. Family members calling, CNAs wanting to ask questions or just chat, family members coming up to the med cart and talking, etc. All the interruptions while trying to pull someones meds makes it sooo easy to make a med error, and wastes lots of valuable time...Does anyone have any suggestions on how to deal with this?

[JDZ344]

Our facility has signs up asking people to please NOT speak to the nurse (unless in an emergency) if s/he is wearing a certain coloured apron because they need to concentrate on meds. Worth a try?

As for the CNAs, tell them to bug off unless its an emergency, you don't have time to chat :)

[A_Flood87]

A lot of hospitals are now having quiet zones at Pyxis machines which is the equivalent of your med cart. There should be a staff meeting addressing the issue and clearly letting other staff know that you can't talk while you are at the med cart. Good Luck!

[Valarie7979]

I have spent many years as both a "med passer" in a nursing home, and as a manager (Dir of nursing). This is an age-old problem. What you need to do is convince your administration that there is no way you can avoid interrupting the nurse passing meds unless there is another nurse at the nurse's station handling phone calls, and problems with staff, familites, patient's, doctors, as well as admin staff and other departments.

It does not work to tell people not to interrupt the nurse unless it is an emergency, because everything becomes an emergency.

I have worked in states where CNA's specially trained to pass meds (called CMA's) have been extremely helpful, freeing up the nurse to do more "nursing" type tasks and handling those problems. But most states do not approve of this. So, the other option would be to have another nurse at the nurse's station.

And if administration cannot "afford" this in the budget, then even a "station clerk" from medical records is very helpful, handling most of the busy work, and putting problems on hold until the nurse has finished the med pass.

Station clerks can be trained to transcribe and process orders, leaving them for the nurse to review and note. They can also handle most phone calls, fax lab results to Dr's offices, and do some auditing as well. A personable station clerk can also go a long way to satify families and patients that their concerns are being heard and will be directed to the appropriate person as soon as possible.

Of course, the best would be a nurse. There are many times a nurse is needed right away to provide first aid, assessing a patient that has had a sudden change in condition, deal with IV's or feeding tube problems, etc. Station clerks can't do these things which often take the med passing nurse away from the med cart for extended periods of time.

You might talk to the other staff nurses about bringing this problem up to the Director of Nursing at your next licensed staff meeting. It should make for some great discussion.

[kew_11]

firstly, 40 patients..i cant even imagine how many meds that is or how long that would take me to pass those, so good job to you! however, as far as the CNA's i would kindly ask them to only talk when on a break or something, unless it is important and involving a patient. with family phone calls, i would ask someone to take a message, and kindly tell the family member that you will call back once you have been in to see your patients and their loved one, and follow through with your word. as far as family members physically coming up to talk to you at the cart, i would redirect them and sort of say that you can go to their family members room next, after finished with your current patient, and then talk with them while doing your assessment/seeing that patient. also you mentioned you do accuchecks? our CNA's are able to do accuchecks, do you physically have to do the accuchecks or are you just getting the readings that the CNA's have done for you?

[shiccy]

I think the apron idea is a good one, myself. Either that or letting family know that talking to a person passing meds in unacceptable.

Many times when I'm confronted when I need to be concentrating or if I have meds in hand I will literally tell the person, "I have to give these first and will be in in just a second." Luckily for us, however, our Pixis is behind a locked door in the "clean" room, where visitors and family are not permitted. It doesn't say anything like that on the wall/door, but it's generally understood by the family. I can only think of one time where this has not been the case.

Possibly setting up a few carts in an extra room at either sides of the halls and instead of you going from room to room you go back to the cart to get the meds would be helpful? I live in a world where med carts are not portable what-so-ever, so it's foreign to me to not have a machine spit doors open at me to get my meds.

Please remember that while it shouldn't be, nursing is a "service" industry of sorts.

[Havin' A Party!, ASN, RN]

Stand firm and communicate well that you'll be happy to speak with them at _________, because the residents' medications is priority at this time.

If that time is not a convenient for them, ask if you can call them at _______.

Otherwise, obtain two times which would work for them, and advise that you or another staff member will contact them then. If anything interferes with following through, call them in advance of the scheduled time, explain the intervening problem very briefly, and advise when you'll attempt to reach them again.

[CapeCodMermaid, RN]

I don't do med pass any more (Thank God) but I often wrote admission orders for 4 or 5 residents in one shift. If a family member came up to the desk and got mad because I didn't immediately stop what I was doing to get their mom/grandmom/wife a glass of juice, I explained that "I am dealing with complicated medication orders and don't want to make a mistake." If they got huffy, I added "Surely, if I were working on YOUR family member's orders, you wouldn't want me to make a mistake because someone else wanted a glass of juice?" I smiled ever so sweetly of course and pointed them in the direction of the diet kitchen.

[makes needs known]

I once asked our unit clerk to refer telephone calls to our head nurse, and not me while I was doing a med pass, (40 pts). The unit clerk passed my request onto the head nurse and I got my a** handed to me. She was way too busy to be bothered and I asked her what she was doing that was more important than what I was doing, and she said smoothing over upset patients and family members because they don't get their meds on time.

[Nascar nurse, ASN, RN]

Currently arguing this very issue with our administrator. The secretary leaves at 5pm & corporate is calling at 5:30pm and complaining no one answers the phone. It is now mandatory that the nurses carry the cordless phone and they must answer every time a call comes in.

Now why can't the administrator and the corporate big shots realize that it just isn't possible to pass meds, serve dinner at 5pm AND answer the phone (that rings non stop from 4:30 to 6:30)? The newest proposed solution is to possibly have nsg admin rotate late just to answer the damn phone. Now how stupid is that..wouldn't it be just as reasonable to hire a good high school kid for a couple of hours in the evening.?

[SuesquatchRN, BSN, RN]

Now how stupid is that..wouldn't it be just as reasonable to hire a good high school kid for a couple of hours in the evening.?

We're going to do precisely that - 4-8 pm, front desk, phones and keeping the sneaky elopers from the front doors.

[Finallydidit]

On my unit I work on the "Long Hall" so basically everyone that enters has to walk past me. So I am the "Greeter" Drug Pusher..... Though my name tag states "charge nurse" Everyone likes to stop at my cart, even if I have a cup of meds in hand, that I am about to deliver, drives me crazy...

As time passed I started to realize that if people saw me with a insulin syringe in hand they would just keep walking. EUREKA!! I now keep a big ole IM syringe in my top drawer and if I see someone approaching I simply open the drawer and Hummmmm most people don't like the sight of needles!! :)