If you are not giving a patient their meds within that two hour window then you are not giving them "safely". There is a reason for that time frame and a reason an MD orders a med at a certain time (usually). That window is not just to make you hurry up and get the job done. If you dont give a med ontime then you are commiting a med error and that is the way the state will see it if they catch you. How is not giving a med ontime "safe"?
Just how exactly are you supposed to give 25 sometimes 50 residents their meds in only two hours is my point....
I doubt the doctor has the slightest clue what a med pass entails and I don't think him NOR the state surveyor could do the beast of a med pass that us LTC nurses have to do.
LTC facilities are these residents HOMES. Would they be rushing to take all their pills on time? Absolutely not. I check in on a little old lady. She takes her all meds ONCE A DAY!.. No 9am, 1:30pm, 4:30pm and 8:30pm..
Sorry but I have to disagree. Most meds are ordered daily or two times a day. The actual time the medication is given is very arbitrary based on the med times the facility has chosen. Most of the meds we give are SAFELY given once a day even if one day it's at 830 and the next it's at 11. These people wouldn't be so careful taking all these meds at home. The one hour before and after rule was made years and years ago when nurses in nursing homes gave maybe one or two meds to the residents. It's time the rule was changed. With the coming of Culture Change, many facilities have given up the antiquated notion of meds at 9 1 5 and 9 and the orders are written 'give in the morning.' We all need to be a bit more realistic.
If you are giving a med once a day and your MAR shows it is due at 0900 and you are giving it at 1100 you are not giving it at the ordered time. The state will ding you for that. You can not day by day decide what time you want to give a med. Your facility may have a protocol that you are required to follow but I am very sure you are not changing times meds are given on your own day by day. You and I dont have authority to decide on our own whether or not the two hour rule is old and should be discarded or if it is still relevent. If you doubt that, call the state and tell them you have decided not to follow that rule. That comment is a perfect example of why the state inforces those rules in spite of what a particular nurse thinks about it. I am curious what state allows you to give a med without a time listed? I am sure it is not mine. Does every am and pm mean I can give that antibiotic at 1100 and 1230? How about Norco BID, 1200 and 1400? Protoni every AM, is that 1130, 0600, 0300? Yea right. There are recommended times to give any med and your facility is following them just like the rest of us are.
If you are giving a med once a day and your MAR shows it is due at 0900 and you are giving it at 1100 you are not giving it at the ordered time. The state will ding you for that. You can not day by day decide what time you want to give a med. Your facility may have a protocol that you are required to follow but I am very sure you are not changing times meds are given on your own day by day. You and I dont have authority to decide on our own whether or not the two hour rule is old and should be discarded or if it is still relevent. If you doubt that, call the state and tell them you have decided not to follow that rule. That comment is a perfect example of why the state inforces those rules in spite of what a particular nurse thinks about it. I am curious what state allows you to give a med without a time listed? I am sure it is not mine. Does every am and pm mean I can give that antibiotic at 1100 and 1230? How about Norco BID, 1200 and 1400? Protoni every AM, is that 1130, 0600, 0300? Yea right. There are recommended times to give any med and your facility is following them just like the rest of us are.
Please answer my question.. Have you ever done a beastly medpass in LTC?
If so.. then you should know that the two hour rule can turn into three or four hours for a medpass because there just is not enough time in two hours to pass meds for 25-50 residents. Especially in that 4:30 medpass the residents are in dinner and activities which sets everything back also.
Specializes in Gerontology, Med surg, Home Health.
"You and I don't have authority to decide on our own whether or not the two hour rule is old and should be discarded or if it is still relevant. " Sorry but I had to fix the punctuation and the spelling before I quoted you.
I have the right to voice my opinion here or to the DPH (and have) about ANY rule I care to comment on. If MY doctors at MY facility write an order to give a med in the AM then I have from 6 am to 11:59 am to give it. You can list all the meds you care to which need to be given 4 or 6 or 8 hours apart. Those should be the exception rather than the rule. And not one of the surveyors I've ever seen could do a med pass they way they expect us to. They don't even have to have any long term care experience to be surveyors.
Specializes in Assisted Living nursing, LTC/SNF nursing.
With the culture change, we've changed how we give daily, BID, TID, QID med's. With the Dr.'s approval we can set daily as morning, noon, afternoon, bedtime, noc depending on the resident. Morning = 6 AM through 10:59 AM. Noon = 11 AM through 1:59 PM. Afternoon = 2 PM through 5:59 PM. Bedtime = 6 PM through 9:59 PM. Noc's = 10 PM through 5:59 AM. This is State approved since we've gone through a survey with it in place. Of course, every hour, two hours, four hours, six hours, eight hours, twelve hours has a set time. We do not give scheduled med's during the night unless careplanned since State feels they shouldn't be woken up for medication. If a skilled resident though, we can wake them for scheduled med's but try to get that lifted if we can so they can sleep. No major/invasive treatments to be done on nights besides the usual barrier creams during check and changes. If a resident wants to sleep in, the nurses must communicate between shifts to make sure they aren't getting medications too close to each other. With the culture change where I work, that is about the only thing that changed since most still want to get up between 6 - 8 AM, go to bed between 7 - 11 PM.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
I am mostly acute care experienced but working through agency and there are a lot of LTC shifts coming my way.
I have worked at facilities that staff from 15:1 to 40:1.
This weekend I worked at a 40:1.
First time at this facility.
Unbelievable. There is no way a nurse can safely and legally give all meds to all patients!!
I had to ask for help and had another nurse take part of my team.
The oncoming (staff) nurse gave me one of her tips.
She signs the narc sheets at beginning of shift! All of them!
Signs she took out the medication, the time, the remaining number!
Unbelievable.
In California and maybe elsewhere facilities are getting tighter and increasing number of patients
on each team. So in my mind, I now understand , there are many nurses that need a job so badly they
are willing- and DO- things like above. Just to cope. Just to manage. Because we all need to work.
(Well almost all of us here)
So illegal practice and compromising patient safety are probably more common than is ever spoken.
Hence I call it the dirty little secrets of LTC nursing.
How many of you do the above? Or skip routine meds like vitamins or minerals and just sign the mar?
Chart something you did not do? What are all the dirty little secrets kept by LTC nurses?
Is this the way of the world now? Why aren't nurses coming together and demanding legislature to change
these unsafe ratios? Because until we do it will never get better and will only, as it is now, become much worse.
That is totally unsafe. How can you sign off something that you haven't given yet? I don't mind taking shortcuts like: Patient A only gets a MVI and Colace at 1600. I give it altogether with his other meds at 2100. I believe that it wouldn't hurt. But signing off meds especially narcs that haven't been given yet is a big NO-NO.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
How many of you, have went in to do a BID treatment on a wound, only to find that your own initials are on it from when you worked last... 3 days ago....
This is soo true! And when you check the treatment book, the previous nurse on your shift didn't do any treatments. When they come back and see the treatment book, all they do is affix their signature and that's it. Poor patients being cheated. That is the reason why I always write dates on dressings and affix my signature on it.
Specializes in OB, Peds, Med Surg and Geriatric Nsg.
I would love it if LTCs would hire more nurses...
True! And the funny thing is, the admin had the nerve to tell one of the aides orienting in my wing that we are overstaffed. How the hell can you say that we are overstaffed when you only have 2 aides working in a hall with 28 patients? When 1 aide goes to break, the nurse is left to help out whether you're done with your med pass or not. I wish my aides could also help me out, that would've been great.
How many of you, have went in to do a BID treatment on a wound, only to find that your own initials are on it from when you worked last... 3 days ago....
I have heard that some facilities don't want you to date treatments because they might not get changed often enough. That is so messed up! No wonder so many people have infections and then have to be sent back to the hospital. Some nurses are so busy talking they never get anything done besides passing meds.
I worked at a place where the nurses did not even bother to initial that they had done treatments when really they had not. They did not do the treatments, nor did they chart them. And nobody said anything that I know of.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
Sorry but I have to disagree. Most meds are ordered daily or two times a day. The actual time the medication is given is very arbitrary based on the med times the facility has chosen. Most of the meds we give are SAFELY given once a day even if one day it's at 830 and the next it's at 11. These people wouldn't be so careful taking all these meds at home. The one hour before and after rule was made years and years ago when nurses in nursing homes gave maybe one or two meds to the residents. It's time the rule was changed. With the coming of Culture Change, many facilities have given up the antiquated notion of meds at 9 1 5 and 9 and the orders are written 'give in the morning.' We all need to be a bit more realistic.
I agree. Why are we so consumed with the time? Yeah the regulations talk about time, but if you do not give a colace within an hour of when it is ordered (before or after) is someone going to die? Time is basically for those medications that are ordered more than once a day so that you don't end up giving the too close together. I just don't understand though why at 88 years old someone needs 15 medications anyway....Medication orders should be for "in the morning", or "afternoon", or "evening", or "bedtime". That allows flexibility and takes the "time" thing" away. I have never written a citation because of "time"- mostly dumb stuff like not washing your hands or crushing something that should not be crushed- things every nurse should know that should be straight-forward common practice.
Forever Sunshine, ASN, RN
1,261 Posts
Just how exactly are you supposed to give 25 sometimes 50 residents their meds in only two hours is my point....
I doubt the doctor has the slightest clue what a med pass entails and I don't think him NOR the state surveyor could do the beast of a med pass that us LTC nurses have to do.
LTC facilities are these residents HOMES. Would they be rushing to take all their pills on time? Absolutely not. I check in on a little old lady. She takes her all meds ONCE A DAY!.. No 9am, 1:30pm, 4:30pm and 8:30pm..