Dispensing meds from a punch card?

Published

I have a question for nurses that work in LTC facilities. When dispensing meds from a punch card do you dispense by date or dispense in order until the card is empty? I've looked it up with no definite answer and the BON doesn't have guildlines for this specifically and my facility has no policy regarding this. I always punch from the next available pill. It is less wasteful and how I was taught. I began working PRN for a facility where nurses punch by the date. A nurse complained about this and suspected I wasn't giving meds and reported me to the BON. The facility had no guidelines for dispensing r/t the punch cards. No body was harmed and no patients complained. I'm just wondering if anyone knows the correct way.. I've never heard of dispensing by date because it would be costly and wasteful at times. Was I wrong for dispensing that way or another Is she? I'm opened to any opinions or advice.

Up Vote Up Vote ×

Whatever the system per facility policy, all employees should follow the same system. We have always gone in order, writing date/time initials next to empty bubble or some such. It has been a long time.

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

I can understand the wisdom of both options: dispensing in order, regardless of the date the medication is given, or dispensing according to the dates on the punch card. But I don't understand how the latter option is wasteful. Doses that are "skipped" remain sealed in the packaging. Why wouldn't they be used at the end of the month?

Up Vote Up Vote ×

That's what I don't understand. This facility disposes of meds that were not given.

Up Vote Up Vote ×

Where I work we have 2 sets of cards, one for scheduled meds and one for prn meds. On the scheduled card it has date and time, we punch out the correct date and med time and if all doses have been given the correct dose should be the next pill in the pack. It's usually easy to tell if a dose has been missed. If the dose has been missed and not documented we fill out a med error sheet for the date and time of the pill missed on the med card. So if I come in and the noon dose of meds it's still in the card and I pop it out for the 8pm dose instead, when the next shift comes in it looks like I missed giving the the 8pm dose when I didn't. So, we always make sure to pop out the right date/time. For prn meds our cards aren't dated just numbered so, we just pop out the next pill in the pack. If we have a pack with lots of leftover pills for some reason at the end of the month, it's sent back to the pharmacy to be repackaged.

Up Vote Up Vote ×
Specializes in Geriatrics, Dialysis.

We've always used the next available dose on the card. Our rationale is not all meds are dispensed in a full months supply for varying reasons. A few have a payer source that refills meds bi-weekly and a few have meds that are dependent on lab values to dispense and these can come weekly, bi-weekly or monthly. Then we have a few that receive day specific dosing of some meds, a couple are M-W-F and a few are every other day. The result is the numbers on the cards do not necessarily line up with the date the med is given anyway so punching on the date number is not a reliable way to track administration times. Then there is also the not uncommon problem of the dates being off when a med is dropped or destroyed when it's punched out of the card.

Up Vote Up Vote ×

I appreciate all the responses. I wish this facility had a policy. I needed reassurance that I'm not the only one who gives meds this way. I really wish the other nurses would have just asked me first instead of reporting I didn't give them.

Up Vote Up Vote ×

Suggest to TPTB that a policy be adopted and followed up on. If they say no, well then mgmt is lacking.

Up Vote Up Vote ×

I agree and that facility they come the same way. I just dispensed by next available dose.

Up Vote Up Vote ×
Specializes in retired LTC.
Suggest to TPTB that a policy be adopted and followed up on. If they say no, well then mgmt is lacking.
Have you tried asking your pharmacy consultant? They'll usually VERY helpful in issues like this. I'm surprised that they haven't noted it when they check things during their visits.
Up Vote Up Vote ×

They've never addressed it to my knowledge but I just work prn so I'm not sure.

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.

Our punch cards have a different color strip on the right side which is supposed to remind the nurses to reorder the med. We start at the top left hand corner and punch consequetively....especially important on the cards of narcotics.

Up Vote Up Vote ×
+ Join the Discussion