Dispensing meds from a punch card?

[Brady29]

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.

[CoffeeRTC, BSN, RN]

If you are prn, I woun't rock the boat. As long as the meds are given, that is what counts. When we did montly refils, we used to go by the date. I loved this for my OCD, lol. Now it is a free for all . Some start at #1, some start at #30. Narcs are always counted back from the largest #.

[Jolie, BSN]

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

That's not right. As a previous poster mentioned, meds can be repackaged. To discard a perfectly usable dose of medication simply because it wasn't given in "order" is to show a total lack of regard for patients' financial rights.

[Kooky Korky, BSN, RN]

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.

She says her facility has no policy.

OP - give the one that makes it known that you did definitely give the dose you were supposed to give.

[countrynurse09, LPN]

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.

This is how I've always been trained to give the meds. That way, everyone knows which nurse missed giving the meds so it doesn't come down on you. A med error sheet would need to be filled out for missed doses at my facility. If the dose was purposely skipped for a legitimate reason, then the dose was left in the pack and the reason was charted, no incident report needed. Otherwise, the pack will be off all month long, with no verifiable reason. If the state inspectors wetter to come in and see the card is off, without a documented reason, they would then penalize the facility for improperly administered meds at the least, and med diversion at worst. This is assuming the meds are packaged by the specific date and time that they are to be given. Otherwise, yes I would go in order.

[mlbirkner]

The LTC facility that I recently worked at had you punch out the pill that corresponded with the date and would have a separate card for each time slot (TID=3 cards; QID =4 cards, etc.). However, most of the nurses wouldn't follow the rules! They would punch out the meds wherever they deemed fit to punch them out, creating mass confusion! Even after numerous inservices. I'm halfway OCD so I memorized how many pills were left on the card when I was going to have a day off. Most of the time when I came back the same amount of pills were still on the card. Their excuse was they punch differently than me. It was such a problem I started writing how many pills were left on the card on the back of the card real tiny. Nothing never got done after it was reported! It was like a big waste of breath. So I just concentrated on the pills I punched out to make sure they were correct!

[CapeCodMermaid, RN]

Things vary state to state. We are not allowed to write anything on the card...not a check mark, not an initial, nothing. Nothing in this state is available for repackaging. The unused medications are disposed of unless they are on the short list of the meds the pharmacy must take back for credit IF the med was paid for by medicaid. I've never heard of one card for the QID, one for TID...y'all must have med carts the size of a battleship.

What I find most disturbing reading all these posts: all y'all seem to be more concerned about getting in trouble for someone else's mistake but you're leaving the resident out of the picture all together. It's not about us people. It's about the residents.

[mlbirkner]

The med bins of the meds we were actually giving were the only ones in the cart, except for OTC meds. The meds not in use were kept in locked cabinets in the med room. The reason I was concerned about the meds was because I worked on an Alzheimer's Unit and the you could actually see in the way the resident acted if they were given their meds routinely or not. So, yes I agree it's all about the residents when something as important as meds aren't being administered appropriately!

[countrynurse09, LPN]

Things vary state to state. We are not allowed to write anything on the card...not a check mark, not an initial, nothing. Nothing in this state is available for repackaging. The unused medications are disposed of unless they are on the short list of the meds the pharmacy must take back for credit IF the med was paid for by medicaid. I've never heard of one card for the QID, one for TID...y'all must have med carts the size of a battleship.

What I find most disturbing reading all these posts: all y'all seem to be more concerned about getting in trouble for someone else's mistake but you're leaving the resident out of the picture all together. It's not about us people. It's about the residents.

Yes, of course it's about the residents, that is why important for Administration to KNOW which nurse isn't doing her job. When that nurse isn't doing her job, the residents aren't receiving their medication, therefore it's important to know who isn't giving meds properly. Also, at my facility med errors were heavily penalized. So if I were accused repeatedly of not having administered meds correctly, I would be out of a job (and possibly out of a licence), and the residents would be left with a nurse who wasn't carrying for them properly. So while I'm protecting my job, I'm also protecting my residents. The two go hand in hand.