Do you Pre-Pour? Is it legal?

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Hello everyone -

I'm a new grad, and just got my first nsg job in a LTC facility. I've been there 6 weeks; I'm working overnights. At this point, I still have a 'mentor' (I'm using the term loosely here) - she is someone I can go to with a question, but basically, I have my own side of the unit, am responsible for a med cart, and am passing meds for 22 patients. At night, our only scheduled med pass is 6am, which is when, imo, you are at your most tired (shift ends at 7:30) and you are trying to get everything done so you can count narcs at 7 with the new shift and report off, etc etc.

After the first night, I asked the mentor if it's okay to 'pre-pour' the meds. I was thinking that you know, I have all this down time between pretty much 0100 and 0400 in which to get ready for the 0600 pass. She replied, "Absolutely - I can't tell you to do that, but we all do, and it helps quite a bit. Although, if a supervisor comes in, throw them out and start over."

Of course I gathered from this that it's against policy. However - why? Is it against JCAHO rules? And do any of you do it?

Thanks in advance -

Pre-pouring is a bad habit and will get your facility cited. Worse yet, it raises the risk of med errors because at some point you WILL get flustered, hurried, distracted etc., and you WILL grab the wrong cup of pills and give them to the wrong resident. I've done it. Now that I'm back in LTC, I'm slower than many of the nurses and CMAs who pre-pour, but I'd rather be slow and do things correctly!

Just my two pence worth.

I agree - and when I first started my nursing career, we acute nurses had to fill in at times for the LTC nurses and if it took me longer (and it did) to pass the meds, I just wrote "late due to patient load" or something like that.

I never pre-poured because it is unsafe and illegal.

I did work with a nurse on the acute side who pre-poured the morning meds on 4 or 5 patients :madface:. . . . he would get in trouble, stop for a while and then start up again. He is working in the prison system now.

If the system is broken - try to fix it or leave if they won't fix it - but don't compromise. Please. It starts you on a path you won't like.

The role of a professional nurse is patient advocate - and not allowing this kind of staffing issue to continue.

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Most experienced nurses precheck there med drawers ahead of time to make sure everything is there. They(and me) will put the unit dose still wrapped in front of the drawer or in a med cup in front of the drawer early in shift. They will then get in touch with pharmacy or MD about any problems. That way when the heavy med pass time comes you don't have to spend so much time on problems like missing meds. This does not guarantee there will be no bottlenecks but it will lessen them.

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Ok, so then - do any of you have any tips on how to do your med pass more quickly? I do realize I'll get faster with time, but I am also one of those who tries to be extremely thorough. I do the 5 rights for everyone.

I've been wondering if I should go through the mar at the beginning of the shift and make notes on who gets what at what times - kind of making a schedule for myself. OR, should I just go through the MAR at the scheduled med time from start to finish?

There is no reason that you cannot make a system for yourself but meds change and so looking at the MAR as you pass is still important.

Just pass the meds in a safe manner . . and if that makes you slower, then so be it. Just document that.

steph

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in ltc, you have to do things you wouldnt ordinarily do. sure presetting meds is against state regulations, but if you have just under 40 pts, by not presetting them you will go way over the two hour allotted time to give them. no matter how you slice it, some rules are going to be broken, and truly we have done this to ourselves by accepting assignments that are too big. so the question becomes, which rules do we break? by presetting the meds, you do all your bending at once, instead of bending at every room, and that certainly saves your back a whole lot, as well as allowing you to save an hour on your med pass. on the other hand, dont preset and your med pass may wind up over 3 hours long. either way you have violated the regulations, but with the latter some of your patients had to wait 3 hours to get their meds. thus, by using your downtime to prepare for your med pass, you benefit both you and your patients.

nonetheless, no one should preset meds before they know all their patients and their meds. once you are seasoned a bit, put the patient's initials (or names) on the cups, and stack them in your med cart. however, if you are lucky enough to have a med pass that can be completed on time, then there is no need to preset.

in ltc, nurses are forced to break so many rules that i could spend the whole day listing them. any nurse who has more than 30 patients and thinks they are following the rules, please step forward and i will help you end that illusion.

shame on ltc. and shame on us for letting them get away with it.:)

which rule would i break? the time limit rule. not the pre-pouring rule.

steph

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Specializes in Med Surg, LTC, Home Health.
Which rule would I break? The time limit rule. Not the pre-pouring rule.

steph

Well i must say if you break the time limit rule, it is the fault of the facility for giving you more patients than you can handle, whereas if you preset your meds, any problems that arise are your fault.:)

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LogCabinMom, everyone in the world has a "cheat sheet" with the names of who gets meds at what time on it as well as any VS checks - AP, BP, FS. Make one and just make sure not to make a lot of copies and check it against the MAR every night when you have down time. It makes flipping through a lot easier.

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Well i must say if you break the time limit rule, it is the fault of the facility for giving you more patients than you can handle, whereas if you preset your meds, any problems that arise are your fault.:)

It is the facility's fault for giving a nurse more than any nurse can safely handle without resorting to the illegal practice of pre-pouring.

And that is simply wrong.

steph

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Specializes in Med Surg, LTC, Home Health.
It is the facility's fault for giving a nurse more than any nurse can safely handle without resorting to the illegal practice of pre-pouring.

That is what i meant. One is on the facility and the other is on you.

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That is what i meant.

I know - agreeing with you.

If only we would all stand up and not compromise.

Something that should be addressed in nursing school by the way.

Nursing is striving for a "professional" status . . . . this is important!

steph

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Oh, and if agencies are around there is NO cheat sheet.

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Specializes in LTC, MDS, Education.

Remember years ago, we had a med room. With a door that closed and locked. There, in peace and quiet, you could pour meds and put them into the little cup with the colored cards......Then take the whole tray out and pass meds. Come back with the little cards, chart them, and then replace them in the rack in the med room where they were separated by times... Of course, folks were not on 15-20 meds then either. Oh well........:nurse:

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Specializes in Med/Surg.

I dont pre pour because with my luck that would be the day the state walks through the door. I also know if i do that i will either give the wrong medicine to the wrong person or forget the cup entirely. Better to be slow and accurate than fast and screw up. I generally during my down time go through the mar and flag my 5 and 6 am meds. You also have an hour before the meds are due and after to be within compliance. Good luck to you. 22 Patients in ltc is a dream!

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