Do you Pre-Pour? Is it legal?

LogCabinMom · Nov 12, 2008

wow, I didn't realize 22 pts was so great --- I guess when you're new it is all overwhelming. I'm going to get started on my cheat sheet... no other nurse there uses one b/c they've all been there awhile and know the pts... altho we're constantly getting new ones, so I don't know how they keep track of those.

morte, LPN, LVN · Nov 12, 2008

if your meds are ind. wrapped and in ind. patient drawers; which i would doubt in LTC, i have only seen it once.....then the drawers should have dividers in them...the 12m meds go in the front. and the 6am go in the next section , unless there are odd timed meds in between....THIS DOES DONT mean that you dont look at them when you give them!

If you are giving meds off of multidose cards....go throught each and every patients meds and pull the cards that you will need and put them in the front of that patients section....in order....this will speed up the med pass AND you will know if something is missing well ahead of time...also as a new grad...this will familiarize you with the meds and what they look like.

SuesquatchRN, BSN, RN · Nov 12, 2008

if your meds are ind. wrapped and in ind. patient drawers; which i would doubt in LTC, i have only seen it once.....then the drawers should have dividers in them...the 12m meds go in the front. and the 6am go in the next section , unless there are odd timed meds in between....THIS DOES DONT mean that you dont look at them when you give them!
If you are giving meds off of multidose cards....go throught each and every patients meds and pull the cards that you will need and put them in the front of that patients section....in order....this will speed up the med pass AND you will know if something is missing well ahead of time...also as a new grad...this will familiarize you with the meds and what they look like.

I forgot about that. I would organize my cart during quiet time and put the next meds in front.

Also, we always highlighted or circled the time in a different color pen depending on shift. Obviously, you still look, but it's a good, quick visual cue.

CoffeeRTC, BSN, RN · Nov 12, 2008

Okay..I have to ask....how many meds are you giving to 22 pts in the LTC setting on an 11-7 shift. I've been in LTC for all of my yrs and worked all three shifts in a few different homes. Most often only about 1/2 or less will be getting a med on 11-7 and the number of diabetics will vary.

22 pts is like heaven. Most of us would kill for that type of ratio...SRSLY. (If you are in SW PA...PM me!, LOL)

Make sure you are organized first. During that down time flag all the pts that get meds during the 6 a pass. Check your cart and make sure that it is organized too. Get to know your residents. I will pick the pts that are quick in and out give them the pills, drink and go. If you are heavy on the tube feeders and they need am meds, see if you can get the times changed for an earlier pass. Keep a cheat sheet to see what works best.

morte, LPN, LVN · Nov 12, 2008

I forgot about that. I would organize my cart during quiet time and put the next meds in front.
Also, we always highlighted or circled the time in a different color pen depending on shift. Obviously, you still look, but it's a good, quick visual cue.

in mass color coding the med sheet is not allowed, in ct. it is expected,lol

Thornbird · Nov 12, 2008

I, too, remember the days when we pre-poured all the meds in the med room. It was hard for me to get used to doing it the "new" way, pushing the cart around. But, now it is definitely against all rules to pre-pour. If some nurses are pre-pouring and whizzing through the med pass, then we can't get things changed. Management will just say, "Well, Mary and John always get it done on time". If everyone is always running late because the med pass is too heavy for the allotted time, something has to change to maintain compliance. If the meds are late and the nurse started at the earliest allowable time, then it's on the facility, not the nurse for being out of compliance.

I'm not sure what people mean by "cheat sheet". It is common practice and perfectly allowable to have your report sheet where you have noted who is on VS, BS, special monitoring, etc with you to make notes and to use in giving report.

I work in many different places and rarely get the chance to "know the meds". So, I got myself some of those colored stick on tabs you can get in office supplies. At the beginning of the shift, I go through the med and treatment sheets and "tab" the ones I need. I use one color for 1st med pass, another for 2nd med pass, a different one for odd hours (which I also make a note of) and one for BS/insulins. I make sure all the cards are in order, insulins are available and syringes. Since glucometer QA's are usually done on nights, I re-stock those supplies then. If it's not night shift, I check it. I do as many VS, assessments and treatments early in the shift as it is possible to do. No matter what shift I work, I always operate on the premise that if something is going to go wrong it will at the worst time, so I try to stay ahead.

22 patients for 11-7 is excellent in long term care. I have had anywhere from 30 to 80 on nights and find 40 to be about average these days. It used to be a lot less heavy working nights. We had time to do a lot of other chores. In recent years, I find that the patients' need for sleep has been sacrificed for convenience and keeping day shift staffing down. I see patients getting all their daily meds scheduled for 6am which seems just ridiculous to me. I never minded waking people up for q6 hr antibiotics or cardiac meds(back before extended release) or for insulin because this is necessary. But, I think it's cruel to wake people up at 4am for Tylenol, multivitamins, colace and others that could be given in the daytime. And it's an unsafe time of day for a nurse to be doing a 2-3 hour med pass due to fatigue.

caliotter3 · Nov 12, 2008

I wouldn't quit the job just because other people prepour their meds. Just don't do it yourself. When I worked LTC, a nurse told me about prepouring. She did this and then placed the meds in the top drawer of the cart. I would never do it because I noticed a day supervisor would come in early and snoop around. I heard that she caught someone with prepoured meds in the cart. Twenty two residents for night shift? Stay where you are. You have a good assignment. Better than having to rotate around and have 60 or 80.

CheyRN · Nov 13, 2008

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

I HOPE you are not implying that working in a prison is somehow a lower form of nursing. How would YOU fare in an environment where security is first and taking care of lives second? Where lying and deception are most inmates primary form of communication? How about when the correctional officers want you to attend to a bloody nose RIGHT NOW and neglect to inform you about a seizure because "they always fake those". After having worked in many different facilities including prisons, I will tell you that it takes a special and multi-talented nurse to thrive in a locked down facility.

That being said, in alot of prisons, it is routine to pre-pour meds as it is impossible to take the med cart up a flight or two of stairs to pass meds. Most correctional facilities use small white envelopes that let you write the inmates name, number, meds, time of day, etc. on the outside of them so that you know who, what and when to administer. This method is not a luxury it is a nessecity as when you are trying to pass meds to 150 or so inmates 2-3 times a shift.

When in doubt, follow the policies of your facility and the laws of your state.

BradleyRN · Nov 13, 2008

If some nurses are pre-pouring and whizzing through the med pass, then we can't get things changed. Management will just say, "Well, Mary and John always get it done on time". If everyone is always running late because the med pass is too heavy for the allotted time, something has to change to maintain compliance.

In my years in LTC, the state only watched the nurse with 4 patients, and then moved on, never stopping to do the math and realize there were too many patients to possibly finish on time. If "maintaining compliance" never seems to be an issue with the regulators year after year, then it is hard to believe that not presetting your meds could make a difference. It will take a lot more than that!

BradleyRN · Nov 13, 2008

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...

That certainly sounds safer than standing in the hall with commotion all around you performing the same tasks.

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.

Presetting meds is not about going fast. It is about utilizing down-time to prepare. By doing so, the time i would have spent at the patient's door making up their meds, i now got to spend with them. The stress of having a hall as long as a football field was gone, knowing that the next room was already ready.

The benefits go in the opposite direction of "screwing up" or going "fast". It actually allows you more time. And, from the patient's perspective, you went slower and gave them extra attention they would not have otherwise received. Rules are made to be challenged, because presetting your meds during downtime is the superior method, at least in a situation where you have way more patients than you should have accepted in the first place.

Ms.RN · Nov 13, 2008

ok, so then - do any of you have any tips on how to do your med pass more quickly?

i've worked in nursing home few years and i organize my mar and med cart before i start my med pass. first i make sure med cart has spoon, apple sauce, insulin syringes, blood sugar machine and strips. then i use a tag inside the mar. our mar has 5 colored tags (green, blue, yellow, red, gold). i know during midnight shift, not all residents are suppose to receive medications and i know there are tons of blood sugar checks and insulin to be given during midnight shift. so before you start your med pass, go through each mar of each patients and pull out all the blue color tags for those patient who needs meds. and use red tag for those who needs blood sugar checked and insulin that needs to be given. around 5am, start your med pass. give all the meds that are flagged blue and after you gave those medications, put those tags back inside the mar so you know you've given them. after you are done with meds, then write down lists of patients who needs blood sugar checked and go through each room and check their insulin and give coverages. hope this helps. just because other nurses are using a bad habits doesnt mean your facility is a bad place. you are going to see that in every places you go. if you know its wrong, just dont do it yourself.

allnurses Guide · Nov 13, 2008

I HOPE you are not implying that working in a prison is somehow a lower form of nursing. How would YOU fare in an environment where security is first and taking care of lives second? Where lying and deception are most inmates primary form of communication? How about when the correctional officers want you to attend to a bloody nose RIGHT NOW and neglect to inform you about a seizure because "they always fake those". After having worked in many different facilities including prisons, I will tell you that it takes a special and multi-talented nurse to thrive in a locked down facility.
That being said, in alot of prisons, it is routine to pre-pour meds as it is impossible to take the med cart up a flight or two of stairs to pass meds. Most correctional facilities use small white envelopes that let you write the inmates name, number, meds, time of day, etc. on the outside of them so that you know who, what and when to administer. This method is not a luxury it is a nessecity as when you are trying to pass meds to 150 or so inmates 2-3 times a shift.
When in doubt, follow the policies of your facility and the laws of your state.

I was not implying anything negative about his new job. In fact, he makes a considerable amount more money now and has great benefits and enjoys what he does. In fact, we've lost a few nurses to this prison.

Sorry if I wasn't clear.

steph