Electronic charting- administration time out of compliance

riverwoman74 · Oct 12, 2013

The facility where U work just went to E-MAR What a nightmare! I have 33 LTC rsdts on a 12 hr day shift. Med pass starts at 8am and it NEVER stops until after 6 pm. No breaks, no lunch, nothing. forget about treatments or charting. Management said it would cut hours off our pass time, but it actually added to it. I used to have time to use the bathroom, but not now. Meds are scheduled almost hourly and the rsdts are spread from one end of the building to the other. Not to mention there are several morbidly obese rsdts (well over 500 pounds) that need extra time, trachs, tube feeds, plus all the demented ones that need coaxing to take meds, not to mention chasing them when they try to go outside, respond to numerous pages to answer phone calls that someone else could have handled ( I want to speak to rsdt so and so) I could go on and on. This facility is a new one to me, I hadn't worked the floor in 4 years, at my previous facility I had been there 15 years, the last 4 in MDS, and never had this many rsdts to pass meds to. But EMAR has made all of our lives much worse. Kinda got totally off the subject and ranted but I am rapidly getting frustrated at the lack of care that I am unable to provide to my rsdts since I am a slave to the E MAR now.

chrisrn24 · Oct 12, 2013

My EMAR cut my med pass time a lot.

kbrn2002, ADN, RN · Oct 12, 2013

My EMAR cut my med pass time a lot.

Gosh, please tell me how. What software are you using? Our emar added tons of time, wasted time at that. All I do is pass meds and check off meds in the emar.

chrisrn24 · Oct 12, 2013

Point click care. I love the EMAR side of it.

But you have more residents than I and more complicated things (we don't have trachs at my work).

morte, LPN, LVN · Oct 12, 2013

If patients require hourly meds, they should be in hospital....

The facility where U work just went to E-MAR What a nightmare! I have 33 LTC rsdts on a 12 hr day shift. Med pass starts at 8am and it NEVER stops until after 6 pm. No breaks, no lunch, nothing. forget about treatments or charting. Management said it would cut hours off our pass time, but it actually added to it. I used to have time to use the bathroom, but not now. Meds are scheduled almost hourly and the rsdts are spread from one end of the building to the other. Not to mention there are several morbidly obese rsdts (well over 500 pounds) that need extra time, trachs, tube feeds, plus all the demented ones that need coaxing to take meds, not to mention chasing them when they try to go outside, respond to numerous pages to answer phone calls that someone else could have handled ( I want to speak to rsdt so and so) I could go on and on. This facility is a new one to me, I hadn't worked the floor in 4 years, at my previous facility I had been there 15 years, the last 4 in MDS, and never had this many rsdts to pass meds to. But EMAR has made all of our lives much worse. Kinda got totally off the subject and ranted but I am rapidly getting frustrated at the lack of care that I am unable to provide to my rsdts since I am a slave to the E MAR now.

LadyFree28, BSN, LPN, RN · Oct 13, 2013

\ said:

If patients require hourly meds they should be in hospital....

hourly meds can be clustered.

In LTC, prioritization and clustering care is key. Pts with treatments and meds can be done together; the ones who am take PO and are low key are done first.

My strategy:

BPs/VS blood sugars first Insulins done, the PO wholes done in 3-5 pt increments; otherwise insulins, or immediate AM meds

or

airway pts first, insulins/immediate AM meds, then PO wholes, then crushed; then treatments. Bathroom break/ break, then blood sugars/PM meds, left over treatments, charting. Then lunch, charting left if needed, PRN meds. I have EMAR at my facility. I get done by 10:30 with AM med passes ; break and treatments are usually clustered with the AM meds pass; I delegate lotions/non-mediated skin treatments to my CNAs since they are getting them up; then any treatments left and AccuCheck/insulins are done by 12; I do a 15 minute break/bathroom break. between 10 am and 11 am, regardless of the day I'm having. Lunch at 1-1:30; pm meds are usually done, with the exception of PRNs that can arise; all documentation done, unless a change of condition occurs. I have usually 8 hour shifts; and this is even when I get pulled to a cart, float, or agency...it's a system that has served me well in my career.

Have a brain sheet of what and how you pts prefer their meds, med times, diabetics, snacks, and VS. It will cut down on time-especially if you have a system-with and without EMR. Having that knowledge will keep you on schedule and anticipation of anything that may arise.

morte, LPN, LVN · Oct 13, 2013

Lady, my statement was very specific "if they REQUIRE' hourly meds. Yes they can be clustered, with a doc's order, if they are not REQUIRED to be hourly.

hourly meds can be clustered.
In LTC, prioritization and clustering care is key. Pts with treatments and meds can be done together; the ones who am take PO and are low key are done first.
My strategy:
BPs/VS blood sugars first Insulins done, the PO wholes done in 3-5 pt increments; otherwise insulins, or immediate AM meds
or
airway pts first, insulins/immediate AM meds, then PO wholes, then crushed; then treatments. Bathroom break/ break, then blood sugars/PM meds, left over treatments, charting. Then lunch, charting left if needed, PRN meds. I have EMAR at my facility. I get done by 10:30 with AM med passes ; break and treatments are usually clustered with the AM meds pass; I delegate lotions/non-mediated skin treatments to my CNAs since they are getting them up; then any treatments left and AccuCheck/insulins are done by 12; I do a 15 minute break/bathroom break. between 10 am and 11 am, regardless of the day I'm having. Lunch at 1-1:30; pm meds are usually done, with the exception of PRNs that can arise; all documentation done, unless a change of condition occurs. I have usually 8 hour shifts; and this is even when I get pulled to a cart, float, or agency...it's a system that has served me well in my career.
Have a brain sheet of what and how you pts prefer their meds, med times, diabetics, snacks, and VS. It will cut down on time-especially if you have a system-with and without EMR. Having that knowledge will keep you on schedule and anticipation of anything that may arise.

kbrn2002, ADN, RN · Oct 13, 2013

Point click care. I love the EMAR side of it.
But you have more residents than I and more complicated things (we don't have trachs at my work).

Yeah...PCC could be a whole new unflattering thread on it's own. Since they pushed through a so-called upgrade it is even slower and more unwieldy.

LadyFree28, BSN, LPN, RN · Oct 13, 2013

\ said:

Lady my statement was very specific "if they REQUIRE' hourly meds. Yes they can be clustered, with a doc's order, if they are not REQUIRED to be hourly.

I don't know if you work in LTC...but even thought they are 8-9-10 am, your giving then ALL....this is NOT acute care, and any med that does not have a immediate interaction can be clustered EVEN in acute care-the only exception is IV specific meds...and the decision is dependent on a nurses judgement, it DOESN'T need a doctors order. -need to enlighten you on that as well.

SINCE we are taking about LTC, no one should be giving meds one hour apart...no one is going to get their meds on time; not possible.

The person who stated they are giving meds an hour apart may need the direction and the enlightenment of clustering meds...patients go home and those particular "required" meds in acute care are taken at the SAME TIME by the pt AT HOME...this principle transcends in LTC-where the poster is commenting from.

Let's stick to the topic at hand, shall we?

kbrn2002, ADN, RN · Oct 13, 2013

Not to prolong an exchange, but in morte's defense I believe the point is some meds are actually required hourly meds. It isn't very common, but it does happen. I have 28 residents on my unit [LTC, the so-called short term rehab unit] and 2 of them have ordered hourly meds, one is a q1 hr eye gtt, one is a q1 hr G tube flush. I do somehow manage to get the hourly meds done but I rarely chart them off on the EMAR on time.

LadyFree28, BSN, LPN, RN · Oct 13, 2013

Not to prolong an exchange but in morte's defense I believe the point is some meds are actually required hourly meds. It isn't very common, but it does happen. I have 28 residents on my unit [LTC, the so-called short term rehab unit'] and 2 of them have ordered hourly meds, one is a q1 hr eye gtt, one is a q1 hr G tube flush. I do somehow manage to get the hourly meds done but I rarely chart them off on the EMAR on time.

Those can still be clustered; case in point, you arrange your med pass around patients in the area; that's what I mean by clustering care; one can cluster care to patients as well as around subsequent timely occurrences. You still have an hour before and an hour after; and sometimes those orders are transcribed from the hospital; if they are maintenance (ie saline) eye drops-that's what they sound like; I would ask if they could be changed from every hour to 2-4 hours; they are out of the hospital.

If q 1 hr GT flushes are giving one an issue, suggesting a Kangaroo pump that give scheduled flushes may be a more sensible product to have; most things are covered under DME for the patient.

As far as PCC; you can modify schedules; even document that they were given hourly; if you can't; I would bring it up in some way if an issue arises-can't do everything on time...

Sometimes it's about getting creative and sometimes it's about asking questions; even in short stay, they are supposedly transitioning to LTC or home; they are not going to be on hourly eyes drops when they get home. :no:

On the unit I'm on, people were directly from short term and had full VS every shift; I notified the doctor and got 75% of those pts D/C'd and the rest were down grades to BP and pulse for specific meds; even during the madness, things should at least be reasonable to the setting at hand; sometimes the work that one is doing and going crazy over, can be modified, because it's not within reason in some cases; it depends. :yes:

chrisrn24 · Oct 13, 2013

Those can still be clustered; case in point, you arrange your med pass around patients in the area; that's what I mean by clustering care; one can cluster care to patients as well as around subsequent timely occurrences. You still have an hour before and an hour after; and sometimes those orders are transcribed from the hospital; if they are maintenance (ie saline) eye drops-that's what they sound like; I would ask if they could be changed from every hour to 2-4 hours; they are out of the hospital.
If q 1 hr GT flushes are giving one an issue, suggesting a Kangaroo pump that give scheduled flushes may be a more sensible product to have; most things are covered under DME for the patient.
As far as PCC; you can modify schedules; even document that they were given hourly; if you can't; I would bring it up in some way if an issue arises-can't do everything on time...
Sometimes it's about getting creative and sometimes it's about asking questions; even in short stay, they are supposedly transitioning to LTC or home; they are not going to be on hourly eyes drops when they get home.
On the unit I'm on, people were directly from short term and had full VS every shift; I notified the doctor and got 75% of those pts D/C'd and the rest were down grades to BP and pulse for specific meds; even during the madness, things should at least be reasonable to the setting at hand; sometimes the work that one is doing and going crazy over, can be modified, because it's not within reason in some cases; it depends.

You are right.

Read orders for meds. If its once a day schedule them for the AM Pass. At my facility that is like 7 am-11 am or something similar. There is no need for 0800, 0900 etc. unless its like a narc or antibiotic.

Lady is right too...call and have these things d/c'd or changed. You are a nurse! Use your critical thinking.