Electronic charting- administration time out of compliance

Specialties Geriatric

Published

We're currently paper charting but I was recently told we'll be going to electronic and that really worries me. I'm still new, relatively slow, and last night I was passing 4pm meds at 7:10pm (I've got 30 residents, probably 25 on each of my two med passes). How do you do it if you're electronic charting and you're out of the med window? At this rate that would make me even slower because if I've got someone with a 4pm and 6pm, I can't really combine them unless I'm on the dot of 5pm. UGH!

Are there facilities with electronic charting that don't have the same time constraints? Or maybe it would be up to the management how they deal with those that are out of compliance? It is technically a med error to administer outside the hour before and after, correct? I just hope we don't have barcode scanning on top of it.

I've got enough stress there just learning the field, this will knock me for a loop!

both states that I have a lic. in, you can not do that.

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. :no: -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. :no:

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?

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Specializes in Pediatrics, Emergency, Trauma.
both states that I have a lic. in you can not do that.[/quote']

Ok...so your policy of an hr before and an hr after and making decisions on what med to give first, especially within a hour time frame can not be done without a physicians order or a faculty policy in place???

So it your license doesn't allow for autonomy within REASON???

BID, Q hr, Q 12, Q 4 hr, etc...it's specific, a lot of times according to faculty. I'm not taking about giving an AM med at HS, I want to make that clear. Even in home care settings, the CMS care plan allows for "flexibility upon nursing judgement".

Please let me know so I won't get a licensee in that state; I've been practicing in PA for 8 years; and I NEVER heard in home care, hospital, faculty, or LTC that I needed a doctors order to not cluster meds WITHIN REASON... Or prioritize which med can be given first; this is AFTER verifying the six rights...and this is working in critical care, even; when the medication needed to be adjusted, we have autonomy to adjust the meds times as long as it was given; it would be impossible to give meds, especially abx all at the same time. If we needed to stagger, so be it, again within reason. Again, sticking to the topic, it's LTC, and it may be facility specific; again, in the surrounding states that I know (and looked into licensure) I have NEVER heard this. NEVER. That's my facts and I'm sticking to it; back to the thread. :yes:

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On the other hand if you are doing exactly what you are supposed to be doing you won't have a problem.

-that's just my experince.Usually if a co-worker of mine if being dogged by someone they have deserved it. Some of the nurse's notes I have seen over the years are too ridiculous-these peole are gtting the education they need and deserve now that anyone can easily access the charts and do an audit.Seriously-if you can't write a freaking nurse's note you have a problem.

When it comes to passing meds to upwards of forty residents, expecting the meds to be within the "hour before, hour after" timetable is completely unreasonable. Saying "If you're doing what you're supposed to..." doesn't apply here.

But I agree 100% about the nurses notes. Reading some nurses' documentation can be both horrifying and hilarious.

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what I am saying is that the only time I could give those three meds together is the DOT of nine oclock. therefore, to maintain compliance, you need to get the times changed to reflect reality. and of course many med passes are rarely in compliance. But why shouldn't we work with the docs to make them doable? where I work, BID is 9 and 9, now, does tht make any sense for metformin? No. in that case I have been given by the DON, latitude to fix that. In fact she would expect it. But we need to make the paper world as "real" as we can. Do you really want to be the nurse passing those meds with the state surveyor?

Ok...so your policy of an hr before and an hr after and making decisions on what med to give first, especially within a hour time frame can not be done without a physicians order or a faculty policy in place???

So it your license doesn't allow for autonomy within REASON???

BID, Q hr, Q 12, Q 4 hr, etc...it's specific, a lot of times according to faculty. I'm not taking about giving an AM med at HS, I want to make that clear. Even in home care settings, the CMS care plan allows for "flexibility upon nursing judgement".

Please let me know so I won't get a licensee in that state; I've been practicing in PA for 8 years; and I NEVER heard in home care, hospital, faculty, or LTC that I needed a doctors order to not cluster meds WITHIN REASON... Or prioritize which med can be given first; this is AFTER verifying the six rights...and this is working in critical care, even; when the medication needed to be adjusted, we have autonomy to adjust the meds times as long as it was given; it would be impossible to give meds, especially abx all at the same time. If we needed to stagger, so be it, again within reason. Again, sticking to the topic, it's LTC, and it may be facility specific; again, in the surrounding states that I know (and looked into licensure) I have NEVER heard this. NEVER. That's my facts and I'm sticking to it; back to the thread. :yes:

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Specializes in Pediatrics, Emergency, Trauma.
what I am saying is that the only time I could give those three meds together is the DOT of nine oclock. therefore to maintain compliance, you need to get the times changed to reflect reality. and of course many med passes are rarely in compliance. But why shouldn't we work with the docs to make them doable? where I work, BID is 9 and 9, now, does tht make any sense for metformin? No. in that case I have been given by the DON, latitude to fix that. In fact she would expect it. But we need to make the paper world as "real" as we can. Do you really want to be the nurse passing those meds with the state surveyor? [/quote']

I have...no shutdowns yet, or marks against my license, because I give my meds-again, within REASON; hr before and an hour after, as well as safe, effective nursing JUDGEMENT. :blink:

Again I do work with my providers; they rely on my critical thinking skills and judgement; a again if you read my post entirely, you would have saw my options that I suggested; those were REAL suggestions that I have collaborated with my providers to get RESULTS for my patients; ALL deemed SAFE. :yes:

Like I said, in MY area, the rule

OF thumb is hr before, hr after; med pass starts at 7 am, depending on what I have to do; it gives me the ability to safety check, assess, VSS, accu checks, then start with the med pass; all perfectly legal and safe. :yes:

Again, use your nursing judgement and critical thinking skills safely; the providers will

Love you for it, and your sanity will thank you.

Back to the thread.

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Specializes in Gerontology, Med surg, Home Health.

I think the 'rule' about giving meds an hour before/after the scheduled time was started in the late 70's or early 80's when we passed out a Colace here and there and maybe a dig. You could do a med pass for 40 residents and be on time. The business has changed so we are now caring for sick people and handing out an average of 19 meds a person. The rules need to change or we all need to get smarter about scheduling meds. Best thing would be to get rid of 90% of the cr** we hand out.

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I think the quality of the device (laptops) that the facilities purchase make all the difference. If they use a machine that isn't ideal in handling the functions of the program, this can make a nurse's job a complete nightmare. Nothing is more aggravating than trying so hard to do your job, and every stop being pulled out to prevent you from doing this. Add to that frustration running out of supplies, patients calling for help, cna's reporting problems, family members waiting to talk to you (for the 10th time) all at the same darned time. :arghh:

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Specializes in LTC,Hospice/palliative care,acute care.
I think the 'rule' about giving meds an hour before/after the scheduled time was started in the late 70's or early 80's when we passed out a Colace here and there and maybe a dig. You could do a med pass for 40 residents and be on time. The business has changed so we are now caring for sick people and handing out an average of 19 meds a person. The rules need to change or we all need to get smarter about scheduling meds. Best thing would be to get rid of 90% of the cr** we hand out.
I remember starting at 7am and passing meds until 10 am on 54 to 56 residents. If anything out of the ordinary occurred you were SUNK. One year during the DOH survey the admin was told too many of us were out of compliance and by the next month we had TWO new med carts on each of those large units and a nurse for each one.Today our largest med pass is 22.It's very doable even on the units with the highest acuity.

I'm on a dementia unit and our meds are pretty light.We have also worked hard to look at every shift and switch things around to minimize disruptions to the residents,facilitate acceptance of the meds and streamline the pass.As for cutting back,every time we do the pharm consultant sends a recommendation to restart the med....

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Specializes in LTC, Education, Management, QAPI.

So, here is what we do. Our E.M.R. requires a specific time for medications. 0800, 0900, etc. We have 30pts/nurse. For the QD meds, they are scheduled 0800 for first 10 patients, 0900 for second 10 and 1000 for third ten. For BIDs, it is 0800/1600, 0900/1700, and 1000/1800, so on and so forth. There are some that are Q4 or Q6 that are a little off, but we deal well. This has allowed times form 0700-1100 to do medications while keeping in a linear fashion. Not the best, but it works well with us.

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