Feeling off about job

[Cmanursestudenta]

So I took a job working at a new LTC. I work there one day a week and pick up every other week. Just got an email about how they are unhappy about the narc count. Now it went out to all the nurses. Let me just say the Narcs there are difficult to count and we have 150  individual pills to count one by one and many narc cards are 1/2 pills and 1.5 pills up to 30. I generally have to use a calculator to count. It is easy to make an error there and while we are counting are interrupted constantly. I always stop counting and restart due to being interrupted while counting. I have told techs repeatedly I'm counting right now please come back when I'm done or write out your request. The off going nurse will not give meds while counting and I refuse to give any meds until after I count. The one time my count was off we got interrupted 8 different times. The email said we can be reported for diversion if the count is not correct. I never sign off on an incorrect count and am willing to recount as needed(one time we had to count 90 pills 4 times due to interruptions). Would it be OK to suggest to management that the techs be educated about not interrupting during count? Or maybe I'm being over sensitive as I'm not there often.

 

[londonflo]

26 minutes ago, TriciaJ said:

He refuses to use the pharmacy and insists on buying pills.

Communicate the problem to the DON to get a policy change. What would happen if every patient required this?

OR

27 minutes ago, TriciaJ said:

Can the pills not be divided into batches of 30 and each batch hermetically sealed until it is needed?  Then you need to count only 30 individual pills each count. 

This patient is requiring more time for counting his pills than necessary, yes drugs are expensive and is actually misusing the nurses time. Could wherever he buy the pills put them into bottles of 30 each? Could the family bring them in one bottle at a time. It sounds like someone is going to his pharmacy to get them. 

[amoLucia]

On ‎4‎/‎7‎/‎2021 at 3:40 PM, amoLucia said:

Can some meds be dc'd? How about asking your pharmacy consultant for some suggestions. I believe the contract covers assistance.

I say this again. The consultant prob can come up with some suggestion. Esp something that is compliant with DOH regs & Inf Control. Has any surveyor watched your counting during a survey? 

[Hannahbanana, BSN, MSN]

I saw an article once about a unit that instituted a policy that anybody at the med cart (or counting) wore a red vest while handing meds. Anyone wearing it was not to be disturbed or interrupted until they took it off. Med errors dropped hugely when this became policy. Perhaps this will help.

As to the policy of the patient's own meds in the facility, administration often forbids this because of possible errors at a pharmacy outside their control. If they won't do that, they could institute a policy to limit the amount of out-of-house meds that can be put into your care, or require limited supply packaging. Or the pharmacy that fills his prescriptions can package them in bubble packs so you can see what you've got and account for them more safely. Many pharmacies will do this now; if his won't, there are many mail-order pharmacies that will, so he/his family can transition to one.

[BostonPedsRN]

You are not being unreasonable at all! This actually happened when I was working at in LTC and we did a couple of things.

First, we placed a sign at the med cart / med room that said something like "keep our residents safe - please do not interrupt count".

I'm not sure how the layout of your facility is, but we actually had a med room with a door on it. At one point it was really bad with CNAs/techs interrupting that we would close the door and insist it only be opened if there was a true emergency that necessitated a nurse's presence.

Is there a way to confine the med carts into a room? Or at least shuttle them into a room during count and then bring them back to the floor if needed? 

[amoLucia]

HB - used to be in LTC/NHs that residents were allowed to supply their own meds through any licensed provider other than the facility-contracted pharmacy. The families were being cost-conscious and looking to save money. It WAS permitted within R&R by the State. And this was New Jersey, the most regulated state ever!

Only remember a few residents doing meds that way. Biggest problem was getting meds resupplied in a timely fashion and how to get new scripts quickly.

With all the avail options today, it may be diff getting some pharm warehouse to specially process medication delivery to individual NHs. But a search can be attempted, and some agencies might be cooperative.

And re the 'red vest' - I've known it to be a 'customer service' thing that no employee was unapproachable, for any reason, if pt, family or visitor had to interact with them. All about 'making the customer HAPPY' and avoiding complaints to Admin. Not kidding! So NO vests or signs were allowed.

 

[Hannahbanana, BSN, MSN]

15 hours ago, amoLucia said:

And re the 'red vest' - I've known it to be a 'customer service' thing that no employee was unapproachable, for any reason, if pt, family or visitor had to interact with them. All about 'making the customer HAPPY' and avoiding complaints to Admin. Not kidding! So NO vests or signs were allowed.

An excellent rationale for the med room to be behind a closed door with a shade on the window or otherwise out of easy public view. Management should see the wisdom of this from a risk management standpoint, because anybody with a question can easily “approach” somebody else who’s not doing a function known to be prone to critical errors if disrupted. Out of sight, out of mind...

Your facility or corporate risk manager will be very interested in this, I promise you.  Drop him or her a line.
 

[amoLucia]

Agreed!!

Just a caveat here. I've seen nurses complain bitterly re multiple interruptions during med pass.  HOWEVER, I've seen where the most vocal 'complainers often were the most 'chatty Cathys'. They'd be carrying on personal conversations with whomever they chose to chit-chat. So mixed messages were being sent.

When is it OK to talk to the med nurse when she is on the cart and when shouldn't you??? They can't have it both ways.

[Cmanursestudenta]

I have a solution in that instead of working 24 hrs a week there gonna work 8 hrs. I am tired and at this point think I am gifted at finding bad jobs. The full time job I have I like though. I am getting wound certified and have decided to take a vacation.... Nothing I say or do matters at the PT job....4 hrs at a time during the week 2x max seems better.