how are med passes possible on time?!?!?

tyvin, BSN, RN · Nov 24, 2013

Look up all the old threads on this site about the nurses who have the time machine... You think the noc shift is something; try doing that med pass during the day. I promise you your dropped jaw will be on the floor for a long time. The first time I was oriented on a cart the person never looked at the MAR but only to change the page like I didn't notice they weren't signing off the meds given. The first time I did a med pass during the day by myself I was still passing the am meds when the noon pass started. I just love when survey comes and they bring in extra nurses to pass meds.

People will tell you you'll get faster as you get more experience and that's true, but really, to get done in the time limit for real you have to cut corners somewhere if you have a large pass. :yes:

Now, if you're fortunate enough to work in a facility that doesn't bog you down with a horrendous number of people then great, but they are far and few between. It's not you, it's the system.

chrisrn24 · Nov 24, 2013

Holy cow 40 residents with meds on NOCs?? What is your census?

anashenwrath, ASN, RN · Nov 25, 2013

Thank you tyvin. It feels a little better knowing...at the very least...I'm not alone in being shocked and overwhelmed. I just hope it gets better--or at least that I learn my patients--soon.

Our total census is 100. 40 on the LTC floor, 40 on the dementia unit, and 20 in rehab/post-acute. During nights it's one RN and one or two CNAs per unit.

Edit: I should clarify that not every single resident gets meds during nights. I would say maybe 30 or so. But I do have 10 finger sticks at 6:30 on the LTC unit as well.

Future FNP 14 · Nov 25, 2013

Omg I've been a nurse for 14 yrs med surg float clinic correctional setting etc. but when I was hired at assisted living prn it took me forever to pass. Meds on 35 patients. Yes forever!!!! I would have to find the patients then crush medicine then tell them how much they needed their meds I loved it but sadly I left due to many residents falling and breaking bones I was afraid for my license. Anyway I found out those nurses that were done early did not give all meds at the same time or they will skip and give them lunch time. But what helped me was when I got to know the patients who will b up first, diabetics, those on oxygen. When you start your shift look at the orders if possible then always double check your order but never rush never that's when u make mistakes. It's going to take time but you will find your own way trust me.

MsMamaShort · Nov 25, 2013

I'm in the same boat as you! I'm on my med pass almost the entire shift! Its difficult!

Brekka, ADN, RN · Dec 2, 2013

I work at a rehab/LTC center where I have 26 patients to care for on a 6am-2pm shift. 10 of my patients are long term care, and the other 16 are rehab. It's definitely not easy, nor is it really possible to pass all the medications to everyone within your 2 hour window. While I have seen several nurses pass their medications on time, I can guarantee you that it isn't being done safely or accurately.

Lately, a lot of my rehab patients had been discharged from cardiac unit or stepdown too soon, and end up coming in very, very sick. I have patients with peg tubes, PICC lines with IV drips and IV antibiotics. I have unnecessarily needy patients (you know the type), drama queens, VIPs, hypochondriacs, and patients who's pain control requires close monitoring. I've worked this unit for over a year, because I somehow survived as a new grad (apparently that's very rare). Do I get everything passed on time? Nope. I occasionally get close when I'm down 4-6 patients, but that doesn't last more than a day.

I work during the day, and 3 out of my 5 days are doctor days, so I always get interrupted in the middle of med pass because the doctor wants me to stop everything and do rounds with them. I have to call doctors and get orders, assess a patients emergency runny nose, some patients may be in the middle of therapy, or out on an appointment. Even on good days without all of this chaos my morning med pass tends to blend into my noon pass as well. I'll finish morning med pass and have to get my finger sticks and start with the afternoon pass.

I'm not trying to compare the different sides of the coin here, I'm just stating how much really goes on that people don't seem to realize. Don't feel too bad about not getting your med pass done quickly. Like I tell all of the people I orient or precept, it's not about speed, it's about safety. Avoid falling into any bad habits or cutting corners, they're hard to break later and can cause a lot of damage to your career and to the people you're caring for. Remember to follow the rules for medication administration, despite what others are doing. After a while you'll start to learn what medications need to be given on time, and who needs their medications first. After you get those out of the way, just take it one person at a time.

HouTx, BSN, MSN, EdD · Dec 2, 2013

OK - so even though I have no LTC experience, I do have basic math skills. If you have 40 patients & your med pass has to be completed in 2 hours that only gives you 3 minutes per patient!!!! YIKES!!!

I have a visual of clicking a timer on the med cart to start the 'time' for each patient. I hear "ding" and have to run to the next one. OMG. Knowing how long it takes to administer even PO meds to geriatric patients, how in the world do you guys ever get this done? Have any of the 'bosses' done the math on this?

My hat's off to the LTC crowd who can apparently give Usain Bolt a run for his money.

Toby1225 · Dec 4, 2013

I worked in LTC and I felt the same way on the 3-11 with only 25 residents. I couldn't imagine doing the overnight. I know you hate to hear it, but the more you learn your residents, it will get easier. You will learn who always wants a PRN at 3am, and who refuses meds all the time. You will be able to budget your time better then, but it takes time to get there. Week 3, your still trying to learn the facility and how things are done, let alone the 40 residents that you are in charge of. It will get better, but there will always be bad nights where everything happens at once. You will get there, keep the faith!

Jasel, BSN, RN · Dec 5, 2013

When I worked nights I'd flag orders in the MAR that were scheduled to be given later. That way I could just flip right to the meds I'd need to give. I'd also try to get familiar where meds are if you're using a cart. Heparin syringes would be prefilled (Don't do this if the state/higher ups in the building), sometimes I'd work with the more involved patients first, etc. You're only 3 weeks in. When you're familiar with the medications and the patients eventually your med pass will fly by. Especially on the night shift.