Floor Staff Pre Pulling Medications

[NurseEe1, BSN, RN]

New to a facility and have recently learned that floor staff is pre pulling medications for the next shift. These medications are being popped from a blister pack and then are unidentifiable pills in med cups with resident info labeled and the next nurse is passing to the residents. Also have overheard, but not witnessed talk of nurses giving meds early for next shift and then next nurse signing out meds. 

Anyone been in this situation? Any tips on helping shift the staff to safe practice and stopping this? It seems like it’s been going on for quite some time in this building and majority of the nurses are doing it and okay with it. 

[amoLucia]

It's obvious nsg school rule #1 being ignored.

What is your role there? Mgt or staff? That will guide you.

"Well, that's how we always do it." Prob be a rough uphill battle.

[NurseEe1, BSN, RN]

On 11/26/2021 at 4:43 PM, amoLucia said:

It's obvious nsg school rule #1 being ignored.

What is your role there? Mgt or staff? That will guide you.

"Well, that's how we always do it." Prob be a rough uphill battle.

Management, new to the building so just finding these things out. It seems to me other managements knows and doesn’t do anything to correct it. I plan to have a discussion with them about it further and plans for fixing these issues. 

[amoLucia]

Does your DON know? I think that would be your first move.

I just think, if DOH walked in for surprise survey, you'd sink if they caught you.

[NurseEe1, BSN, RN]

We are currently in between DONs, new one should be starting soon but as of right now I am kind of alone in this. Staff has been in building for a good while, so it seems it’s probably been going on for awhile.

I am very concerned about survey, patient safety, new nurses learning these habits and not learning how to actually work the floor and develop time management. 

[amoLucia]

Only thing I can say is to start S L O W L Y. ALL nsg staff need to be included.

For THEM, maybe just reminders re nsg sch rule #1 and concern for State inspection can be helpful. State DOH will not look favorably upon such wrong practices.

Am curious - when is your next survey and how did the last one go?

[AmandaBeaverhausen]

This happened at my old facility. The day nurse set up the night nurse who then set up the day nurse and so on, but only on the weekends. 

Also questionable, I was told by two different nurses to give thyroid meds at bedtime (I work 7P-7A) while at that facility as well, so as to have a smaller med pass in the AM. When I got moved from one unit to another during a shift, the nurse in the former unit would always ask, "Did you give your thyroids [at bedtime]?" It made me feel uneasy, so I never did, but it seemed to disappoint the nurse. 

Neither of these practices happen at my new facility, as far as I can tell. As I'm just a medication aide, I'm interested in hearing nurse input on these things. I take my job seriously and intended it to be a stepping stone to getting my LPN and then RN. I don't want to start out with bad habits. Thanks for the topic.

[NurseEe1, BSN, RN]

29 minutes ago, AmandaBeaverhausen said:

This happened at my old facility. The day nurse set up the night nurse who then set up the day nurse and so on, but only on the weekends. 

Also questionable, I was told by two different nurses to give thyroid meds at bedtime (I work 7P-7A) while at that facility as well, so as to have a smaller med pass in the AM. When I got moved from one unit to another during a shift, the nurse in the former unit would always ask, "Did you give your thyroids [at bedtime]?" It made me feel uneasy, so I never did, but it seemed to disappoint the nurse. 

Neither of these practices happen at my new facility, as far as I can tell. As I'm just a medication aide, I'm interested in hearing nurse input on these things. I take my job seriously and intended it to be a stepping stone to getting my LPN and then RN. I don't want to start out with bad habits. Thanks for the topic.

This is definitely not a practice I would ever be involved in. I want to fix this at my facility but it seems these are very much set ways of these nurses that Im not sure I can fix it. I have been very vocal about my concerns with them doing this and have been met with not many similar feelings. 
 

this is poor practice, a huge safety issue. I would never give medications that were pulled by someone else unless they were packaged and easily verified. All it takes is that person pulling to make a mistake. 

[PoodleBreath]

I've been in facilities where this happened. It's incredibly bad practice and could sink a nurse and a facility. And I've seen nurses get fired for that.Terrible safety issue, especially if the patient has things like b/p meds with hold parameters, or pain meds, or a new med or a change in condition and all of a sudden a med needs to be held or changed.

I would never give meds another nurse pulled, just the fact that they're doing that is a red flag about their own standards of practice.

Having been on the other side of this issue I know how nurses will respond to a new face with new plans. The first thing to do is to just put the information out there that it's not accepted practice. And just keep reinforcing so people know that it's a concern that isn't going to go away. Once you've set the boundary and have more administrative support you'll be able to be more proactive.  

Like others said, Go slow.

[amoLucia]

Maybe an inservice by your pharmacy consultant would help. It WOULDN'T be you banging the same old drum to the staff.

Amanda - re thyroid meds. I've known places that did thyroid meds at HS. It was acceptable because all that was needed was pts' empty stomachs. Supper in NHs was usually around 5pm, so that was OK. Thinking about it now, I wonder if there was any effect on lab thyroid values (always drawn early am). But some nurses 'cheated' and passed hs meds early with the dinner meds (wrong).

[GoldenRN28, DNP, APRN]

Root cause of this problem is too many patients to one nurse. I worked in a SNF as a new grad and saw practices like this. No amount of time management can help you safely pass medications on time using blister packs/doing it correctly. 
 

you could try to adjust the med schedule to even out the med pass between shifts and still keep dosing frequency safe. This is a huge safety issue currently as receiving meds too early (especially beta-blockers and CCB) can lead to bradycardia and hypotension. 

[NurseEe1, BSN, RN]

1 minute ago, GoldenRN28 said:

Root cause of this problem is too many patients to one nurse. I worked in a SNF as a new grad and saw practices like this. No amount of time management can help you safely pass medications on time using blister packs/doing it correctly. 
 

you could try to adjust the med schedule to even out the med pass between shifts and still keep dosing frequency safe. This is a huge safety issue currently as receiving meds too early (especially beta-blockers and CCB) can lead to bradycardia and hypotension. 

While I get that med passes are heavy in LTC, it is possible to pass meds to patients properly. I have done it for years and never have I used meds pre pulled by other nurses. 
 

typically the morning med pass is the heaviest then it’s a few throughout the remainder of the day.