Floor Staff Pre Pulling Medications

[NurseEe1]

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. 

[Hoosier_RN, MSN]

4 minutes ago, NurseEe1 said:

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. 

I did it without pre pulling as well. It's not easy for sure, but it is do-able, especially after you get a routine

[GoldenRN28, DNP, APRN]

Giving medications within an appropriate timeframe (1h before or after), doing dressing changes, checking vital signs, blood sugars, giving insulin, neb treatments, supervising meals, giving g-tube bolus feeds and writing notes is nearly impossible to do. When I worked 3-11, the evening med pass started at 4. That’s way to soon to give a 9pm Metoprolol. I think there is something to be said for nurse/patient ratios in long term care. 

[NurseEe1, BSN, RN]

1 minute ago, GoldenRN28 said:

Giving medications within an appropriate timeframe (1h before or after), doing dressing changes, checking vital signs, blood sugars, giving insulin, neb treatments, supervising meals, giving g-tube bolus feeds and writing notes is nearly impossible to do. When I worked 3-11, the evening med pass started at 4. That’s way to soon to give a 9pm Metoprolol. I think there is something to be said for nurse/patient ratios in long term care. 

Time management is a requirement for long term care, but it is manageable and can be done safely and properly. I’m not saying lower ratios wouldn’t benefits the staff and residents but it’s not a reason for this behavior.

 

I’ve worked 3-11, 7a-7p, and 11p-7a. I know it’s a lot of work and sometimes it takes longer than your shift to get it all down but once you get the hang of it and get a routine it’s not bad. The thing is these nurses are using prepulled meds from another nurse so not only are they risking their license and the safety of those they care for they aren’t learning time management at all. One nurse told me with her meds being prepulled she has a 10 minute med pass rather than 1.5-2 hour morning med pass. 

[GoldenRN28, DNP, APRN]

100% agree that it’s a risky, unsafe practice. Just offering some perspective on how this practice likely came to be. 

[Fleabooger, RN]

This will practice will put your building into IMMEDIATE JEOPARDY at survey or a lot sooner, if they happen to show up for a complaint investigation. What does your facility policy state regarding med pass? There should be a policy about pre-pouring. However, this is BASIC nursing 101–you do NOT administer anything you, yourself, didn’t pour. What if the previous person poured warfarin instead levothyroxine? Or if they dropped the meds on the floor and poured them back into the med cup? Or they labeled the med cup with the wrong info and you administer something they’re allergic to? 
If your facility policy is not clear—clear it up, in-service, proceed with disciplinary actions up to & including termination. Just because “this is the way we do it”, does not mean it’s the appropriate method or SAFE thing to do. You WILL get a lot of resistance & undermining but you HAVE to follow-through on your policy enforcement, otherwise you will fail. The safety of your residents/patients are your priority. 

[Glycerine82, LPN]

Cold day in hell before I administer anything I didn’t prepare or see prepared.