New Grad LTC Med Pass Problems

Nurses General Nursing

Published

I've been orienting at a LTC facility (my first nursing job) for about 3 weeks now. So far I'm loving what I do and have been with different nurses to see how exactly they do things. However, one issue I come across is the med pass. I'm still doing the med pass with another nurse watching, but every nurse I'm with tells me to do things that could result in a major problem. Meds are given super early. For example, if it's 0730 and a patient is getting something like insulin, the nurse will tell me to go ahead and "pull" their 9, 10, even 11 o'clock meds and administer them. However, they don't document giving them until they are actually due. So, when they get their 7am medications, they're also getting 9am, 10am, and even 11am medications, to "save time". Sure it saves time but at what cost?

Then when 11:30 comes around and it's time for more insulin or something else, they'll tell me to go ahead and give 1 pm and 2 pm medications, just not document until the actual time. This makes me really nervous especially as a new grad. What happens if I do this and then can't remember if I gave a certain medication or not? If they have 15 meds and I can't remember if I gave them their meds and they start developing an issue that puts me in a horrible position. Or what if they need to be transferred to the ED and the computer says they haven't had any meds, when in fact they've had lots of them? One nurse suggested writing it down and checking it off but that's so tedious, I'd be so much more comfortable just giving them their meds when I'm supposed to (1 hour before and after the time). What should I do about this? I really don't want to make a med error and I'd much rather give the meds when they are due.

0 Votes
Specializes in Med/Surg/Infection Control/Geriatrics.

What they are asking you to do is falsify a legal document which is not only illegal, but a blatant violation of the Nurse Practice Act. This is NOT something a careful and prudent nurse would do. Stop this immediately. Report it and start looking for another position. You have a license to protect.

5 Votes
Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.

Do not pass meds in that manner. You're correct in that it is unsafe and a fast track to creating problems.

1 Votes

However, there is nothing wrong with talking with the provider about whether administration times can be changed to facilitate the med pass.

6 Votes

When you are on your own, then do the med pass the way that you want, insuring that meds are passed at the proper times. One mention to these other nurses and then don't make an issue of it unless you want to speak to the supervisor. Something tells me the supervisors are aware of what is being done and are turning a blind eye to the practice. Keep in mind that if you leave this position because of this, chances are high that they do it the same way at the facility across the street. Any way you look at it, you need to make sure you are doing it correctly. The other nurses can worry about their practice.

1 Votes

I'd say smile and nod. Let those nurses cook their goose doing med passes in this manner. Honestly this is pretty common in LTC. Is it right? Nope! You pass medications your own way to protect yourself. Best wishes.

0 Votes

I’m a new nurse working on a nursing home a little over a month. Passed meds on my own three times. Twice it was for 25 residents. The first time majority had g-tubes meds that needed to be crushed. I was unfamiliar with the generic drug names had to look them up, also not totally familiar with the residents. Second time, almost the same situation but not as many g-tubes but needed to be crushed. Half the meds weren’t in the cart because the pharmacy didn’t send them or they haven’t been recvd in the system. Both times it took me approx. 4 hours after the time to give meds the right way. If a med was due at 11 am and it’s 10 am I would have to write a memo for giving it early so I didn’t give it until the time. A second med cart was added to one side to split up the meds pass because it was a heavy side. Now this is the 3rd time I have given meds but only for 11 or twelve residents. Again, I gave meds at the right time. This is my third time. I finished by the end of the shift. I was elated. At the end of the day, I was called in to the DON’s office and asked what took me so long to give meds and if I needed assistance. Was told I couldn’t be floated because it takes me so long to give meds. Was asked what would I do if I worked in a hospital. I was so confused. I broke down everything I did and she said she couldn’t understand. I was told the first time to give all the meds at once but I didn’t. I’m being s prudent nurse but being called into the DON’s office because I’m moving too slow. I almost felt personally attacked. All I can say is that I’m so confused. How can you give meds on time as a prudent nurse and not get a med error for not giving the meds when all the meds are due the same time for all the residents. I see now everyone is finishing because they’re give 8, 9, 10 and 11 o’clock meds simultaneously. Then when the 11am meds are due they’re giving 1 and 2 pm meds. That’s how they’re finishing faster..

1 Votes
Specializes in Hospice.
On 7/4/2018 at 11:18 AM, beekee said:

However, there is nothing wrong with talking with the provider about whether administration times can be changed to facilitate the med pass.

^^This^^ Scheduling meds the way you describe in LTC is completely irrational. In fact, I have read about facilities scheduling non-time-sensitive meds to be given in a loose time frame such as “in the morning/afternoon/bedtime” without specifying an hour.

3 Votes

I agree. That’s what should be done. I will speak to the provider the next time I’m on...

1 Votes
On 5/22/2019 at 6:15 AM, Mtitus123 said:

I’m a new nurse working on a nursing home a little over a month. Passed meds on my own three times. Twice it was for 25 residents. The first time majority had g-tubes meds that needed to be crushed. I was unfamiliar with the generic drug names had to look them up, also not totally familiar with the residents. Second time, almost the same situation but not as many g-tubes but needed to be crushed. Half the meds weren’t in the cart because the pharmacy didn’t send them or they haven’t been recvd in the system. Both times it took me approx. 4 hours after the time to give meds the right way. If a med was due at 11 am and it’s 10 am I would have to write a memo for giving it early so I didn’t give it until the time. A second med cart was added to one side to split up the meds pass because it was a heavy side. Now this is the 3rd time I have given meds but only for 11 or twelve residents. Again, I gave meds at the right time. This is my third time. I finished by the end of the shift. I was elated. At the end of the day, I was called in to the DON’s office and asked what took me so long to give meds and if I needed assistance. Was told I couldn’t be floated because it takes me so long to give meds. Was asked what would I do if I worked in a hospital. I was so confused. I broke down everything I did and she said she couldn’t understand. I was told the first time to give all the meds at once but I didn’t. I’m being s prudent nurse but being called into the DON’s office because I’m moving too slow. I almost felt personally attacked. All I can say is that I’m so confused. How can you give meds on time as a prudent nurse and not get a med error for not giving the meds when all the meds are due the same time for all the residents. I see now everyone is finishing because they’re give 8, 9, 10 and 11 o’clock meds simultaneously. Then when the 11am meds are due they’re giving 1 and 2 pm meds. That’s how they’re finishing faster..

Lol if you worked in a hospital you wouldn’t have to give 25 patients their meds! That was a ridiculous question from your DON.

0 Votes
On 5/22/2019 at 7:15 AM, Mtitus123 said:

I’m a new nurse working on a nursing home a little over a month. Passed meds on my own three times. Twice it was for 25 residents. The first time majority had g-tubes meds that needed to be crushed. I was unfamiliar with the generic drug names had to look them up, also not totally familiar with the residents. Second time, almost the same situation but not as many g-tubes but needed to be crushed. Half the meds weren’t in the cart because the pharmacy didn’t send them or they haven’t been recvd in the system. Both times it took me approx. 4 hours after the time to give meds the right way. If a med was due at 11 am and it’s 10 am I would have to write a memo for giving it early so I didn’t give it until the time. A second med cart was added to one side to split up the meds pass because it was a heavy side. Now this is the 3rd time I have given meds but only for 11 or twelve residents. Again, I gave meds at the right time. This is my third time. I finished by the end of the shift. I was elated. At the end of the day, I was called in to the DON’s office and asked what took me so long to give meds and if I needed assistance. Was told I couldn’t be floated because it takes me so long to give meds. Was asked what would I do if I worked in a hospital. I was so confused. I broke down everything I did and she said she couldn’t understand. I was told the first time to give all the meds at once but I didn’t. I’m being s prudent nurse but being called into the DON’s office because I’m moving too slow. I almost felt personally attacked. All I can say is that I’m so confused. How can you give meds on time as a prudent nurse and not get a med error for not giving the meds when all the meds are due the same time for all the residents. I see now everyone is finishing because they’re give 8, 9, 10 and 11 o’clock meds simultaneously. Then when the 11am meds are due they’re giving 1 and 2 pm meds. That’s how they’re finishing faster..

Yep. I noticed that too? A friend pointed out that if I made a med error because I was going to fast and god forbid made a med error, the company would throw you under the bus in a hot minute! So if you’re too slow you get in trouble and if you go too fast and make an error you are in trouble. You just can’t win it seems☹️ I came to the conclusion that the nursing home “med pass race” was not for me. I’m not a machine and a nursing home is not a factory.After all this is people’s lives we are talking about and I take that seriously.

0 Votes

It is a big problem on a med pass to administer meds if you don't have them on the cart

0 Votes
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