Blister Pack Blues & The Dreaded Med Pass

kimsey · Jun 27, 2011

If you have that many missing meds, then that is a serious issue, it sounds like people are either stealing meds or misplacing them and instead of finding them are just "borrowing" from others. This is an issue to take up with the DON, despite you saying you don't want to be labeled as a trouble maker - if the DON doesn't help then go over his/her head. It is YOUR licensed that is at risk by not reporting it and by allowing it to continue, especially if you have nurses "borrowing" for themselves or family members. They're ordered meds, if the patients are not receiving them, then that's a critical error that could be pinned on you, whether you 'misplaced' the meds or not.

With that said, I have worked where there were 50 patients to 1 nurse, and having to give out meds by yourself.. it sucks. If meds are missing you have to go search, however, I do know with our pharmacy that as long as it is not a narcotic, you can just fax off and they will send a replacement dose for the blister pack. I've suffered from the same disorganization that you have, and it is very very frustrating to be short a medication and having to go search and find a replacement dose.

It's a tough situation to be in and a difficult choice, either way, you definitely don't want to risk your nursing license for it.

classicdame, MSN, EdD · Jun 27, 2011

this is an issue that could close down the facility if the State was aware. The checks and balances are too slack. People could be stealing. Residents may be charged for items they did not receive and vice versa. The Pharmacist and DON need to work on resolving this issue, if for no other reason than productivity and safety.

hope3456, ASN, RN · Jun 27, 2011

Wow!! we must work in the same facility. I was thinking about making a similar post. In my facility - not only is it common practice to 'borrow' from another resident - nurses will just give all the meds at one time, at meal times. For example if they have 1600, 1800 and 2000 meds they just give them all at dinner. You have to or you will be outrageously behind and then no one gets their meds on time.

Yes it bothers me too. It seems to me the DON as well as the state surveyors seem to be willing to turn a blind eye. We recently got a survey (state and fed) and they watched us give out meds to just a couple residents - not the whole med pass. Of course we know what to do when we are being watched.

My theory is that it is going to cost too much to 'fix' the system...although I heard things are going to change in november - the pharmacy is going to start packaging all the pills together...ex 1600 pills...not exactly how it will work. Also a federal law that all healthcare facilities have to start using Electronic MARS within the next couple years? anyone know about this?

queenjulie, RN · Jun 27, 2011

Not a single shift goes by that I am not playing "treasure hunt" searching for the missing blister pack of Simvastin, or some other drug.

Wow, that's awful. I'm only a student, but the 35 people in my class just did a nursing home rotation, and we each had to do three med passes, so that's 105 med passes in total. We did a long debriefing afterward, so I know how it went for pretty much everyone. As far as I know, only three people had missing meds out of the entire 105 passes.

I have heard plenty of nurses say they do what @hope3456 mentioned, the "give all the meds at once, no matter what time they're ordered" thing, because there simply isn't any way to get through it otherwise. At our nursing home, the two RNs who do med passes have a total of 80 patients. :sigh I can't imagine how stressed they must be, and trying to do that will missing meds all the time? Yikes.

NurseKatie08, MSN · Jun 27, 2011

I was hired as a staff RN 8 weeks ago at a LTC/rehab facility and I am climbing the walls about the med pass. My two reasons for climbing are:
1) I have too many residents
2) Their medications are always missing
Not a single shift goes by that I am not playing "treasure hunt" searching for the missing blister pack of Simvastin, or some other drug. One nurse told me to "borrow" from another residents supply, anything to "get through the med pass." But after a few times of doing just that, I realized this "borrowing" was just plain stealing and I refused to do it any longer. The end result? My residents often do not receive one or two of their medications. This is not acceptable. I try to keep on top of the missing medications, but I am already stretched to my limits as regards shift time. With so many residents (average 28) I am barely getting their meds passed. You know it's bad when you feel smug about actually getting those dry eye drops in. It is pathetic.
Does anyone else have this problem? Please do not tell me to go to the DON. She will "take the matter under consideration", nothing will be done, and I will have a black mark on my file for being a "trouble maker". Not that my DON is a bad person, but these things have a way of leaking out, and everyone that reads these boards knows how quickly the grapevine spreads.
I guess my reason for posting this is to see if this is a common problem or just the result of disorganization at my facility? Is the pharmacy company partially to blame? I don't have the answers, but I do have a concussion from banging my head against the wall.

Are people reordering meds when the supply is low? May seem like a silly question, but I know sometimes if people are rushed they forget to reorder. I would make sure you take the time (what little we have, trust me, I know) and call the pharmacy to make sure missing meds are coming stat. Doesn't solve the immediate problem of having the pill to give at that time, but keeps it from perpetuating itself.

We've found (not sure if this applies to your facility if you use paper charting) that where our computer charting system upgraded & our pharmacy's system didn't that there are some issues in terms of what orders the pharmacy sees on there end compared to what the orders are intended to be. Maybe similar issues could be happening at your facility...just some food for thought.

tyvin, BSN, RN · Jun 27, 2011

After working in 2 LTC facilities I can say with great conviction that it could be almost normal. Depends on the nurses, the facility and the shift. Sounds like there's a lot of borrowing going on and no one is following up and the facility is big.

Also sounds like a lot of burned out nurses trying to survive the almighty, must be insane to attempt, and no one believes that there is a med pass from Hades syndrome. Not even Dante himself could have written about such torture. I know if I had never worked in LTC and seen and done the things it takes to do in order to complete such a humongous task, I wouldn't have believed it.

Another thing, do we really believe that the surveyors (or at least some of them) are not aware of this problem with the med pass? When ever I had to do the med pass due to a nurse calling in sick I literally had to go into combat mode. Imagine a nurse only oriented on the carts for one day for each cart with 4 carts ... and then going on the cart to do the am med pass at random, without warning ... complete suicide.

As someone said earlier we need to change things. With the new health care rules coming down the pike who knows what's going to happen. One thing is certain, we need to be advocates for each other.

Nurse_Breonna21 · Jun 28, 2011

Could someone do an inventory of the med carts? There is obviously an issue with meds being re-ordered or your pharmacy. At facilities Ive been to someone does a audit of the med carts periodically. I have personally had to go through the MAR and check against whats actually in the cart get rid of DC'd meds and re-order stuff and call pharmacy.... I just got sick of it and I worked nights on low census haha. If everyone gets in the habit of doing this it will drastically improve your workday. We got it all turned around in a month. Would also like to say 28pt med pass is common in LTC it sucks waaay more for day shift 9am pass then anything. Try working nights if you want to get away from a massive med pass. It gets easier once you learn the pass and you get your cart in order! hang in there!

Bruin's Mom · Jun 28, 2011

One thing I have gotten into the habit of is keeping a list of all the meds missing and making out an incident report. At least you would have a paper trail and it looks like the pharmacy may not be delivering the meds on a timely manner.

Another thing is that some meds are not covered by insurances, but the pharmacy fails to tell the facility that which in turn holds up the nurses in their med pass. If you think about it, you probably pass over 100's of meds and if possible, look at your meds before the pass starts and see what you are missing or what you need. Also, document everything.

tyvin, BSN, RN · Jun 28, 2011

Could someone do an inventory of the med carts? There is obviously an issue with meds being re-ordered or your pharmacy. At facilities Ive been to someone does a audit of the med carts periodically. I have personally had to go through the MAR and check against whats actually in the cart get rid of DC'd meds and re-order stuff and call pharmacy.... I just got sick of it and I worked nights on low census haha. If everyone gets in the habit of doing this it will drastically improve your workday. We got it all turned around in a month. Would also like to say 28pt med pass is common in LTC it sucks waaay more for day shift 9am pass then anything. Try working nights if you want to get away from a massive med pass. It gets easier once you learn the pass and you get your cart in order! hang in there!

In both LTC places I've worked it was the night shift's job to do the monthly audit and re-order to the pharmacy. Always did the audits to be ready to go to pharm a few days before the end of the month. They also did the restock when the meds come in. That means going through each MAR and going over all the orders etc... Don't all facilities do this? If not how in the world do the meds get re-ordered to the pharmacy.

CoffeeRTC, BSN, RN · Jun 28, 2011

How are meds re ordered and when is the cycle change. Find this out first.

We pull stickers when they are low and have a sheet that we fax to pharmacy. The pharmacy gives us a date that they will come in and do cycle change. If it a cycle med and it is close to the change, it goes on a separate sheet and we tell them how many we have left until the chage. They will only send a few to make it until that time (this could be for a dropped pill or accidental punch etc)

If it is a narc that needs a new scrip..that could be part of the problem with getting the med re ordered.

croppyRN · Jun 28, 2011

Thanks to all of you for your replies and helpful suggestions. I am so happy to have this forum, it is very helpful to realize I am not alone :thankya:

Our facility does have a reorder sheet to place the stickers from the blister packs, but obviously, people are not doing it on a regular basis. Also, sadly, the management seems more concerned about the "holes" on the MAR (missing initials written after each med pass) than the actual med pass. Whether or not the med pass was given, they probably look the other way. But you'd better have those signatures, or The State will issue a Citation, and god help you then! As far as audits or inventories of the med carts, I don't think our facility does this, and if they do, they are obviously not accurate. I am very frustrated and looking for employment elsewhere, being very careful about where I go. I can't take much more of this.