Giving meds in a timely manner

  1. I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?
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  2. Visit debbiemig profile page

    About debbiemig

    Joined: May '04; Posts: 44; Likes: 2

    63 Comments

  3. by   explorer
    Quote from debbiemig
    I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?
    The VA hospital in Kansas City uses a program BCMA Barcode Computerized
    Medication Administration. Basicly the patients wear an armband with a barcode of their social security system on it. When you scan their armband
    up comes the list of meds due at that time.
  4. by   CoffeeRTC
    Yep major problem. I havent done 7-3 in years, but the problem is the same for 3-11 shift. Most of our residents have breakfast in their rooms, so that helps. The meds are times for 9-1-5-9 for the most part. In order to get them done, I would start by 7:30. I have an order/ routine. For the ones who were hard to swallow, etc I would get them while they were sitting up or getting fed. We break the rules as far as interupting them when they are eating/ in the dining room. Tube feeders are checked, but they get their meds when I can. People goiing to therapy or other appts are priority.

    On 3-11 I start meds at 3:30 or when I get done with report and set up etc. Accuchecks are done first and I will give them meds along with that. Since alot of our folks go back to their room for dinner. I get the people sitting up in lobby etc first the go down the halls. This works for me.

    A few attempts at a solution....look at reducing the number of meds the are on. 9 triggers the QIs. Also look at changing med times. like half the hall due at 8 the other at 9. just to give you some flexability. For the most part....it is impossible to get them all done in the 2 hr window.
  5. by   CoffeeRTC
    Quote from explorer
    The VA hospital in Kansas City uses a program BCMA Barcode Computerized
    Medication Administration. Basicly the patients wear an armband with a barcode of their social security system on it. When you scan their armband
    up comes the list of meds due at that time.

    Ha...most long term care facilities are far from this technology. Add in the fact that arm bands are missing, you need to pass meds for 20+, hunt down the resident, crush the meds, etc...this only saves alittle time.
  6. by   MickyB-RN
    Quote from debbiemig
    I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?
    like half the hall due at 8 the other at 9. just to give you some flexability.>>

    This is a good idea. On 3-11 we have pills due at 8, 9 and sometimes even 10pm when it's possible.
    Maybe some of the 8am meds can have their times changed to 9 and 10 am instead for example and the 1pm's can be changed to 2pm.

    Kelly
    Last edit by MickyB-RN on Jan 25, '05
  7. by   cannoli
    Quote from michelle126
    Ha...most long term care facilities are far from this technology. Add in the fact that arm bands are missing, you need to pass meds for 20+, hunt down the resident, crush the meds, etc...this only saves alittle time.
    I work in acute care not LTC. However, I do work with the scanned meds, scanned armband, etc. and that system is way more time consuming than passing meds with a paper MAR, so that certainly isn't the solution.
  8. by   CoffeeRTC
    Oh....don't even think of spending any time with the resident while passing the meds. I do quick focused assesments when needed. If they want to chat I alway tell them I will be back if and when I have time. Sounds harsh, but with a load of meds to get done......
  9. by   obillyboy
    I work 4 - 12, and I have 3 bins of meds on the 8 p med pass and only one on the 5 p med pass. What I am looking into is that a lot of the meds are once a day on the 8 p pass. So why can't I get the order changed and Pass them at 5 p as long as they are not time sensitive or interactive with any of the other meds. Things like Docusate, Paxil, Iron supplement, and a number of other once a day meds. I wil be contacting the Dr in a few days once I have completed my list and checked it over well.
    Hope this idea might help you.

    Billy
  10. by   meownsmile
    Is there any way you can split meds up and the people who are ambulatory can stop by the nurses station and get their meds on their way to the dining room? Since they probly get in there reasonable early? Then move to the doorway of the dining room and give others as they go in? People wait in line at restaurants all the time correct? I'm not a LTC person here so my opinoin is worth zilch, but if they demand you not "interrupt" their dining experience maybe they should let you take care of "business" before they enter the dining room.

    Granted it is important for them to keep their nutrition up but its just as important that they get their meds etc. My guess is the state is going to be less concerned that they have their dining experience interrupted as they will be that the meds are given in a timely manner.
  11. by   cursenurse
    Quote from debbiemig
    I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?



    wow, you are able to pass meds on 39 patients by 11am! that's commendable. i worked ltc for 5 years in a NH where i had 40 patients and started my med pass at 8am and finished around 12pm. i think that the way the management has mandated med administration at your facility makes it virtually impossible to pass meds in a timely manner. discuss this matter again with your DON. he/she needs to see exactly how difficult it is to pass meds on all those pt's with the strict rules that are in place. i think that the feeling that the nurse is "disrupting" the pt's meal by medicating the pt during a meal is ridiculous; the nurse should not have to feel bad about doing her/his job. why don't you ask the DON to accompany you on an a.m. med pass so that he/she can see the issues you're dealing with. the management has to do something about the med admin. rules or the facility is going to receive citations for sure!
    Last edit by cursenurse on Jan 26, '05
  12. by   oneLoneNurse
    The nursing homes I have worked in encouraged you to goto the table with all 4-6 patients meds pre-poured. You would also use techs to help give the meds. Now, I know everyone is going to comment that's not compliant. But its totally unaccepted to give 8 am meds at 11 am isn't it ?

    My point: you do what you have to, to get the job done.
  13. by   ragingmomster
    pre-pouring scares me...

    On another note, after working ltc for a decade I can say that in the past I have pushed for, and gotten time changes for lots of meds.

    Administration particularly likes the argument that such a med pass would be impossible to complete appropriately if the state or heaven forbid JCAHO were watching.

    I am guessing that some patients are up early enough to get cardiac meds during the 11-7 shift. I know 11-7 nurses are busy in the am with blood sugars etc. But adding 2-3 regular meds should not be impossible.

    In the past I have been discouraged from asking patients to stop at the med cart on their way into the dining room, as that is "not encouraging a home-like experience". (As if these folks never took meds with meals at home). :chuckle

    Anyway, I would recommend asking MD's to change times so that as a previous poster said, one end of the hall has meds at 8, or even 7:30, and the other end is as late as 10. And afternoon meds spread out from 12:30, for the residents who get really early morning meds, to 2:30 for those whose am meds are listed at 10.

    That is not to say that you need to be medicating at 7:30 or 2:30, but it would be great to have that leeway.

    Best of Luck, and way to look for a new solution.
  14. by   CoffeeRTC
    Quote from oneLoneNurse
    The nursing homes I have worked in encouraged you to goto the table with all 4-6 patients meds pre-poured. You would also use techs to help give the meds. Now, I know everyone is going to comment that's not compliant. But its totally unaccepted to give 8 am meds at 11 am isn't it ?

    My point: you do what you have to, to get the job done.

    This is against the regs. Interupting them during their dining experience is also against a reg. Some facilities get around this by making a policy. Pre pouring and mass medication is also a big no no... Not all states permit med techs..PA doesn't. (You do need to cut corners thou..I admit..I don't always lock the cart if I can see it..sometimes I get the meds ready)
    How about getting meds in liquid form for the ones you need to crush.. I still think cutting down on the amount of meds to be given helps. Also switching q day meds to the pm shift when you are able to.
    As far as working the 3-11 shift..our big med pass is at 5...this helps. It is so difficult to get some residents to take meds at 9 pm since many like to be in bed and asleep by 8.

    As far as giving some meds on 11-7....see my other post about sleeping. In our facility..they are giving synthroid and some other meds in the morning. In order for them to get these and the accuchecks done add in some blood draws,etc...they start thier med passes at 5 am Might work for the consistant earlie risers tho.
    Last edit by CoffeeRTC on Jan 26, '05

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