I'm a Medications Menace - page 3
This new facility documents all med errors. I find one every day but frankly don't report them because I really don't like narcing on my coworkers over a missed vitamin. But anyway. I will be... Read More
Apr 22, '07Quote from LotteLotte, have you ever worked in LTC? some of these pt's need only a few pills, some need more. When you are passing pills during meals, you have all of your people in one place, and giving one person their meds takes about 1 minute. You can do the entire room of forty to fifty people in about an hour.I can't help thinking that forty pts is way too many for one nurse, even in LTC. Is there anyway you can delegate some of the med passing to another nurse?
As a nurse at a nursing home, I regularly passed meds to 50 people. As a med-surg nurse at a major metro hospital, my load is less, because the acuity is greater. If all I had to do was pass meds (not vitals, assessment, etc), I could pass meds for my whole floor of forty patients in an hour or so.
Apr 22, '07Sue-ever considered Assisted Living? Not as crazy (IME) as LTC, and many times the patients do either get better, or at least they lead productive lives (a few still worked part time, many volunteered, went on plenty of outings, to church or temple every week, etc). MUCH less depressing IMO. Less crazy...less acuity...less meds...more patient and fmaily involvement.
Might be something to look into. Sunrise Assisted Living is one chain I've worked for through agency-they have branches(right term?) all over the country I believe. Google em. Pay was no diff for me.
Apr 22, '07At our facility we take our med book after the med pass is over and pass it to the other team nurses and she scans the mars to see if we have any open holes and I scan the other nurses MAR for holes. It works rather well. And it only takes 5 mins or so...
Apr 22, '07I hear you, Sue. I've had to pass meds to 30 people with a lot of acute care - brittle diabetics, tube feeds, TPN, IV, IM, SQ meds - many people don't realize how difficult it is to pass meds correctly to that many people within the time frame allotted.
There IS a time frame. At the time I worked, it was a two-hour window.
I used to wonder how one nurse got done on time every day, but then I discovered that she was a regular and she was pre-pouring meds.
Others who were floated from other units would get a late start, and I knew that they were just passing "the biggies" - that is, only the meds that were essential.
I agree, a ruler helps, but if the primary problem is that you have too many patients and too much distraction, you're set up to fail. You either accept that and do the best you can or you can choose a different area, like I did.
Best wishes to you, Sue.
Apr 22, '07LTC - very difficult nursing - elderly pts, constant interruptions and way too many meds / Organization is key - prepouring is vital /I also found it very depressing
Apr 22, '07Quote from LotteLotte-I can't help thinking that forty pts is way too many for one nurse, even in LTC. Is there anyway you can delegate some of the med passing to another nurse?
40 pts is pretty standard in LTC...no one else to delegate to.
Map-Prepouring in not the standard way to give meds.
And to the person who said they have to do a head to toe on every medicare patient every day??? That must be your facility policy. Medicare requires a skilled note daily, but you only have to chart on the reason they are there...ie. new knee...you'd chart the incision,the pain,the anticoag. therapy. I think you're going over board where you don't have to.Last edit by CapeCodMermaid on Apr 22, '07 : Reason: as always I had more to say
Apr 22, '07Things may be different in other facilities. I am the night shift supervisor (LPN) The LPN and the RN have virtually the same responsibilities, except an RN is the only one that can mix an IV med. We all pass meds, usually 1 nurse to 20 patients, except at 6 am, we have 1 nurse for up to 40 patients. That's enough. Each nurse does there our own admissions and treatments. I help wherever needed. I check over all the admissions. Maybe you could look into working in another area of nursing or at least another facility that would give you more control over-all. Nursing IS detail oriented, we do have to pay attention to every little thing. Med errors do happen. I once forgot to transcribe a lanoxin order for a new patient, therefore, 1 month later, he went back to the hosp. with CHF and A-fib! How bad did I feel about that? VERY. I found the error myself and admitted it and now we have another nurse check our meds before faxing the orders to the pharmacy. Good luck with what you decide to do!
Apr 22, '07Thanks again, everyone.
I am in a very rural area with very limited opportunities. My feelings about LTC are really mixed. When I don't want to beat my old ones I really love them.
I think I'm going to focus on getting a good practice down. There have been some really great tips here and, as I said, I've printed put a list for myself to read every morning before I start. I also asked, last week, the nurse I'm generally on with to review my MAR after morning pass. What I miss she'll pick up.
Thanks again. As I said, I love my old farts, I just hate med pass.
Apr 22, '07Quote from LotteBack when I was in LTC, many moons ago, I read the MAR out loud to myself, one by one going down the list and counting how many pills I should end up with. It worked. It seems time consuming but actually once you get into the routine it's rather easy and saves mistakes. Checking the five rights is essential and E-Mar is awesome but neither apply in this situation.Passing meds is a major part of nursing in the US - use the five "rights", and keep checking and rechecking the MAR.
If you have electronic medication records it's virtually impossible to forget to give a med because the computer pops up an icon to indicate that meds haven't been signed off. Even so, I always check and recheck.Last edit by DutchgirlRN on Apr 22, '07
Apr 23, '07I work LTC via agency now, and I am in a different facility every night. Honestly, I could never do this if I had to work days. God bless you nurses that work the day shift in LTC. I've done it, and hated the constant interruptions and distractions. I like organization, and it's darn hard to have this on days. The only time it was bearable was if I was working in a state where they had med techs. In states where the nurses do it all, it can be chaotic. I can understand why your nerves are jangled.
Sue, some of the advice here is really excellent. If it doesn't work out, consider another shift. It really is different on evenings and nights. Ask your co-workers.
Apr 23, '07to the writer that said dining rooms were a good place to pass meds - in my facility you are not to pass meds during a meal - my med pass starts at 7am and breakfast starts at 8 - thats not including doing the routine fingersticks and answering call bells while my GNAs are passing out trays - and when i have to cover 2 units that includes 12 FSBG with a 30 second glucometer and covering two halls before i even get to start with the pills for the morning - and yes we have that hour before hour after - but when the med pass takes almost 3 hours somedays - well thats just a little much for me
Apr 29, '07Just wanted to let you all know that the tips worked, and I thank you for the time you took in typing this stuff out.
I'm reading left to right, times first, and using a ruler for the check. No med errors!
Another new LPN keeps making the same kinds of errors I was and he was doing the same things WRONG. The excat same things. I told him scan times, forget looking for initials, you'll be looking at blanks when new orders come in, and his face lit up. He was doing exactly what I was! So you helped two for the price of one.
And again, thanks a whole lot.
Apr 29, '07Hi Sue, Just a question,do you really enjoy what you do? I mean working
LTC and specifically working with the elderly. you sound frustrated and
although I know we all have been there, you can only work so long in
that area without becoming frustrated. Do you take time for yourself
outside of work? ie; exercise, meet with friends, go out with hubby.
even considering you work pt. time, you sound like you need a break.