Quote from Suesquatch
I hate the small stuff, and meds is all small stuff. I keep missing new orders that are handwritten in and start on the day I'm covering the unit.
I'm not the best person on earth for details. And passing meds for a bunch of people consuming polypharmacy is a lot of details. Small stuff.
Glad to see your looking for advice for your problem. I've highlighted areas that I see contributing to your problem. Changing your thinking on these issues will go a long way in problem resolution.
a.. Not being detailed oriented.
b. Meds as small stuff
1. Nursing is all about paying attention to details.
LPN's working in SNF assume the role's RN's perform in the hospital as the first line defense and patient advocate. From patient assessment & interview, review of lab work, following and evaluating treatment order results, communication with doctors /NP's /PA's re change of condition to med administration all require details for what we fail to do/communicate/pay attention to will result in PATIENT HARM.
2. Meds ARE big stuff as drummed into nurses in nursing school. Long term practice and rote med administration lulls many into complacency...who's trap you've fallen into by your post.
3. Polypharmacia, especially in geriatric population. When I started practicing in 1977, patients took 3-5 pills/day. Nowadays it is rare for those in SNF to be on less than 8 pills/day
8x40 pts = 320 meds passed in just one round
Looking at ways to minimize med errors.
a. Gear up in your mind that you are PATIENT SAFETY ADVOCATE at start of med pass. If you know that docs been in prior to or start of med pass, check patient charts before or immediately after med pass.
b. Do not allow yourself to get sidetracked/med pass stoped unless emergency. Pull out to side med kardexes with questionable orders, those expiring .
c. Check front and back card for notations/changes.
d. Have fully stocked cart at start of shift, including drug book, fluids, applesauce/pudding etc.
e. Give meds first to those you are going offsite or to early rehab sessions.
f. Discuss with doctors and pharmacist ways to decrease meds in patient getting more than 8 per day....should be a standard facility review as part of Quality improvement.
g. Write up sticky note and place on top of med kardex for outline med pass issues for day.
h. Develop a routine of checking orders after AM pass so can get sent off to pharmacy to have meds for later in day.
i. Last week of month, comb through 8-10 kardexes/charts day for monthly order renewal rather than waiting till last 2-3 days.
j. Plan for emergencies to interrupt day so don't get defensive when they occur.
k. One nurse kept tape recorder on top cart....just spoke into tape while pulling meds so no writing, ran tape when back at desk as reminder.
If above already tried then maybe SNF not a setting for you.