LTC med nurses-Are you obeying all of the rules?

  1. I just got a bunch of paperwork about meds at my LTC. According to the policy, I am required to check for all allergies each and every time before administering meds. I am also required to check for expiration dates on each med before administering meds. So how many of you are checking for allergies each and every time you give a med? How many of you are checking for expiration dates each and every time you give a med?
    I have 30 patients. I certainly do not have time to do it period.
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  3. by   ktwlpn
    The head of our staff education dept. is an MSN with NO bedside experience( in LTC or anywhere else,for that matter)We are seeing policies like that.Our DON and ADON have to "talk her down" when she throws a temper tantrum because all of her new policies are based on her own" carefully researched evidence based practice"
    We received a new policy shortly after she was hired that stated every time we had to crush a resident's meds we had to crush them and admin them seperately.That's what she was teaching new hires-a brand new nurse came to me on her second day in tears and told me what she was doing .The new hire was so upset because she knew she could never complete a med pass.I got right on the phone to my supervisor and told her what was going on and that policy went out the window pretty fast. I did understand some of her rationale but we have policies in place to cover us.She was not being realistic,even the DOH doesn't expect that.Everytime a resident refuses meds we document it,carry it on shift report,monitor for adverse symptoms and notify the MD during his rounds.We often have residents whom consume a partial dose of meds and we document accordingly.They are in LTC and are stable,seldom will missing one dose of any med cause harm to them.
    Allergies are cross checked everytime a new order is received by the nurse receiving the order and the pharmacy. We check the exp. dates on our bulk ordered meds (eye drops,insulins,etc) every Monday and re-order what we need.Quality assurance does periodic audits to make sure nothing is expired and everything has been dated upon opening.
  4. by   tokebi
    Everytime someone comes up with such ideas that tack on more tasks onto already busy med-pass nurses, they should first shadow a med-pass nurse with a stop watch, record the time it takes to do all those tasks they came up with, and calculate how long the med-pass will be for the given number of residents a nurse has, and of course the time it takes to walk from room to room should be added too, not to mention the occasional (errr... frequent) distraction that pops up throughout med pass. And then increase the number of staffing so that all those tasks can be done within the time frame they want. When I worked at LTC, I often thought of timing myself for each med-pass, time it takes me to walk from point A-to-B, doing the cart audits, etc, and show them how inhuman it is to do it all in the allotted time. But what do you know, I never had the time!

    Evidence-based practice? Ha! All that research doesn't mean squat if it doesn't follow with practicality!

    Sorry for the rant.
  5. by   Anne36
    I know we were taught to do that in clinical but we were taught a lot of things in clinical that are not time effective. If we have 20-30 clients to pass meds on how would you be able to check the exp date on each packet of medication every time? One of the reasons we never got many patients in clinical is because it took forever to do med pass with an instructor. When I started my first job last week I was taking the time to pull meds, dot the entry and then go back and sign it after the med is given like you are supposed to, then I noticed that the experienced Nurses were not doing that, they were initialing when they pulled the med. Now I know why, after I passed meds on 28 clients. Anyway, the case manager for the floor saw me doing it and was not happy, probably because I am new and it is not correct to do so. She knows all the other Nurses are doing it. I also saw other Nurses passing meds that fell on the med cart when we are supposed to pop a new pill if it touchs anything. I am orienting and worry about how slow I am when I do everything by the book. It really increases my stress level. I am also on the ceiling about patient identification in these LTC facilites. There is nothing proper like an ID band, all I have is the word of the closest CNA that Im getting the right patient, because I dont know all the residents yet. There is a picture in the MAR, but it doesnt seem like the best way to make an ID on an elderly client.
  6. by   barbarake21
    I don't know any LTC nurses that follow *all* the rules. It's impossible to do everything we're supposed to do in the time allotted (at least at my former facility).

    (Each nurse had 30 residents, mostly medicare.)
  7. by   CapeCodMermaid
    Anne36,Just so you don't think all the experienced nurses are doing the medpass incorrectly because they're not making a dot on the page.......The procedure is: pour, chart, pass. OR pour, pass, chart. Either way is fine as long as it's consistent. Your dots are going to go away once EMR is in use.
  8. by   Psychcns
    Pharmacy should not send expired meds. Allergies should be checked when order goes to pharmacy.. I think nurses need to check these things too--you don't want to give an expired med or give a med pt is allergic to-- but not at med pass
  9. by   CT Pixie
    Our 'bubble' packs of meds have the expiration date on the label...right by the drug name and strength. So its very easy for me to check the expiration date of the med, and I do it with each med I pass. If its a stock med, again...very easy to turn the bottle and look for the date.

    As for checking for allergies, I have a computerized MAR so the allergies are listed right at the top of the page with the patients info and meds. So again, yes I do check for pt allergies with each med.

    I pour, chart, pass and leave my screen on that patient until after I've given the meds. If the patient refuses one or all of the meds, I can remove my initials from that med's 'box' and replace it with a 'refuse', if they aren't in the room, I can remove my initials completly. I do it this way because I had a issue that came up early in my LTC career. I had popped my meds and then passed them. On the way back to the computer, I was called into another pts room. Then a phone call...then another pt calling for me. By the time I got back to my cart, I just looked at the screen and saw that Ms Jones meds were not signed off and automatically thought she was the next one to give meds to. As i was popping the meds, it dawned on me..I had JUST given her her meds.

    Maybe its easier for me to follow the rules (checking for allergies for each med, checking exp dates) because of how my facility does things (computerized MAR)..ID'ing the pt is easy even if they don't have their band on b/c we have up to date recent pics of all our residents on the computer when every you pull up their file. Every page has their picture on it, even for charting.
  10. by   BrandonLPN
    A med that the pt is allergic to should never make it on the MAR in the first place. When you transcribe the order is when one must check for allergies. If a pt receives a med he's allergic to, the primary fault is with the nurse who took the order
  11. by   CT Pixie
    Quote from BrandonLPN
    A med that the pt is allergic to should never make it on the MAR in the first place. When you transcribe the order is when one must check for allergies. If a pt receives a med he's allergic to, the primary fault is with the nurse who took the order
    And if it were brought to court, the one who gave it is more responsible. Because errors happen you HAVE to be sure to check for allergies.
  12. by   txredheadnurse
    I would like to add that checking for expiration dates is especially critical for insulins, eye drops, inhalers and nebulizers. Surveyors are watching to see if nurses are consciously checking those particular items prior to pouring or administering. Quite a few facilities this year have received IJs for having undated and/or expired insulins on the carts. I have suggested to all the facilities that I audit that the nurses begin checking for dates on the insulins whenever they do their shift to shift narcotic counts. It takes a couple of minutes and gets one into the habit of paying attention to this frequently overlooked area.
  13. by   tokebi
    It is easy to tell the nurses, "You must do this, this, and this" and more documentation to boot in order to make sure those things are done. Problem is, the more tasks are dumped on nurses whose time is already stretched to the limit, nurses will inevitably come up with shortcuts. You can blame the nurses for not doing what they're supposed to do, or for taking shortcuts, but what about the faulty system that leads nurses that way?

    People in product marketing or advertising know a lot about human behavior and utilize it well. Supermarkets or malls control consumer behavior by using certain layout, music, lighting, all kinds of things. What if healthcare facilities used a similar approach to "control" nurses' behavior? What I mean is, to make it easier for nurses to do the right thing rather than wrong things? Streamline documentation, adopt EMAR system, design med rooms and supply closet in such a way that nurses don't waste time looking for things. But it seems like a facility's priority is everywhere else but nurses.
  14. by   NamasteNurse
    In general, no. However, I have 20 residents and the other floor nurse has 20. For the main part, our residents are long term and get the same meds day after day, sometimes year after year. I know their allergies because I've had them a long time, been in their charts, written new orders and transcribed into the MAR so many times.

    If they get a new med, of course I review everything including allergies because as we all know, doctors don't always do that. If a doc see a res and prescribes something new, I check interactions and allergies and if I find an incompatibility I report it.

    As to expiration dates, when we put a stock med on the cart we label it with the date it is opened and check the expiration date. Probably every couple of months or so I look through and check for expiration again, and sometimes our pharmacy rep comes through and does a check. Of course if we hear the dreaded "State's coming" we do a thorough check and throw stuff out.

    If I float, then yes, I look at the MAR more closely every resident and make sure nothings incompatible. The allergies are right on the MAR as we still have PAPER MARS !

    Bottom line, it's the nurses responsibility to ensure pt safety.