Med Pass - page 5

Hi all. Although I am working med/surge full time now, I still pick up a shift in a LTC facility 1/wk. PRN, so I working someone else's routine. Last night's 2-10 was a nightmare. Unfamiliar with... Read More

  1. by   jjjoy
    Quote from rexie68
    i wouldn't question this hospice order....we routinely give hospice pts a lot of meds at the same time or in larger dosages than usual. these pts have developed a tolerance to the same thing that would knock most of us out.
    you wouldn't question the order because you are familiar with common practice. a nurse new to the environment has a more difficult making the call and should question any practice he/she is unfamiliar with.

    on the one hand, they clearly don't know as much about these patients as those already there and one want's to assume that whatever has been being done is safe and correct. on the other hand, it is one's professional responsibility to understand why this variation is acceptable and to not just follow previous practice without question.

    it's a tough position, because too many times when someone new to the area asks about something, the experienced folks get defensive. i suppose they get defensive because they feel the question is like an accusation that they may have been engaging in unsafe practice. but if they truly understand why something is done the way it is (and not just because 'that's how we do it' or 'that's what i was taught') then there's no reason to be defensive.

    unfortunately, nurses are often pulled in so many different directions that it's hard to stay on top of thoroughly understanding all of the day-to-day practices. and they often get defensive or condescending attitude if they ask for an explanation by their colleagues or the physician for his/her choices. and even if attitude isn't a problem, there's not a lot of time for discussing the underlying rationale and pathophys and pharmacology while everyone, nurses and mds, have so many other responsibilities demanding their attention now.
    Last edit by jjjoy on Feb 8, '08
  2. by   CapeCodMermaid
    Precisely---you should question anything you don't understand or think is wrong or anything that makes you uncomfortable. It's your license. On our pre-employment med test, there are 15 questions with doses of certain medication. The question is would you question the MD about this dose for this particular medication. You'd be amazed at how many nurses wouldn't question anything because a doctor said it.
    I went to school 25 years ago. We were taught to always have a second nurse check a dose of insulin or heparin before you give it. I still practice this way and don't really care who thinks it's backwards or slow.
    Question away and ask for help if you need it. Don't let anyone make you feel dumb or slow or whatever because you are careful and have less experience than they do.
  3. by   NursKris82
    I've been an LPN for 2 weeks now and am on orientation. Normally our facility does (on 3-11) a 4p with 1600,1700 and 1800s given) and an 8p (with 2000 and 2200 given) med passes. I have many of the same concerns as you all re. safety of this practice and not even being able to do all this within the hour window. But, that's not my focus of this post. I am going to be working some AM shifts on a particular hall, so even though I had heard the nurse was lazy I figured I had to get to know the med pass and routine down there before I was on my own- so I worked with her. It was terrible- she too told me that since they all ate in the same dining room she gave ALL the meds at 6 or 7p! I was shocked. Then we went to do pills via a J- tube and this nurse in plunging them down the tube. I was taught to always let them run to gravity. I'm not talking a lil' push to encourage it, I'm talking about "put in and push it fast"! my: I was so appaulled. Plus, the med pass took so much longer because I was doing 2 in 1. It was awful. This was like only my fourth day or so passing meds by myself, so I did it her way :innerconf, but guaranteed I won't ever do it that way again or work under her again! Man, it was terrible!! :scrm:

    PS Another poster mentioned the additional smiles, I didn't even realize they were there before and I hit the JACKPOT! (Is there such a thing a smile abuse?)
  4. by   *Pepper*
    I share everyones frustrations about med pass, the one hour rule, high acuity in LTC, the push to be fast by those above.

    I REFUSE to answer the phone in the office during my med pass and REFUSE to leave the cart for diddly poop.

    What worries me is not just getting it done, but not having the time to do it the way I was taught in school. Five rights, documentation, having all the drugs to administer.

    It is alot of liability to be doing it with short cuts that are pushed on you by management. We are not fixing cars here..
  5. by   wearingmanyhats
    I agree with everyone.... I am an agency LPN, and have pretty much seen it all. The one facility that I go to frequently uses a computerized med pass. This is one med pass that goes fairly quickly and smoothly. The meds are prepacked by pharmacy, and barcoded. (there is a number on the pack that is the same as the ID number on the pill so you can verify what you are giving)

    I have worked places with MARs --- HATE THEM!!! You need to read and re-read (if you can actually read the writing) ....

    As for doing pills all at the same time .... NOOOOOOoooooooooo!!!!!

    I will give 1600/1700 together (if I know they also get at 1800 I will give all at 1700 for that pt, but wait until 1700)

    The shear number of meds these folks get it BIZARRE..... no one need to take Lipitor at 80 yrs of age with dementia..... do we really think this is going to help them???? I truly believe that the only one making out in this scenario is the drug companies and the pharmacies.....

    Ok..... off of my soap box LOL

  6. by   nightmare
    I'm amazed at your med pass times! We give out at 8,12,2,6 and 10.We have the odd tab at 8pm and 7 am but certainly not so close together as some of you have.You must spend literally all shift just doing med passes!
  7. by   Baelyll
    I have been working in LTC for about 5 years now. I have been a nurse since 1984. I have 30 patients and there has not been one day that I had my med pass completed on time. It is a neverending medfest, indeed.

    I have tried to minimize, if not abolish completely, any unnecessary interruptions, I diligently strive to improve my time management but it is impossible to give everyone their meds, tube feedings, Iv meds within the time prescribed. I refuse to take shortcuts to make it go faster. I guess I am guilty of giving in.

    I have discussed this with my supervisors..they kind of talk around it. My partner (the other full time nurse I work with who has the other 30 people on our unit) and I got together and after much soul searching decided in the favor of safety even though it means we are out of compliance time wise. And on our own enlisted the MD to change some of the times around to help us be less out of compliance.

    I, quite frankly, do not know what else to do but quit. But I love my patients..and I like working with my immediate coworkers.

    I don't think there is any answer but it felt good to get it off my chest.
  8. by   jjjoy
    Quote from Baelyll
    I have been working in LTC for about 5 years now. I have been a nurse since 1984. I have 30 patients and there has not been one day that I had my med pass completed on time.

    My partner (the other full time nurse I work with who has the other 30 people on our unit) and I got together and after much soul searching decided in the favor of safety even though it means we are out of compliance time wise. And on our own enlisted the MD to change some of the times around to help us be less out of compliance.
    Thanks for your honesty! Too many accept that they just have to take shortcuts and so management gets away with ignoring the reality that what they are asking for is impossible. And of course, management loves playing the "well everyone else seems to be getting it done" card. Ugh!! I hate generalizing about "management"... but TPTB quickly get rid of managers who demand higher staffing, telling them that *have* to make it work on the given budget or else give it up... which good managers do.

    So kudos to you for making the tough decisions and for making an effort to make it better as much as you could!! up:
    Last edit by jjjoy on Mar 2, '08
  9. by   eldragon
    I'm glad I found this thread today.

    I just finished my fourth day of "orientation" in a LTC facility, as an a.m. med nurse.

    By day two, I was expected to do it mostly by myself, with the regular med nurses helping me.

    Mind you, this place has a low-turnover rate, nurses stick around, not sure why. Here are a few issues and thoughts I have:

    First, my shift starts at 7 - I do the narcotics count, and then immediately head to the dining room, where I am required to stay until everyone is finished eating. I have to document intake on about 25 residents. If one resident is late, or picks at their food, I can't leave to start my med pass. I have to wait.

    PT starts at 8, and as you can imagine, several patients want pain medicine. So, that is another setback.

    Then I head out to do medications on 24 residents, none of whom I knew before Monday. Needless to say, I'll be checking namebands forever, because this is a skilled nursing unit.

    I can start at 8, but I am supposed to be finished by 10:30. The experienced nurses have been doing this, but I'm only able to get about 12 patients done during this time frame right now. And I am frustrated, rushing the whole time. Residents want to talk, and my ability to converse and be compassionate is the reason why I went into nursing, but I can't stand around and talk. Most residents have something else that impedes swift progress: feeding tubes, warm water requests, crushed meds in pudding, crushed meds in syrup (yes), problems swallowing, and many are just plain SLOOOW. Then many of them have Lovenox shots/multiple inhalers/eyedrops, nitro patches, pain patches and narcotics that are under double lock in the med room to which I have the key.

    Today was the worst - I felt like quitting and/or laughing at the impossibility of getting this done on time!

    Only with help did I get it done. Then at 10:30, I do CBG's. Then at 11, I go to lunch for 30 minutes, which is unpaid. Now, if I work through the lunch, they dock 30 minutes from my check, which i do not think is fair, but that's the way it goes.

    After my lunch, I go back and give insulin before their lunch at noon, which I have to monitor.

    I couldn't do todays pass on time, I was literally about 5 patients short - and there were 3 admits this afternoon.

    So, I'm talking to an experienced med nurse who told me she was, at one point when she started, going in and putting meds in cups for about 5 residents, to hand out like that - because there was no way she could finish on time. Then, she said sometimes she parks the resident at their door with their meds and water, and starts punching out the next pts meds then. So she took short-cuts to get the med pass on time.

    I'm thinking, BS, I'm not concerned about q day meds getting passed by 10:30, I'm concerned about patient safety, and my license.

    So I'm going to go in - do breakfast watch, which I think is a waste of time when i could be doing meds, but oh well...

    Then I'm going to start passing meds at 8 and work until I'm done. Forget the 10:30 cbgs - they can be done at 11 or 11:30 - followed by insulin - and then I'll watch lunch at noon and take my lunch when that's over.

    If I can't stretch out the morning med pass to a reasonable time length, at least until I'm more experienced, then they'll have to just find someone else to do this. Because this is not nursing, in my opinion.

    Thanks everyone, for letting me vent.
  10. by   MegRyanGirl
    I am also frustrated with the med pass situation like most of the nurses on this forum. I am an RN and I am fairly new at the large number of med passes. My last job was as a psych nurse for 1 year, and it's nothing like LTC.

    The first day I got an orientatio, I got it from an LPN, which I thought was weird -- I mean, no offense to LPNs but shouldn't RN get an orientation from an RN?

    And this LPN hardly ever took BP or checked HR for pts that were on BP and cardio meds. She would put some safe sounding fake BP and HR numbers and continue her med pass!! I was scrutinizing the MAR trying to get familiar with it, and some of the stuff I wasn't sure about and asked her what it was, she said "oh, just sign it." I was SHOCKED!!! Just sign it????? She would put some random number for the volume of GT feeding that went into the patient withotu looking how many cc's per hour the pt was supposed to get!!! And the assistant DON was raving how great thsi LPN was!! When I pointed out the mistake of the GT tube feeding volume and refused to put down the wrong number just because the nurse before me put it down, the charge nurse who was also an LPN said "ooh, but if you do that, everyone else will get written up." That's none of my business!!! It's their damn fault that they don't look at the order for the feedings and calculate the correct amount!

    It's been a month since I started at this LTC, and last Friday I was so frustrated I was ready to cry. I had about 20 pts to give out meds to, and it took me some time because I hadn't done that floor for a couple of weeks. I checked the glucose, BPs and HRs for those that needed those things checked, and by 1pm, I was still doing some 9am meds while doing 11:30pm and 1pm meds at the same time. I asked the LPN for help, since I am supposed to be still on orientation, and she refused to help saying that she was busy (she was transcribing orders). I think it's all backwards that I am doing the med pass and she is transcribing, when it should be the other way around... am I wrong? Either way, she refused to help.

    I also don't get paid for lunch, and I wasn't gonna work through an unpaid lunch although I felt uncomfortable not finishing on time. The assistant DON who gets a salary says "you have to work through lunch if you don't finish meds. Sometimes I work through lunch." Yeah, but you get a salary, I don't. I told her I wasn't comfortable leaving the floor without finishing the floor, but that I wasn't gonna give them free labor. I said I would work through lunch if I got paid, so she said she would sign off on it.

    In the end, I spoke to DON and told her that it's plain impossible to give out all the meds on time if you do it the right way and that others don't take BPs, HRs, etc.... She goes "I can't believe I am telling you this, but sometimes you just can't take BP. Once you get to know the residents, you know their range, and you don't have to take it every time." I couldn't believe my ears!!!

    But the truth is, there was one patient that was there the last time I did that floor, and she is on lots of cardio and BP meds. I had to hold 3 cardio meds from her because of her HR and call the MD. Imagine what could have happened if I gave her the meds like the DON said just because I am "familiar" with the patient and took the vital signs only every so often??

    I refused to work on that floor and insisted on staying in the Vent Unit where the Pt - Nurse ratio is normal....

    Ahhhhh, *sigh.* this is really stressful and unethical thing that they are doing. They care more about the quantity than quality. I am sure they would hire more people to do a better job, but the nursing department is probably not being backed up by the management on this, and that's why they to do what they have to do.... It's really frustrating and scaryy.
  11. by   proud2b1
    Anal is always better!!!Oops,OMG,you know what I mean!:imbar:chuckle
    Last edit by proud2b1 on Mar 10, '08
  12. by   eldragon
    MEGRYANGIRL, I hear you.

    Today was my 6th day and I was able to pass meds to 18 residents in the right time time.

    This is all I think about; how to cut the time it takes to pass these meds.

    It's aggravating.