Ques. about presetting up of meds - page 2

Hey all. I'm an RN who works the night shift at a 60 bed LTC facility. Of course, I'm the only nurse there during those hours and have a 22 bed RCF to oversee as well. I don't have many 0600 meds,... Read More

  1. by   allevi
    We use that system also. I never preset meds, but there have been times that i got the med out and the resident wasn't around, and then i just put it in their drawer. I know this is technically wrong, but isn't it also wrong to put the med back into the cassette?
  2. by   sandigapeachlpn
    i got really lucky in our facility. our DNS had to come in along with some of our RCM'S and work 2a to 6a to help out on Noc's. At that time we had a pretty heavy load for 0600 med's. After they had to try and pass that many med's along with all the BS, ETC. they changed our 0600 pass to only the absolute bare minimum and added the rest to 0700, since these resident's are going to get 0700 pills anyway. It has made a major difference in our last hour. And i personally don't set up med's. Not only is it grounds for dismissal but for me it creates more of an atmosphere for med error.
  3. by   2LTCnurses
    In PA. it is absolutely against state reg's to pre-set meds! We have had the state pop in several times early in the morning, and it would be a big deficiency for the facility and I'm sure disciplinary action for the employee. That is the reasoning behind the "one hour before and after" dosage times. The reasoning is that you are supposed to check the meds against the MAR immediately before giving them, and if you pre-pour you can't do that. Also, just as an aside, I was previously a Unit Manager and these rules are not just something "the powers that be" dreamed up to make ours lives harder........the state sets the reg's!
  4. by   Catsrule16
    The last facility I worked in used unit dose packets. The pill pack wasn't opened until it got to the resdient's room. Some of the night shift nurses would pull up the pill pack but not open them to help speed up the med pass... Still able to compare the name and dose of the pill to the MAR and if it wasn't right could put it back without an added expense to the resident. The narcotics, stock meds, and liquids couldn't be done this way. Also couldn't leave them on top of the cart. The nurse would write the last name of the resident and the room number on the outside of a 5 oz paper cup and preset the pill packs that way. Had a surveyor walk in at 5:30 AM and see the cart set up this way and was not cited. Could have been just lucky that morning.
  5. by   aimeee
    Against regs to pre-set up meds here too. BUT, we are able to keep our narcotics in a lock-box on the cart. We used to keep them all in the med room in the narc cupboard which meant that we had to run back and forth to that damn box about a hundred times in a shift. For YEARS I kept asking why we couldn't keep the narcs on the cart. Finally they said yes! Now each cart has its own narc supply and the nurses who have that cart do the counting. It saves SO much time! Recently they got new med carts and they got ones with a deeper lock box so it even accomodates the large liquid narc bottles.
  6. by   km rn
    How about looking at the 6am meds and weeding out the ones that should be given at a later time. I agree that it is very hard to get resident awake and in proper positioning for swallowing pills.

    So....I would ask that everyone focus on getting rid of some of the 6am meds, discontinuing some, etc.

    Good luck.
  7. by   tinkertoys
    It is against regs to pre-set meds. I MIGHT be able to go along with gathering up the unit dose meds together for a few pts who get lots of meds that you have to search for (leaving them in their med drawer) ahead of time, but even that is iffy when it comes to Survey time. Also, if you recheck the gathered meds against MAR's right before giving, you are essentially doing a task twice- once when setting up, and again before giving - and I rarely have that extra time to spare. And if you skip that second check, you run a very real risk of a med error-
    At our Center, our med passes are organized to disturb the pts as little as possible when it comes to the med pass, so if they have meds to be taken before breakfast, they get all their AM meds at that time unless contraindicated. Makes sense for the patient - reduces the number of times we interrupt their therapy, etc. for meds, but can turn the 6am medpass into a nightmare. Especially if there are lots of pts with fingersticks and swallowing problems. There are some who request their meds at a later time, but for the most part, works very well.
    The real key to surviving that last medpass is organization. Make use of the "one hour before and after" window. The more things you can get done before you start that last pass, the better off you will be. Make sure that your medcart is well stocked before you start. Try to organize your medpass so that you are in the same part of the hall as your CNA's, so you don't get stuck answering lights, etc. If you answer the phone, too, lobby for a portable phone you can take with you on your medpass - that alone will save MILES of running and valuable minutes.
  8. by   patmostoi
    can't see the forest for the trees. ok first in michigan as far as i know. if in individual pkgs the meds may be set up. the pkg must stay sealed until time of use. the liquids ,stock meds, and narcs may not be preset(or to some prepoured) it is not illegal to pull the meds and stuff them(still in their pkgs) in a dixie cup and keep it in the pts med drawer until time of use. this prevents med errors.however the problem people have is presigning. the triple check insists we triple check med pkgs just prior to administering. i cut time by sticking my sealed meds in a dixie cup at the beggining of the shift. right before i give it i triple check them like any other time sign them out, add the stock meds, narcs, liquids that may not be prepored. it is a time saver and it is legal and safe for the pts. prepouring may be easy and save time and"everyone does it"(not me saying this) but how time consuming is it for you if you have to code a pt because he received something he was allergic to , then you have the supeonas and being unable to practice nursing for at least 6 mo during an inquiry. stay with what you were taught in school or learned at recent inservices. it will save you your life and license
  9. by   Catsrule16
    When do you sign off the meds? Before you give them or after you give them?

    In South Carolina, the surveyors want to see you sign them off after you give them. What about in your areas?
  10. by   tinkertoys
    Our protocol is to give meds, THEN initial the MARs. I, personally, have a problem with that, in that it's easy to get side-tracked and forget to initial after leaving the pt. My personal preference is to gather my meds, make sure it's all right, then initial and give meds. If something is refused, etc, then I circle on the MAR and document details on the back. I find that there are fewer blanks that way, and I have the med in front of me when I initial so I can verify... not try to remember later. Saves time, too.
  11. by   catlady
    I can't imagine signing off MARs before giving a med. What if you're not the one who ends up giving the meds? I know nurses who go through the med book at the beginning of the night and sign off all their meds. I'd hate to be that nurse if she or he has to go home sick, or the resident gets sent out in the middle of the night. Same thing with nurses in the hospital who sign off assessment flow sheets at the beginning of the shift. Then the patient codes and dies at 2 am, but the flow sheet says they were fine at 6 am....

    I had one night working with another nurse when there was an emergency at 5 am and he had to deal with the resident. I offered to do his meds for him, and found that he not only had signed off all his MARs, but all the pills were in the drawers, not only poured, but already crushed.
  12. by   grandmanurse1
    Definitely illegal to prepour meds in Florida. Big cites, fines, etc. Increases the risk for med errors. It seems you have two problems that could be solved fairly easily....you need to have a locked drawer on your med cart so you can store your narcotics there....and you need to keep your meds to a minimum on 11-7. In Florida, it is also a cite if we move meds to 6 a.m. for staff convenience....it must have a legitimate reason...abt therapy q 8 hours or on an empty stomach, etc. All others go to 9 a.m., etc.
  13. by   P_RN
    I'm in SC and I have not heard that setting meds prior to the med pass is illegal

    We used the Pyxis Dispenser. Night shift would pull day shift's 9am meds, and day shift would pull night shift's 9pm meds. The meds were put in a zip lok bag with the patients name on a sticker. That bag went into the patient's drawer in the med cart.

    The med nurse still had to do the 5 Rights, but it certainly helped. Meds were not signed out on the MAR until after they were given. DHEC, JCAHO and OSHA had no problems with this. Now this was a hospital and not an ECF/LTC.

    I haven't seen one of those cup and tray deals since the 70's though
    Last edit by P_RN on Oct 27, '02