Giving meds in a timely manner

Specialties Geriatric

Published

I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives.:rolleyes: The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?:uhoh3:

Specializes in Psych, Informatics, Biostatistics.

The nursing homes I have worked in encouraged you to goto the table with all 4-6 patients meds pre-poured. You would also use techs to help give the meds. Now, I know everyone is going to comment that's not compliant. But its totally unaccepted to give 8 am meds at 11 am isn't it ?

My point: you do what you have to, to get the job done.

Up Vote Up Vote ×
Specializes in many.

pre-pouring scares me... :o

On another note, after working ltc for a decade I can say that in the past I have pushed for, and gotten time changes for lots of meds.

Administration particularly likes the argument that such a med pass would be impossible to complete appropriately if the state or heaven forbid JCAHO were watching. :rolleyes:

I am guessing that some patients are up early enough to get cardiac meds during the 11-7 shift. I know 11-7 nurses are busy in the am with blood sugars etc. But adding 2-3 regular meds should not be impossible.

In the past I have been discouraged from asking patients to stop at the med cart on their way into the dining room, as that is "not encouraging a home-like experience". (As if these folks never took meds with meals at home). :chuckle

Anyway, I would recommend asking MD's to change times so that as a previous poster said, one end of the hall has meds at 8, or even 7:30, and the other end is as late as 10. And afternoon meds spread out from 12:30, for the residents who get really early morning meds, to 2:30 for those whose am meds are listed at 10.

That is not to say that you need to be medicating at 7:30 or 2:30, but it would be great to have that leeway. :balloons:

Best of Luck, and way to look for a new solution.

Up Vote Up Vote ×
The nursing homes I have worked in encouraged you to goto the table with all 4-6 patients meds pre-poured. You would also use techs to help give the meds. Now, I know everyone is going to comment that's not compliant. But its totally unaccepted to give 8 am meds at 11 am isn't it ?

My point: you do what you have to, to get the job done.

This is against the regs. Interupting them during their dining experience is also against a reg. Some facilities get around this by making a policy. Pre pouring and mass medication is also a big no no... Not all states permit med techs..PA doesn't. (You do need to cut corners thou..I admit..I don't always lock the cart if I can see it..sometimes I get the meds ready)

How about getting meds in liquid form for the ones you need to crush.. I still think cutting down on the amount of meds to be given helps. Also switching q day meds to the pm shift when you are able to.

As far as working the 3-11 shift..our big med pass is at 5...this helps. It is so difficult to get some residents to take meds at 9 pm since many like to be in bed and asleep by 8.

As far as giving some meds on 11-7....see my other post about sleeping. In our facility..they are giving synthroid and some other meds in the morning. In order for them to get these and the accuchecks done add in some blood draws,etc...they start thier med passes at 5 am :uhoh3: Might work for the consistant earlie risers tho.

Up Vote Up Vote ×
Specializes in ER, PACU.

I used to do LTC also, and I would sit down with the MAR first thing in the morning, MAKE A LIST OF ALL THOSE RESIDENTS GETTING THE SAME MED AT 9 AM AND 1 PM PLUS ANY ACCUCHECKS and pass the 9 am meds FIRST to the patients who were recieving the same med again at 1 pm. I would also start my med pass at 730-745 am in order to get that 1 hour window before and after meds were due. The PEG patients meds were usually scheduled an hour later, so I did them last.

Up Vote Up Vote ×
Specializes in many.
The PEG patients meds were usually scheduled an hour later, so I did them last.

Never thought of that one, it would be nice to to have to switch back and forth between PO's and PGT's! :)

Up Vote Up Vote ×
Specializes in Education, Acute, Med/Surg, Tele, etc.

I have this probelm also at my facility, and I reminded my administration of a simple fact. Which has more liablity, customer complaints of medications at the dining room table...or missing/late meds! However, be careful pointing out the obvious to managment...it can bite you back!

But with that mindset, I have been able to schedule meds on MAR's for valid times of the day, giving those first thing meds first...and delaying others or other residents within reason (sometimes you can't..so you comprimise). A nurse has the ability to change the times of meds as long as they are within parameters of safety and proper administration, and if a MD hasn't ordered a med for a certain time. Really looking into this has saved time, and I have been able to switch certain meds for later in the day for some to best fit the staff and patients schedule. Of course I have 160 and CNA's do med pass (assisted living), so I can focus more on researching med times, what needs to be taken with what, what shouldn't be taken with what, and talk with the CNA's about the residents schedules and what would work out best in regards to activities and direct care times!

If worse comes to worse, do you have an administrator you can talk to about this. Go into it with patient safety/client satisfaction on top...reminding them that you are getting these meds done as quickly/accurately as you can, however you could use some assistance to have the AM meds go more smoothly, timely, and fit into the schedule of the residents day. We changed our staff schedules to fit this two years ago, and now all staff must arrive at 0600 so that med pass and all ADL's were on the move before breakfast.

Anyway...good luck!

Up Vote Up Vote ×

I have staggered times for the meds. The beginning of the hall is 9-1-5-9 and the last half is 10-2-6-10. Don't think it's necessary though, for an assignment of 22 residents!:rolleyes: I think that is doable within two hours.

Up Vote Up Vote ×

I too have had that problem. Different clients require different methods. Some floors where a majority go to the dining room you can take your cart to the spot they have to pass before going to the dining room. Pass meds before they go. They will automaticly do it if you teach them. then pass meds of pts. on the floor. Give oral meds first, the eye drops, etc. Give the most important meds first, pts. leaving etc. Do you think nursing will ever catch on that that is too many pts. in the curent day with heavy medications? I think there are only 2 facilites in this city that only have 20 pts. per nurse. Try different things, Keep at it. Fast is not always acurate, and I would rather be acurate. Good luck.

Up Vote Up Vote ×

Thanks for your inpt. The DON is very well aware of the problem, she was my supervisor a few years back. The facility didn't mandate the rule of 1 hr before the scheduled time and 1 hr after. this is a state mandate. Many of the states rules are very unrealistic as most of you know.I have been reading your replys and I see many great suggestions. I thank you all. I did a double shift last eve. and saw how few meds the residents get in the evening. I am thinking of possibly adding some to that shift. Also, we start our eye drops on the 11-7 shift at 6am. The resident is lying down, making it easier on both the res and nurse. I also add things like Lovenox injections to 6am, for the same reason. I do thank all of you for your ideas and experiences. Debbie:)

wow, you are able to pass meds on 39 patients by 11am! that's commendable. i worked ltc for 5 years in a NH where i had 40 patients and started my med pass at 8am and finished around 12pm. i think that the way the management has mandated med administration at your facility makes it virtually impossible to pass meds in a timely manner. discuss this matter again with your DON. he/she needs to see exactly how difficult it is to pass meds on all those pt's with the strict rules that are in place. i think that the feeling that the nurse is "disrupting" the pt's meal by medicating the pt during a meal is ridiculous; the nurse should not have to feel bad about doing her/his job. why don't you ask the DON to accompany you on an a.m. med pass so that he/she can see the issues you're dealing with. the management has to do something about the med admin. rules or the facility is going to receive citations for sure!
Up Vote Up Vote ×
Specializes in Psych, Informatics, Biostatistics.

Yes, pre pouring is scary. BUT, if you do all the checks, ie. 5 rights, maybe 6 rights and take your time instead of rushing it may be safer than running around attempting to beat the clock to give meds for 40 or more patients. Just a thought and please I don't mean to suggest that in a perfect world pre pouring should exist.

Up Vote Up Vote ×
Specializes in ICU, PICC Nurse, Nursing Supervisor.

I am a LVN med nurse in charge of medications for 2 units that equalls over 50 residents. Now our policy is 1 hour before and 1hour after. I start at 7:30 and get done about 9:45 at the lastest. I do nothing else but pass meds , no call light ,no phone calls nothing else but meds. On the first unit, I get all the patients that are going to the DR first before meals are served then when the tray's come I go to the hall and give meds by that time, the dining room patients come out and I get them. Second hall is the hardest because they have more people. If I dont get them before the trays come;Im standing outside the dining room waiting on them ( and yes, I have been known to preset up the meds, I know it's wrong but I have to be done by 10 am). I never chase a resident because all of mine are alzheimers patients and they eventually will come back to me. What makes me mad at my job is the 9 pm med pass, all the sleepers are set for 9pm . These people go to bed at 6pm, which means I must awaken somebody to give a sleeper. MAKES ALOT OF SENSE DONT IT!!! :angryfire When I brought this issue up to my boss, she said "WAKE THEM UP" (meaning at 9pm). Then we have people crawling out of bed and falling. I thought the order was for QHS but our policy is for 9pm now which do you follow. ...

Up Vote Up Vote ×

I work in DDS and we have separate 7 separate "homes" our people live in.

In order to get our meds done in a timely manner we had to stagger our med times.

Some are scheduled at 8, 12, 4, 8, and some are scheduled at 7, 11, 3, 7, which gives us more leeway.

Works for us.

Up Vote Up Vote ×
+ Add a Comment