Giving meds in a timely manner

MiaLyse, APRN · Jan 29, 2005

I thought the order was for QHS but our policy is for 9pm now which do you follow. ...>>

I follow the h.s. order at my facilities. We leave it written as h.s. on the MAR. Do they have you write the order as 9pm when it's been given as an h.s. order? just wondering

My many patients go to bed between 6:30-8pm for the most part.

Kelly

CoffeeRTC, BSN, RN · Jan 29, 2005

My many patients go to bed between 6:30-8pm for the most part.

so do ours... Pain in the but to wake folks for meds. I start my 9 pm at 7...I know, not within the hr, but you try waking them!

RNview · Jan 31, 2005

all the sleepers are set for 9pm . These people go to bed at 6pm :angryfire When I brought this issue up to my boss, she said "WAKE THEM UP" (meaning at 9pm). .

It reminds me of my Clinical Instructor saying "When the patient is asleep and he has a sleeping pill scheduled to be taken, DO NOT wake them up and say "Mr. X WAKE UP! YOU HAVE TO TAKE YOUR SLEEPING PILLS." :chuckle However if I were in your position, I'd do the same thing.. ask my DON. But if she says "WAKE HIM UP", it still doesn't make sense. :uhoh21: Oh boy, did I just confuse myself there?

Blackcat99 · Jan 31, 2005

:chuckle When I worked day shift at LTC I was never able to pass out the meds in a timely manner. I would see a resident right in front of me and would get the meds ready. Before I could actually give him his meds I would be constantly interrupted with phone calls "Doctor Jones on Line one" and "so and so just fell." So by the time I got back to that resident his pills were pre-poured and he was long gone. I got tired of being made to feel "like a criminal" because the meds were never on time. I quit that job and will never work as a med nurse at LTC on days or evenings again.

LPN1974, LPN · Jan 31, 2005

:chuckle When I worked day shift at LTC I was never able to pass out the meds in a timely manner. I would see a resident right in front of me and would get the meds ready. Before I could actually give him his meds I would be constantly interrupted with phone calls "Doctor Jones on Line one" and "so and so just fell." So by the time I got back to that resident his pills were pre-poured and he was long gone. I got tired of being made to feel "like a criminal" because the meds were never on time. I quit that job and will never work as a med nurse at LTC on days or evenings again.

You make a very good point. I did work a part time job for awhile in a nursing home, about 2 years. A nursing home is certainly different than the job I have now, where our people are in 7 different homes. {See my post above}.

Phone calls, especially, interrupting the med pass are just unreal. Family, doctors, family and friends of staff......it was just terrible. We had several CNAs working there who were from Africa, and here in the US going to school, and working to put themselves thru school here. Well, they have a different accent than us, and administration had told them not to answer the phone, because if it was patients family they couldn't understand them, so guess who that left to answer the phone on evenings? The nurse, of course.

I got to where I just didn't answer it alot of times, because MOST of the time it was staff phone calls. If I had a call in to the doctor or were expecting a return call I would try to stay close to the telephone.

For many reasons, this one included, I quit that job and do NOT ever want to go back to nursing home work, if I can help it. I will have to be on starvation.

Fiona59 · Feb 1, 2005

I would mark "withheld" and document that the resident was asleep. After a week or two of this, I was able to get the hs meds moved to 1830 or 1900, or even changed to prn (if they woke up before midnight it was given). Sometimes warm milk worked wonders at 0200...

The amount of meds given in LTC makes the mind boggle. Why am I giving a 92yo woman premarin? Does she really need calcium supplements, when she doesn't weight bear, uses a w/ch or gerichair? Managed to get the colace cancelled by keeping really good BM records!

LaShell · Feb 1, 2005

eeer, memories of rehab... nope believe it or not it's the state that's concerned with their dining experience. when they are doing surveys, that is one of the things they look for--that we aren't giving meds in the dining room. from my experience, many patients didn't mind getting meds during their meal, and many of them preferred to take meds with food to help get them down.

I worked at two subacutes and it was on a rare occasion that meds got done on time. also, we couldn't always start passing meds right at the beginning of our shift because residents didn't want all their meds on an empty stomach before breakfast, or they're stuck in the bathroom, or they don't want to be woken up so early...... Many bad habits were done by the staff, like putting meds in cups and taping them shut with the pt's initials on them and then passing them all quickly before breakfast.

so sad we don't have the time/staff to do our jobs correctly and risk our licenses..........

People wait in line at restaurants all the time correct? I'm not a LTC person here so my opinoin is worth zilch, but if they demand you not "interrupt" their dining experience maybe they should let you take care of "business" before they enter the dining room.
Granted it is important for them to keep their nutrition up but its just as important that they get their meds etc. My guess is the state is going to be less concerned that they have their dining experience interrupted as they will be that the meds are given in a timely manner.

**SKM-NURSIEPOOH, BSN, RN** · Feb 1, 2005

"...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...."

most 11p-7a nurses work alone! typical ltc units have two hallways made-up of residents ranging from 29, 30, up to 33 patient per hallway. the 11p-7a shift nurse has to give meds to both sides. now imagine just how time consuming waking-up most (if not all) of these patients for *one* or *two* pills just so that the day shift nurses don't have 'all those pills' to give. can you imagine how pissed-off most of the oriented folks would be? cuz one would have to start such a med pass that's written for 6:30a at approx: 5 to 5:15am in order to get the morning fbs & to wake those poor unfortunate souls up for one or two pills. now...do most people typically wake-up to start their daily routine that early in the morning? i think not!

the answer isn't passing off the buck to 11p-7a shift nurses...the answer would be the facility reviewing the necessity of all the polypharmacy most mds write. is it necessary for patient to take soooooo many pills daily? it has been proven via literature that polymedicating patient causes more problems from all of the adverse reactions....often times leaving residents with what is called polypharmacy caused dementia.

something to consider before passing the buck/workload onto nurses who typically are scheduled to work the units alone. they have to do *many* tasks within that time frame which benefits the residents & the unit overall. the night shift nurses are the ones who have all those *extra duties* they have to perform cuz everyone else "don't have time" to do. they not only have meds, & tx...but they also have their nightly, discharge from either hospitalization from the previous shift or death (night shift typically get the most death...usually early mornings i.e.), & monthly summaries, nightly v.s., change or set-up o2 concentration bottles/tubings, 24* chart audits, mars/tars change & review for the new month, re-order stock/meds for the unit; double check all upcoming appointments for those residents who have to go out on pass to their mds or to have a particular procedure done that's not offered at the facility....etc....etc. get the picture? night nurses don't have it all easy....nor do they sleep the night away as many may suspect. heck....many don't even take a break cuz there isn't even an opened cafeteria about! nope...night nurses will eat at the desk while doing their nightly audits/checks.

as a former night shift nurse (& soon to be returning), i take great exception to the notion that *2* or *3* routine meds thrown onto the night shift wouldn't be "impossible" for those nurses. that smacks of either total ignorance or lack of respect for what your night nurses do on a daily basis :angryfire . if it weren't for your co-workers....many who prefer to work days/evenings wouldn't have their pick of shifts...many would be forced to work 7p-7a....etc.

cheers!

moe

CapeCodMermaid, RN · Feb 1, 2005

I would mark "withheld" and document that the resident was asleep. After a week or two of this, I was able to get the hs meds moved to 1830 or 1900, or even changed to prn (if they woke up before midnight it was given). Sometimes warm milk worked wonders at 0200...
The amount of meds given in LTC makes the mind boggle. Why am I giving a 92yo woman premarin? Does she really need calcium supplements, when she doesn't weight bear, uses a w/ch or gerichair? Managed to get the colace cancelled by keeping really good BM records!

AMEN sister! What's the point of half the meds we give out? They come to us on all sorts of meds they've been taking for years because none of the docs has the time or inclination to do a thorough review to see if they actually need them. I want to clone my GYN doc. He said he would have a rule that everyone only gets 3 meds. If they need more, the doc would have to decide which of the first 3 to get rid of.

CoffeeRTC, BSN, RN · Feb 2, 2005

remember the Beers List? What ever happened to that? What about the QIs..res on 9 or more meds? Why does that 92 yo lady need premarin? We also have many residents getting blood sugar checks 2-4 times a day when they are norm??

I like the 3 meds rule. Heck I would even settle with 5!

sassynurse78 · Feb 3, 2005

I am glad to know that I am not the only one with these problems. We have two units of 42 pts each. Days has 3 nurses to divide these units, second two nurses and nights one. So I defiantly agree that nights cannot take on the extra burden. I don't know where anyone ever got the idea that evenings are any better time wise so we only need two nurses. (seems like almost all of our pts, get meds bid which is 9am and 5pm) I often hear well days has to deal with dr calls, which I found to mostly be an untrue statement since they all call back at 5pm when we are trying to pass all these meds....the bottom line is that managment knows but chooses to ignore the fact that two many pts and two few nurses equal a disaster. If we as nurses continue to find ways to "be in compliance" why would management ever have to deal with the problem appropiatly? Like By hiring a couple more nurses!! I for one am not of the opinion that I need to go and make lists and call docs to make my med pass within compliance. I feel like I am just proving to the management that too few nurses can work. I love my pts, and even have a great respect for the facility, however I don't care if the facility gets fined for not being in compliance with med pass. I am one person I give 150% daily. When nurses are giving that much effort then it is the facilities responsibility to step in, if they don't it is their fine.

Sorry to vent here, I do not intend to offend anyone, I just wish on some subjects like this one that we would stick together and make the folks in charge take some of the responsibility. This post touched a nerve because this is such a daily issue at my facility that our management has chosen to shrug their shoulders on saying they don't know how to fix it. After as many times as we have went to them, I just feel like it will be their problem when we get fined.

panurse101 · Feb 9, 2005

Our ltc facility has the same problem, I think this is a common problem in ltc. One thing that we do try to look at, is to see if any med times can be changed. If its a daily med, ask why cant the med be given at 12 or 1pm, try to break them up. It should help relieve some of the "pain".