Giving meds in a timely manner

littleplaynurse · Feb 9, 2005

Wow! - this post surely opened a Pandora's Box, and for obvious reasons. You certainly can see by the response that you are not alone in this situation. It's across the board. Last year I took a position with a LTC facility, and from day #1 the med pass was NOT do-able......at first I blamed myself (new facility, not knowing the residents yet, not having my own "system" down yet, etc....). I found myself going thru the MAR every morning and making a list of pts. who were going out to appts., needed premedication for PT, blood sugars/insulins, and those who were on scheduled narcs for pain management......these people took precedence over the others.....

No matter how I tried - by the end of 2 months these were still the ONLY pts. who were actually receiving their meds on time. I was becoming a little more unglued with each passing day - because it began to take on a personal tone - (i.e. ..maybe it IS just me..) When I mentioned it to the other nurses, they all said, "It's not you - it's the med pass. It can't be done in a timely manner". I asked them why this had not been brought to the attention of the DON and the response was, "it won't do any good - YOU can mention it to her if you think you can change it....."

Lots of support, right? I figured what the hell? I can't continue to work like this. I felt like I was on a treadmill going nowhere fast........I swallowed my pride and went to the DON (on 3 separate occasions) I told her that this was not in compliance, and that I felt strongly that this was now a patient safety issue. I asked her why the times couldn't be changed, and/or why some of the "unnecessary" meds couldn't be DC'd......her response? "It's not that simple. You just don't go around changing med times......Let me worry about the safety of the patients - just do the best you can and don't worry about it. As long as they GET their meds, that's all that matters"......H-E-L-L-O???? I found myself coming in earlier and earlier (and not punching in until the shift started), and leaving later and later - determined that I was going to make this work. In the end, I was so stressed and worn down that I ended up with pneumonia. I KNEW I would be out for at least 2 weeks - and rather than leave them short staffed and having to call out sick until I recovered, it became my excuse to resign.

I can't tell you what a failure I felt like - it felt just as bad as if I had been fired. My self esteem was in the toilet. As it turned out, I ended up being sick for a month - so leaving the job was the wisest decision for many reasons. Four weeks to the day after I resigned, I received a handwritten note from the Staff Development Coordinator (who was on vacation when I left). I will treasure this note for the rest of my life. She said that she was so sorry that I had resigned, and so wished that I could have just hung on a little bit longer (to see the fruits of my labor).......

She went on to explain that after I left, they were forced to use Agency for the lst time in 6 yrs. They ended up with a different agency nurse every single day for 3 weeks - because NONE of them would come back after the first day - and they had all complained to the DON.

In the end - she told me that the DON was forced to do the following: The one person med pass I struggled with for 2 months, had to be changed to a 3 person med pass. Also, the pharmacy and the MD's were in the process of changing med times, in addition to DC'ing all "unnecessary meds", as I had suggested....... even though I could have gone back there - the wounds were so deep and the experience left such a bad taste in my mouth - I swore I would never go back there again. I have no regrets about my decision, because I felt totally vindicated when I read her note.......maybe I wasn't able to benefit from the changes that eventually took place - but I felt good knowing that OTHER nurses could now do their jobs and not feel like there was something wrong with THEM.

I know this is a very long reply - but the bottom line is this - you need to protect your license. Patient safety IS an issue. I am hopeful that you can advocate for them until your facility agrees to making some changes so that you can do your job to the best of your ability.....I wish you the very best of luck.

LPN1974, LPN · Feb 9, 2005

her response? "It's not that simple. You just don't go around changing med times....

Your DON just didn't want to fool with it, in short she didn't CARE about the hassle you were going thru everyday.

It isn't the doctors who set the TIMES.....they set the frequency.

If he says QID, that's all he is saying. He doesn't care if it's 7-11-3-7 or 9-1-5-9.

The facility is the one who sets the policy on what times the med rounds are.

The times can be reset to give more time for the med passes to be completed.

We just recently did the same thing at my job. I work in MR/DDS, and we have 7 homes to give meds to people, with about 20 people served in each home. The times were reset to accommodate med rounds at 7-11-3-7 and 8-12-4-8.

We now have more time to get the meds done, and we are in compliance with state regs.

My DON just did this herself. No MD approval required.

Of course, it still remains to be said that LTC facilities traditionally work the med nurses short handed. They won't hire more nurses to do what one has been doing unless they actually get into trouble for it.

It's all about money.

littleplaynurse · Feb 9, 2005

I agree with you - that when is all said and done, it really IS about the money. If these places would hire more nurses this problem wouldn't even be an issue. I just can't fathom how a lawsuit brought against a LTC would be less expensive than adding another one or two nurses to the payroll........ and yes - my DON just couldn't be bothered - until she was FORCED to make some changes. It only goes to prove once again that if we don't continually advocate for ourselves and the patients who depend on us for their care - no one else will............

irishnurse67 · Mar 22, 2005

I recently took a job w/an agency going to nursing homes about one day a week. (My regular job is on a med-surg flr.) The nurses in nursing homes act like it's a totally foreign concept to give meds within an hour of the time they're scheduled. If it can't be done, then some meds need to be d/c'd or more nurses need to be pushing pills.

pediatriclpn · Mar 22, 2005

I think the state regs need to be changed so that med passes can once again be done in the dining room, or with me and my cart outside the dining room, and me taking their meds to them. And what about the pt who gets OOB early and won't go into a bathroom, or back to their room for their insulin injection? What does the state say about that? Isn't it infringing on their rights to get their meds where they want them and in a timely manner? I have NEVER in all the time that I worked LTC, had someone complain about me giving meds with a meal. I have had pts complain because I was late, because they wanted to take their meds with breakfast, and me being new was later with their meds than they were used to. :uhoh3:

CoffeeRTC, BSN, RN · Mar 22, 2005

I recently took a job w/an agency going to nursing homes about one day a week. (My regular job is on a med-surg flr.) The nurses in nursing homes act like it's a totally foreign concept to give meds within an hour of the time they're scheduled. If it can't be done, then some meds need to be d/c'd or more nurses need to be pushing pills.

Please read the rest of the thread...This is what we have beed discussing. It is not that it is a foreign concept...sometimes it is just impossible. I can to it most times on my shift, but I only have 26 residents some nurses have up to 50.

bugsbee · Mar 22, 2005

I only worked LTC for 4 weeks and it was scary to think you gave meds like they do. You can;t give them the way your taught or you would never get through med pass. Lots of med errors and they were swept under the rug. Most meds you could not find and you were told just borrow from another resident. I have been a nurse for 20 plus years and would not ever work under those conditions. I hope there are some LTC facilities that do care and hire enough staff. I would hate to have a family member in the LTC facility I worked for.

debbiemig · Mar 23, 2005

2 weeks ago we had our state survey! There were about 10 survey people, several were being trained. We did'nt have one citation in regard to med errors or untimely med administration. Could it be that the state is well aware of this problem and just don't include timeliness in the survey?I don't know!Any survey nurses out there that can enlighten us?

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!

PHTLS · Mar 24, 2005

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. 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?

Who cares! just do the best you can. What are you? a martyr?

PHTLS · Mar 24, 2005

I only worked LTC for 4 weeks and it was scary to think you gave meds like they do. You can;t give them the way your taught or you would never get through med pass. Lots of med errors and they were swept under the rug. Most meds you could not find and you were told just borrow from another resident. I have been a nurse for 20 plus years and would not ever work under those conditions. I hope there are some LTC facilities that do care and hire enough staff. I would hate to have a family member in the LTC facility I worked for.

Of course! What do these "State" people think? We're super nurses.

If you want to be perfect all the time, go get a home health job where you only have one patient to take care of. Better yet, work ICU.

bugsbee · Mar 24, 2005

PHTLS

All I can say is wow you are taking care of residents? I would hate to think it was a family member of mine. If we as nurses have no pride in what we do what will it say about our profession. The place where I worked would give meds at the time they had available not at the given times. Why bother to put times down and just give them random.

rebel_red · Mar 25, 2005

Ohhhh I feel the pain. My med pass is for 20 rehab patients and 10 long term care. The hallway I work is called "the bermuda triangle." Nurses go in and are never seen or heard from again. Most of my patients have 6-8 page MARS, 5 meds to a page and I am not counting the PRNs. Plus I work doubles all weekend, so my families are there.... often during the first med pass. We have constant admits and families require quite a bit of tlc and education. I consider myself lucky when the morning medpass is done by 12 noon. Food? Whats that? Unless breaking all sorts of laws someone is kind enough to dump a donut and coffee on my cart I rarely eat.

Sit at the desk to chart? Lovely concept. Except everyone needs to speak with whoever is at the desk. Try to tell a family "I would love to answer your question, but I don't know the patient." Though I'll pull the chart and give it a shot. I love the whole nurses are interchangable theory. I think my favorite thing is when you are sending someone to the hospital 911 in ARD or with CP and the family members at the desk stare at you hard and make loud obnoxious comments because "Mom needs icewater and we asked a whole 5 minutes ago....." Treatments and assessments are about the only time I really get to spend time with my patients. I can actually live with all of this because I love my job. What I can't live with is when you try to promote positive change and people respond with "Thats the way it is you just need to accept it." Like hell I do. Oh well, sorry for being less than constructive. Needed to vent.......

Tres

Who is currently comtemplating being a wal mart greeter.......Hiya how ya doin? Welcome to Walmart...What can I help you with today??? And I'd look really cute in the vest.....