Gving all the meds all at once?

[ari3sdog]

I've been working as Nurse in LTC for 2 months now. Woot. I'm just concerned about the ways of other Nurses who gives all the meds for 5pm and 9pm all at once?

Is that bad?

I asked one of the Nurses if it is ok. She said.....

It's ok to give earlier if....

1. Vitamins

2. Eye drops

3. Docusate

4. Senakot

You have to give the other medicine on time if

1. B/P meds

2. Insulin

3. Heart Meds

4. Coumadin

5. Dilantin

6. Vicodin

7. Inhalers

8. Sleeping pills

I was thinking, if you guys do agree or disagree on these. It seems so hard to give all the 5pm meds and then later give all the 9pm meds on time. There are a lot of charting to do and Treatment, it so overwhelming.

They told me about the 1 hour before and 1 after rule on passing meds. They even laugh at me because I was doing the "Book Way" that pass all 5pm meds and then later 9pm meds, so I'm doing what they are doing. I felt I'm doing the wrong way, but everyone is doing it and nothing seems to go wrong. Also, I somehow agree about they told me about that certain drugs are ment to give on time, and some are ok to be late. Most of them are doing it for 17 years now and the patients are ok. Any comments to experience Nurses out there?

[Spidey's mom, ADN, BSN, RN]

If the current schedule doesn't work, get it changed. One of our nurses bribed the medical director and the pharmacy consultant with breakfast and they all sat down and went over the med schedules and made a ton of changes that make med passes easier for the staff and more convenient for the residents. They did things like give higher doses BID instead of lower doses QID, got rid of a lot of vitamins and things like that, and changed med pass regulations so that HS reflects the time the resident goes to bed rather than a standard HS time. It took them almost all day to get it done, but our med passes are much nicer now...for both the residents and staff.

Exactly! Communicate!!

steph

[Daytonite, BSN, RN]

OMG! If a medication is scheduled to be given at 5pm then it needs to be given at 5pm. There is usually a one-hour leeway (4pm-6pm) to give it. NO, it is not OK to give all the meds for 5pm and 9pm at once. In fact, it's illegal. You should report that this is being done to the DON. The correct way to give a medication at any other time is how your facility policy tells you to do it in their medication policy. Otherwise, these medications should be rescheduled on the MARs to be given at whatever times these other nurses are actually giving them. To not do that is just plain lazy and unethical on their part.

You continue to do things the "Book Way". That is the correct way. If you listen to these other ninnys you will get into trouble along with them. Just because everyone says they are doing it and they have been doing it for years doesn't make it right. These kind of nurses in LTC make me sick and is why I kept going back to LTC--to run this kind of deadwood out. These nurses have no business working--they are wrong and violating the nurse practice act. Please report them to the DON and keep reporting them until somebody does something to remedy this situation. If the DON turns her back to it, I'd notify the state department of health of what was going on.

[NursingAgainstdaOdds]

In addition to the advice already given, I would add that it's important to time even vitamins/supplements correctly because they can inhibit the absorption of other medications. Also, eye drops frequently aren't "just" eye drops - the scheduled intervals w/ them are important to maintain therapeutic effects.

[Jo Dirt]

OMG! If a medication is scheduled to be given at 5pm then it needs to be given at 5pm. There is usually a one-hour leeway (4pm-6pm) to give it. NO, it is not OK to give all the meds for 5pm and 9pm at once. In fact, it's illegal. You should report that this is being done to the DON. The correct way to give a medication at any other time is how your facility policy tells you to do it in their medication policy. Otherwise, these medications should be rescheduled on the MARs to be given at whatever times these other nurses are actually giving them. To not do that is just plain lazy and unethical on their part.

You continue to do things the "Book Way". That is the correct way. If you listen to these other ninnys you will get into trouble along with them. Just because everyone says they are doing it and they have been doing it for years doesn't make it right. These kind of nurses in LTC make me sick and is why I kept going back to LTC--to run this kind of deadwood out. These nurses have no business working--they are wrong and violating the nurse practice act. Please report them to the DON and keep reporting them until somebody does something to remedy this situation. If the DON turns her back to it, I'd notify the state department of health of what was going on.

Well, if they've been at it for 17 yrs. I doubt much is going to change with that.

[Jo Dirt]

Sorry..but I'm just upset the way things is going on and I don't konw what to do.

But I'm ok now. I did try passing all meds at 5...then I do 9 today...I found out that there are 10 residents that I'm suppose to give meds at 9. So, I'm ok now. I felt that I'm doing the right thing. And the NOC shift nurse notice that all the residents are sound asleep for the first time. I felt good inside after hearing that.

Are there only ten residents on your hall?

I've been there. I know what it is like to work a floor with 42 patients who get meds around the clock. The only nurses who have lasted any length of time were the ones who knew how to prioritize and organize and who weren't worried about running to the BON because something wasn't done a certain way. The DON of the facility told me herself that you have to develop a system that works for you. This is purely anecdotal (that is really all we have to go by, though) but at that nursing home we had little to no skin breakdown (in spite of using diapers), the place was so clean you could eat off the floors, and the patients were exceptionally taken care of. This was always reflected in the stellar evaluations we received from the state inspectors every year. We even had surprise visits when a disgruntled ex-employee would call...still passed with flying colors.

I guess I got spoiled working for this nursing home because it was so well run and we did not have the issues it seems like so many have. When others start slamming down the old timers at your nursing home for using their expertise and discretion about when and how to give the meds. it makes me remember the RN who lost her desk job after 12 yrs. and came to work the floor at this nursing home. She was incredibly stressed out because she wanted to give every pill at the exact time and it just didn't work out. The more detailed she tried to be the further behind she would get and at one point she ran out of the place hysterical and in tears. She came back in and tried again but only lasted two more weeks. It was the 3-11 pm shift and she would be there until 2:30am. I know there are medications that are important to take at certain times and on a regular schedule but I also know when the rules can bend a bit and if any nurse in a nursing home tells you they do everything by the book they are LYING.

I say learn from these nurses who have been there and can help you. If they weren't trustworthy and didn't know what they were doing they wouldn't still be there after 17 yrs..

[Spidey's mom, ADN, BSN, RN]

OMG! If a medication is scheduled to be given at 5pm then it needs to be given at 5pm. There is usually a one-hour leeway (4pm-6pm) to give it. NO, it is not OK to give all the meds for 5pm and 9pm at once. In fact, it's illegal. You should report that this is being done to the DON. The correct way to give a medication at any other time is how your facility policy tells you to do it in their medication policy. Otherwise, these medications should be rescheduled on the MARs to be given at whatever times these other nurses are actually giving them. To not do that is just plain lazy and unethical on their part.

You continue to do things the "Book Way". That is the correct way. If you listen to these other ninnys you will get into trouble along with them. Just because everyone says they are doing it and they have been doing it for years doesn't make it right. These kind of nurses in LTC make me sick and is why I kept going back to LTC--to run this kind of deadwood out. These nurses have no business working--they are wrong and violating the nurse practice act. Please report them to the DON and keep reporting them until somebody does something to remedy this situation. If the DON turns her back to it, I'd notify the state department of health of what was going on.

:w00t::bowingpur:flowersfo:yelclap::yeahthat:

steph

[Spidey's mom, ADN, BSN, RN]

You do not have to devise a system to run around the rules. Just go to the docs and the pharmacist and find another time system that works so people don't have to cheat and lie.

This is just not professional. This is the image we professional nurses are trying to change.

The nurse who came back on the floor and had trouble - all she had to do was correct the bad system instead of trying to keep up with it. She needed to document how bad the system was and get it changed.

Stand up for your patients' rights and for your license.

steph

[Jo Dirt]

I will venture to say the ones with the strongest opinions on how to work the floor of a nursing home have little to no experience doing so.

[ari3sdog]

Thank you for your support...=D

[lvlissl2ebecca]

It is in no way acceptable to give all 9pm meds at 5pm. I am a new nurse of only 3 months working at a LTC facility, and while I admit that I don't do everything by the book, I would never do this. There are nurses who give 9pm meds to one particular resident at 5pm because they say that "He never takes his meds if you dont give them all at 5pm", but I do not do this, and the only thing I have had to do is go in and wake him up to take his meds. Who cares if you have to wake up a resident to take meds..that is what they are there for and thats what the doctor says you should do. Certain things are okay to take shortcuts on (sometimes you have to), but meds are not one of them. Every evening I do a 5pm med pass starting at 4pm and a 9 pm med pass starting at 8pm.. this covers all the meds (except for a couple insulin shots and neb tx.) for the evening within the alloted window. Cut corners other places, but not with medicine. You never know if giving those 9pm meds at 5 pm could cause an adverse reaction, even if others do it.. it could happen anytime. You just never know. Even if it does take you longer to do a med pass.. atleast you can go home and sleep at night instead of wondering if someone "Knows you didn't give your meds at the right time". They say that cutting corners at all is bad nursing.. but its smart nursing and allows you to be more effecient for your residents... you just have to find the right things to cut corners on.. and it doesn't even have to be cutting corners.. more of developing a system and using your time wisely in between med passes and treatements for charting. It always helps to have good aides... I love my CNAs.. they work so hard for me and having a good team of CNA's makes the day soooo much smoother.

[Jo Dirt]

It is in no way acceptable to give all 9pm meds at 5pm. I am a new nurse of only 3 months working at a LTC facility, and while I admit that I don't do everything by the book, I would never do this. There are nurses who give 9pm meds to one particular resident at 5pm because they say that "He never takes his meds if you dont give them all at 5pm", but I do not do this, and the only thing I have had to do is go in and wake him up to take his meds. Who cares if you have to wake up a resident to take meds..that is what they are there for and thats what the doctor says you should do. Certain things are okay to take shortcuts on (sometimes you have to), but meds are not one of them. Every evening I do a 5pm med pass starting at 4pm and a 9 pm med pass starting at 8pm.. this covers all the meds (except for a couple insulin shots and neb tx.) for the evening within the alloted window. Cut corners other places, but not with medicine. You never know if giving those 9pm meds at 5 pm could cause an adverse reaction, even if others do it.. it could happen anytime. You just never know. Even if it does take you longer to do a med pass.. atleast you can go home and sleep at night instead of wondering if someone "Knows you didn't give your meds at the right time". They say that cutting corners at all is bad nursing.. but its smart nursing and allows you to be more effecient for your residents... you just have to find the right things to cut corners on.. and it doesn't even have to be cutting corners.. more of developing a system and using your time wisely in between med passes and treatements for charting. It always helps to have good aides... I love my CNAs.. they work so hard for me and having a good team of CNA's makes the day soooo much smoother.

They aren't your CNAs. They are CNAs you work with. They don't work hard for you, they work hard for the patients.

As for meds, the MAR sets nurses in LTC up for failure. Wait, I can't say that as a blanket statement because I don't know what all nursing homes are like. My friend works agency andthe nursing home where she is all she does is pass meds. No charting, no treatments. Anyway, I find it hard to believe there are only two times a shift meds are scheduled because where I worked, patients were getting meds at all hours, especially on 7-3 and 3-11. One of the problems with the MAR is that most of the time, when doctor's prders were given to the nurse they did not specify 3pm or 5pm, they would say either QD or BID or TID or QID or 2x's per shift, which would mean it was up to the nurse taking the order to put whichever time she saw fit. Looking at the MAR, you would see meds were laid out out for 3, 4, 5, 6, 8, 9...and most of the patients were on A LOT of meds. If juggling the med pass to get things done as best as we knew how makes us liars and cheats I guess we're the scourge of the earth then. I just know it's awfully easy to see what's wrong with how someone does something when you don't have to do it yourself.

A lot of times, meds would be specified simply HS. I was taught that for a lot of the patients, their HS was right after supper, which was around 6:30pm. You don't catch the patients when they are awake and you are likely to be out of luck expecting them to get up again to take their meds. And the patients are not there for us to give them medicine at all hours of the night. We are taught that is their home and if a patient requested all their meds at once you were expected to give it to them that way, within reason of course.

The nursing home is not the hospital and when nurses come in and expect to see it work like one they are in for a big surprise. It is a totally different animal.

[CoffeeRTC, BSN, RN]

but I do not do this, and the only thing I have had to do is go in and wake him up to take his meds. Who cares if you have to wake up a resident to take meds..that is what they are there for and thats what the doctor says you should do. .

wow. Um No. See that is the problem. This is their home. Sleep is soooo important. Do you like to constantly be woken up at night? I don't (unless is is for the baby, but that's a different story;))

LTC needs to be changed. Some places are going thru "the change" but I'm a realist and I don't think it will ever change to where it needs to be. Why do we all have to wake up at the same time, eat at the same time, take our pills at the same time. Why do I need to get a finger stick at 5 in the morning and take my pills then? I know the answers....because, I have 30 something residents today and I need to do x, y, z by this or that time.

I'm gonna chime in and say that things can't be done by the book 100% of the time. Ain't happening where I work. Do my pts get their meds early or late? Yah, but not as a habit.

A lot of other posters mentioned just changing the orders or getting the med changed. I/ we do that. You might also want to consider careplanning med times or general med times. Surveyors love this. We have a few pts that like to take their pm meds at dinner or after dinner since they go to bed at 7pm. CP it and CYA. If a pt request a certain tim, we try to adhere to it...more often that not, they want the meds earlier.