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?

[lvlissl2ebecca]

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

I did not mean for that to be taken so literally. Of course I know they are not "My" CNA's and dont work "For me".. but I figured you would catch the meaning behind it. That was a little too hostile of you for my taste. I simply meant that they work as hard as they can and that makes me more efficient as a nurse. If they didn't do their daily tasks (which I can relate because I worked along side them before going to LPN school), I couldn't imagine doing my tasks to the best of my ablility. I help where/when I can.

As for not waking someone up at 9 pm to give them their meds, I would love to not have to give meds after 7pm (which is the time at which a lot of residents lay in bed to sleep)... 9pm is a standard time for a lot of medicines in our facility. Of course I don't like being woken up in the middle of the night, noone does but I am here to do my job the way its supposed to be done. If I were to go to my DON or the doctor and say hey.. lets not give any medicine after 7 or 8 pm.. they would probably give me some long answer why that won't work or something about regulations and think obscenities in their head. Sure, we could make QID medicines BID with larger doses, but the doctor orders it the way its ordered for a reason. I worded the "Thats what they're here for" part wrong. I was in no way saying that they are there for us to inconveinance them. They are there for care.. healthcare and holistic care.. and often times end of life care. This, however, is not hospice and the residents every wish is not always granted as if it were. Yes, we accomadate their needs within reason, but that reason is a very limited one.. not because we don't want to but becuase of the heavy regulations. A lot of residents get QID medicines which are spaced 6 hours apart for a reason. Standard time for that is 3, 9, 3 and 9. If I could go with out waking a single resident up, believe me I would.. I'm sure the CNA's would love to just be there to help those who get up as opposed to checking and changing every single incontinent person every 2 hours, as well. Unfortunatly, LTC facilitys are so regulated that it is a requirement.. sleeping or not. Yes, it is their home. In a perfect world it would even seem like a home.. but, like I said, because of regulations put upon LTC facilities.. this is how it has to be and there are rules that I and every other LTC nurse must go by. The fact of the matter is you can only do so much and you HAVE to do your job no matter what. I would love to see a change in all of this, but I never see it happening. In fact, I feel it will only get worse.

[Kymmi]

I see no reason why the times of meds cannot be customized according to the PATIENT's needs (not for nurses convience). If the patient goes to bed at 7pm then make the med ordered at hs 7pm for THAT patient. I currently work hospital but prior to hospital I worked LTC for 10 years and did med passes for all that time. I also see no reason that if a stool softener is ordered BID doesn't mean it has to be 12 hours apart. Also remember that when patients at home have meds that are ordered QID they do not get up and take them every 6 hours....most take them every 4-5 hours in order to get 4 doses in the day. I think its all a matter of making sure that the med times are set as to what works best.

I've read all the posts and I realize everyone has a different take on this however bottom line is what is done should be done all the time and if you can say that when the state is there things are done differently then for sure you are setting yourself for something to happen and even though it hasnt happened yet doesnt mean it won't and chances are it will at some point.

The thing that really stuck out to me when reading this was the comment about the man who was ordered Neurontin 200 mg at 5pm and 9pm and was receiving both doses at 7pm .....I dont care how hard you try to justify that one there is nothing you can say to ever make that right and Im willing to bet that it wasnt charted as him receiving 400 mg at one time but it was charted as receiving 200 mg at 5pm and 200 mg at 9pm.

[softstorms]

Sometimes Hs meds are different things to diffent pts. What you do is get to know the pt. then ask the Dr. to change the med time. I have found in long term care that most pts. go to bed right after dinner. That would be around 7 pm. If the have a Hs med of colace at 9 pm, then ask the Dr to write it for earlier. Most of the Dr's I work with are more than glad to change times to fit the pts. convenience. This can help you keep within the guidlines.

[CoffeeRTC, BSN, RN]

My other take on this is that just because one person does it doesn't make it right. The OP is right to question the other nurses practice. Working only on the weekends, I get weird looks all the time when I try to give residents their meds on time or a "huh, no one gives me pills twice ( the 5s and 9s). I would never ever double up on doses. Meds are timed for a reason.

Just a question for the PP and maybe this should be another post....do you really time your qids for 9, 3, 9, 3? That seems a bit harsh to be waking up folks at 3am? How do you others do it? We do a 6, 12, 6, 12 schedule and only for a few meds that must be given that way. Please remember this is LTC question.

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

Sometimes Hs meds are different things to diffent pts. What you do is get to know the pt. then ask the Dr. to change the med time. I have found in long term care that most pts. go to bed right after dinner. That would be around 7 pm. If the have a Hs med of colace at 9 pm, then ask the Dr to write it for earlier. Most of the Dr's I work with are more than glad to change times to fit the pts. convenience. This can help you keep within the guidlines.

Thank you. It is as simple as that.

We are trained professional nurses - not robots.

Speak up!!

steph

[Jo Dirt]

I did not mean for that to be taken so literally. Of course I know they are not "My" CNA's and dont work "For me".. but I figured you would catch the meaning behind it. That was a little too hostile of you for my taste.

I apologize (and I sincerely mean that.) I understood what you meant, I just had a knee jerk reaction because that is something that has always drove me around the bend when I hear it.

It just sounds demeaning to me to refer to anyone as "my"...aaahhhh!!!

You are absolutely right, I was way too hostile and I am sorry about that.

[SuesquatchRN, BSN, RN]

We had leeway to set a lot of times ourselves.

If we had someone who needed to be given meds off-times for specific reasons we documented the heck out of it. For example, I had one man who would refuse and everyone, down to the DON, knew the objective was to get his QD meds into him whenever.

When changing times, though, be careful of interactions. Somewhat innocuous seeming things can be contraindicated - iron inhibits Synthroid, for example, and the ubiquitous 6 a.m. tummy meds usually deleteriously interact with, well, everything.

[middlekane]

If I were to go to my DON or the doctor and say hey.. lets not give any medicine after 7 or 8 pm.. they would probably give me some long answer why that won't work or something about regulations and think obscenities in their head. Sure, we could make QID medicines BID with larger doses, but the doctor orders it the way its ordered for a reason. I worded the "Thats what they're here for" part wrong. ... A lot of residents get QID medicines which are spaced 6 hours apart for a reason. Standard time for that is 3, 9, 3 and 9. If I could go with out waking a single resident up, believe me I would..

Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.

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

Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.

I like your style.

Work with the pharmacist, the docs, the other nurses to come up with a system that makes sense.

This antiquated system needs fixing - "The emperor is naked". :monkeydance:

steph

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

We had leeway to set a lot of times ourselves.

If we had someone who needed to be given meds off-times for specific reasons we documented the heck out of it. For example, I had one man who would refuse and everyone, down to the DON, knew the objective was to get his QD meds into him whenever.

When changing times, though, be careful of interactions. Somewhat innocuous seeming things can be contraindicated - iron inhibits Synthroid, for example, and the ubiquitous 6 a.m. tummy meds usually deleteriously interact with, well, everything.

This is why it is essential to have the pharmacist and docs work with you.

steph

[lvlissl2ebecca]

Give it a try. I bet that if you do, they would be impressed by your initiative. Sure not every med pass at 9 pm could be changed, but a lot of them can be. The docs don't often think about the timing of the meds in terms of it fitting into the patient's life, meals, sleep timing, etc. Believe me, I'm an NP student and one of my rotations was in a nursing home with a geriatric NP. It wasn't something we would really think about, but a couple patients, the nurses came to us and pointed out that the timing was a problem and we were able to drastically rearrange and simplify the pass. Give it a shot, pick out a patient where it's a real problem and discuss it.

I appreciate your post. I think I will give it a try as I thought about this thread last night and what I said about them thinking obscenities and then I thought... why do I care? Atleast I can give it a try. So, thank you for your insight. I don't mean to offend anyone when I tell the truth and say these things. I don't like the way that long term facilities work at all. a 31:1 nurse/patient ratio tops it all off. No, they aren't in critical condition, but all of them are demanding and time consuming in their own way. I do try my best to do everything the way it is supposed to be done, and with all of the things that go on in one 8 hour shift its hard to even get a moment to think about that (which sadly enough is low on the priority list with falls,neurochecks, meds, and treatments, doctors etc). I know I'm preachin to the choir.. my point is I may just go in on one of my days off and go speak to my DON about this.

[SunbabiLPN]

I remember all too well what it was like to be a new nurse in LTC. I was also an agency nurse so I always was assigned the worst halls. It takes time to learn how to manage your time efficiently it doesnt happen overnight. Doing things by the book does bring great satisfaction as you said when the noc nurse commented on all your patients resting soundly. There are shortcuts that you will learn along the way but it is never safe to alter med times. Soon you will be able to do a million things at once and you will be done with your work, charting and treatments on time. Until that day comes just breathe in peace and breathe out stress. Your day will come trust me.