Help, need tips for doing a much faster med pass...

CoffeeRTC, BSN, RN · Jun 22, 2005

We don't do bps with every med. It is our policy to only do them q week unless the md specifically orders it. That saves a bunch of time. I still tend to to bps alot. :rolleyes:

CoffeeRTC, BSN, RN · Jun 22, 2005

I tried working in LTC, but cannot due to the craziness of getting things done in a "timely manner" and doing it "as safe as possible". I find it hard to believe that the "right patient" is always getting the right dose, at the right time, etc. as fast as the staff passes their meds. It's shocking to me, and no way was I going to rush through passing meds or doing treatments on a slew of patients and not know who they were. They do not wear nametags or ID bands on their wrist, so how do you all tell them apart? Don't tell me by their photo that is taken when they are admitted to the center because those photos all look alike to me. :chuckle
Hats off to all who are LTC nurses! I can't do the job! It's too hectic for me.:)

Since most of them are ltc..you get to know the pts, so Rt pt is the easy one..the only thing we all seem to have a prob with is the time :uhoh3:

lizscott nurse · Jun 22, 2005

Hi! You are not alone! I have the same problem working in a 31 bed assisted

living (nicer term for long term care : ) ) I work 6a to 6p. Report and narc count usually takes till at least 6:20. I then get my cart loaded: gloves,

one touch supplies, ice water, cups etc. Then I unlock the doors and the day

begins. It usually takes me till 8:30 to complete, often closer to nine. The

nurse who works opposite me is always done at 8a.m. She presets meds in

medcups (already punched out of paper) I don't see how this really helps

whether you punch them out before or at the time you are going to give them. Anyhow I don't preset meds. I struggle all the time trying to think

of ways to save time. I keep telling myself it's not a race. It's more important to cover all your bases (not omit anything). Of course no matter how we struggle to get done a little earlier to start on that paperwork, make those phone calls, track those lab results, assess the residents who aren't

feeling well, etc. something can and often does happen ie transport to ER

fall. I have another med pass at 10a and the final one at 4p. Those aren't

as lengthy. Thank goodness. I guess all you can really do is keep on keepin

on. We do arrange our med drawers to match up to the MAR's, which is

very helpful. Also our narcs and sheets are in alphabetical order making them

much easier and faster to locate.

night owl · Jun 22, 2005

We don't do bps with every med. It is our policy to only do them q week unless the md specifically orders it. That saves a bunch of time. I still tend to to bps alot.

I only wish I didn't have to take it every time, but the Dr orders a parameter with each and every anti-hypertensive med, "Hold if SBP

DG5 · Jun 22, 2005

I find it can't be done any faster than what I know I am safely doing it at. And then I have to keep reminding myself that the most important thing I am doing right now is the one med that I am doing right now. I can't focus on all the meds ahead to do. I remember my mom telling me "just put one foot ahead of the other, one step at a time." What's the use of worrying whether you can get it done as quick as the others?? You are responsible for your professional practice and if it takes all evening, so be it. I find that when I am not worrying about all the meds ahead of me, I can be more observant and listen better to my resident as I am giving it out. There is planning and foresite, and that is what the other posts are all saying - make sure your cart is stocked well, plan it well before starting, and then, just put one foot ahead of the other. Best of luck.

Ms.RN · Jun 22, 2005

i dont know if this is going to be helpful, but what what've learned helped me to pass medications faster. i found that tagging the mar is very helpful. i work 3-11, so i tag green for all 6pm meds, and blue for 9pm, and red for blood sugar checks and insulins. and after giving them their meds, i untag it, and if i missed giving medication becuase they are not in their room or whatever, i pull out the missed medication tag. at the beginning of the shift, i do all the blood sugars first and i prepare their meds and take it to their room and do blood sugar and give them medication at the same time. i dont know about your facility, but a place i'm working, dinner starts at 5pm and almost everyone of my patients are in the dinning room. so i start preparing medications for those patients who are eating in their room by the nursing station, and while doing that, i catch alot of patients on their way to the dining room. i call them and ask them to wait for their medicine and most of them do wait!!! after i'm done, i park my med cart by the dining room and start giving their medications. also what i was taught was when i'm doing med pass in the hallway, do it in z pattern, like do one patients room, do the next room, then a room across from it, then the next room, the a room across..... if you dont know the patient ask the cena, they are the best people to identify the patients. but.... i give medications to the same patients everyday that i memorized all the medications they are taking. i think thats why some nurses are so fast at med pass.

Hairstylingnurse · Jun 22, 2005

i dont know if this is going to be helpful, but what what've learned helped me to pass medications faster. i found that tagging the mar is very helpful. i work 3-11, so i tag green for all 6pm meds, and blue for 9pm, and red for blood sugar checks and insulins. and after giving them their meds, i untag it, and if i missed giving medication becuase they are not in their room or whatever, i pull out the missed medication tag. at the beginning of the shift, i do all the blood sugars first and i prepare their meds and take it to their room and do blood sugar and give them medication at the same time. i dont know about your facility, but a place i'm working, dinner starts at 5pm and almost everyone of my patients are in the dinning room. so i start preparing medications for those patients who are eating in their room by the nursing station, and while doing that, i catch alot of patients on their way to the dining room. i call them and ask them to wait for their medicine and most of them do wait!!! after i'm done, i park my med cart by the dining room and start giving their medications. also what i was taught was when i'm doing med pass in the hallway, do it in z pattern, like do one patients room, do the next room, then a room across from it, then the next room, the a room across..... if you dont know the patient ask the cena, they are the best people to identify the patients. but.... i give medications to the same patients everyday that i memorized all the medications they are taking. i think thats why some nurses are so fast at med pass.

:blushkiss i absolutely love the idea of multi-color flagging. i have always flagged similar to you but never with the colors for certain meds. one of my problems i have is i'm not usually on one floor, and so i never get to know the pt., their conditions, and their meds. the one job i had where i excelled at was at life care, a ltcf on the alzheimers unit. it was 3 cna's , myself and like 25-30 pts. we were on a locked unit, phone only rang after being screened for our unit. i did get to know the pts. and everything else. i haven't found anything even close to that. let me ask you, on your "z pattern" med pass are you not constanly fighting with that big mar bookflipping back and forth out of order?????? i will defiantly try that. as far as setting up and cleaning my cart that is one of the easiest part of my days:bowingpur .and i'm a hyper person so i can't attribute my slow med pass to that(i'm usually running 90 to nothing:rotfl: ). i do a really thorough report sheet on my pts. this is not a competetive problem(i'm so not competeive)it is just i want to be really good and thorough nurse. i take alot of pride in my work and i don't want to let myself or anyone else down. there have been some great suggestions in this forum so far. thanks everyone:p

OntCaRPN · Jun 22, 2005

I'm not sure I have anything to add other than my own practice and the notation that 'faster is not always better' (the old adage haste makes waste, ya know).

If you can, take the MAR to report with you, you can skim and familiarize yourself with some of the meds or times or methods.

Each of my pts has a little drawer. I take the bottles out and set them in a row as they are written on the MAR. I then pour them as they are written in the MAR ( check check check ....) and then put the bottle back in the drawer. When the bottles are all gone .... I've got that pts 'lot' and I go give them.

Another tip is to make sure there are notations on the MAR like 'needs meds crushed in applesauce' or 'give one tab at a time with milk' That'll save trips back and forth for extras.

And to the gal who was slow her first day with 44 clients!!!! Bless you for getting done at all that's humongous! and first days are always slow. There should have been someone with you for orientation anyway. You'll be waaaay quicker in a few days

Antikigirl, ASN, RN · Jun 22, 2005

In my facility my CNA's do the med pass, I do treatments and CBG/Insulins at that time. So when I have a CNA frantic because their med passes are late..I simply go there, look at the meds, and try to help them by analyzing what meds are essential at that early morning time (we have so many meds at 0800!), and write an amendium in the MAR that I (I am RN), have delayed the 0800 meds to 0900, or what not.

I take a look at it this way...I want them to do it right, and if time is rushing them...oh you can guarentee a med error! So since I am the one that typically sets the time to give (unless MD makes it specific) I can change them! I am also very good about being able to space meds throughout the day so that 0800 med passes are less stressful (I had one lady with over 30 meds in the am! She hated taking all them at 0800, the CNA was having to take on too much...and three errors happened over a week!).

Taking your time helps with med errors, and using the medication administration guidelines are essential...even if it takes time! So best to be safe, and if need be change the time of the meds if possible (actually I found so many meds that should have been given at other times because almost all my pts are on meds that should be given one hour away from others, or stomach meds that will lower the absorption anyway!).

Ms.RN · Jun 23, 2005

let me ask you, on your "z pattern" med pass are you not constanly fighting with that big mar bookflipping back and forth out of order??????

i guess you can also tag the flag based on room numbers, like blue tag for the first 2 rooms, then greeen for the every 3 rooms, so you dont have to flip back and forth

Hairstylingnurse · Jun 23, 2005

In my facility my CNA's do the med pass, I do treatments and CBG/Insulins at that time. So when I have a CNA frantic because their med passes are late..I simply go there, look at the meds, and try to help them by analyzing what meds are essential at that early morning time (we have so many meds at 0800!), and write an amendium in the MAR that I (I am RN), have delayed the 0800 meds to 0900, or what not.
I take a look at it this way...I want them to do it right, and if time is rushing them...oh you can guarentee a med error! So since I am the one that typically sets the time to give (unless MD makes it specific) I can change them! I am also very good about being able to space meds throughout the day so that 0800 med passes are less stressful (I had one lady with over 30 meds in the am! She hated taking all them at 0800, the CNA was having to take on too much...and three errors happened over a week!).
Taking your time helps with med errors, and using the medication administration guidelines are essential...even if it takes time! So best to be safe, and if need be change the time of the meds if possible (actually I found so many meds that should have been given at other times because almost all my pts are on meds that should be given one hour away from others, or stomach meds that will lower the absorption anyway!).

Hi and I agree with you I don't want to make any med error's. I think that is a big issue of mine. I didn't seem to be so panicky when I worked at the hosp. I was on a surgical med surg floor and those pts. too were on a ton of meds but I was much quicker. I've only been a nurse for a few years so maybe it speed just comes with a little time. Thanks again.:) :) :)

Hairstylingnurse · Jun 23, 2005

let me ask you, on your "z pattern" med pass are you not constanly fighting with that big mar bookflipping back and forth out of order??????
i guess you can also tag the flag based on room numbers, like blue tag for the first 2 rooms, then greeen for the every 3 rooms, so you dont have to flip back and forth

i'll deifinatly have to try all these suggestions. and you better believe [color=dimgray]i'll try flagging with the different color flags.:) :) :) and to the poster who mentioned the report sheet with how pts. take their meds(such crushed in pudding or applesause), i defiantly do that. i tend to be too thorough which sometimes is not to my advantage:rotfl: .