Help speeding up

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New to LTC. I have 40 patients and can’t seem to do all my med passes in time because of so many interruptions. All 40 patients have 8 o’clock meds; that leaves me a 2-hour window which is 3 minutes per patient. Plus, I have to take vitals and fingersticks. Inevitably when I see a patient to pass a med, there is an issue that needs to be addressed or the patient requires a treatment, nebs etc. That is slowing me down, and the constant but necessary interruptions, i.e. doctors and families, patients trying to escape, and the paperwork is NUTS. The GNA’s are awesome and take care of ADL’s.

The nurses who are training me all insist that management expects too much, and they are correct. They all have ways to cut corners to get the work done, i.e. giving 2 o’clocks with the 8 am med pass or they just sign a treatment as completed when it is not. I see now how they get their work done on time! My manager says I need to speed up. Of course I never take a lunch and always get out late.

In any case, I really need this job. I’ll take any advice on how to speed up while still remaining safe and legal.

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Specializes in LTC, New to Tele/ Cardiac!.

Designate your vitals for your CNA's to do! (Unless you need to do a BP for a parameter). I know they have alot to do as well, but you cannot waste your time doing vitals too!! 40 patients is awful, I feel bad for you! I would have 40 on 3rd shift but on 2nd shift I only had 20... I wish I had more advice to offer you.. I hated when the nurses would sign off on things and not do them! It was my pet peeve! It would always explain how they would be READING a BOOK for leisure when I would come in at 3pm.. "It was so quiet today".. WHAT?! Then I would find that NOTHING was done, yet of course was signed off on! GGRRR sorry, just venting there! lol. Don't give up! And ya know what? If you can't finish on time, its okay! Maybe its time for management to re evaluate their policies! Good luck to you

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Specializes in LTC, Med-SURG,STICU.

Have the CNAs do your VS. Remember almost everyone is passing meds late. Too many residents not enough time. It also takes a while to get a routine down, but that is the key, routine.

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I feel bad for you. LTC is not what it should be. There are some short cuts you can take and not feel bad about. Try to do things the right way and request some time saving changes. Consolidate meds on medex, eliminate some of the VS, and refuse to let visitors to bother you while you are passing meds. It can be mentioned nicely that you need to focus on patients meds. And yes I do pre- pour and label meds when necessary.

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I don't like the sounds of this place and I would recommend running far away from there. 40 residents is way to many to handle.

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Specializes in LTC.

Med-passes in LTC do take 3-4 hours. Because there's just no way to pass meds to 30, 40, sometimes 50 residents in a two hour time frame.

Have your CNA's do vitals. Creams I pass onto the CNAs when they change them. Those are listed in the treatment book in my facility but the only treatments I do are dressings and g-tube care.

Start your med-pass as early as possible. I find when I go in room order.. it goes more orderly and sometimes quicker.

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Specializes in Acute Care. ER. Aged Care/LTC. Psyche.

the most number of residents that I've handled was 23. I have 2-3 CNA's.

Majority of the medications are given 0800, and I'm starting my med pass around 0745, that's after my 4-5 accuchecks. (I'm doing 7am-7pm) So I'm doing the accuchecks first. Then med pass.

All the treatments (wound dressing, etc) are given every 1000. If around my med pass time a resident needed something not urgent, or if it can wait after I pass my meds, I'll politely say that I need to pass my meds first and will get back to them as soon as possible.

Sometimes I do change the sequence of to whom I'll give pills first. Usually those who can swallow a bunch of pills without difficulty are the ones I go first. Or those without narcotics that you need to get from a locked drawer. Or those with fewer meds.

Also, since its pretty routine, even their concerns are routine. So if I know that a certain resident will complain about a "routine" concerns, I'll say it in advance. Example: a resident constantly asks you to change his wound dressing, or to give his pills first. Just go ahead and tell them that "hi, good morning. How are you? Blah blah I will change your dressing around 1000". In that case, you addressed their concern and you saved time answering the call lights.

And I don't know about how your facility wants you to do paper works. But there are certain days that are not busier than the other. So there are paper works that I do on days that are relatively quiet, such as the weekends. Usually, these paper works include monthly summaries, skin assessments, patient assessments that are not done every day but on a weekly or monthly or quarterly basis. So technically, at least on my facility, I can do it within the given time frame, not exactly on the date its written on the treatment sheet.

Also, be friendly to your CNA's. They can help you tremendously. Like watching for a resident who tries to escape, or doing routine VS, or simply "covering" for you when an "unnecessarily-needy" resident wants you.

Good luck!

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Specializes in Acute Care. ER. Aged Care/LTC. Psyche.

just to add:

all, as in all of the residents in the facility that I'm working wakes up for breakfast and go to the dining room. so med pass is easy.

I also have a cheat sheet, with all the resident's name, things I already done, and things that needs to be done.

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Specializes in Home Care.

I thought 20 was enough for a new nurse, on a bad day I have 30 if one of our nurses doesn't show. But 40? Heck no...

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Thank you all for your advice (and concern!). You have given me wonderful suggestions and I plan to incorporate these suggestions in my daily work. I had no idea how difficult it is to work in LTC. Wish I had more time with the patients! But at least I am learning how vital it is to stay organized. Thanks again for your replies! Will keep you posted.

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Specializes in Gerontology, Med surg, Home Health.

Ask your pharmacy consultant to help you either get rid of meds, increase the dose and decrease the frequency, or change the times so you stay in compliance. You can NOT give 2pm meds at 8am...you can NOT prepour and label...unsafe practice. You can do some assessments while the slow poke is taking meds...lung sounds...peek at a wound...you'll find a way to get it done and get it done the right way.

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Specializes in Pediatrics, Geriatrics, LTC.

You can do some delegating. You can have the CNA's do vitals, but I wouldn't use them for meds like lopressor which is held depending on vitals, those I do myself.

You can sometimes combine the 5 and 7 med pass but I wouldn't go as far as 6 hours apart! That's just not ok, especially since many LTC residents get similar meds at different times.

You will get faster as you learn the residents, their usual meds and where to find things on your cart. I started in April and it took me the whole shift to do my med pass, now in August I'm down to maybe 4 hours or so. You will get a feel for it. I do my first med pass when i come on shift, along with ac dinner insulins. Then treatments while they are getting ready for bed from like 6-7, then take a quick break. By 8 it's time for the 9 o'clock med pass and more insulin. That pass is faster and smaller. I aim to be done by 9:30 for paperwork. Hopefully no one falls or gets sick!

It's a hard hard job, but you get a lot of good feelings from it once you get it down believe it or not.

Good luck

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