How do you balance your med pass?

Forever Sunshine, ASN, RN · Sep 27, 2010

When I first started out my main concern was passing the right meds to the right residents.

Don't be worried about being out of compliance. We have 25 residents. 120 minutes divided by 25 residents is what?. 4.8 Minutes per resident to give meds to.

This includes finding what meds to give, getting them out, signing the mar, getting the resident to take the med, answering any interruptions inbetween. Its impossible unless you have been doing that med pass day after day and have developed a strict routine and told your CNAs not to bother you during your medpass.

I always go over the time. I finish my 4:30 meds around 7. On a good night, 6:30. When I first started it was 8, 8:30.

pistolchick · Sep 27, 2010

Come join us for this almost-daily topic in Geriatric/LTC specialty... I'm sorry to sound negative, but the short answer is you'll probably never be within your time constraints. Let's assume you're passing to 25 residents who are all ordered 0800 meds (and they probably are, but probably a few of them are 0700 or 0900 and that'll mess you up). You have 120 minutes and 25 residents, which is 4.8 minutes to read the MAR/check the medsx3/pour... and most likely half the time you'll crush, mix, and don't forget the Miralax or Metamucil, plus draw up the insulins, take out the patches, bring everything to the residents room, and - aw, nuts, they're in the bathroom. They weren't when you started. Well, there goes that 4.8 minute allowance. How many times does THAT - or something LIKE that - happen to you during your med pass? And is someone else getting all your BPs/BSGs? 'Cause those weren't accounted for in your 4.8 minutes. Neither was an alarm going off down the hall when all of your aides are tied up. Neither was the family member who just wanted to ask you a quick question five minutes ago and is still talking. Neither was the last resident you tried to give meds to who didn't want to take them and you spent ten minutes trying to convince him/her. Neither was the fact that the next resident you try to pass to will have meds missing from the cart, and you're going to have to go back to the med room to hunt for them, and then when you can't find them you'll have to page your supervisor...

Legally, I should be passing all my meds - UINTERRUPTED - between 0700 and 0900. In reality, I pass from 0615 until 1000 and sometimes 1030. I prioritize the best I can. I save my "once a days" for last - I mean, if I have people getting hydralazine 0800, 1200 and 1700, I don't want to be giving THAT rt their meds at 1015 and then again at 1200. (Because my goodness, if I don't get most of those noon meds out before lunch gets here, I'm DOOMED...)

This is the way it is in LTC. We're chronically understaffed - as a general rule.

JenniferSews · Sep 27, 2010

Hell I have 15 skilled patients and have NEVER in 6+ months finished my med pass in the time limit. 8 minutes per patient? Great, except each one wants to complain about the number of pills, question what they are getting and why, want a detailed explanation of how each pill gets to where it needs to be, then they want some before eating and some after breakfast. I still read the MAR and the orders and it takes at least 3 minutes to pull out 12 pills CORRECTLY. It's not possible, so don't focus on it. Worry about giving the right pills to the right person and it will get easier. In LTC they usually take the same meds every single day so there isn't as much change. You will memorize the majority and find a routine that works for you and your patients.

sea~level · Sep 27, 2010

LOL i'm in the same boat. Glad to see it's not just me. Recently graduated working in LTC. Thinking I better eat some wheaties and drink my V8. LTC is no joke. :clown:

makes needs known · Sep 27, 2010

Our long term care units have 40-42 pts and one nurse. I usually work on a rehab unit in same facility, we have 2 nurses; we have just as many patients and very often have 3-4 new admits, too. Multi-tasking, cutting corners, and fudging things is the name of the game. Its not right, but what can we do? Management doesn't listen and they don't want to know. Is it more important to get VS on stable patients or do treatments? Is it more important to pass meds on time or do a mountain of paperwork? 1-2 nurses, 42 patients, no treatment nurse and its very important that all paperwork be done. Management blames us when a problem occurs.

NamasteNurse, BSN, RN · Sep 27, 2010

It takes time. In two more weeks you will be twice as fast. When I started I had 43 patients! You will figure out and know by heart, where in the cart each residents things are. You will just get faster, there's no magic to it no way except practice to get better at it. I shaved about 15 minutes a week off my med pass and now am a pro, took about 4 months to be confident.

newtress, LPN · Sep 27, 2010

Pistolchick, what you just posted is a masterpiece. That is exactly what a med pass is like in an LTC. I still feel down on myself for not being able to stay on time in compliance. Last week, I was completely on time even 10 mins ahead when the other time buster happens at 945 pm, a fall.. the incident report and there goes my on time happiness at the end of the shift. Throw in the breathing tx, and the clogged peg tubes. I'm now doing agency at LTC's and it's even worse for me because I can be at three different facilities in one week. Like being a newbie every single time I go in, and the unfamiliarity of their paperwork and where is everything! and the "why are you still on the floor? oh yeah, you're agency."

tyvin, BSN, RN · Sep 27, 2010

Another said it; you will be faster with time. I know it looks impossible and it is.

The trick is to know the residents. Who are the diabetics (catch em fast before they get to the food) , heart(BP), etc...Who has to have their meds crushed, who has crushed meds and has meds that can't be crushed, who has to have their crushed meds with butterscotch pudding and an English tea cookie while watching the sun rise, etc...Who will be out of bed and gone and who stays (it's a slice when they take off and you can't find them).

I know not everyone can afford a good BP cuff but it got so bad with all the nurses trying to get the "best" machine that I acquired my own. That way I didn't spend time looking for one. Same goes for the scope, thermometer, scissors etc...

Know who is going out. That way you can give them their meds before the family comes to get them. You have to know the schedule (activities, bus rides, etc...).

Having a good relationship with the CNA's is crucial. They can make you or break you especially with them in control of taking residents off to where ever.

You have to have a plan. Know where you're going to start and why. Have a rationale for it like these people go to the dining room right away etc... and have all supplies needed on your cart. Forget about the dressings until later.

Pre-pooring, post signing of the MAR; me, always but I wouldn't recommend it as a newbie. Forget I even said that. I don't know how I ever thought of such a thing. You would have to have a mind like a steel trap. The one thing I have not skimped on is the x3 rule of checking meds. I've only had 2 med errors in my lifetime which is very small for the amount of meds I've had to pass.

Anyway; good luck with the war because that's how I felt. When the LPN's would call in sick and no cover could be found I, as the nurse manager, was it. Without training I was sent on my first mission (with great reluctance) and didn't come out until it was time to pass the noon meds. In fact people thought I was starting my noon pass when in fact I was finishing my am pass! Yes disgusting and you all have my sympathies. After that disgusting experience my boss decided that I needed to be trained on all 5 carts (large place) Ahhhhhhhhhhhh. But I remain alive today to tell my story and sympathize with all of you. After all; it takes a very special person to be able to give 45 resistant humans 426 pills, 13 patches, 9 insulin shots, take 27 BP's, mix 16 packets of Metamucil, flush and hang for 18 feeders, crush and mix pills for 29 humans, stand by bedside while Auntie Elizabeth takes her 14 pills.......... one pill at a time, all in 1 hour. I know, I know, I've left out quite a bit but that's what makes us so GD special!

Jag815 · Sep 27, 2010

Thanks so much EVERYONE!!! You all hit the nail on the head of how my typical day is. I work the morning shift (7-3) and that 3 hr window between 8 and 10 is nuts!! If I'm done with those meds at 11:30, I'm thrilled. But lately it's been 11:45. Throughout the day, I'm speedwalking (I thought I walked fast before, here I'm really speedwalking) and sweating like a pig. Aside from trying to be safe, I feel like I have the pressure on me from my superiors to speed it up and be in compliance and that's what I think is making me feel overwhelmed. I'm only there 2 days a week and I'm trying to do the best that I can. Although everyone tells me I'm doing well, I feel like I'm not (because of the speed) and am afraid of losing my job because I'm out of compliance.

KaroSnowQueen, RN · Sep 27, 2010

OP, as may have seen, you are not alone. Even those of us who have worked somewhere for years, get in a rhythm, and are doing good, we can get side tracked by the unexpected (a fall, unexpected MD visit, family members who come in to yell at you about something the weekend nurse (not you) did to Aunt Mabel, pt with blood sugar of 22 and feeling totally fine - where's the OJ??!!!) and well, lookee there, 8 am meds are taking til 11, even tho we TRIED!!!

Nobody loses their job for non compliance with pill times, in a normal situation. Now if your 8 ams are taking you til 7 pm on a regular basis, we may have a wee problem.....but calm down, you're fine. You'll get faster as time goes by, and in a LTC, any number of things happen to slow you down. Its fine. Really it is.

Finallydidit · Sep 27, 2010

I work 3-11 I have 30 Residents, 11 of them are diabetic.. 2 med passes and 2 sugar checks per shift. As you know to be in compliance we have an hour before and an hour after the posted time to give the meds. The first half of my hall is set up for 5p meds and the last half is set up for 6p meds. with blood sugars being sched. for 4 and coumadin being sched at 6. So I actually have 3 hours to get my meds out and 4 hours for meds and sugars according to the MAR. It is still very very hard to stay in compliance.

After getting report, and stocking I can usually start my BS by 3:30 I go and do all of the finger sticks on my diabetics, come back and pull their meds and draw up their insulins and they with few exceptions get their meds first and I basically don't care if the MAR says 5p or 6p. (If I have a diabetic that is on coumadin, I try to do theirs last so the coumadin is given closer to 5p but at times it is given closer to 4:30) So that being said, sure it makes me out of compliance by 30 minutes, does it harm the Resident? NO.... Now on the flip side of that Say I have a diabetic that has sched xanax at 2p and 6p. I won't give the xanax at 4 or 4:30, due to the fact that they just had one around 2p. So I will wait until the end of my med pass and sometimes won't give it until I get back from lunch at 7:30 This to can make me out of compliance, but does it harm the Resident? NO...

Samething with the little ole lady that can never be found, has only an iron pill sched at 5p while all her other meds are sched at 9p. Do I spend 15 minutes searching for her to give her an iron pill at 5p or do I wait until 9p when I know she is getting ready for bed, and give it with the rest of her meds, (there are no conflicts with the other meds) Is it out of compliance? Yes, does it cause harm? NO!

As I have said on here many times, we are not robots, and more times then not it is impossible to stick to such guidelines when we are dealing with so many variables. We just have to use good nursing judgement, and hope we make the best decision on the choices that are presented to us.

I try to be a accurate as I can be, but I also try to manage my time to where I can do the most good for the most residents, and if that means I'm out of compliance 30 minutes or so, then so be it! I would like to see the maker of the rules come and do it any better..........

You will get faster, you will get your routine, but chances are you will never be in compliace all the time. But that doesn't by anymeans reflect poorly on your abilities as a nurse, its just life in LTC.