In the name of efficiency?

[NNNikki]

I am a newbie LPN working my 6th week in a LTC facility as the floor nurse on NOC shift with 43 residents. I am still working on my efficiency with paperwork especially and wondered how other people in other facilities handle the load of initials and signatures needed per shift. :wink2:

In school I was taught never to sign out a drug or treament without first administering said med/tx. However, when I had my whole 4 days of orientation, no one signed out a med when they gave it, especially the scheduled meds. They all either signed them at the beginning or middle of the shift for all 43 residents. We have cheat sheets that we base most of our med passes on and that's what they use to reference. When there is a change in 24hour report etc. it is the next noc shifts responsibility to update.

I guess my point is, I am seeing the benefit, in terms of efficiency, for signing out meds all at one time; it saves a lot of time by the end of the shift. However, it goes against all I have learned in school, and I know that if we were being "reviewed" this method would be frowned upon.

I am curious how everyone else handles the signing off procedures...

Thanks in advance for sharing!

NNNikki:nurse:

[Jen1228]

I would worry about missing a drug. I work in rehab, but have been pulled to LTC before. I did my med pass the same because that's what I'm used to. I initial by each drug right when I give it. I see how it would be easy in LTC to sign them all out at once because you know the patients and what meds they're on. And there's not many new orders to worry about.

I do sign off all of my treatments together at the end of my shift because all the patients treatments are in one notebook. I make a list of all the treatments at the beginning of my shift and check them off as I go along.

I can't believe you only had 4 days of orientation! I thought mine was short at 6 (and 1 in the classroom). I guess it's a LTC thing because at hospitals new grads orient for months.

[AprilRNhere]

I worked LTC for 5 years as a CNA..the night nurse always got frustrated because if one of the night nurses missed updating a med....becuase of cheat sheets....it would often get passed wrong for up to a week or more.

[catslave]

This is what I do:

Arrive on the unit 15 - 20 minutes prior to shift start and grab a shift report sheet and the LNA assignment sheets.

Make out the LNA assignments.

Check the bowel book listing who gets prune juice, BAP and MOM on the bottom of my shift report to check off as they are given with the first med pass of the day.

Check the treatment book - flagging treatments to be done and listing them on my shift report as well as times for glucometer checks for my diabetics.

Now it's time to punch in, count narcs and listen to report.

I then go through the MAR writing down med times next to residents names on the shift report sheet to cross off as completed.

I prefer to pour, sign & pass my meds but it is acceptable to pour, pass then sign (directly after passing the med). I also may do a required treatment at that time as well if appropriate.

I check off the treatments I have listed on my shift report as they are completed, signing them off in the treatment book at the end of the shift.

I often chart mid shift if time allows, adding any necessary addendum's at the end of the shift and as well as document on the 24 hour report. I also check for MAR holes at the end of the shift.

Tape report.

My relief arrives and we count.

With any luck I'm out within an hour after my shift ends.

43 residents with 3 days orientation - God Bless You!