Is this how med pass is supposed to be?

[designer-mommy, BSN, RN]

This is long, sorry. Thanks to those of you who have the patience to get through my vent/rant. So, I started my first nursing job a month ago. There are many things that I don't particularly like about the job, but the biggest thing is the med pass. I'm wondering if it is this way everywhere and I'm just being a weenie, or if it really is more difficult than the typical med pass.

OK, some background info...I work at an independent psych/chemical dependency facility. We have two sides to the facility. One side deals with crisis patients who usually stay a max of 23 hours. There are a max of 30 patients on that side with one RN (thank God I'm not that RN). Then there is my side. It used to be a 3-5 day stay where patients were "stabilized." Now we extend some of those stays to 10 days, sometimes much more, because we started accepting direct admits from some of the psych hospitals nearby. I have 16 patients on my side and I'm the only RN. I don't have any techs, etc., just a peer support guy who doesn't do any of the medical stuff.

The one thing I was most scared of when thinking about my first nursing job was the med pass. I am absolutely terrified of making a mistake (what RN isn't?!), so I'm wondering if my fear is making my med pass more stressful than usual. Here's how it goes: Around 7:30 p.m. I print a bed list, look at the paper MAR and start writing the patients' meds next to their names. I also have to note the new orders in the MAR as I go. Mind you, depending on the NP that's working, I might not get the new orders from the rounds until about 8:30. The other night I got them at 9:45--and med pass starts at 9:00! So, I might have to change those lists at any time. Then, I go in to the med room about 8:30 and start pulling the meds. The patients might have meds in bubble packs already from the pharmacy, but in most cases I have to pull from the E-Kit. I have to sort through about 60 pill bottles for each med, which may or may not be listed under the brand name. Then there are also the home meds the patient's bring in which aren't listed on the main MAR sheet, they're listed on separate sheets and kept in a separate bin in the med room. I get the patient's meds together and then start calling them in my office one by one, taking vitals before I give them their meds. I know I'm new, but this takes a long time. Usually the med pass itself takes about an hour to an hour and 15 minutes, sometimes longer. That's not counting the time I'm pulling. It doesn't help that I have med seekers knocking on the door constantly, asking if they can have their meds yet or if I can give them something for anxiety.

Is med pass like this at a hospital where there's a pharmacy and a Pyxis machine? I just feel like I'm bound to make an error with all of the rushing, disorganization, confusing MAR entries, late NP orders and constant interruptions. I have a headache for hours after med pass from all the stress. Does this sound abnormally stressful to you experienced nurses, or am I just being a weenie? I never expected nursing to be easy, but give me a break! Thanks for any help, suggestions, etc.

[PacoUSA, BSN, RN]

You're still relatively new, so there is a time management component here that can only improve with experience. However, one problem I see here is the multitude of places in which you have to record meds. I think all meds regardless of whether from the Pyxis or it is a home med should be listed on the MAR. This way there is only one place to reconcile giving it. Is your facility open to changing this? My hospital lists everything the patient gets on the MAR.

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[Hygiene Queen]

We have a Pyxis, a pharmacy and we also have an eMar and scanner.

Yes, it is much much easier than you describe.

Back when our MARs were paper, we still wrote home meds on there... why the heck wouldn't you? Even with the eMAR, the home meds show up in the same place the pharm provided meds do.

Can you organize the meds by generic?

I cannot understand why people bother with using name-brand!

If everyone could agree to organize consistently, I would think that would have to help.

Why are you having to pull from the E-Kit so often? Is someone not ordering meds soon enough? Is the pharmacy slow?

I would start my shift checking orders in the chart, updating my MAR's and then pulling per MAR. I'm not sure why you write the meds on your bed sheet? Sounds like double work writing.

I do check my MAR's and write the times each pt gets meds (as some are outside the usual times), such as "Betty: 1600___, 2000___, 2100___". This just helps me remember I'll have meds at those times, but details are already on my MAR.

I don't know what to tell you about the NP orders. I get irritated when HS med orders come in after 2100 and then the doc wants the meds to start that same night . Not sure what you can do about that.

I would shoot myself if I had to do things the way you do.

It does sound disorganized and stressful!