Large med pass at 6 am!!!!!!

[NurseCard]

One of the reasons my new job went from being, eh, pretty tolerable... to being miserable... is because management decided that night shift would start passing *AT LEAST* half of all of the patients' morning medications at 6am. So, instead of being able to wrap up all of my charting, wrap up I+O's, and generally get off work anywhere near on time... I have to do this big med pass at the end of my shift.

Management did this to make things easier on our day shift... right now our day shift is WAYYYYYY understaffed and MANY things do not get done that should be done on day shift. However, this idea of lightening their 9 am med pass is so far not working. They are still slammed out the rear and not able to get things done; the lighter med pass is not making a difference.

But, we have the type of management team that doesn't care to listen to what we have to say.

Anyway, I was wondering if anyone else has this type of system on their floor or in their hospital?

[EmmaG, RN]

If a patient only has a few once-a-day meds at 9am, and they are meds that can be given on an empty stomach, then I see no problem with giving them at 6am. But if they are going to have to get certain meds at 9am anyway, I don't see where giving some earlier is going to help the day nurse all that much. Also, many of our patients have a diminished appetite to start with; filling them up on medications and fluids before breakfast isn't such a grand idea, IMO.

[pwp1289]

we have 1 1/2 hr before and after window to pass meds--we have mostly LPNs pass meds and they have no more than 20-23 pts to do both po and iv meds--its especially heavy at the 10am ( our QD time) pass but they can start at 830am--with our computerized system, they can see on the screen the last time the med was given so spacing between meds isn't too close

[PamUK]

Gosh... this thread really isn't focussing on the patients needs. I would have a fit if a nurse WOKE ME UP at 6am to give me bloody tablets! The routine of the floor/ward really needs to reorganise itself to the needs of the patient (including a decent nights sleep) and NOT to the needs ot the nursing staff or financial management needs. In my hospital, the patients are not disturbed for ANYTHING before 8am, unless it is urgent or absolutely necessary.

Once you get this ethos embedded into your whole culture, its easy! You look back & think... what the hell where we thinking then???

[NurseCard, ADN]

I guess bottom line, my issues are:

1) We are giving some patients a LOT of meds on an empty stomach. I actually have patients that are getting about eight different meds at 6 am, and then none at 9 am. I guess pharmacy has gone through and decided which specific meds can be given early. With some patients I HAVE to give them some sort of snack to eat with their meds.

2) It's NOT making a difference in the day shift's work load. At least it really truly doesn't SEEM to be.

3) If I get busy at the end of the shift and tell the day shift nurse that there are meds left over that I simply didn't have time to give.. due to getting an admission or a patient going bad or what have you... I get looked at like I'm from mars.

I really don't feel like going to management by myself with this issue and while my coworkers moan and cuss about the whole thing as well... I don't see any of them expressing any desire to complain either. *sigh*

There is very little encouragement on the part of management at my hospital... for staff RN's, LPNs, and CNA's to express any opinions or ideas or anything. This is the first hospital I've ever worked in in which the only floor staff who have any type of Email access are the charge nurses and on up. So, there goes that vehicle for writing and expressing any complaints, opinions, concerns, etc...

We get these stupid little letters handed to us by our charge nurse on occasion, that say "Such and such policy has been revised, sign here to show that you have read it and place this back in the mailbox".

I don't know.

[Poochee]

I strongly believe, that LTC facilities with large med passes, should have med lpn's. If a persons sole job is to pass meds only, then everyone is a winner.

[Elektra6, ASN, BSN, RN]

"I'm not a doc, but I believe a lot of our LTC patients take waaaaayyy too many meds."

I counted over 300 pills on my 3-11 shift for 30 people!

[Tait, MSN, RN]

"I'm not a doc, but I believe a lot of our LTC patients take waaaaayyy too many meds."

I counted over 300 pills on my 3-11 shift for 30 people!

I tell my patients often to advocate for less medications.

My stepmother was taking almost 16 potassium a day amongst a raft of HTN meds, she went back and told him she wasn't going to take that much and that he needed to find another way. He adjusted her potassium-losing and introduced more potassium sparing meds and now she is down to about 6-8 potassium tabs, plus a little conscious supplementing in meals.

[Valerie Salva, BSN, RN]

As a lowly student I can only comment on what we are taught in lecture and clinicals, but it has been drilled into our heads that if the med is ordered for 0900 you have an hour on each end to pass it, so you'd have from 0800-1000 for your meds. I'd fail clinicals if I passed meds 3hrs off schedule... Anyone know if this is right? like I said, I only know what we're taught

This is the way we were all taught, but in reality, it doesn't always work that way.

When you have way too many pts, and way to many meds to give, not enough staff (because of $$, not because of a fake nursing shortage), and a time limit in which to give the meds, it just does not work.

I once worked in an LTC where I passed meds to four halls in a single med pass. I had over 1000 total meds (pills, injections, liquids) to pass, along with doing finger sticks at the same time. This required four med carts, and just doing the narc counts w/ the previous shift took over 45 mins.

These were 0900 meds, and theoretically, the pass should be done between 0800 & 1000. In reality, no one can give 1000 meds in that amount of time. I worked at a frantic pace, and was very organized. It took me from 0700 to 1100 to complete the pass. It took others even longer.

With a two hr window to pass 1000 meds- subtract 45 mins for the gigantic narc count. That leaves an hour and 15 mins, to give 1000+ meds to 100pts.

That is 75 minutes- Meaning with this particular med pass, the nurse has 0.75 (or 45 seconds) per pt to get to each pt, check their meds, dose, pour them (crush, mix, reconstitute, draw up, etc), sign each one off, take BPs and pulses, before giving cardiac meds, get a cup of water ready, get a straw, help the pt take the meds, make sure they swallow it ok, put the bottles/bubble packs back, sign and document, etc, and run to the next pt.

And we know that many of the pts will ask the nurse to do other things for them while she's there.....

Nurse after nurse quit that place, and the Impossible Med Pass From Hell was just one of the reasons.

A more reasonable and common number of pts a nurse may have to pass meds to on days in an LTC setting would be 20.

Let's see how that breaks down-

First, we will assume the cart is completely stocked with all needed meds and supplies, and that all equipment is in proper working order.

Lets say the narc count for 20 pts takes 5 mins. Let's say the pts average 10 meds each. (some pts may get only one or two meds, others may get 15).

So, that's 115 minutes divided by 20 pts. That is 5.75 mins per pt.

To check, pour, sign for, crush, mix, etc the meds, get water, make sure pt swallows them ok, flush g-tubes after meds, put things away, take things out, etc. Then, a pt asks for help to go to the bathroom, wants to talk, asks a question, falls...

Even 5.75 mins per pt is inadequate.

All over the US, nurses are taking longer than the two-hr window to give meds, because they have no control over the situation.

[Valerie Salva, BSN, RN]

Gosh... this thread really isn't focussing on the patients needs. I would have a fit if a nurse WOKE ME UP at 6am to give me bloody tablets! The routine of the floor/ward really needs to reorganise itself to the needs of the patient (including a decent nights sleep) and NOT to the needs ot the nursing staff or financial management needs. In my hospital, the patients are not disturbed for ANYTHING before 8am, unless it is urgent or absolutely necessary.

Once you get this ethos embedded into your whole culture, its easy! You look back & think... what the hell where we thinking then???

I agree with this and wish things were done this way here, but they are not. I especially hate doing full body assessments, daily dressing changes, etc. in the middle of the night, but this is the way they are scheduled at many places.

I think nights should be a time of uniterupted rest for pts. I do not think any routine care- other than turns/repositioning, and incontinance care- should be done at night.

I think night shift staff should be there just to moniter pts, and assist them as needed.

All procedures, assessments, ADL care should be done during the day, and day shifts should get a lot more staff to allow for this.

[Tait, MSN, RN]

I agree with this and wish things were done this way here, but they are not. I especially hate doing full body assessments, daily dressing changes, etc. in the middle of the night, but this is the way they are scheduled at many places.

I think nights should be a time of uniterupted rest for pts. I do not think any routine care- other than turns/repositioning, and incontinance care- should be done at night.

I think night shift staff should be there just to moniter pts, and assist them as needed.

All procedures, assessments, ADL care should be done during the day, and day shifts should get a lot more staff to allow for this.

I will give this post the benefit of the doubt that you are generalizing about LTC and rehab.

I am sure my patients in acute care would much rather have three nights of interrupted sleep, than wake up dead in the morning.

We don't do it so we can claim a paycheck and follow protocol, we do it because it saves lives.

Tait

[joprasklpn]

It is ridiculous to me how when night shift is short staffed we are to "adjust", but when days is short the world is coming to an end. Let them pass the meds themselves. They have more aides who can help with the residents then nights does. I know how it is to have to give meds and put someone on a bedpan and so on as it usual does not stop with one request.

[chocokitten]

When I was working in an Assisted living while in nursing school (unlicensed staff). We had about 20 elderly (very highly medicated) patients. Sometimes there would be only 1-2 staff on days (max 3). We did EVERYTHING from toileting to med pass, including spooning out food and doing dishes. We also had the one hour before one hour after medpass. Sometimes we just COULD NOT do it in two hours. Many of my coworkers took dangerous short cuts such as pre-dosing pills and some just started 15 minutes early. Some of us, like me, violated policy by passing meds in the dining room. Of course I always asked the patient if they minded taking their pills there. Even with this "shortcut" it often took 2 hours to pass all these meds. I had a few patients that took me 15 minutes just to get their meds together and administer! I would save these for last, then if I went over on my time it was only for one or two patients. Stressful times. Oy, wish I had a solution for your guy's horrendous med pass.... all I can think of is more nurses on days! Have they though of staggering the midnight shift hours a little to allow one staff to come in an hour later and stay an extra hour in the morning?