Leaving meds at bedside in LTC

[systoly]

Happy New Year !

Many new nurses, entering LTC, are faced with this dilemma. They observe seasoned coworkers leave medications at bedside. Furthermore, some residents demand it, arguing that the other nurses do it. While this may or may not be true, it is rather irrelevant. Unless a specific may leave at bedside order exists, it is not ok to do so. The risks are harm to the patient from omitting the dose, doubledosing at a later time (oding), mixing the medication, etc. etc. Other patients are at risk due to sharing, rummaging, or being medicated by the first patient. There are a number of ways to address this. When first faced with the situation, validate the patient. Instead of immediately citing that this is against the rules you might say something like I'm sorry I didn't know this, this seems very important to you. Try to find out why it is important to the patient. Is it a control issue, is it a convenience issue, etc. Try to accomodate as much as possible such as returning at a later time, getting a different drink, more or less ice, anything to show that you are not trying to take control away, but rather operating within the law. If the patient gets upset, that's ok, change can be upsetting. If the patient becomes very unreasonable, then this person is most likely not safe to self medicate anyway. The point is, there's no easy button. However, no matter how difficult the situation is, do not leave meds at bedside. In some situations it might be ok to leave some or certain meds (perhaps a vitamin) at bedside and an appropriate physician's order can be obtained. Please share your experience and how you feel about this issue.

[nightmare, RN]

We have dedicated risk assessments that must be done before medication can be left with a resident.At the moment we only have 2 out of the whole building that are deemed safe to leave medication with.Both these residents are A&O x3 .The specifics of leaving medication include the fact that this is only done in their rooms not in the dining room or public areas because of the risk of other residents taking the medication.These risks are reviewed monthly or more often if there is any change in the condition of the resident.

[Fiona59]

Hey, I just stand there and explain: THIS nurse doesn't leave meds at the bedside. I am LEGALLY required to observe the swallow. If now isn't a good time, let me know when is, and I'll bring the meds. Then I turn to leave. 99% of the time, patients take the meds.

It's a control issue for the vast majority in LTC or active treatment. If the times are that bad have the Doctor changes the times.

[pagandeva2000, LPN]

I am not comfortable leaving meds at the bedside, either. And, I have trouble understanding nurses that do...there is so much risk involved. For one, even if that patient is deemed competent, wanderers can find their way into the room and take it themselves, it can fall on the floor and the patient may be a hoarder...even planning a suicide. This is one of the nightmares that keeps me hating the bedside...some people are so lax in their practice. Oh, and let's not forget the nurses that give their meds to CNAs to administer...

[yoshana_x]

I am a new grad and I have seen where many seasoned nurses leave the meds at bedside. I am not comfortable with it myself but some residents are so accustomed to it that they refuse to take it while you stand and watch.

My approach so far is to engage in light conversation while the people who are resistant to you watching them take their meds take it. It seems to work so far but honestly I do find it time consuming.

[SuesquatchRN, BSN, RN]

In LTC we had the occasional patient who had it care-planned. Then I would. Otherwise? Oh, no, not even for the A & O x 3.

I always guffaw when an episode of House ends with some disease identified because the meds fell off the bedside and the service dog ate it. I'd love to see how high someone's butt would bounce for that in the real world! And yes, I still watch the show.

[caliotter3]

Nurses kept telling me that it was ok to leave medication at the bedside of a resident and when the DON happened to come to the bedside one morning and I remarked that we should get an order from the doctor for this, she acted like she did not know that an order was necessary. No wonder nurses and other caregivers develop bad habits.

[Lexxie, LPN]

With the sheer number of residents that a med nurse has to administer meds to in LTC, it's no wonder that some nurses do this. Not saying that it's appropriate, mind you, but it obviously happens. As others have stated, too many things could happen by leaving meds at the bedside. This is not a good habit to get into.

[softstorms]

Some times it is just this simple...I am the Nurse and I am here to give you your meds. Refusal is always an option! At home, maybe you took them after eating or after drinking your coffee... BUT HERE, I need you to take them now! I may not be avaliable later to bring them back to you. THEN..back yourself up. Call the family and say..I keep trying to give (mom, dad, daughter, son, aunt,ect) thier meds and they refuse to take them, can you speak with them about this?

Then document the same. Make the family a part of it.

[pagandeva2000, LPN]

With the sheer number of residents that a med nurse has to administer meds to in LTC, it's no wonder that some nurses do this. Not saying that it's appropriate, mind you, but it obviously happens. As others have stated, too many things could happen by leaving meds at the bedside. This is not a good habit to get into.

This is why I say that the premise behind LTC is a load of crock...this is not a caring environment for the patients or the nursing staff. The fact that ONE NURSE has to administer medications to over 60 patients at times is an example of it. This is why some nurses place meds in the garbage and say they gave it, dressings are not done, patients are not turned. I don't believe this began because the nurses and CNAs didn't care, but that it is a no win situation where at times, the mentality is 'every man for himself' or 'the squeaky wheel gets oiled'. When I was an aide, I would see how more care was rendered to the patients who had very involved family members or the patients who were coherent enough to know who to contact and did so.

What is so sad is that actually, I wouldn't mind working LTC. I have no issues with caring for stable patients with relatively predictable outcomes or having a basic routine. But, because many of them are more like meat markets and backstabbing DONs, nurses and other ancillary employees there is always a high turnover.

[Lexxie, LPN]

what is so sad is that actually, i wouldn't mind working ltc. i have no issues with caring for stable patients with relatively predictable outcomes or having a basic routine. but, because many of them are more like meat markets and backstabbing dons, nurses and other ancillary employees there is always a high turnover.

i left ltc 2 months ago. i loved the residents, talking to them, hearing stories of what their lives were like when they were younger etc.. for the above reasons i won't go back. unfortunately, lack of experience in anything else is making it difficult to find another job.

[kythe, LPN]

I have never left a med at a patient's bedside and rarely pre-pour, but my biggest weakness is taking too long to do a med pass. This in itself is a med error because you are supposed to give meds within an hour either way of the prescribed time. No matter what, you can't win.

I have worked floors where it is expected, even by residents, that two med passes will be combined since there is literally not enough time in an entire 8-hour shift to give everyone their meds at the right time. In theory, we should call the doctor to change the times of as many meds as possible to reduce the med passes. In reality, that could take a shift in itself to go over everyone's meds, call the dr's, and try to make things more efficient. No one has time (and management will not make the time) to do this.