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.
I always worry about the folks who get their med pass done way faster than me, it's just like the ones who say they can drive 85 miles in an hour. As far as the one hour before and one hour after rule is concerned, I don't really pay much attention to it. First of all, condition always supercedes time. Second, I've been followed by state inspectors several times during a med pass and nobody ever said anything about time. They know it cannot always be done. Nobody on any state board (I believe) would fault a nurse running behind during a med pass when everything else was ok. Of course you have to be mindful of meds that are given four times a day, etc. I do believe that some DONs encourage short cuts, but they will also be the ones to cast the first stone.
I always worry about the folks who get their med pass done way faster than me, it's just like the ones who say they can drive 85 miles in an hour..
It does make you wonder how they get done so fast - if they're giving ALL of the prescribed meds. I mean, it takes 20 mins to give 3 different types of eye drops & 2 different puffers. I was never the speediest med passer, but when you know how heavy of a med pass another nurse is doing & they are sitting down an hour later saying "I'm all done"......can't help but think the worst.
Specializes in Community Health, Med-Surg, Home Health.
I always worry about the folks who get their med pass done way faster than me, it's just like the ones who say they can drive 85 miles in an hour. As far as the one hour before and one hour after rule is concerned, I don't really pay much attention to it. First of all, condition always supercedes time. Second, I've been followed by state inspectors several times during a med pass and nobody ever said anything about time. They know it cannot always be done. Nobody on any state board (I believe) would fault a nurse running behind during a med pass when everything else was ok. Of course you have to be mindful of meds that are given four times a day, etc. I do believe that some DONs encourage short cuts, but they will also be the ones to cast the first stone.
I agree that one cannot pay strict attention to medication pass time. What most nurses do is they always start at patient #1, so that when it is, in fact, 4 hours later, at least it is around about the same time. If we paid strict adherence to that, meds would never be given; and depending on the circumstances of the day, one is fortunate to be able to give anything at all on a real, bad day.
Last night I took some po meds and a neb tx to a lady, and she said "nope' I don't need them tonight. Two hours later when I was busier than heck she sent a message out to say that she wanted her neb tx then. Guess what, she didn't get it. She was right, she didn't really need it.
as a new LPN on the search for employment,I know this happens all the time and I always thought"what if the Pt does not take the meds??"but after watching a movie about a woman who kept all her meds untill she had enough to commit suicide and the nurse was responsible then I had a whole new look on this!!!!I forget what the name of the movie was???
Specializes in Geriatrics, Hospice, Palliative Care.
I used to float evenings in a facility, and the day nurse always left meds at the bedside. When I started my 5 pm med pass, I had to pick up little bins of meds that were left behind - antibiotics (hey, why isn't that pneumonia clearing up?), antiglycemics, psych meds, even narcs. When I asked a senior nurse about it, she said, "honey, this is long term care. It isn't that deep". The day nurse is one of those golden nurses who has been there forever, and can't be touched. *sigh*
I just chat with the resident while they take their pills and if they demur, I tell that I once had a patient choke on their pills and I don't ever want that to happen again - so they gotta swallow in front of me.
I used to float evenings in a facility, and the day nurse always left meds at the bedside. When I started my 5 pm med pass, I had to pick up little bins of meds that were left behind - antibiotics (hey, why isn't that pneumonia clearing up?), antiglycemics, psych meds, even narcs. When I asked a senior nurse about it, she said, "honey, this is long term care. It isn't that deep". The day nurse is one of those golden nurses who has been there forever, and can't be touched. *sigh*
I just chat with the resident while they take their pills and if they demur, I tell that I once had a patient choke on their pills and I don't ever want that to happen again - so they gotta swallow in front of me.
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When I look at the deductions from my paycheck and think about the cost of meds, I'd like to say Oh yes, it is that deep.
Specializes in Geriatrics, Hospice, Palliative Care.
It is *that deep* and it really bothers me. The funny thing is that our facility is a Medicare five star; and most of the time, I think that we provide pretty good care, but some of the stuff that goes on sets my hair on fire. I have little tolerance for people who yell at residents - this includes aids and nurses - but I don't want to leave because if this is what goes on at a five star place, what happens at a three star? Oye.
You are so right about that. Most of my LTC experience is with not for profit facilities. The staffing ratios and care delivered were pretty good, but those hair igniting events occurred all too frequently. Im glad that some nurses decide not to go with the flow. And while you may have to keep a fire extinguisher handy for a while (just kidding), one day you'll be the senior nurse and newer nurses will have less garbage to deal with.
I just think it is so wrong,we are trained one way and then you find it soooo different out there,and it's suppose to be all about the patient being safe..friend told me how when somone is suppose to get 5pm and 7 pm meds at 5 they get all.....there is a reason why the meds are given at different times isn't there:(
WOW! I don't know where some of you work, but good grief, we never, never leave meds bedside. Our basic rule is try three times if they don't take it then consider it a refusal and document. Yep we did have a nurse who left her meds bedside when state was there (can you believe it, and then tried to argue with state that it was okay)! Needless to say she was out the door in record time!
I dont find it acceptable to leave meds at the bedside...I've never trusted any resident enough to do so...if they wont take it when I am watching, I leave and come back. Ive seen other nurses do it and cannot figure out why or how they can think its ok. I worry about my license too much to do that. Its too risky.
systoly
1,756 Posts
I always worry about the folks who get their med pass done way faster than me, it's just like the ones who say they can drive 85 miles in an hour. As far as the one hour before and one hour after rule is concerned, I don't really pay much attention to it. First of all, condition always supercedes time. Second, I've been followed by state inspectors several times during a med pass and nobody ever said anything about time. They know it cannot always be done. Nobody on any state board (I believe) would fault a nurse running behind during a med pass when everything else was ok. Of course you have to be mindful of meds that are given four times a day, etc. I do believe that some DONs encourage short cuts, but they will also be the ones to cast the first stone.