LTC emergency...sorry no meds today

vintagemother, BSN, CNA, LVN, RN · Oct 10, 2015

In the facilities I worked in, I was able to consult with my DON to ask her about my appropriate prioritization when things like this came up. My very awesome DON fully understood we couldn't be everywhere at once as the sole nurse in the facility.

Also, I'm not sure if you are new to your unit, but for me, when I was new, falls and send outs to the hospital would set my med pass back. However, eventually I learned how to work fast enough to allow for emergencies and still complete meds on time.

I think my nursing critical thinking tells me that certain meds have to be given on time-seizure meds, antibiotics, insulin, etc, but others would not result in adverse effects to the pt if given late due to emergencies.

I worked in facilities with 1 nurse to 40-50 + residents.

tsm007 · Oct 10, 2015

In the facilities I worked in, I was able to consult with my DON to ask her about my appropriate prioritization when things like this came up. My very awesome DON fully understood we couldn't be everywhere at once as the sole nurse in the facility.
Also, I'm not sure if you are new to your unit, but for me, when I was new, falls and send outs to the hospital would set my med pass back. However, eventually I learned how to work fast enough to allow for emergencies and still complete meds on time.
I think my nursing critical thinking tells me that certain meds have to be given on time-seizure meds, antibiotics, insulin, etc, but others would not result in adverse effects to the pt if given late due to emergencies.
I worked in facilities with 1 nurse to 40-50 + residents.

I've started going through at the start of my day and marking all critical meds on my patient sheet so I know which ones I really have to give on time.

garciadiego · Oct 10, 2015

In the facilities I worked in, I was able to consult with my DON to ask her about my appropriate prioritization when things like this came up. My very awesome DON fully understood we couldn't be everywhere at once as the sole nurse in the facility.
Also, I'm not sure if you are new to your unit, but for me, when I was new, falls and send outs to the hospital would set my med pass back. However, eventually I learned how to work fast enough to allow for emergencies and still complete meds on time.
I think my nursing critical thinking tells me that certain meds have to be given on time-seizure meds, antibiotics, insulin, etc, but others would not result in adverse effects to the pt if given late due to emergencies.
I worked in facilities with 1 nurse to 40-50 + residents.

Well thanks vintagemother...I'm reluctant to talk to DON, that's another topic. So the important meds are given and things like calcium get circled on MAR, I guess.

vintagemother, BSN, CNA, LVN, RN · Oct 10, 2015

I really wish some more experienced nurses would chime in! ðŸ˜€

To be honest..I've stayed quite late to finish med pass before. I don't like leaving things undone. Id rather give the med late than have the dose skipped.

My facilities allowed pre-pouring of meds. I signed later on after meds were given, even when I was off the clock before. I'm saying, I'd pour pour pour, pass pass pass. Sometimes I wouldn't have time to sign the MAR before stating the next pour pour pour, pass, pass, pass.

My priorities would be getting the narc log ready for the next shift and getting the shift report done. I'd do all my other charting later on, sometimes after the new shift started. That only happened when I was new. And the problem disappeared once we went to emar.

I'm not recommending this. But it did happen when I was newer.

If your DON is not easy to talk to, I'd get the med pass done and then at a later date, tell her, "I was feeling very rushed and wasn't sure if I'd get my meds passed the other day when I had 2 pts to send to the hospital. What do you suggest I do in the future to prioritize my work flow? I needed to send them out and also needed to complete med pass on time."

If your DON doesn't understand the pressure of passing to a lot of residents as the sole nurse, I'd look for another position. It's like she's setting you up for failure if she doesn't empathize and more importantly, offer solutions/suggestions.

anewsns · Oct 10, 2015

I'm not even really sure what I did, it depended on the day , I would recreate my plan depending on the situation. Treatments can usually wait. Ideally I would be targeting some of the heavier med passes with important stuff first so even if this thing rolled on till 2 in the afternoon I'd be down to just bowel meds and cranberries etc. Sometimes I tell the oncoming shift if someone got their med late so that way if it's a BID they could give their dose on the later end of the two hour window.. Again , just depends..

bluegeegoo2, LPN · Oct 10, 2015

Meds need to be given, period, even if they're late. Pay attention to who gets the same med twice on your shift (Lasix, Neurontin, scheduled pain meds, carbo-levo, etc) and make sure those are the people you get back to first after your emergency. Even better, make sure they get their meds first in case there is an emergency.

QD tx's can be passed off to the next shift in extreme situations, but should not become a common thing. BID tx's would still need to be done.

One thing that I do in an emergent situation is grab a piece of paper and jot short notes for times, events, calling MD, order to send out, family notified, etc. Once the person is on the way to the hospital, I resume my med pass and chart the events and write official orders when I have time. I am usually slowed down for less than 20 minutes for the emergency before getting back on the cart to resume med pass.

To illustrate, a couple of weeks ago I had a resident fall with injury right before my a.m. pass. No sooner did I have that one tidied up I was told that another res was emergent who was ultimately sent out. I managed to get my meds done close to on time and left for the day on time as well. Why? Not because I'm awesome, but because I've learned excellent time management skills over the years. One piece of paper + 1 pen is an amazing tool for keeping organized on on track. Works for me, anyway. Best of luck.

Forever Sunshine, ASN, RN · Oct 12, 2015

Emergencies trump med pass. Deal with the emergency then when its done, resume med pass. You can't not give the medications and you must tend to the emergency.

CoffeeRTC, BSN, RN · Oct 12, 2015

I think we've all been there before or will be at one time.

I concur with the above. Try to stay organized even during an emergency. Keep notes, do what you need to do to deal with the emergency then get back to the med pass. Meds need to be given even if they are late. If a med is not given, then MD needs to be notified.

Biggest thing.....get help when you can from the other nurses in the building or delegate some things to the CNAs or support staff. They can make copies, do some vitals, sit with the resident or direct traffic if needed.

Junebug903, LPN · Oct 12, 2015

Your charge nurse should help you. The DON or ADON should help, if necessary. Sometimes, if the other floor nurses aren't busy with their pass, then they should help too...that is what I do. Especially, if the other nurse(s) is less experienced. I have many years of experience and I have an easier time thinking quickly in stressful situations, think on my feet, remain calm, multi-tasking then going right back to where I was. Good luck!

ambr46 · Oct 14, 2015

I'm just laughing thinking about this nurse I know who said he tried LTC care for a day. He said he asked his co-workers at the end of the day, "So what am I supposed to do with all of these leftover meds?" Apparently he had am, noon, and pm meds in little cups everywhere. He didn't go back for day 2.

morte, LPN, LVN · Oct 14, 2015

where is your supervisor?