LTC emergency...sorry no meds today

[garciadiego]

Ive mostly worked LTC, with a little med surg., I usually have about 30 residents on day shift, and all the tons of meds and Tx. that goes with it, some times Ill get floated to a 6 bed unit they call acute. What do you do when its 0900, in the middle of med pass and there is an emergency. Some one gets hurt badly from a fall, or cardiac or resp' problem or what ever.....all your attention and time is devoted to the emegency and the am meds on't get done....there is no nurse to help,its the weekend what do u do with the very late or not given meds and treatments?

[NurseSpeedy, ADN, LPN, RN]

If you have a good supervisor, they will handle one while you do the other if they are there and if they are off they will come in and help you catch up with your med pass if you are way behind. This is what my supervisor did (I also had over 100 residents and was the only nurse so if I was passing meds it was because we were already missing the med tech-otherwise I usually passed meds on 18 or so residents). I had a patient who was later a confirmed STEMI and a fall at the same time plus all 4 med carts during day shift, yeah, help needed.

Then I got a new supervisor who would go MIA after she said she was coming in (she was supposed to be on call for when staffing issues occurred) It didn't take long for that game to get old and I found another job. The situation needs to be safe. If you cannot call someone in to help, then the ratio needs to account for emergencies, because both the emergencies and the meds need to be taken care of.

[gonzo1, ASN, RN]

I start passing meds the minute it is legal. In my case I can start 9 am meds at 8 am. That way if something goes down I can usually stay somewhat on time. I like the idea of giving critical meds first. Get the dig done and wait till later to give the colace, etc.

[vampiregirl, BSN, RN]

Some LTC facilities don't have a supervisor on evenings, weekends etc. When I worked in a LTC, I was often considered the "supervisor" by default if I was the only RN in the building, in addition to taking care of my residents. As previous posters mentioned, being organized and having a plan is the best way to deal with emergencies. But this plan comes with experience - both working as a nurse and at that specific facility. Check w/ a co-worker that you respect for suggestions - even if it's someone from another shift.

Also, don't forget most DON's worked the floor before they were DONs. If you approach the DON in a professional manner at an appropriate time and pose this question, you might be surprised at the response you get. I had what I thought was a very intimidating DON (she was extremely by the book), but when I asked for her expectations in a similar situation I was pleasantly surprised at her realistic response and suggestions. Of course, it's also important to not be one of those nurses who encounters "emergencies" every single day they work. And trust me, even state surveyors understand an occasional true emergency - what they are looking for is that staff respond appropriately and follow regulations, policies and procedures. Which may mean obtaining a physician order to pass meds late (hint, I once got an order from the SNF medical director to pass meds late for all my remaining patients during a very unusual situation so I didn't have to call 10 different physicians).