LTC med pass

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I am a new grad RN working at an LTC. There is 1 Charge Nurse to pass meds/treatments and 31 patients with about 4 CNAs, and 1 unit nurse for 62 patients. The side I am on is considered the most difficult because there are many psch issues with the patients and many fallers. It takes me 4 hours to do my morning med pass. I often feel like I'm between a rock and a stone because someone is unstable or has fallen or bed alarms are going off that CNAs cannot answer. The only way I can figure that the seasoned RNs are passing meds on-time is if they are not taking BP manually for people on BP meds and not giving OTC meds, eye drops and/or breathing treatments. This means I have 3.5 minutes per patient to stay in compliance to give meds. I take a refills sheet with me to add to ass I go along, I have a BP cuff in the bottom drawer and all insulins and inhalers are labeled. The MAR is color coded by time. I do pain, DM and ABX patients first one way down the hall then catch everyone else on the way back while stopping patients in the hall who are mobile. Last I do my tube feeders. I don't like shortcuts and the patients are my priority, but I don't want to be that nurse that everyone hates because of too much over time. Any tips?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Your post has been moved to the Geriatric/LTC Nursing forum with the goal of attracting more responses. Good luck to you.

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Specializes in Med/Surge, Psych, LTC, Home Health.
I am a new grad RN working at an LTC. There is 1 Charge Nurse to pass meds/treatments and 31 patients with about 4 CNAs, and 1 unit nurse for 62 patients. The side I am on is considered the most difficult because there are many psch issues with the patients and many fallers. It takes me 4 hours to do my morning med pass. I often feel like I'm between a rock and a stone because someone is unstable or has fallen or bed alarms are going off that CNAs cannot answer. The only way I can figure that the seasoned RNs are passing meds on-time is if they are not taking BP manually for people on BP meds and not giving OTC meds, eye drops and/or breathing treatments. This means I have 3.5 minutes per patient to stay in compliance to give meds. I take a refills sheet with me to add to ass I go along, I have a BP cuff in the bottom drawer and all insulins and inhalers are labeled. The MAR is color coded by time. I do pain, DM and ABX patients first one way down the hall then catch everyone else on the way back while stopping patients in the hall who are mobile. Last I do my tube feeders. I don't like shortcuts and the patients are my priority, but I don't want to be that nurse that everyone hates because of too much over time. Any tips?

I'm confused by your numbers... how many residents/patients are YOU having to give meds to in the mornings?

The first tip is to NOT take BP's on every single resident who is on BP meds unless a) every resident has parameters on the mar i.e. "hold for sys

Another tip... some residents are on routine breathing treatments, and truly do not need to be; their tx's could be changed to PRN.

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Like the above poster said, only take the Bp if there are parameter orders, otherwise don't check it. This isn't the hospital, it is considered their home, and you don't routinely check the Bp at home. Also, don't assume the seasoned nurses are taking shortcuts, they are seasoned and likely just faster than you. Even though some eye drops and inhalers may be unneeded, to not give them as ordered is a med error, and I doubt they are just ignoring all these meds.

My advice? As you keep going you will get faster. Just keep with your routine, don't take any shortcuts that will get you in trouble with state, and just work on perfecting your med pass. And honestly, sad as it may be, 3.5 minutes is enough time to politely converse with patient and give them their meds (in most cases). You'll get there, it just takes time!

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The first tip is to NOT take BP's on every single resident who is on BP meds unless a) every resident has parameters on the mar i.e. "hold for sys

That is a good point.

I work overnights, but when I started working by myself, my 6 am med pass would take me almost an hour and a half. I move much faster now, and can get it done in about an hour.

I'm not sure how your med cart is set up, but we have cards with meds on them, and if I need refills, I just pull the card and put it to the side. Think of all the little things you can do before med pass or after. You could wait to do your refill sheet until after med pass.

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Im a new nurse and still doing my orientation on at a LTC facility. I have between 24 and 36 residents depending on the Hall. I have been frustrated as well by how long my med pass takes. Some of these people need a dozen meds for first med pass and insist on taking each pill one at a time. Some of them want you to tell them which pill is for what, and then have you wait while they decide if they are going to take their pills. m still trying to learn names and faces along with how each resident likes their pills given, some of them you cant please at all. I can get the pills passed, but getting through the treatment cart is a challenge. Ive been told by some nurses to delegate , others that the CNA are too busy and to do it myself. The BP/HR parameters are on the MAR for a few clients. I wouldnt mind having an automatic BP cuff for that. Eye drops, Ear drops, breathing TX do slow med pass down a lot. I dont save the tube-feeders for last. They can be getting their tube feed while you are passing other meds. What would help me a lot is if they would let me stay on 1 Hall because each Hall is different and has their own way of doing things, plus I could get to know my residents names, meds and concerns. Good luck, how long did you get for orientation?

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Specializes in Hem/Onc/BMT.

- Don't waste time trying to convince stubborn residents to take their meds. Just document refused and then try to talk to them during downtime.

- Reduce walking around needlessly by clustering tasks as much as possible.

- Manual BP is faster than automatic.

- Assess for pain and give them pain med if necessary so that they won't be interrupting you later.

- Make sure your OTC meds and other supplies are well-stocked before you begin med pass so that you won't be running back and forth later.

And continue to stay the heck away from shortcuts!

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If I understand correctly, you and another RN function as "med nurses" for two halves of a unit, while another RN functions as "charge" for the entire unit. Since this unit manager does not have a med pass, that frees her up to do admissions, falls, phone calls, etc. Don't be afraid to concentrate solely on meds and treatments and let her handle the rest. That stuff is *her* job and meds/treatments are *yours*.

The situation you describe is a cake

walk in LTC. Three nurses and eight aides for 62 residents? That should be a breeze if all of you work together....

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Specializes in Cardiac Care.

Seasoned nurses actually have the routine meds for ALL of their patients memorized... which speeds up the process for getting the meds out and to the patient faster. I didn't think I would ever learn the meds of all of my 30 residents, but a few months in and I knew exactly who got what and when, including who to hit up first and who to give meds to last. (all about who takes the least amount of time first) You get a system that works for you and you go with it it takes time and you won't always be the nurse that runs late.

Did I personally check the BP of everyone with parameters? Nope, I usually left them for last because they would be on the vitals list for my CNA and we had our CNAs get the vitals by a certain time so we were able to streamline some of the processes. Delegation is a good thing when you can trust it.

Eyes drops and inhalers are very fast to give, SVNs take awhile, but I don't hang around for 15 minutes while they are on it, I move on get a few more rooms done and WHAM... 7/8 am meds done by 8/9am

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Specializes in Hospice.
Seasoned nurses actually have the routine meds for ALL of their patients memorized... which speeds up the process for getting the meds out and to the patient faster. I didn't think I would ever learn the meds of all of my 30 residents, but a few months in and I knew exactly who got what and when, including who to hit up first and who to give meds to last. (all about who takes the least amount of time first) You get a system that works for you and you go with it it takes time and you won't always be the nurse that runs late.

Agreed, but I have to add that it's important to resist the temptation to actually give them from memory. I save a lot of time by being able to pull the cards for the meds all at once from memory but then I force myself to pour from the MAR ... that way I don't miss med changes.

It will get better, I promise!

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Some will disagree, but I say it's okay to pour meds by memory *IF* you flip through the MAR first for med changes. Once you've confirmed there's no med changes, I see no reason not to go by memory.....

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Your facility's Nurse/CNA/Resident ratios seem pretty standard and not out of this world. I agree with many of the previous posters. Don't be so hard on yourself. I've been working at my current LTC facility for about 8 weeks and I have plenty of residents' meds memorized as well as a pretty solid routine as far as who should get meds first/last etc.

You'll get better and faster, but don't resort to shortcuts! You have to know where & when you can do certain things...

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