LTCF quick med pass, plus all the other stuff

PsychNurseWannaBe, BSN, RN · Feb 25, 2008

OK...first breathe!

You are a fairly new nurse. I personally would not do an agency job as a newbie. You have no consistency and that leads to frustration. Which is were you are at. Organization seems to be a big thing holding you up. However, since you don't "work" there, it would be hard to fix it. I can tell you I worked for a place, not as agency, and my med passes took forever also! However, it was because they did not have their meds organized. AM, PM and NOCs. It was one BIG ole mess of pills that I had to dig through.

Do NOT combine med passes! That is not right to do that. Stop grasping at straws and just remember to go as fast as you are able. Take it one patient at a time.
Do you have your med cart set up prior? Water, juices, 2-cal, spoons, puddings, straws, cups, etc...?
Bunch some things. I give residents on insulin their meds when I am going to give their insulin...so not until supper time. In the mean time... skip them. But mark it on the chart so you can go back. It doesn't pay to give the patient some of their meds and wait for supper time and go back and now give insulin. If you have a lot of neb treatments, start the treatment and return in 5 - 10 minutes. Don't stand there and wait...if you are.
Work smarter and not harder! Delegate. Also, if you can...start at the end of the hallway if you are not doing this already. For me it helps because there is less foot traffic. I only move the cart 2 times up the hall and then I am done. It doesn't pay to move the cart constantly.
Do the charts have tab things on the side? You could possibly just go through the MARs and flip a green one for 1600 and a blue on for 2000 and a red one for insulin...or something to that extent. You don't have to go through each med...just when you see one at that time...stop and flip the tab up and move on. That way when you hit the floor you have tabs to help you. Plus you can bypass slower med taking residents at first and give your meds to the people who take them fast. Then at the end, give the pills to the slower people. It doesn't make sense to be able to give meds to 2 residents real quick and suddenly the next person is slower and then 3 faster ones and 2 slower people. Try to group em.
Make your aides accountable and delegate. My aides will ask me a question or 2 but for the most part they are doing their own thing. I give them a quick report in the beginning and then follow up as I fly in and out of rooms.

I hope this helps. Remember to breathe!!

NursKris82 · Feb 25, 2008

I am a very new nurse and am having the same problem. There are several threads devoted to med pass and LTCF issues on the geriatric specialty and LPN/LVN boards. I'm not sure how new you are, but I think maybe agency is not right for you. A new nurse is slower and needs more time for get into the flow of thing. I would not work agency- I am slow enough at a facility where I know the residents and have the support of the staff. You have to be safe, for your patients and your liscense. I know agency is flexible and pays well, but is it worth it? Don't be tempted to combine the passes- I know nurses who do that and it's just wrong. So is putting the meds in their drawers- what if another resident or a residents grandkidchild got into them? If I were you I'd go to a permanent placement at a LTCF that will give you a good orientation (some people say that they never will, but there are some places that do) and staff that are willing to help you grow as a new nurse. Then, after you've gotten more experience and learned some tricks of the trade you can go back to an agency and make the big bucks but be able to do it safely and completely. Just my :twocents: .

kcochrane · Feb 25, 2008

I am a very new nurse and am having the same problem. There are several threads devoted to med pass and LTCF issues on the geriatric specialty and LPN/LVN boards. I'm not sure how new you are, but I think maybe agency is not right for you. A new nurse is slower and needs more time for get into the flow of thing. I would not work agency- I am slow enough at a facility where I know the residents and have the support of the staff. You have to be safe, for your patients and your liscense. I know agency is flexible and pays well, but is it worth it? Don't be tempted to combine the passes- I know nurses who do that and it's just wrong. So is putting the meds in their drawers- what if another resident or a residents grandkidchild got into them? If I were you I'd go to a permanent placement at a LTCF that will give you a good orientation (some people say that they never will, but there are some places that do) and staff that are willing to help you grow as a new nurse. Then, after you've gotten more experience and learned some tricks of the trade you can go back to an agency and make the big bucks but be able to do it safely and completely. Just my .

I think she meant the drawers in the med cart, not the drawers in the room, but that's how I took it.

chase4myheart · Feb 25, 2008

I agree that agency is not the place for a new nurse. Building up speed on a med pass takes time. I can remember the time that both med passes almost seemed to run together, but you do build up speed. If you stay at the same facilityl, there will come a time when you can almost remember the meds without looking at the MAR (don't ever do this because things are constantly changing on the MAR). As for talking to your residents, this is a good thing. This is how I know when something isn't right with my residents. It's a great assessment tool. If you see a resident who has suddenly become confused then you begin thinking UTI. A slight change is resident's speech, then possible TIA. Talking to your residents gives you a heads up when things can change at the drop of a hat. Believe me, I've seen the nurse who goes into a room, shoves the pills at the resident and are out of the roon in less than a minute. They don't have a clue as to what is going on with their residents. This is not to say that you can have a 30 minute coversation with each resident, but do talk and assess your patients as you are doing your med pass. As for pulling up your meds before the med pass and putting them in the resident's drawers on the med cart, "BIG STATE VIOLATION" if state were to suddenly walk in the door. Another spoke of making sure that your cart is organized. This will help. Make sure you have needles for your insulin, needles for IM injections, alcohol wipes, apples sauce, thickened liquids, meds pulled from the stat box for the new antibiotic that has been prescribed that pharmacy hasn't delivered yet, spoons, cups, straws, fresh sharps container, etc. The less time that you spend looking for items, the sooner you will build up your speed. Hope that some of this has been helpful. Please don't give up. I think that you are going to be a great LTC nurse.

Blackcat99 · Feb 25, 2008

I have been an LPN for over 30 years. ;)I would never do agency work. I'm sure the money is good but the non-stop stress of new assignments and different places would surely kill me. I really do admire nurses who can handle that kind of constant stress but I would never make it out alive.

Dolce, RN · Feb 25, 2008

I am an agency nurse who never, never, never, never pulls an assignment in LTC. I couldn't perform the med pass safely on 20-30 residents that I do not know. I'm sure that "SUPERNURSE" could do it but am sure I would make a med error, give the meds to the wrong patient, miss meds, not be able to find meds, etc. There is the whole issue of who gets crushed meds, who gets their meds with applesause, and who takes their meds one at a time with milk. I would just be so overwhelmed. It is hard being an agency nurse at hospitals but at least you only have 4-6 patient's. Being an agency nurse at a LTC is just a bad idea, IMO.

Can you refuse assignments at LTCs and just work at hospitals as agency staff?

yurnurse · Feb 25, 2008

I work agency in an LTC facility and have done so for the last 4 years. I think as the other nurse said you just have to breathe and try not to allow yourself to get frustrated with everything. It is definately a challenge to pass meds to 30+ unknown patients and still have time to do everything else. I have been fortunate enough to find a facility that has given me a 13 week contract that just continues to get renewed but every once in a while I will work at a new place. When this happens I just make sure that I get there early (15-30 min) so that I have time to ask the previous nurse all of my questions ie who are the diabetics, crushes, who takes their pills at specified times etc. I also try and find the most friendliest cna and introduce myself as the agency nurse that has never been there before and ask them if they wont mind me asking/verifying who my patients are. I flag my medbook as I am passing meds if they are on the next pass. I make sure that I do the meds for the people who my cna's tell me go to bed early. I sign as I go and can usually get done with all meds by 9 pm. I then do my charting and will do the major treatments then if time permits. Although its not allowed everywhere, I will give my cna's my peri creams to apply when they are toileting/changing residents. If you are unable to complete all treatments I always let the relief nurse know that it got late and that most people don't want to be woken up for me to change a bandage. They are usually good about doing them for me when the resident wakes up. Basically do what you can as best you can. The majority of the places that I have worked at are really understanding when it comes to a new agency nurse.

alkaleidi · Feb 26, 2008

I have been an LPN for over 30 years. ;)I would never do agency work. I'm sure the money is good but the non-stop stress of new assignments and different places would surely kill me. I really do admire nurses who can handle that kind of constant stress but I would never make it out alive.

That *almost* sounds like an insult masked by a phony compliment.

I have done agency work PRN as well as a few contracts since 6 months after graduation as an RN. Working PRN at a variety of facilities is constant change, but not by any means constant stress. I find the politics and butt-kissing of hospital or LTC facility administration FAR more stressful. To each his & her own! :nurse:

PsychNurseWannaBe, BSN, RN · Feb 26, 2008

Stress is subjective and I think the poster was giving you a nice compliment by acknowledging that for her she couldn’t do it but kudos to the ones who can.

MrsCaseyRN · Feb 26, 2008

It is normal to feel overwelmed on a LTC med pass. You said you were a newer nurse...When I was a brand new grad, I worked per diem at a LTC while waiting for my start date at the hospital. OMG!! Because I was so new, there were a lot of things about meds that I didn't know that really slowed me down. Like if a pt was on pro-stat...I didn't know that was a liquid and spent time searching elsewhere. Or if a med was in the frigde but I didn't know that I'd be looking all over. Since then I've worked in the hospital and now am back in LTC. The med passes are a lot easier. The meds are familiar to me and that makes a big difference. As for other people and pts slowing you down, you just get better at managing those situations. Good luck!

witchypoo · Feb 26, 2008

Agency work is tough, If you like ltc,find a job in a nice facility. Now how to speed up a med pass. my only suggestions are to set up your cart, ask the out going staff, who is on insulin, blood sugars, gt feedings and at what rate, who is cruched and how do they take them applesauce, pudding or in juice, who is on thickened liquids and nectar or honey, A caring nurse will orient you to the floor, tell you where the supplies are for example,and tell her cna's to help you so you recognize the residents. Some harry houdini's slip off wrist bands, and in ltc it is bingo night and half the residents are not in their room or in their beds. When start you 5 pm med pass markout your follow up meds, by either moving the mar page over or using a marker like a straw, and check each page as you go on your second med pass for any you may have over looked, do not ever give out 5 pm and 9 pm meds together, they are spaced out for a reason possibly because of interactions. be the best nurse you can be. take care