Med admin times

[Birdy2018]

Hey guys! I work in an assisted living facility. I have a bit over 4 years experience as an LPN and have worked in SNFs and homecare so this is my first assisted living job. I work overnights 11p-7a, there is only one 6a med scheduled. I was told during training that it was expected for me to give residents their 8a medication during my time to "help out" day shift. I didn't question it at first but rather just observed. Residents were being woken up at 5am to be given their 8am medications. When I started on my own I gave a few meds starting at 6a but i still felt weary about it and tried to chose residents that only had vitamins in the morning . I was then told I was expected to give 10-12 residents their meds before day shift came in. This facility is vey big on resident choices so I find it hard to believe they think it's okay to wake people up at 5am just to make things easier for the next shift. And also coming from a SNF it was never expected for overnights to give AM meds especially because it would be outside the hour window. I can't find a specific policy on med admin times here, I don't know if the regulations are different because it's an assisted living and this is their "home", but in my mind they are going against doctors orders for med admin times. I don't want to rock the boat but I am also first of all an advocate for my residents, and I want to do what's best for them. Anyone from assisted living have a similar situation or any advice? Thanks!

[caliotter3]

When working in a LTC facility, I was instructed to get residents up at 4 am to shower so day shift did not have to do it. The CNAs did not want to do this, understandably. I was then told that the residents were too confused to know what time it was. I think this is even worse in an ALF environment. Unless specifically ordered, the administration time should be changed to reflect what mgmt wants. If mgmt refuses to do this you know who the bus will run over.

[Neats, BSN]

I think it is wrong to wake up a patient just because the facility staff would be inconvenienced. If this were my loved on and I found out you were waking up Aunt Betty just to give her medication to her I would be fuming. Aunt Betty has worked for over 40 years and now enjoys sleeping in the mornings.

I would get a new medication order if you have to do it for no time except AM/PM this way you are covered. Placing time constraints on routine medication is only setting yourself up for failure. When the provider writes the order have them write... EXAMPLE Synthroid 20 mg once in AM and 20 mg once in PM. You just need to ensure it is routine and at the same time each day, and this is an example only as Synthroid is mcg and this example is not real.

The administration time should reflect what the patient schedule not the facility management, this is just selfish and greedy on the management.

There are alternative tasks the night shift can do to shoulder the many tasks that need to be completed. MAR updates are one of those. Reviews, Audits, Documentation....to many to list.

If my Aunt Betty was in this ALF I would transfer her to a better ALF, just for this greedy reason.

[Accolay]

Yeah, that's weird. I understand the busy day shift schedule in a nursing home, but it's no reason to wake grandma up at 5am and shove pills down her throat. Ethically yucky.

I think if an organization I worked for supported this i.e. the DON etc. I'd be looking for another place to work. Check the policies. It's quite possible that the facility managers don't know about this more than likely unwritten policy (not like they're there at 5am) but tread carefully when you bring it up.

[1TiredOldNurse]

This is not meant to be snarky at all, I just can't think of a better way to say it.......Facilities often have policies and allowed procedures that violate the BON scope of Practice especially when it comes to their LVNs . So when the state does a surprise visit at 5am, do you think that stating 'I was told to give the 8 am meds at 5 or 6 am to help out day shift' is going to keep the facility from being fined,and you from being fired ( you WILL be the one thrown under the bus ) and reported to the BON ? Timed meds have to be given 59 minutes before the scheduled time up to 59 minutes after the scheduled time. (At least in the 5 states I've worked in over the last 30 years). I have worked at a facility that had the state show up at 5 in the morning without warning, because the patient complained to their family about being woken in the middle of the night for meds. They sat outside and waited for the nurse to wheel out her med cart, and caught her in the middle of administering 8 am meds at 5:15 am. The facility received a HUGE fine, and the nurse was fired,reported to the BON and lost his license. Just remember.... the BON rules are the same whether it's a hospital,SNF, or AL facility. I once applied for a job at a small (25 bed) rural hospital. The medical director (who was also the doctor who owned the hospital), tried to tell me that a PUBLIC HOSPITAL did not need to have a doctor in the building at all times, that because they were a small rural hospital, the rules were different for them. I didn't believe him so I checked with the Illinois BON, and just as I thought, he was full of it. I could have lost my license if I had taken that job.