med nurse role

[lilly6767]

Hello,

At my facility, usually 2 or 3 nurses will be scheduled per shift, for 25 patients (plus some mental health techs). We have one large med room, so one of the RNs is assigned to the role of "med nurse" and strictly passes meds for all patients and does the CIWA and OWA assessments in addition to blood sugar monitoring. Aside from signing off the meds in the med administration record, the med RN does not chart. The other "floor" nurses will do the admits and discharges. The 24 patients are divided amongst the floor staff (as I said-NOT including the med RN-he/she soley administers the meds) to be charted on in a narrative note. When the mental health techs are assigned to a patient, the floor RNS have to sign off on their note that they agree and add anything pertinent to the tech's note. So, as the med RN, when I give a PRN to a patient, I am not charting a narrative note on the s/s that led up to administering the PRN, the follow up, etc. When I was oriented as my preceptor said "with 25 patients, there is no way the med nurse could paper chart too." I'll mention the PRNs I gave to the charge RN or whoever is assigned to narrative chart on the patient, but since I'm not actually doing the note, I can't say for sure if they include this in their narrative.

At the last facility I worked at, a nurse was assigned 10 patients and administered the meds AND charted on these patients. I feel this was a better practice because this way, it wasn't as disjointed. You were doing everything for that patient. At the place I am now, it makes me a little uncomfortable that I am administering the med but not elaborating on why or the after-effect. As I mentioned though, for 25 patients, it would be literally impossible as the med nurse to elaborate on every single PRN given for every patient during a shift. But, this is the established practice where I am now, and there is only one med room so logistically, things aren't going to change.

Is this a cause for concern in your opinion? If something were to come up with patient and their chart was reviewed and there wasn't mention of PRNS given, would it be on the nurse assigned to chart on the patient or would it be on the med RN (even though the established practice at this facility is the med RN doesn't narrative chart and it would be impossible anyway)?

[Meriwhen, ASN, BSN, MSN, RN]

This is me, but if I'm giving a PRN, I'm charting on why I'm giving it. I'm not necessarily writing a book about it, I'm just focusing on the medication itself: "Lorazepam 1mg PO PRN given at 2200 for anxiety." I'll let the assigned nurse know about the PRN and why, and they can meet with the patient to explore why they were anxious. I'm documenting my actions.

I think what is more important about following up is not who does it, but that it gets done period (otherwise, what would we do if the follow-up was on the next shift? Stay late just to chart on it?). I would let their assigned RN do the reassessment to see if the PRN helped. If they can't/won't do it, I will take care of it in order to CMA: "Patient reported that the lorazepam was effective and they now feel much calmer." Again, no need for writing a book.

Hope this helps.

[PsychNurseLisa1]

Our MAK software allows us to chart effectiveness of a PRN medication within the hour of giving it. I have 14 pts on a pscyh unit, so if someone is particularly acting out and requires agitation protocol I will write a brief note about the behavior and meds given. But I won't write a note for tylenol prn for a headache, the MAK software will open a dialog box I can check for that med.