Med Pass/interruptions

[violetrose]

I'm a charge nurse in LTC, I make most of the MD calls and orders, do MD rounds monthly plus many other tasks. I have an issue with interrupting the nurses while doing there med pass, so when I have to put these orders in the MAR it is very difficult to do without interruping them. I sometimes delegate the orders for the nurse to put in, but consequently if they don't do it or if it isn't put in correctly, (the old card not pulled, marked changed, ordered from the pharm etc.), the DON tells me it's my fault, my error because I am responsible to put all orders I write in the MAR including all the above. I work anywhere from 10 - 12+ hrs/day (I'm salaried) don't get paid overtime:angryfire I feel I should be able to delegate this to the unit nurse or other misc. tasks, it should not be my error if not done right. Any comments about interuptions during med pass. Our AM med pass takes at least 2 hrs PM med pass about 1 1/2 hrs. less staff and lots of behaviors due to sundowning.

[sharlynn]

Two Med passes- that's it? For how many residents? We have Breakfast, Lunch, Supper and HS, plus 6-7 AM mostly eye gtts,TX and Fosamax, 10-11 AM eye gtts, TX,supplements and misc. and 3-4 PM Coumadin, eye gtts,TX and misc. This is for 70 residents, two nurses.

[BackInTheGame]

Yeah, it's the same here. Multiple med passes even though we try to standardize times, there's always those who need meds at "odd times". On my unit a full house is 35 patients. On my 3-11 shift, I'm the only licensed staff so med orders aren't an issue but they do have a similar problem on day shift. Usually there is a charge nurse plus one other LPN. Usually she's really good about putting orders in the MAR when the med nurse is in a pt's room. But for me, I don't mind someone interrupting me to add med orders or change existing ones. I'd rather be interrupted than have a med error. I also agree that there are times, especially when the floor is extremely busy and the orders directly impact that particular med pass, it's ok to delegate. Seems to me that if you hand the task off, it's no longer your error although I can see why your DON is saying it is. I guess the rationale is that YOU are the charge nurse, therefore you should have some kind of psychic power or ability to enter someones mind and MAKE them do the orders, and obviously your DON must think your transmitter's broken. Sorry, poor attempt at humor.

What I want to know is, how do you deal with the fact that most of the time, when you step up to the med cart, families and patients come out of the woodwork with all kinds of questions, comments, and requests. I've tried everything I can to tactfully convey that when I'm at the med cart, I really need to give the meds my full attention but to no avail. Any suggestions?

[luvmy2angels]

My RN supervisor always comes over and puts new orders in the MAR as we are working and I don't mind at all. In my opinion...whoever takes the actual order should be the one that writes it up and puts it in the MAR, less chance for any type of error. We are currently in the middle of training a whole group of nurses (both LPNs and RNs) and there has been MASS confusion over orders, hopefully a mess that will soon be fixed!!

[weirdRN, RN]

I think that new med orders should be put on the MAR by the receiving nurse as soon as possible after it is received. I would rather be interupted than make an error.

At our LTC facility, we are developing an order tracking tool to help ensure that orders make it every where they are supposed to.

Ex: day before yesterday. Diabetic A usually gets 10 u of Lantus at 4pm. The Dr changed the order to 5 u of Lantus at 10 am that morning. At 3:50, the new order had not made it to the MAR yet. If the receiving nurse had not stopped me, I would have given Diabetic A the 10 u of Lantus and been in error. Her sugar would have bottomed out again and I would have gotten a piece of paper on the incident b/c the order was received at 10 that morning. (The other nurse had had two falls and those two residents then went out to the hospital, so she had a good excuse)

At our facilty, we have 6,8,12,4, 6, and 8 med passes. Plus treatments and charting to do. Typically on 3-11 it is for each floor either 2 LPNs and 1 medaid and 6 GNAs or 1 LPN and 2 medaids plus 6 GNAs for 64 residents. I haven't paid much attention to Dayshift but their staffing isn't much better.I as an RN shift supervisor, float and help out as much as I can on both floors of the building. It is still hard to get everything that I have to do done with out being there over time.