Med pass in LTC

[Cat Truitt RN]

I am more accustomed to working in acute care settings and later as a nurse teaching new nurse students. Is it me or the med pass in the LTC setting for 45 patients time consuming and almost impossible. I worked 7p-7a and found the pass to be almost unreasonable with this many patients. I had 2 CNAs who worked with me that night but yet I felt it was very hard work indeed. I admire those nurses who work this shift without any other help. I was the nurse who answered the call from the facility when another nurse called off. I feel that I didn't get a chance to do a good assessment of the patients because my time was spent passing meds. I had a pass at 9pm, 12am, 4am and 6am. The GLUMS at 6 were tremendous with 15 of the residents getting BS test with coverage. This did not account for the other insulin being given. No only that but the night I work the power in the building was affected by outages so that no call lights worked on that unit and residents were given bells. Also, the refrigerator was out and the meds refrigerated meds were being stored on another unit. I spent my time getting those items refrigerator to give to my patients. I also do not understand the pass set up at the facility I am at. I am used to 8am, 4am, 8p, 4a pass or a 6a 12p 6a 12midnight. The pass is totally illogical with some getting meds any time during the night. I hate to wake up patients, who are confused, just to give 1 or two pills. I know some of the items I gave were antibiotics so I could see this a reason for the time. But others tabs or meds could have be given more on routine and with other meds. Any suggestions, I would appreciate. I handled the cart only 3 times before.

[CapeCodMermaid, RN]

People need to sleep at night. No one should be woken up for any routine medication. Treatments shouldn't be scheduled during someone's sleeping hours. If these people were home, would they set an alarm to wake up to take meds? Nope.

[tiroka03, LPN]

I work nights, and the doctors have specifically written orders to give meds every 8 hours. Then we find a lot of meds that are given 12mid, 6am, 12noon and 6pm. This really bugs me, because I need to wake up these pts twice.

As for my 22 accuchecks, I will flag those meds with stickies.

I also make up med cups, that I don't fill, and use them to make sure that all my meds are given. Once I turn over a cup in my cart, I know that med was given, and I don't have to worry about it. I have a 60 bed unit, and get pulled away a lot. I find this works best for me. If I have different meds, antibotics or such, I then flag them with a different colored sticky, just to make sure that I don't miss the odd pills that come up from time to time.

[arika2010]

I just started working at a nursing home and on most units it's 1 nurse to about 50 patients, which is crazy. Orienting with a nurse,we split the number of residents in half, 25 for her/him and 25 for me. I wanted to cry in the BR so bad. I felt useless. It to from 4-9pm to finish med pass, I didnt get to orders, calling the doctors or families until 9-10pm. Charting is a killer, I dont know the residents at all and I dont know how long I will last. I never even take a break. What should I do. HELP!!!

[Neptuneschyld]

I just started working at a nursing home and on most units it's 1 nurse to about 50 patients, which is crazy. Orienting with a nurse,we split the number of residents in half, 25 for her/him and 25 for me. I wanted to cry in the BR so bad. I felt useless. It to from 4-9pm to finish med pass, I didnt get to orders, calling the doctors or families until 9-10pm. Charting is a killer, I dont know the residents at all and I dont know how long I will last. I never even take a break. What should I do. HELP!!!

I feel your pain already. Stick it out though. I start a LTC this coming Tue. and I'm a brand new LPN. My DON

told me that I will probably feel useless for the first 3 to 6 months!!! Just keep at it. If it doesn't work out after 6 months for me, I will have 6 months of experience to try something else.

Good Luck!

[Forever Sunshine, ASN, RN]

Stick to it. Ive been at my job almost 7 months now. Things are so much better now. 4:30 med pass takes me 3 hours and not 6. I am not running around like a chicken. I know my residents. I come prepared, rested and I make sure I take my break.

I am still learning all the damn paperwork. There are times when I still feel stupid and useless. It is a package deal.

[nursenow]

I noticed some posts here where people claim to do a legal med pass with 60 plus patients within the legal two hour limit. That is physicaly impossible. By the time you pull the med out of the cart, do your three checks, check BP... (depending on the med) crush the meds that need it, mix them with sauce, walk in the room, greet the patient, tell them each individual med, raise ther bed, pour some liquid, (add thickner for those that need it) spoon feed the patients that need it, watch them swallow. lower the bed, walk back out and sign the MAR, and do all the other things I neglected to list(like sign out narcotics...) it is IMPOSSIBLE. If you spend 120 seconds per patient that is only 60 patients but the thing is you can't correctly do a patient in two minutes Include the time to move your cart down the hallway, deal with all the interuuptions... Add in breathing treatments, the PRNs you are interrupted to give... I have enough experience to know it CAN'T BE DONE. You may have 60 patients but not all of them are getting meds for sure. That is why the state doesn't follow you on your entire pass. They know it can't be done. I talked to the state employees that were at my facility this year and two of the three had LTC/SNF experience. We weren't fooling them.

[Angeljho, MSN, NP]

I noticed some posts here where people claim to do a legal med pass with 60 plus patients within the legal two hour limit. That is physicaly impossible. By the time you pull the med out of the cart, do your three checks, check BP... (depending on the med) crush the meds that need it, mix them with sauce, walk in the room, greet the patient, tell them each individual med, raise ther bed, pour some liquid, (add thickner for those that need it) spoon feed the patients that need it, watch them swallow. lower the bed, walk back out and sign the MAR, and do all the other things I neglected to list(like sign out narcotics...) it is IMPOSSIBLE. If you spend 120 seconds per patient that is only 60 patients but the thing is you can't correctly do a patient in two minutes Include the time to move your cart down the hallway, deal with all the interuuptions... Add in breathing treatments, the PRNs you are interrupted to give... I have enough experience to know it CAN'T BE DONE. You may have 60 patients but not all of them are getting meds for sure. That is why the state doesn't follow you on your entire pass. They know it can't be done. I talked to the state employees that were at my facility this year and two of the three had LTC/SNF experience. We weren't fooling them.

Absolutely correct. I have 40 residents to give meds to and from day 1 I've been trying to come up with a system to quicken my med pass safely. There's just no way around it. I found that if I rush, I'm going to make a mistake. The best thing to do is to come to terms with the fact that it's going to take 2.5 hours for a med pass in LTC. I know other nurses do it in an hr and it discouraged me at first, but I learned that it's best to do it the safe way or no way or at all.

[Forever Sunshine, ASN, RN]

Absolutely correct. I have 40 residents to give meds to and from day 1 I've been trying to come up with a system to quicken my med pass safely. There's just no way around it. I found that if I rush, I'm going to make a mistake. The best thing to do is to come to terms with the fact that it's going to take 2.5 hours for a med pass in LTC. I know other nurses do it in an hr and it discouraged me at first, but I learned that it's best to do it the safe way or no way or at all.

Used to take me most of the shift. Now I can get it done in 3 if things go smoothly.

[jkaee]

Anyway, the take-home lesson here is that nurses CAN manage LTC med passes if they're willing and able to do the legwork that can help streamline the process, as well as management that's willing to listen to their ideas (a most crucial component!). Good luck!

Wonderful post, Marla, and full of helpful info. When staff start complaining about heavy med passes, the first order of business needs to be a med review on all the residents. Yes, it takes some time, but it must be done, not just to make the med pass easier but to keep our residents safe. As much as 75% of elderly hospitalizations can be traced back to polypharmacy, and that's unacceptable.