Med Pass

[Lfransis]

Hi all. Although I am working med/surge full time now, I still pick up a shift in a LTC facility 1/wk. PRN, so I working someone else's routine.

Last night's 2-10 was a nightmare. Unfamiliar with residents on the station, family complaining of AM breathing Tx not being done, no charting, etc.

This could go on, but my main concern/question of the day being.....

Say a Resident has meds at:

1600

1800

1900 (mostly Xanax here)

Obviously,these meds are all being given @ 1700, with "supper".

1600 and 1800 fall into the time frame, but 1900 does not.

So I have alert residents refusing the 1900 med because "they don't get a pill now"( But I went by the mars timeframe)

I understand not wanting to be on the med cart all night, but giving xanax 2hours early seems extreme (and illegal?)

As a new nurse I am trying to practice good habits, as well as what I was taught in school. I double check residents by comparing the picture, asking their name and having it clarified by a staff member, etc. I am already being classified as "a little anal".

Any input?

-Lelu

[weirdRN, RN]

I have meds to pass at 8A. I start at 7A. I never get done before 1030. I give over three hundred pills every day for 30 some residents. I suspect the nurses that get done earlier are somehow cutting corners they shouldn't.

I follow the MAR as closely as I possibly can for time frames and combinations of medications. However, the number of meds and residents makes it IMPOSSIBLE to stay with in the one hour prior and one hour after rule.

[Markthemalenurse]

In my LTC facility our am meds take so long that we are ALWAYS outside of the 1 hr before 1 hr after window.

:smiley_aa In fact it is one giant medfest from 6 am to 2pm.

In response to your post - I admire the nurses who are "anal". Keep it up!

We need more nurses like you. I am very very new and it is nurses like you that I want to learn from.

Sounds like my last LTC job.

[Markthemalenurse]

I was wondering can you use Wake up as a time instead of 7AM or Bedtime instead of 9PM? This way if the patient wants to go to sleep earlier than 9PM, you can give the med without worring about a set time.

[rehab nurse]

I was wondering can you use Wake up as a time instead of 7AM or Bedtime instead of 9PM? This way if the patient wants to go to sleep earlier than 9PM, you can give the med without worring about a set time.

sounds like a good idea, but i doubt it's legal. it's not objective enough. and really, if the pt wants it at a different time than what it's normally given at at your facility, an order just needs to be written specifying the time they want it.

i am sure some of the lazy nurses from my last job would use this as an excuse to not give their meds. "oh, i didn't know what that meant, so i just circled it...."

to be safe, if the resident wants it at an unusual time, get an order saying it. at my last place, we were allowed to write "ambien 5mg po q hs, give at 8p.m. per pt's preference". the doc would sign it with no problem. of course, the nurse needs to make sure it will not interfere with any other meds and their times (like an incompatability) and if the nurse unsure, they need to call the physician to make sure (or the pharmacist!).

[Markthemalenurse]

Just curious. At the agency I work at now, we use that (wake up instead of 7AM) and it is legal, but I guess there are different regulations that must be followed where you and the original OP are from.

[Kashia, ASN, LVN]

This is insane! Med passes at skilled nursing..I am trained in acute care but have been trying skilled nursing, two shifts so far and hesitate to do more because it seems so dangerous. When you are with an agency you get no orientation..so how do you know in a timely manner who the patient are??

The system is a fraud ,nurses put their lic on the line....but more importantly patients put their life on the line while the facility rakes inthe money. The system is a fraud.

Amen-Ra

[weirdRN, RN]

Most LTC Facilities do not use agency nurses. You learn the residents by their pictures on the MAR and by name from other staff. Not having an orientation is DANGEROUS esp in LTC. In the hospital you have safety measures like ID Bracelets. In LTC, you have pictures of the resident on the MARs and TARs, depending on Hippa and Dignity issue interpretation you may or may not have pics on their doors next to their names. If I were you I would not sign on for a LTC facility unless it came with at least a week long orientation. If working there F/T, I would ask for a minimum three to four week orientation.

[Kashia, ASN, LVN]

Good advice. I turned down a shift this morning at a SNF even though I desperately need the money. I thought day shift would be even more dangerous than a PM. I am going to approach the registries I work through and discuss orientation at SNF's they would be sendig me to. It is just flat out dangerous and not right to walk into a place with no knowledge of anyone or anything and be given a heavy load. And I consider myself a very good nurse, when I worked full time med surg my reviews always came back excellant.

I hope doing the "right" thing will give me good karma to find work that is suitable, and soon!

[colter517]

Most LTC Facilities do not use agency nurses.

I'm wondering what state you live in? Around here (Massachusetts) nearly every LTC facility uses agency. I'm an agency nurse and there are shifts available everywhere.

I also wonder why the state allows the med pass at LTC faciilties to be the way they are. One facility I went to I had 38 pts., 6 g-tubes (3 were scheduled bolus) and 1 IV. The amount of meds each resident received was incredible, full plastic med cups chock FULL. I passed meds from 7am-3pm non-stop. The DON asked me if I would be willing to come back because I did so well. I nearly died. Needless to say, I called my agency asap and refused to work there ever again. Most places I've been it's nearly impossible to stay within the hour before/hour after time frame.

[CoffeeRTC, BSN, RN]

What ever happened to the Beer's list..."no more than 9 meds"?

Our docs and pharm try to stick to this rule,but sometimes we are getting those residents with a med cup full of pills. I realize this is Off topic, but when the list first came out and we did the tons of dose and med reductions,it helped and the residents health did not change for the worse.

Just a thought.

[weirdRN, RN]

I live and work in WestVirginia. And there are relatively FEW agency nurses in LTC here in this area. In the LTC Facility where I work there are none. Nor are there any in the other twelve facilities within an hour's drive of my home town.

My DON said that she wouldn't want an Agency at our facility mostly b/c agencies don't stick around long enough to really get to know the residents. I am not sure how I feel about it. I love my job b/c of the people I serve, some of the folks that I work with, and the time it allows me to spend with my child.

I do not understand WHY meds MUST be given within the two hour time frame. As long as the resident gets the medication at approximately the same time every day, then what is the big deal?

We did the whole BEERs thing too. But consider that I pass meds for 30+ residents every day. Even if it went PERFECTLY with NO interuptions, I still would take better than two hours to finish an AM med pass.

[CapeCodMermaid, RN]

I think that one hour before one hour after rule was formulated YEARS ago when residents took 3 meds each and the most potent one was a colace. 1. There is no reason for such a stringent time rule. 2. Most of these residents take way too many meds. 3. This isn't going to change until we make it change. Most of our long term (short term too for that matter) do not need 12-15 medications several times a day...any more than 80 year olds need to be on any kind of restrictive diet. I've got my rule for myself...3 meds is my limit. If my doc thinks I need another, she darn well better come up with a combination drug or get rid of one of the others.