Med Pass

CapeCodMermaid, RN · Feb 6, 2008

There are many things you can do to be in compliance with the antiquated one hour before/one hour after rule.

Set the time for half the floor at 8, the other half at 9. You won't be any faster, but you will be in compliance.

Change the times of some daily meds to 12 or 2pm. Once a day is once a day and there is no reg that says daily means 8 or 9 in the morning.

And lastly, and probably the hardest, work with your pharmacy consultant and doctors to get rid of the useless meds...no 93 year old person needs to take 23 pills in the morning, 10 in the afternoon and 15 more in the evening.

We try to review all the patients meds at least a few times a year and we really work hard at reducing the numbers of pills these people have to take.

mcneillmama3, BSN, RN · Feb 6, 2008

Thanks Falon for your reply. I need a mentor, preferably someone who knows about this and has been there, done that. To CapeCod, some facilities do the scheduling trick. The odd rooms are set for 7AM and the even rooms are set for 8AM, but some days it still takes 3 hours to finish up on everybody. I think the acuity of nursing home residents needs to be considered. Patients are leaving hospitals sicker and quicker which puts a burden on the nursing home that has to recover and rehabilitate those patients. Also these patients are taking entirely too many medications. It would help if I could go in a facility and find the Med Cart not in shambles and missing drugs, probably because the permanent staff nurses didn't have time to reorder drugs. I've found empty med cards or med boxes with the reorder sticker still intact, so I know no one pulled it and faxed it to the pharmacy.

I am to the point that I don't really care about the one hour rule as long as I don't harm a resident. When I leave work, if all of my residents are breathing, have a pulse, and are not in pain or distress, then I feel I have done what I was called to do. I am not going to sacrifice my safety, or the safety of the residents, to be Jeff Gordon or Dale Earnhardt, Jr. with the Med Pass. We aren't driving race cars, we are pushing a medication cart which could be life threatening.

Rexie68 · Feb 8, 2008

i'm a fairly new nurse. two months new actually.
i have two patients that request their prns every night
one gets 2 ultram and a sleeping pill
the other wants an ativan and a percocet.
how dangerous is it to give these together? i know it is always done for both patients. the other nurses who give it have been nurses for awhile.
also, i have a pt. that was getting around the clock vicodin and at 9pm the had a vicodin and 5mg of methadone.. i tried to question this timeing with the hospice dr. mostly attitude was what i recieved and no real answer.

i wouldn't question this hospice order....we routinely give hospice pts a lot of meds at the same time or in larger dosages than usual. these pts have developed a tolerance to the same thing that would knock most of us out.

Rexie68 · Feb 8, 2008

on the rare occasion that i pass meds, there's no way i can get done within the one hour before/after time frame. i'm unfamiliar with the way the residents take their meds (crushed/whole/in appleauce/pudding/warm water, etc). no matter how much i want to be in compliance, it isn't going to happen. i don't sweat it, though. i make sure that the meds given more than once a day are given closest to the ordered time as possible. i make sure that pain meds are given asap. i give meds that need to be given before meals on time. anything else....well....that qd baby aspirin might just wait until 10am for its scheduled 8am dose. out of compliance, but not dangerous. changing the scheduled times will just lead to more confusion. we already have each hall scheduled one hour apart, but that still leaves 25 pts with 8, 10, 12, 1 and 2pm meds. no, not all of them gets meds at those times, but some of them do. anyway, i guess my point is that sometimes you do end up doing something out of compliance, but you have to prioritize and do your best. and again, many of our residents take multiple pain medications at the same time. often, at this point in their life, the goal is to keep them comfortable. as long as there are no adverse effects, i don't see a problem with it. thank goodness that we finally take pain seriously and aren't afraid to get strong narcotics prescribed!!

jjjoy, LPN · Feb 8, 2008

i wouldn't question this hospice order....we routinely give hospice pts a lot of meds at the same time or in larger dosages than usual. these pts have developed a tolerance to the same thing that would knock most of us out.

you wouldn't question the order because you are familiar with common practice. a nurse new to the environment has a more difficult making the call and should question any practice he/she is unfamiliar with.

on the one hand, they clearly don't know as much about these patients as those already there and one want's to assume that whatever has been being done is safe and correct. on the other hand, it is one's professional responsibility to understand why this variation is acceptable and to not just follow previous practice without question.

it's a tough position, because too many times when someone new to the area asks about something, the experienced folks get defensive. i suppose they get defensive because they feel the question is like an accusation that they may have been engaging in unsafe practice. but if they truly understand why something is done the way it is (and not just because 'that's how we do it' or 'that's what i was taught') then there's no reason to be defensive.

unfortunately, nurses are often pulled in so many different directions that it's hard to stay on top of thoroughly understanding all of the day-to-day practices. and they often get defensive or condescending attitude if they ask for an explanation by their colleagues or the physician for his/her choices. and even if attitude isn't a problem, there's not a lot of time for discussing the underlying rationale and pathophys and pharmacology while everyone, nurses and mds, have so many other responsibilities demanding their attention now.

CapeCodMermaid, RN · Feb 8, 2008

Precisely---you should question anything you don't understand or think is wrong or anything that makes you uncomfortable. It's your license. On our pre-employment med test, there are 15 questions with doses of certain medication. The question is would you question the MD about this dose for this particular medication. You'd be amazed at how many nurses wouldn't question anything because a doctor said it.

I went to school 25 years ago. We were taught to always have a second nurse check a dose of insulin or heparin before you give it. I still practice this way and don't really care who thinks it's backwards or slow.

Question away and ask for help if you need it. Don't let anyone make you feel dumb or slow or whatever because you are careful and have less experience than they do.

NursKris82 · Feb 23, 2008

I've been an LPN for 2 weeks now and am on orientation. Normally our facility does (on 3-11) a 4p with 1600,1700 and 1800s given) and an 8p (with 2000 and 2200 given) med passes. I have many of the same concerns as you all re. safety of this practice and not even being able to do all this within the hour window. But, that's not my focus of this post. I am going to be working some AM shifts on a particular hall, so even though I had heard the nurse was lazy :anbd: I figured I had to get to know the med pass and routine down there before I was on my own- so I worked with her. It was terrible- she too told me that since they all ate in the same dining room she gave ALL the meds at 6 or 7p! I was shocked. :eek: Then we went to do pills via a J- tube and this nurse in plunging them down the tube. I was taught to always let them run to gravity. I'm not talking a lil' push to encourage it, I'm talking about "put in and push it fast"! :omy: I was so appaulled. Plus, the med pass took so much longer because I was doing 2 in 1. It was awful. This was like only my fourth day or so passing meds by myself, so I did it her way :innerconf, but guaranteed I won't ever do it that way again or work under her again! Man, it was terrible!! :scrm:

PS Another poster mentioned the additional smiles, I didn't even realize they were there before and I hit the JACKPOT! (Is there such a thing a smile abuse?)

*Pepper* · Feb 24, 2008

I share everyones frustrations about med pass, the one hour rule, high acuity in LTC, the push to be fast by those above.

I REFUSE to answer the phone in the office during my med pass and REFUSE to leave the cart for diddly poop.

What worries me is not just getting it done, but not having the time to do it the way I was taught in school. Five rights, documentation, having all the drugs to administer.

It is alot of liability to be doing it with short cuts that are pushed on you by management. We are not fixing cars here..

wearingmanyhats, RN · Feb 25, 2008

I agree with everyone.... I am an agency LPN, and have pretty much seen it all. The one facility that I go to frequently uses a computerized med pass. This is one med pass that goes fairly quickly and smoothly. The meds are prepacked by pharmacy, and barcoded. (there is a number on the pack that is the same as the ID number on the pill so you can verify what you are giving)

I have worked places with MARs --- HATE THEM!!! You need to read and re-read (if you can actually read the writing) ....

As for doing pills all at the same time .... NOOOOOOoooooooooo!!!!!

I will give 1600/1700 together (if I know they also get at 1800 I will give all at 1700 for that pt, but wait until 1700)

The shear number of meds these folks get it BIZARRE..... no one need to take Lipitor at 80 yrs of age with dementia..... do we really think this is going to help them???? I truly believe that the only one making out in this scenario is the drug companies and the pharmacies.....

Ok..... off of my soap box LOL

Faye

nightmare, RN · Feb 25, 2008

I'm amazed at your med pass times! We give out at 8,12,2,6 and 10.We have the odd tab at 8pm and 7 am but certainly not so close together as some of you have.You must spend literally all shift just doing med passes!

Baelyll · Mar 2, 2008

I have been working in LTC for about 5 years now. I have been a nurse since 1984. I have 30 patients and there has not been one day that I had my med pass completed on time. It is a neverending medfest, indeed.

I have tried to minimize, if not abolish completely, any unnecessary interruptions, I diligently strive to improve my time management but it is impossible to give everyone their meds, tube feedings, Iv meds within the time prescribed. I refuse to take shortcuts to make it go faster. I guess I am guilty of giving in.

I have discussed this with my supervisors..they kind of talk around it. My partner (the other full time nurse I work with who has the other 30 people on our unit) and I got together and after much soul searching decided in the favor of safety even though it means we are out of compliance time wise. And on our own enlisted the MD to change some of the times around to help us be less out of compliance.

I, quite frankly, do not know what else to do but quit. But I love my patients..and I like working with my immediate coworkers.

I don't think there is any answer but it felt good to get it off my chest.

jjjoy, LPN · Mar 2, 2008

I have been working in LTC for about 5 years now. I have been a nurse since 1984. I have 30 patients and there has not been one day that I had my med pass completed on time.
My partner (the other full time nurse I work with who has the other 30 people on our unit) and I got together and after much soul searching decided in the favor of safety even though it means we are out of compliance time wise. And on our own enlisted the MD to change some of the times around to help us be less out of compliance.

Thanks for your honesty! Too many accept that they just have to take shortcuts and so management gets away with ignoring the reality that what they are asking for is impossible. And of course, management loves playing the "well everyone else seems to be getting it done" card. Ugh!! I hate generalizing about "management"... but TPTB quickly get rid of managers who demand higher staffing, telling them that *have* to make it work on the given budget or else give it up... which good managers do.

So kudos to you for making the tough decisions and for making an effort to make it better as much as you could!! :bowingpur:up: