Med Pass

eldragon · Mar 6, 2008

I'm glad I found this thread today.

I just finished my fourth day of "orientation" in a LTC facility, as an a.m. med nurse.

By day two, I was expected to do it mostly by myself, with the regular med nurses helping me.

Mind you, this place has a low-turnover rate, nurses stick around, not sure why. Here are a few issues and thoughts I have:

First, my shift starts at 7 - I do the narcotics count, and then immediately head to the dining room, where I am required to stay until everyone is finished eating. I have to document intake on about 25 residents. If one resident is late, or picks at their food, I can't leave to start my med pass. I have to wait.

PT starts at 8, and as you can imagine, several patients want pain medicine. So, that is another setback.

Then I head out to do medications on 24 residents, none of whom I knew before Monday. Needless to say, I'll be checking namebands forever, because this is a skilled nursing unit.

I can start at 8, but I am supposed to be finished by 10:30. The experienced nurses have been doing this, but I'm only able to get about 12 patients done during this time frame right now. And I am frustrated, rushing the whole time. Residents want to talk, and my ability to converse and be compassionate is the reason why I went into nursing, but I can't stand around and talk. Most residents have something else that impedes swift progress: feeding tubes, warm water requests, crushed meds in pudding, crushed meds in syrup (yes), problems swallowing, and many are just plain SLOOOW. Then many of them have Lovenox shots/multiple inhalers/eyedrops, nitro patches, pain patches and narcotics that are under double lock in the med room to which I have the key.

Today was the worst - I felt like quitting and/or laughing at the impossibility of getting this done on time!

Only with help did I get it done. Then at 10:30, I do CBG's. Then at 11, I go to lunch for 30 minutes, which is unpaid. Now, if I work through the lunch, they dock 30 minutes from my check, which i do not think is fair, but that's the way it goes.

After my lunch, I go back and give insulin before their lunch at noon, which I have to monitor.

I couldn't do todays pass on time, I was literally about 5 patients short - and there were 3 admits this afternoon.

So, I'm talking to an experienced med nurse who told me she was, at one point when she started, going in and putting meds in cups for about 5 residents, to hand out like that - because there was no way she could finish on time. Then, she said sometimes she parks the resident at their door with their meds and water, and starts punching out the next pts meds then. So she took short-cuts to get the med pass on time.

I'm thinking, BS, I'm not concerned about q day meds getting passed by 10:30, I'm concerned about patient safety, and my license.

So I'm going to go in - do breakfast watch, which I think is a waste of time when i could be doing meds, but oh well...

Then I'm going to start passing meds at 8 and work until I'm done. Forget the 10:30 cbgs - they can be done at 11 or 11:30 - followed by insulin - and then I'll watch lunch at noon and take my lunch when that's over.

If I can't stretch out the morning med pass to a reasonable time length, at least until I'm more experienced, then they'll have to just find someone else to do this. Because this is not nursing, in my opinion.

Thanks everyone, for letting me vent.

MegRyanGirl · Mar 10, 2008

I am also frustrated with the med pass situation like most of the nurses on this forum. I am an RN and I am fairly new at the large number of med passes. My last job was as a psych nurse for 1 year, and it's nothing like LTC.

The first day I got an orientatio, I got it from an LPN, which I thought was weird -- I mean, no offense to LPNs but shouldn't RN get an orientation from an RN?

And this LPN hardly ever took BP or checked HR for pts that were on BP and cardio meds. She would put some safe sounding fake BP and HR numbers and continue her med pass!! I was scrutinizing the MAR trying to get familiar with it, and some of the stuff I wasn't sure about and asked her what it was, she said "oh, just sign it." I was SHOCKED!!! Just sign it????? She would put some random number for the volume of GT feeding that went into the patient withotu looking how many cc's per hour the pt was supposed to get!!! And the assistant DON was raving how great thsi LPN was!! When I pointed out the mistake of the GT tube feeding volume and refused to put down the wrong number just because the nurse before me put it down, the charge nurse who was also an LPN said "ooh, but if you do that, everyone else will get written up." That's none of my business!!! It's their damn fault that they don't look at the order for the feedings and calculate the correct amount!

It's been a month since I started at this LTC, and last Friday I was so frustrated I was ready to cry. I had about 20 pts to give out meds to, and it took me some time because I hadn't done that floor for a couple of weeks. I checked the glucose, BPs and HRs for those that needed those things checked, and by 1pm, I was still doing some 9am meds while doing 11:30pm and 1pm meds at the same time. I asked the LPN for help, since I am supposed to be still on orientation, and she refused to help saying that she was busy (she was transcribing orders). I think it's all backwards that I am doing the med pass and she is transcribing, when it should be the other way around... am I wrong? Either way, she refused to help.

I also don't get paid for lunch, and I wasn't gonna work through an unpaid lunch although I felt uncomfortable not finishing on time. The assistant DON who gets a salary says "you have to work through lunch if you don't finish meds. Sometimes I work through lunch." Yeah, but you get a salary, I don't. I told her I wasn't comfortable leaving the floor without finishing the floor, but that I wasn't gonna give them free labor. I said I would work through lunch if I got paid, so she said she would sign off on it.

In the end, I spoke to DON and told her that it's plain impossible to give out all the meds on time if you do it the right way and that others don't take BPs, HRs, etc.... She goes "I can't believe I am telling you this, but sometimes you just can't take BP. Once you get to know the residents, you know their range, and you don't have to take it every time." I couldn't believe my ears!!!

But the truth is, there was one patient that was there the last time I did that floor, and she is on lots of cardio and BP meds. I had to hold 3 cardio meds from her because of her HR and call the MD. Imagine what could have happened if I gave her the meds like the DON said just because I am "familiar" with the patient and took the vital signs only every so often??

I refused to work on that floor and insisted on staying in the Vent Unit where the Pt - Nurse ratio is normal....

Ahhhhh, *sigh.* this is really stressful and unethical thing that they are doing. They care more about the quantity than quality. I am sure they would hire more people to do a better job, but the nursing department is probably not being backed up by the management on this, and that's why they to do what they have to do.... It's really frustrating and scaryy. :nono:

proud2b1 · Mar 10, 2008

Lfransis

Anal is always better!!!Oops,OMG,you know what I mean!:imbar:chuckle

eldragon · Mar 10, 2008

MEGRYANGIRL, I hear you.

Today was my 6th day and I was able to pass meds to 18 residents in the right time time.

This is all I think about; how to cut the time it takes to pass these meds.

It's aggravating.