Med Pass

No TMA to be ever allowed? Wow, that's too bad. They have been a great thing here. I don't see how handing out medications in baggies is a help. I would still be checking it as a nurse even prepacked from the PX- they are not fool peoof. Maybe trimming some shift hours?

The only places I have seen the med paks used is in Assisted Living and community based group homes where there are unlicensed people giving meds. The idea behind using them in those settings is to reduce med errors because of misidentification of meds when in individual bottles or blister packs.

I don't think they are suitable in a skilled or even ICF because of the issue of nurses administering pre poured meds which flies in the face of standard nursing practice. In addition if there are changes in the meds then the packs are not useful because even if the discontinued med(s) are to be removed that means nurses would be trying to identify generic meds without a generic PDR available. Even the pharmacy would need one of those if meds were out of their original packaging.

Perhaps if the medication times are not confined to set hours but rather in times of day there would be less stress on the nurses and one nurse would be able to pass to more residents since there would be a time frame of 3-4 hours to do so. In other words instead of 1 nurse per 30-40 residents one nurse might be able to do 40-60 residents if the "morning pass" was from 6:30 AM to 11 AM. This could free up some nursing hours overall or even offer a 75% position of say 28-32 hours a week for a dedicated med pass nurse for both days and evenings.

Depending on the acuity of the unit I think you would still run into multiple problems with mid week medication order changes (I guess I'm "assuming" that pharmacy would deliver these med packages on a weekly basis). What happens to all the mid week new antibiotic orders, the coumadin dosage changes, the never ending PRN's, etc. By the time all of this is taken into account, have you really saved any time?

Can you send discontinued medications back to pharmacy for credit in your state? We can send some back in mine but I wonder if they are packed as you describe if you could ever send anything back. Just something else to think of.

CCM - what would your Survey Team think about this type of med admin? I can't think they would be too supportive??

I don't think the people who have proposed this have thought through the entire process. The surveyors wouldn't like it and neither would the nurses.

I wouldn't want a med tech who doesn't know the A&P/nursing part of drugs and how they effect patients, plus how they work, plus the parameters, plus the patient's medical issues to be passing meds and working under my license, though I do hate that I spend way too much time (in my opinion) just passing meds. And I would never use pre-packed meds. Though I usually would be able to tell what pill is what, what do I do if there's 10 pills, a coreg and a lopressor, I take the person's BP and it's 80/50 with a pulse of 56? I can't say for positive which pill is the BP med, I can't not give them all the other meds, I can't give them anything to make them more hypo... I just don't think pre-poured med packs are a good idea. If we're smart enough to be nurses and responsible for all we have to do, I think we can read packages and bottles and get the right meds. I do like txredheadnurse's suggestion for eliminating "specific hours" and establishing a morning, afternoon, evening system. Obviously this doesn't work for all meds but would make the job less stressful. And instead of cutting staffing in nursing, your management should fire the bozo who wants to cut nurses, period. That will save some money and headaches since more nurses equal better care and more yesmen who only care about the budget and wanna slash it by implementing bad ideas costs lots for no benefit.

In a previous facility, we used a LTC pharmacy called Millenium. The meds were packaged in little bags like you talked about for each admin. time, and the bag had bar codes on it that represented the meds in the bag. They had a great computer system that made the whole administration process very smooth. Pull the bag, shoot the bar codes, and the MAR would be automatically populated with the admin. info (nurses initials, and her digital signature).

I *loved* this pharmacy, and wish we had it at my current facility.

I don't know about other states but in Fl. med techs only need 4 hr training class which isn't enough time ro learn how to use the MOR much less the actions and adverse effects of drugs. We use M.T.'s nut I am not.happy with that practice

My facility (I'm in orientation) has a unit that dispenses the little baggies. There are no more than 3 meds per bag and each comes with the med name, strength, # of pills, and the med's physical description. It is very simple to identify & withhold a specific med if needed. The pharmacy is responsible for reprogramming the machine regularly, and there is some extra stock in it so that if Mrs. Smith's warfarin has just been increased from 3 mg to 4 mg, you punch a few buttons and it spits out your 4 mg tablet for today.

I dunno, We had a pharmacy that filled a month worth of pills on cards- a different card for each medication so that if the pt had 10 dif meds, they sent 10 cards for the month etc. How many times did I find the cards filled with the WRONG pill? Loads of times, and each time it was Ooops , sorry ! If we had given the wrong pill and there had been an adverse reaction, who would be to blame, you got it. Its not being old fashioned, its being responsible and preventing errors. BTW we were told, even though pharmacy filled the order, nurses are responsible to give the right pill and pharmacies errors are our responsiblities!

I would not feel comfortable with baggies of pills, and the surveyors wouldnt either.

My take? the adm are always trying to balance their budget on nurses backs, the problem is , when they look at the budget, they mistakenly think that nsg is getting too big a peice of the pie and forget that its called "Nursing" home for a reason, we are responsible for the majority of the work and without nsg there is no home.

The problems begin when one DNS / DON is willing to lower her standards (her risk) and the Administrators who talk to each other then pressure their DNS's to follow suit. You have to have a real command of the accepted standards of care for your state in order to stand up to the administrators and protect the professionalism in your facility. OTOH, we do have to respect the budget and show that we are making the most of it.

With your experience you must have lots of great ideas and instead of telling the administrator "NO" divert his attention to your ideas on making the most of the nsg budget and show that you are on board with his goals of running a fiscally responsible business that is also professional, passes surveys and progressive.

Good Luck!

The last facility I was in went to the "baggie" system. We had lap tops on our med carts and we had to sign in every shift. The bags were strung together and had morning, noon, evening, and noc meds all in one. The special meds (i.e...antibiotics, coumadin, etc...) were seperate. There was a scanner on the cart and once you brought up the patients pictures and list of meds, you would scan each barcode on the package for the appropriate time and if the med was wrong, it would buzz you, otherwise it would place a check mark in the box with the med. Then when you hit record all, it would list the meds that you scanned and then you would have the chance to put in pulses or b/p's etc...then you would hit record again and a small box would come up asking if you were sure and then you hit ok and the patients picture would gray out so you would know that you gave the meds. It is very smooth and eliminated a lot of errors but the pharmacy would still make errors and place the wrong pills in or not at all. You still have to check them carefully. Also you would refill the cart 3 days a week so you would always have supply. You had to watch the CMT's too because sometimes they would miss things. It did save a lot of time.