Med Pass Timing in LTC

CT Pixie, BSN, RN · Sep 25, 2008

You do what YOU know is right. Giving a 9pm med at 5 pm isn't right! Its your license on the line. And there is a reason that the med is given at a certain time. Certain meds are to be on an empty stomach, some a full one, some work best at night, others earlier in the evening etc. To give a 9pm med at 5 can affect the effectivness of the med.

I also work LTC, I am a new nurse, I work 3-11 and have 32 pts to care for. I would NEVER give a 9pm med at 5pm.

But you can give it between 8 and 10. I don't know if its the same in every State but here in CT you are still in compliance if you give a 9pm med anywhere between 8 and 10pm, we have an hour window before and after the scheduled time.

You will get done giving the meds at the scheduled times. It will take a few weeks on the floor but you will get your own "groove" and med pass will go faster. You will know when so and so wants their meds, if they are crush or whole, and where you start to get finished on time.

Please don't compromise your license because your preceptor is compromising hers. She won't be there to pay your bills if you loose your license and/or job.

I felt exactly as you did not too many weeks ago, but now, I found my "stride" and I pass meds within compliance time and get tx's done, along will all the charting etc. It will come in time for you too.

OgopogoLPN, LPN, RN · Sep 25, 2008

She gives her 9 pm meds at 5??? DANGEROUS!! Once you become more familiar with the residents and their meds/routines, you will become quicker at the med pass.

Only in very certain circumstances will I give a pill at an unscheduled time. Example a resident who receives 8 am pills, no lunch pills except for a multivitamin. I give that during her 8am pass.

I am not an experienced nurse and I still don't know all of the side effects of every med. I would be terrified to mix meds and risk a reaction from the meds being taken together or other stuff that could go wrong.

There are other ways to organize your time. Like giving the residents who don't have HS meds theirs last during the 5pm pass. Giving the residents who you know will be sleeping by 8pm their HS meds first. I work one particular heavy HS med pass line and it is inevitable that I end up waking up at least 4-5 residents for their meds. There's no way around it, otherwise I would be giving their HS meds at 5 pm.

CoffeeRTC, BSN, RN · Sep 25, 2008

Oye....many a thread on this subject.

It is wrong. Period.

How to make it right.

Go by the med times until you can make changes.

Talk with the supervisor, DON etc.

Ask if the timing of meds can be changed so that they official can be give at a more convient time. A lot of times things are done because that is the "way we should do it" but if you look at the system as a whole...it might need fixed.

See if any meds can be eliminated or changed to different forms so that they can only be given once a day.

newLPN04 · Sep 25, 2008

the 5 pm med can be given at 4 pm with that pass just before supper. that is how we gave ours when i worked ltc. good luck, i didn't believe it when i started working ltc, but it does get easier with time...and the fact that you will be floating, don't expect to get done as quick as the ones who always work the same hall all the time.

achot chavi · Sep 26, 2008

OTOH, no one likes to be woken up to take their meds at 10pm, what I do is ask the patient what time he wants his sleeping pill (if that is appropriate) It isn't legal to give a 9pm med at 5pm but if the patient prefers it= ask the dr. to change the adm time.

With time the med pass gets easier- have patience with yourself. don't work under pressure or you will make more mistakes. Hang in there!

CapeCodMermaid, RN · Sep 27, 2008

I don't know any doctor who would allow a sleeping pill to be given at 5 pm. And I'm with the rest of you..it's not fun to wake these people up to give them meds. Talk with your pharmacy consultant. Maybe he/she can help with the times.

nsgnva · Sep 29, 2008

Oye....many a thread on this subject.
It is wrong. Period.
How to make it right.
Go by the med times until you can make changes.
Talk with the supervisor, DON etc.
Ask if the timing of meds can be changed so that they official can be give at a more convient time. A lot of times things are done because that is the "way we should do it" but if you look at the system as a whole...it might need fixed.
See if any meds can be eliminated or changed to different forms so that they can only be given once a day.

I was wondering if anyone would come up with the same solution I have used! I am the only nurse, on 7-3, with 37 residents. Many of the residents come from a hospital setting with med times being very strict....when at home,the residents, for the most part, weren't that strict on themselves. I also work evenings when there is a "call-in" and I am mandated to stay. Seeing all sides, I ask the doctors to review the meds/times. More often than not, the docs are very understanding and will order all pm/hs meds at 7pm, if there are no contraindications. This allows the nurse to give one pass on some of the residents between 6-8pm. Freeing up more time to give ones that must be separated, such as your qid meds. Example, I have a resident that gets Ktab and metoprolol at 6pm, but zyprexa at 9pm.The doc agreed that both could be given anytime between 6-9 without ill effects,,,hence 7pm schedule.

mariyahsmommy · Sep 29, 2008

I was wondering if anyone would come up with the same solution I have used! I am the only nurse, on 7-3, with 37 residents. Many of the residents come from a hospital setting with med times being very strict....when at home,the residents, for the most part, weren't that strict on themselves. I also work evenings when there is a "call-in" and I am mandated to stay. Seeing all sides, I ask the doctors to review the meds/times. More often than not, the docs are very understanding and will order all pm/hs meds at 7pm, if there are no contraindications. This allows the nurse to give one pass on some of the residents between 6-8pm. Freeing up more time to give ones that must be separated, such as your qid meds. Example, I have a resident that gets Ktab and metoprolol at 6pm, but zyprexa at 9pm.The doc agreed that both could be given anytime between 6-9 without ill effects,,,hence 7pm schedule.

I worked last night. My 5th day out of 6 for orientatin. At the beginning of the shift, I said to my preceptor that I still haven't had a chance to chart or do treatments. Her response was "Whose fault is that?" You need to "pick up the pace" I said that it was ony my first time on this floor. ( 30 dementia patients) and she said " I don't care. Nursing is nursing!" I felt like walking out at that moment. I didn't. I stayed and did the entire med pass myself, WITHOUT, Mind you--stopping for the hour to help feed. I didn't get done until 10:30! Help! Tomorrow is my last night to "orient". :no:

nsgnva · Sep 29, 2008

with a rude and nasty co-worker like that, I'd seriously think about looking for work elsewhere, or ask for a permanent floor as soon as one is available. Tell your DON that you don't feel like you can give the quality care you desire when working in the float pool.I so wish that I could be more help, but speed comes with time, and cutting corners only diminishes your feeling of integrity. Believe me, I see it all the time. I'm always reprimanded for not getting my work done in 8hrs (meds,treatments,rounds,dr's orders, admissions....etc...I do it ALL for 37 residents...ICF and Skilled!! mix ). I could easily get done in 8 hrs if I sat on my butt and skipped half the meds, like some nurses.But like one of the other responders...it's your license on the line...stick to your integrity and go with what your heart tells you to do.

southernbeegirl, BSN, RN · Oct 4, 2008

ugh! i feel for you! it is so hard when you first start LTC. people always say "dont worry, it gets easier". i used to roll my eyes at them! but they were right, lol. with time..you will develop your own routine and i promise it will get easier.

your preceptor, is she your supervisor too? i know when my nurses are drowning (like you were at 1030pm that night) they always yell "help!" at me. most of the time i chart for them instead of giving pills because believe you me...they are much faster at it than I. but i used to work the floor and had 48 ICF pts on 3-11 shift. it took me a while but once i got used to it and got a routine that worked for me, i could do it.

one thing we do is try to put everything but bedtime meds and whatever must be given that late at the 5pm pass.

i wont tell you the rules i've broken,lol, but sometimes you gotta do what you gotta do.

but to wake someone up at 9pm for a colace? nuh uh, shouldnt happen.

my husband in an industrial engineer (i love that nerd) so his whole life is time management. he really helped me set my own routine. he'd make me an outline to go by and if i stuck by it strictly, it always worked.

if i had to be honest with myself....working as a floor nurse on a dementia unit is my dream job! they are my favorite type patients. i hope you grow to love it as much as many of us do!

STNA · Apr 3, 2009

I just started my first job as a nurse at a LTC facility. I was hired as a float and have 27 to 31 patients, depending on which unit I'm on. The place I'm at is a skilled facility and we have g-tubes, an occasional trach, and wound vacs. Half of the meds get crushed. I was told by one of my preceptors not to do 3 checks on my medications because I don't have enough time. I agree that it is impossible to check the meds and keep within the appropriate time frame for the morning med pass (everyone is due at 8am), but I've told my supervisors and DON that I will continue to do my three checks. The nurses at my facility tell me that they memorize which medications their residents receive. That sounds all fine and good, except I've found several med errors that they didn't catch because they apparently don't look at the MARS anymore except to sign stuff off. (Which I've seen done in one fell swoop at the end of the day). The DON is aware that her nurses do this and has implied that someday I will be competent enough to not do my checks. Is this the real world of long term care or am I just at a bad facility?