Med passing question from a student

Posted
by MsPebbles MsPebbles Member Nurse

Has 2 years experience.

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That Guy, BSN, RN, EMT-B

Specializes in Emergency/Cath Lab. Has 6 years experience. 3,421 Posts

Make sure you do them one at a time with a feeding tube too ;)

littlehoneybee

littlehoneybee

31 Posts

In nursing school, I failed a medication administration exam because I opened the pill packages at the bedside. We were required to open all of them in the med room and then give a medication cup full of pills to the patient. However, shortly after starting my first job as an RN, I went back to opening them in front of the patient. Too many patients would hold up one of the ten pills they were taking and ask ,"What's this?" Many pills look the same and it could be difficult to differentiate them. Sometimes they would refuse a medication and if I had not opened the package, the pill did not have to be wasted and could be returned to the pharmacy.

A~L~B

A~L~B

104 Posts

Lol @ That Guy. I work adult & pedi ICU. The other night I had an adult pt with 15 meds to go through the G tube at 2200. It took me quite some time just to scan, crush and mix the cocktail of all those meds. Had I spilled the whole concoction I would have had to start all over pulling 15 meds, crushing, mixing etc. I love my pedi job because pharmacy makes all PO meds liquid.

I have to scan in my adult job but not in my pedi job. Most of my patients aren't with it enough to ask questions. If they are I go over the meds and ask if any are new meds that they haven't taken before. If they are I will explain why it is prescribed and possible common side effects.

Lola Lou

Lola Lou, BSN

Specializes in Med-Surg, Precepting, Education. Has 9 years experience. 99 Posts

I bring my unopened meds to the patient's beside and read through the MAR before I even scan them. Very rarely do I have a patient that stops me and tells me to "just give the pills". After listing the meds, I ask if the patient has any questions about the ones that I just named. Sometimes a patient will pick up on a dosing error or even a medication that they no longer take but was still on their home med list. I find that this process works best for me and it doesn't take extra time to do. I actually find it to be a time saver because I can omit any meds before I scan then if the pt refuses a stool softener, for example. Many times a pt will ask "what is this little yellow pill" as I hand them the med cup. It is easier for me to decipher at the bedside than if I had opened up all the packages in the med room. To each their own I guess...

Beautiful Mind RN

Beautiful Mind RN

Specializes in Med/Surg, Oncology, Epic CT. 206 Posts

Hello OP,

What I have learned from many of my preceptors is that, they keep the medications enclosed in their original packaging and take them to the patient's room. That is when they explain what each individual medication is and what it is for. (Before they enter the room, they had looked at the MAR and then they re-check the MAR while naming off the medication/what it is for). They have also asked if the patient likes to take them separately or all at once. Many of my preceptors have noted as well, that, it is best to keep the medication in the original packaging in case the patient refuses the medication. That way, it avoids unnecessary waste.

Towards the end, many of my preceptors, when updating the patient white board, will put down the side effects of some of the main medications, such as pain medications or antibiotics on the white board to remind the patient what to report.

So far, that way has worked well for me and I still manage to be efficient with time. :)

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 7 years experience. 3,488 Posts

I'm in school too... and the way we're taught is an always safe method of passing medications. Unfortunately that method is also quite slow and makes it difficult to pass a lot of meds quickly... but it IS safe.

itsmerae

itsmerae

26 Posts

One reason nursing really eats me alive.....what we are supposed to do is often different than what we are able to do in a timely manner. Unless you work with very little patients and have all the time in the world to do everything correctly. just think about it..in ltc your often given, i would say 25-30 pts....2 hrs to pass the meds...work overload!!!! how is anyone supposed to do what they were taught is the right way in school!

MsPebbles

Has 2 years experience. 119 Posts

I'm in school too... and the way we're taught is an always safe method of passing medications. Unfortunately that method is also quite slow and makes it difficult to pass a lot of meds quickly... but it IS safe.

I agree. I know that when I'm out in the real world there will be more pressure to become more efficient, but I will refuse to do so at the risk of a patient's safety. I just got a job as an NA where I hope to work as an RN when I graduate, and they use scanners, and I'm thankful for that as it'll allow me to be more conscientious when passing my meds.

poppycat, ADN, BSN

Specializes in pediatrics; PICU; NICU. Has 44 years experience. 856 Posts

If I was the patient, I wouldn't be happy having to take each of my pills individually. I take about 10 pills every morning & they all go down at the same time.

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 7 years experience. 3,488 Posts

I agree. I know that when I'm out in the real world there will be more pressure to become more efficient, but I will refuse to do so at the risk of a patient's safety. I just got a job as an NA where I hope to work as an RN when I graduate, and they use scanners, and I'm thankful for that as it'll allow me to be more conscientious when passing my meds.

Scanning the patient's meds is not foolproof. You have to remind yourself not to get ahead of the process of scanning the patient and then the meds before you give them. While I haven't done it outside of some more urgent/emergent situations, I can see exactly where and how that can lead to trouble, especially if you're giving meds to 2 patients in the same room.

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 7 years experience. 3,488 Posts

If I was the patient, I wouldn't be happy having to take each of my pills individually. I take about 10 pills every morning & they all go down at the same time.

Hence, I ask my patients how they normally take their meds and how they'd like them to be given. Most patients like to take them one at a time, but some will happily take them all at once. As long as I'm sure they're getting the right meds, passing those meds goes very quickly for (hopefully) obvious reasons.

BluegrassRN

BluegrassRN

Has 14 years experience. 1,188 Posts

Standard at my facility is to take meds into the pt room, scan them, and as you're opening them, to tell the pt what they are: here's your doxycycine, that's the antibiotic for your infection, here's your coreg, to strengthen and regulate your heartbeat, here's your norco, for pain...." Like an above poster recommended, I always ask if anything is new.

Once you get into the habit of narrating what you're giving, it comes easily and naturally.