Med Prepouring Question (CNA)

DutchgirlRN, ASN, RN · Dec 19, 2007

My question would be are the meds still packaged when they're put in the envelope, in other words, can the person dispensing the pills accurately know that the correct pills are in the envelope or are the pills removed from a container and put in the envelope unmarked?

If they are unit dose packaged and will be identified and removed from the package by a licensed nurse then I don't see a problem with it.

If they are removed from a package or bottle and put into an envelope to where they cannot be identified by a label then H*** NO!!! I would not do it. No way, no how. Additionally I wouldn't think the nurse dispensing the pills would take the responsibility to dispense pills that were not still labeled.

I have heard of medication aids. I believe there are threads here on all nurses about this subject. Try searching here.

shadchan · Dec 19, 2007

Okay, I have done some searching on here thanks to you giving me the right keywords to search for. We get prescriptions from the nearby pharmacy and keep them in the med cart as is. On my shift, 3-11, there is no licensed nurse in assisted living but the RN from rehab/acute comes over twice to give insulin to those who need it and take care of any emergencies. There is no licensed nurse that handles the meds. The CMAs do it ALL, including logging the incoming meds from the pharmacy, and including narcotics.

All meds are in labeled med bottles or bubble paks; narcotics dispensed are logged in a separate log book. When the caregiver pours the medication, she works from the medication record book as to what to give, and pours the selected meds in the envelope with the patient's name and time to dispense on it. However there will only be 1 hour of training to do this and I've seen more than a handful of medication errors in my short time there. The narcotic counts are always off.

Considering that there is very little licensed supervision on this, are my fears justified?

Thank you again. I really appreciate the help.

DutchgirlRN, ASN, RN · Dec 19, 2007

All meds are in labeled med bottles or bubble paks; narcotics dispensed are logged in a separate log book. When the caregiver pours the medication, she works from the medication record book as to what to give, and pours the selected meds in the envelope with the patient's name and time to dispense on it. However there will only be 1 hour of training to do this and I've seen more than a handful of medication errors in my short time there. The narcotic counts are always off.
Considering that there is very little licensed supervision on this, are my fears justified?

Definately! and kudos to you for checking it out. I think whether or not this practice is legal it is undoubtly unsafe and I would be looking for another job. Your butt might end up in a sling with the narcotic count being off, drug addicts can be slick about setting other people up, not to mention the med errors that can occur. Besides giving the wrong medication there are times when the patients should not get their own prescribed medications i.e. BP meds, Diuretics, blood thinners, etc...

RUN!!!

shadchan · Dec 19, 2007

*PHEW* I am so relieved to hear you confirm my gut feelings...THANK YOU!

Now, I have one more question that has evolved from this topic. For the past month or so I have had One Of Those Gut Feelings about work and have deeply considered working for a registry doing homecare either alongside or in place of this job. So in a way I have my butt covered if something happens.

I ask because I'm very willing to stand up for myself and my patients but not sure how - I see the lady doing the training at 10am tomorrow. Our employment is at will also. If I raise my concerns and refuse, if they don't have another position for me that doesn't involve passing medication, would it be better/safer just to put in my two weeks right there? Or just walk out? I am not concerned about my resume so much - I am concerned about the health and wellness of my residents and my career in the long term. My goal is to eventually become a physical therapist and I am not going to endanger that by endangering my CNA licensure.

The place has gone so far downhill in the past 14 months that I've been there...many of my residents have said that 10 years ago, the facility was THE best in the state. Everything seems to be falling apart now.

Thanks again and I'm pretty sure that's my last question. LOL

joprasklpn · Dec 19, 2007

I used to work in a place like this where the CNA administered meds on the assisted living side, even giving insulin shots. Risky practice in itself with no training, not to mention they were not med techs. You will ultimatly be responsible for errors and the facility will just stand by the "oh, we trained him/her" so I would look for new employment and give your notice after you secure another position. It really is a shame that places are so willing to compromise safe practices to save a buck.

DutchgirlRN, ASN, RN · Dec 19, 2007

It's always best to give a 2 weeks notice. I would however, explain to the woman doing the training that you have no intentions of pouring up the patients meds and why. It's so sad to think that our elders are put at risk like that simply because of the almightly dollar. I'd be willing to bet that none of the admin staffs parents or grandparents live in the facility.
Have you thought about being a PTA until you can get your doctorate in physical therapy? It now requires a doctorate, my daughter is in a doctorate program.
Good Luck and please let us know.

shadchan · Dec 19, 2007

The PTA program was suggested to me by several people, but everything I have heard as of late is that it only requires a Master's. Erk...I work with several PTs who only have their Bachelor's!

Thanks for the heads up, it is definitely something I will look into. Also thank you for the encouragement and advice. I'm usually chickenhearted but not when they are asking me to do something like this. I will update you later this afternoon when I return...gonna check out some home care agencies and registries afterwards too.

lindarn · Dec 19, 2007

The PTA program was suggested to me by several people, but everything I have heard as of late is that it only requires a Master's. Erk...I work with several PTs who only have their Bachelor's!
Thanks for the heads up, it is definitely something I will look into. Also thank you for the encouragement and advice. I'm usually chickenhearted but not when they are asking me to do something like this. I will update you later this afternoon when I return...gonna check out some home care agencies and registries afterwards too.

Physical Therapy Assistants require a two year Associates Degree. Physical Therapists require a Dpctorate Degree. Occupational Therapy requires a Masters Degree.

Lindarn, RN, BSN, CCRN

Spokane, Washington

DutchgirlRN, ASN, RN · Dec 19, 2007

The PTA program was suggested to me by several people, but everything I have heard as of late is that it only requires a Master's. Erk...I work with several PTs who only have their Bachelor's!

PTA is a physical therapy assistant which is a two year program, usually in a junior or community college and requires an associates degree.

Physical Therapist use to require a masters degree but now requires a doctorate degree.

stanleyvinet · Dec 19, 2007

Hi all, I'm so sorry if this is in the wrong place - please lead me to the right one if that's the case.
I'm a CNA/CHHA in a big retirement facility with independent, assisted, rehab, and LTC. For the past few months I've been working as a caregiver on their assisted living side because I changed to pt status to return to school.
All the other caregivers (no license or certification) pre-pour the patient meds into envelopes that later shifts dispense to patients. I have always felt uncomfortable with this because I know as a CNA I sure as heck am not allowed to go anywhere near the meds.
They want me to go to a 1 hour training session tomorrow to become a "med tech aide" and learn to pour the meds myself. They have let me slide on it but they say that the training must be done by the end of the year, so here I am in this predicament.
I feel very uncomfortable with this and feel like something is fishy. I've never even heard of a "med tech aide" and Google brings up ZERO search results on it.
Please advise me on whether caregivers are allowed to do this, and if so, would it affect or endanger my CNA certification?
Thank you all very much in advance.

Actually, a CMA is another certification that CNA's can achieve. You have to go to another certification course.

Here in texas it's a State Regulate program , just like the CNA Program. Here's a link to check it out for your self.

http://www.austincc.edu/ce/files/schedule/fall_07_hpi.pdf

MEDICATION AIDE PERMIT

** May Qualify for Financial Aid-Contact 512.223.7547 **

Advanced instruction in preparation and administration of

designated medications by Certified Nurse Aides working under

the guidance of a licensed nurse. Must be employed on the first

day of class. Employment must be in a Medicare Skilled

Nursing/Medicaid Facility, licensed MHMR facility, or be a

Certified Nurse Aide or have a minimum of 90 days employment

providing patient care in a licensed assisted living facility. Must

have high school or GED equivalent. Books at Rio Grande

Bookstore. ($25 state testing fee payable to Texas Department

of Aging & Disabilities Service.)

DutchgirlRN, ASN, RN · Dec 19, 2007

Actually, a CMA is another certification that CNA's can achieve. You have to go to another certification course.
Here in texas it's a State Regulate program , just like the CNA Program. Here's a link to check it out for your self.

There is alot more to giving meds than getting the right med, right dose to the right patient. Meds should only be given by a nurse with a license no matter what the state law allows.