Med Techs in Florida

[newpractice]

I am a brand new LPN in the state of Florida. I recently took a position at an Assisted living facility. I am amazed at the difference in practice after doing clinicals primarily in nursing home settings. The facility I am working uses Med techs to administer medications. Blood pressure medications are given without checking BP and cardiac med given without assessing heart rate, does anyone one out there know if thats okay? When I questioned the LPN training me she said it was ok because if the resident was at home they would probably not check it. I also noticed a med tech going in the computer and changing the orders for medications, is this legal? It is a legal physicians order, can you make changes without a license?? I am so nervous that I might lose my license, something I am so proud of and worked very hard to get. Does anyone out there have any advice?

[TheCommuter, BSN, RN]

I love working with medication aides.

With that having been said, residents in non-acute settings do not need vital sign check multiple times a day since they are not acutely ill. This is their home.

If you were living at home, had chronic hypertension and took Clonidine three times a day routinely, would you check your own blood pressure three times a day? Probably not.

In addition, the "losing my license" mantra is highly blown out of proportion. It is hard to lose a nursing license, and I have never met a nurse who got in trouble over some mistake made by the medication aide. Statistically, most nurses lose their licensure over addiction, impairment, theft or drug diversion.

[HW932j4]

I have to disagree with the above poster, but that's just my opinion, and I seem to be in the minority with this. I NEVER give a BP med without checking vitals first. Sometimes I get laughed at, but that's okay. I'm sure the resident likely wouldn't take their BP before taking a blood pressure medication. Many people don't, and that's their choice, but you're not responsible for them. You are, however, responsible for the resident you are administering medication to. In this circumstance, you are administering the medication to them, and if anything happens (ex. a fall due to hypotension-in which the elderly pt could sustain serious injuries) you would be held responsible, and the board would be questioning why you didn't check before administering. It may take extra time, but your license is worth it. I've had situations where a pt's blood pressure was dangerously low, and if I had given the meds without checking VS, I have no doubt they would have been sent out to the hospital for my mistake. Better safe than sorry. Like I said, that's just my opinion.

[TheCommuter, BSN, RN]

You are, however, responsible for the resident you are administering medication to. In this circumstance, you are administering the medication to them, and if anything happens (ex. a fall due to hypotension-in which the elderly pt could sustain serious injuries) you would be held responsible, and the board would be questioning why you didn't check before administering.

The vasculature of the elderly is inelastic and rigid due to age and structural changes, so hypotension s/p administration of antihypertensive medications is uncommon in this particular patient population. In non-acute care settings such as LTC and assisted living, I still firmly stand by my assertion that checking the elder's vitals multiple times per day is unnecessary.

It may take extra time, but your license is worth it.

In nearly a decade of nursing I have never met a nurse who lost his/her licensure over a hypotensive episode that resulted in hospitalization. As I previously stated, most nurses lose their licensure over addiction, theft, diversion, impaired practice, or intemperate use of alcohol and/or drugs.

[caliotter3]

If the doctor has an order in place that BP does not have to be checked, then I would worry less. What concerns me about this situation is the aide going into the record to make changes to the doctor's orders. Personally, I would find another job based on this observation, and in the meantime, I would address it with the doctor and my boss. Who knows, maybe the previous nurse left because of problems like this and nobody bothered to inform you how much independence the aides have around this place.