Medication administration, not following the rules

[hotflashion, BSN, RN]

Hi,

I'm a recent grad with little nursing experience. Graduated in May 2009, worked at a rest home for 4 weeks and a summer camp for 2 weeks. Both places dispensed medications not according to the rules, i.e., pre-packed meds. In both settings, I did not feel this was dangerous, and at the rest home I certainly thought it was the only safe way to dispense meds to so many people. (I'm not arguing with the legitimacy of it pre-packing, just stating my opinion about the safety in these two settings.)

A classmate of mine was recently fired from a new job (at a residential program for very troubled adolescents) after 2 hours because she questioned the fact that the nurse she was following pre-packed and then signed the MAR before giving the medication.

So, I'm just wondering how many nurses don't follow the rules in this regard? Coming across this kind of non-compliance is a big shock for those of us new grads who have had it drilled into our heads that you dispense medications to one patient at a time, sign the MAR when the medication is given, and you never, ever pre-pack. It seems like there are rules for ideal situations and rules for real life.

I liked the summer camp I worked at and hope to return next year. The kids are all healthy, even if they have to maintain their health with regular medication. I'm thinking about the medication administration method used at the camp and wondering if I will try to change it next year, if I go back.

Any thoughts, comments, opinions welcome.

[Esme12, ASN, BSN, RN]

A classmate of mine was recently fired from a new job (at a residential program for very troubled adolescents) after 2 hours because she questioned the fact that the nurse she was following pre-packed and then signed the MAR before giving the medication. ........

I think your friend isn't telling you the whole truth. My question is HOW your friend questioned the practice. There is definately more to this story.......

[mazy]

I'm kind of groggy here so this may be obvious to others but what is a "prepacked" med?

Also, just because you learned to do things one way in school, that does not mean it is the only way. So if you see something done differently in the real world, doesn't necessarily mean it is wrong, just different from what you learned.

[hotflashion, BSN, RN]

Oh, yes, I wonder that too. On the other hand, my experience at the rest home was such that I believe there can be places that would fire you for such "insubordination" (my word, not hers). (I wasn't fired from my job at the rest home, I quit because I believed that their incompetence was dangerous, and their mishandling of my needlestick injury proved it.)

[hotflashion, BSN, RN]

I'm kind of groggy here so this may be obvious to others but what is a "prepacked" med?

Also, just because you learned to do things one way in school, that does not mean it is the only way. So if you see something done differently in the real world, doesn't necessarily mean it is wrong, just different from what you learned.

Agreed. But I'm talking specifically about giving meds.

[CoffeeRTC, BSN, RN]

do you mean pre poured or pre set meds?

[NoAverageLPN]

One thing to keep in mind is the difference between theory and practice. Some of the things we learned and how to do them just don't make sense in the real world.

By prepack do you mean draw up all meds for each patient at one time, instead of meds for patient A then administer, meds for patient B then administer?? The thing with the MAR has variances, for instance I know nurses who purposely sign it before they go into the room and then if anything is refused (I worked alot in long term care so med refusal is a common trend in my practice) you can circle it and note on the back why it wasn't given. I also know nurses who do the opposite, the theory way. I have also had surveyors from CMS/State go both ways too. You have to devise a practice that is comfortable and safe for you, as long as you have the rationale within your scope of practice to back it up. Just know that it is your license on the line and not anyone elses! As far as insubordination, I have gone toe to toe with plenty of RNs and not once been fired for it. You have to be professional and be able to back up what you say, not go off all half cocked like you are God's gift to nursing and know it all...you feel me!

I agree with the statement above, I don't think your friend told you the whole story.

[hotflashion, BSN, RN]

do you mean pre poured or pre set meds?

I'll go with pre-poured. You look at the MAR for Joe Schmoe, pull all his meds for 8a and put them in a little baggy and mark it with his name. Then you go to Steve Schmoe, pull all his meds for 8a and put them in a little baggy and mark it with his name. Same with Mary TraLa, 8a, and so on. When you're done, you go out onto the floor (or wherever) and deliver the meds to the recipients.

[NoAverageLPN]

And then you put the baggies in the cart and administer them??

[systoly]

Most of us are in for "reality shock" once school is over. I like what mazy said.

Don't discard school teachings, but keep an open mind and please make sure you get all the facts before you decide what is wrong or judge (openly). I'm also not sure what pre-pack means.

[systoly]

And then you put the baggies in the cart and administer them??

Sorry, I can't picture it either.

[psu_213, BSN, RN]

I work in the ER, so it works a bit differently (OK, a lot differently)...anyway, judging by the copies of MARs we get when a nursing home pt comes it, it seems like common practice to pre-sign for meds that are's given yet. For example, a pt is sent to the ED at 8am....his meds for 2 pm are already signed off on the MAR. Not sure what the pre-packaged issue is or means, but the presigning seems to me to be somewhat common.