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.
Yes, then you put the baggies in the cart and deliver them. Or in your pocket while you walk down the hall: wherever. I'm not sure it matters. I'm only asking about pre-packing. In school this was definitely presented as verboten and if I remember correctly it is against policy set by the regulating agency in my state for rest homes.
We were all taught not to do this. And not to sign the MAR until after the medication is actually given. But it seems as though either one or both of these things are done out in the "real world".
When you have 8 patients or 40 residents in a NH you CANNOT keep going back to the Med room !!
As long as you have your MAR with you, your Med Cart has each patient label on it, and you follow 5 rights of med. admin EACH and EVERY patient - you're fine.
See now that is a horse of a different color all together!! You SHOULD NOT be signing 2 p meds at 8a!! When I was a QA nurse at a SNF facility I used to deal with this all the time. My stance to the nurses was this: It is better to not sign the meds at all then to sign them hours ahead of administration. I used the MAR as a guide line for what I have given or given...what if you have an emergency and flip open your MAR at 200 PM and your meds signed already, one might say to themselves Oh yeah I already did that when in fact..you did not.
When you have 8 patients or 40 residents in a NH you CANNOT keep going back to the Med room !!
As long as you have your MAR with you, your Med Cart has each patient label on it, and you follow 5 rights of med. admin EACH and EVERY patient - you're fine.
Not in the great State of Michigan....if you are being surveyed and they observe pre poured medications, you will most likely get an immediate jeopardy citation and you as the nurse can pretty much kiss your current job good bye. Do you not have a med cart? What do you mean med room?? Don't you stock your cart with you what you need prior to starting med pass??
I guess the issue of 'prepackaging' meds never came up in school for me as we were only assigned to one pt (one time two!!) on any given day. That would fall under the school vs. real world discussion others were having.
Where I work it is a big no-no to sign the med sheets ahead of time. Patients can have their meds "set up" ahead of time. Maybe that's what you are referring to when you say pre-packaging, but setting up meds is not the same as administering them and shouldn't be documented as such. The med sheets only get filled in after the patient actually takes the medication.
Yes, then you put the baggies in the cart and deliver them. Or in your pocket while you walk down the hall: wherever. I'm not sure it matters. I'm only asking about pre-packing. In school this was definitely presented as verboten and if I remember correctly it is against policy set by the regulating agency in my state for rest homes.
We were all taught not to do this. And not to sign the MAR until after the medication is actually given. But it seems as though either one or both of these things are done out in the "real world".
Yes, you cannot sign off on meds before you give them. You also cannot prepour meds. So I would say that you are correct and that this situation is not OK.
I would guess that the individual fired after only two hours, presented a situation whereby the employer saw quickly that they did not want to deal with what was to be a big thorn in their side, so they pulled the thorn out before a lot of anguish was expended on it.
I work in a hospital and we always sign when we get the meds out, not after they are given. if they are held or refused we put an "R' or an "H" on the MAR.
I have worked (for a day or so) at facilities where setting up meds ahead of times was, shall we say, encouraged. IMO those facilities are the first ones to throw you under the bus, should something go wrong.
You can either pour, sign, give or pour, give, sign for each patient. It is fine to sign off the MAR right after you pour right before you give to the patient and then come back and circle anything refused or held. Even the state surveyors do it this way in my state.
hotflashion, BSN, RN
281 Posts
Yes, then you put the baggies in the cart and deliver them. Or in your pocket while you walk down the hall: wherever. I'm not sure it matters. I'm only asking about pre-packing. In school this was definitely presented as verboten and if I remember correctly it is against policy set by the regulating agency in my state for rest homes.
We were all taught not to do this. And not to sign the MAR until after the medication is actually given. But it seems as though either one or both of these things are done out in the "real world".