Medication Administration

[Littlefoot88]

I was taught in school to follow "the rights list" and do your "three checks" and I understand what pre pouring is and not to do that... however.. now at my job they are telling us we have to pull meds from drawer/machine, take the packages ALONG w the MAR to the beside and open the packages at the bedside...then sign once pt takes them??? This seems ridiculous to me and was not at all what I was taught. I feel like I would be carrying around a lot of garbage ie:packages, mar book more likely to be contaminated and you are more likely to make a mistake due to distractions???

Normally I would pull meds from drawer/machine, check them against the mar (put a dot to show I have checked that one), take the cup w pills to the patient/check band, give the meds then go back to mar and sign (hope this is clear and makes sense)

Wondering if anyone else has been asked to practice this way???

I am wondering how that works with isolation or is that considered a special circumstance

[Nolli]

Possible reasons:

1) Have you ever had a patient refuse a med? I have and once it's open it can't go back. So possibly a cost benefit.

2) More accurate charting on an at the moment basis. If you document as you give them then you can't really get interrupted by something else and delay/forget to do so before you get a chance to document on the way back and the charting is up to date from the beginning for anyone looking at it.

3) Helps with medication accuracy. If I get interrupted/distracted by something or someone I have a record of what has been checked and/or given and an open wrapper right next to me to confirm it.

I toss the wrappers when I'm done in the in room white trash, so I'm not carrying it around after. The MARs we used were all electronic and some had scanners that scanned the patient ID and the medication itself and checked to make sure you scanned the correct dose. Paper MARs could be a problem esp with isolation patients. I'd ask what the policy was for those situations because I can't imagine bringing it in the room, you can't disinfect it after.

[nlynrob]

I'm still a student so I am NO expert on med giving or policies but...

Every site I've been too requires bringing all of the still packaged meds to the bedside with the MAR (paper or electronic or sometimes both), open them at the bedside after telling the patient what each one is and ensuring they won't refuse it, and check them off or scan them as the patient takes them. I thought this was because I was a student at first but that's not really the case, every nurse I've watched give meds does the same thing.

[SopranoKris, MSN, RN, NP]

The hospital where I have my clinicals requires beside check off of meds on the EMR. We are not allowed to open meds before entering the room. Not only does this cut costs if you can't give a med, but it provides one last check between the EMR & med packaging before administration. By the time you're at bedside to administer, you've already triple checked.

A student at another facility says they scan the pt ID bracelet and then scan the med before administration.

It all depends on the hospital policy. However, I personally like having built-in checks. It really helps to cut down on med errors. By opening each med at beside, it gives you a chance to explain to your patient what you're giving them and answer any questions they have.

[mrsboots87]

What you describe is actually how we are taught in school. We do our first check when pulling the med from the drawer. Take our meds to the prep station and do our second check. Take meds and mar to the patient room and do third check, then pop the pills from the package and place in the cup as we explain the med to the patient. If you think about it, it's the only way to truly do the third check. If you pop the pill from the package on your second check, then all you have is pills in the cup in the patients room with no way to verify med or dose. I know in the real world, things are different at each facility, but taking the package to the toom actually seems like it would decrease errors, and save money if a patient refuses a med.