Medication & treatments on midnight shift

[Micki72]

I started a midnight position at an LTC about 3 weeks ago. I am still having a hard time getting all the medications and treatments done by shifts end. Is there a trick to getting to all the treatments? Do those of you who are experienced do your treatments before you begin your need pass? If so, how do you do this & what time do you start you're treatments & meds? Any insure or info would be helpful & greatly appreciated. Thank you

[Anne36, LPN]

I have one hall that I never get to all the treatments, there just is not enough time. If you get a routine down it should help. If you are able to know who gets midnights meds without having to flag the entire MAR every night that would help. I usually have to go through entire treamtent book and MAR to flag it all down and plan out my night which is time consuming. I usually do midnight meds and then start on treatments and try to start charting around 3 so that I can take a quick break and be ready for the am med pass. I have been told that we are only 1 shift out of 3 and what does not get done is passed on to the next shift, however much we dont like to do that, there is no clocking out late:( The trick is probably that you will get faster once you have a routine down.

[proud nurse, BSN, RN]

When I worked in LTC, if I had a treatment that needed to go on a resident's buttocks I made sure to plan to go the same time the CNA did rounds. That way, we could help each other and we weren't waking the resident up several times unnecessarily. They could help hold them over to one side, and I could help with the rest of their cares. TEAMWORK.

Most of my meds were either scheduled at midnoc, 0200, 0600 or PRN. Meds were never a problem. I would only have a few if a resident was on an antibiotic for 10 days or something. Mainly it was the PRN pain meds or anti anxiety meds that I administered like candy.

[CapeCodMermaid, RN]

Unless it's ABSOLUTELY necessary, we do NOT do meds or treatments on 11-7. People need to sleep. We have a few people with 630 blood sugars or Fosamax, but other than that...nothing.

[chrisrn24]

I guess it depends on your treatments. Most of mine are butt creams which I trust the aides will do. As far as other things, it is a great idea to bring things along on rounds so you can wake the person up and be done. Same goes for assessments, although that rarely happens as I usually help my aides during rounds. After rounds then I'll start my assessments. Then charting, lunch break, then usually 0600 meds.

[laderalis]

Out of 36, I have about 8 that get 0600 meds, otherwise not much goes on. Treatments are done on days or afternoons unless its something that we can't get to on that shift. I have one skin tear treatment now that I do on NOC because its too hard any other time. I do the dressing change when the CNA does bed check.

[barbie76]

I have 32 residents to administer meds and provide certain treatments to .... the meds part still takes me two hours sometimes longer we recently had a very extensive dressing change that took an hour ....LTC nursing is challenging there just isn't enough time somedays, and if u have a fall or death or sending someone to hospital ...... forget your breaks ....

[kguill975, MSN, APRN, NP]

If any of you guys are ever interested in a change of scenery, come on over to OR nursing, where it's one patient at a time. I imagine you would probably die of boredom.

[Fedide]

It really depends on the unit I'm working and how many meds/treatments there are. I go through the MAR and TAR at the beginning of the shift, and write out the times things are due. Then on my report sheet I write the treatments that need to be done sometime during the shift. (So I can glance quickly at the sheet when I'm at the resident's room). I let the CNAs know if I need to be called when they are doing cares on someone to see a coccyx, etc. I then begin my 2300 and midnight meds. Then I begin my full rounds. I chart my vitals, sign the TAR, etc. as I go. Most of the things like checking O2 sats I do during first rounds. If they need a Medicare assessment, etc., and I know they often call several times during the night for toileting, PRN meds, etc., I might wait until they call to do the assessment.Of course if your shift starts crazy (a fall, a found skin tear, a lot of PRN requests) I might do a quick rounds to visualize everyone, then go back up and down the halls with the cart doing treatments). The only thing I save until the end is my Medicare progress note. If I am on a unit that has a ton of 0600 meds and PRN suppositories, I start those at 0500, the earliest I can.Getting your routine down will help, and that takes time. Everyone has a different system that works for them.

[Anne36, LPN]

CapeCod, what does your midnight shift consist of, outside of medications and treatments? I keep asking myself when do these residents get to sleep? LTC is every bit as bad as a hospital. Lights on and off all night, vital signs, meds, treatments, and assessments. I am waking people to do wound care and skin assessments at 1-2 am. Med pass starts at 4 am. "Here is your thyroid pill, back to sleep now". I have a few midnight meds but should a resident be woken up for 2 Tylenol?

[ufo8micats]

I don't know how many nurses say this out loud but, god bless the aids. If it were not for the aids then us nurses would be hard pressed to get our jobs done in an Expedient manner. I try to advise all nurses to be good to their aids, they can make or break you.

[AngelRN27]

At my facility there are currently no treatments (unless you count Nebulizer tx, which I assume you don't mean to include in the scope of tx's) on the 11-7 shift. We schedule skin tear treatments on the shift that they occur/are discovered, wound care is done only on 7-3, and central line dressings are changed on 3-11. Of course, all of these may also carry a "PRN" and occasionally we do have to redress sacral wounds or lines if a dressing comes off or becomes soiled.

As far as med pass, I run two halls on nights and have only two residents with meds due at 12am (both nebulizer treatments that are q6). Prior to med pass I make sure to take care of all of my PEG care, provide my CNAs with any creams they may need to apply throughout the shift, grab the vital signs I need, etc. At med pass, I hang any IV abx first, not only because they are much more time consuming than PO meds, but also because I like for them to be done running before change of shift. My morning medpass pretty much only includes things like synthroid, omeprazole, some sinemet. Also some accuchecks (about 10). I have about 35 residents and I finish my complete med pass in about 1h15m. You have to get into a routine and know your residents. My first week or so on nights I would start med pass at 5am and barely be done by 7 to then begin charting. You'll get there!