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

[aml_rn23]

I usually do treatments as early as possible..usally when my aids are doing rounds at 2 am. I cluster my care as much as i can to wake them up as little as possible. A lot of treatments are creams etc..sometimes ill get a dsg changes that will show up at 5 am but i refuse to do it that late bc i start my med pass at 5. From 2 am to 4 residents usually ask for prns, some IV abx show up at 4. From 5 to 7a im passing meds straight through and i barely finish on time bc something always happens; falls, skin tears, ppl with fall risks getting up on there own.. etc. If i am lucky i finish early, which is rare.

[trac1 one]

I agree with CapeCodMermaid, RN.  I was a day nurse for almost ten years and it never bothered me that the night shift had different responsibilities and passed very few meds. The only patients that were assessed and given meds on night shift were critically ill (like on a heparin drip, getting a blood transfusion, or weaning off a vent).  As soon as the patients were stable one of the first changes the doctors would make would be to d/c meds, vitals signs, tx etc on the night shift because sleep is important! Many nursing home patients are frail and elderly and do not want to be woken at 6am to take 1 pill (usually omeprazole) or strip off their clothes for a skin check. The reality is night shift simply has less distractions so anything missed can be caught and any errors researched and hopefully resolved without burdening the day shift. If the time is used well night shift should support the other shifts and alleviate the workload.  For example:

• Pass on the admission assessment.  Day or evening shift gets stuck verifying admission orders, the rest of the admission can be completed on night shift as long as there is a note detailing where the resident came from and how they were transported.  Summaries and updating care plans can be done on night shift. 
• Non-urgent orders or changes to take effect the next day or evening shift can be left for nights to transcribe.  Same with lab requisitions and updating the census sheets and CNA assignments.
• Med reconciliation is very time consuming.  If done correctly the night nurse learns all the details of the hospital stay, events that led to the hospitlization and reason for admission to the SNF.  This info can be relayed in report or on the census sheet. This saves the day shift digging around the chart when family  members or doctors inevitably bombard them with questions.
• Med carts should be clean and organized, day and evenings should never worry about expired meds. Nor should the day and evening shifts be searching for missing medications. The night nurse should confirm they are available for the day and evening shift med pass.  
• IVs should be scheduled at night when possible.  Definitely if they are once a day.  This is better for the resident because they often agree its OK to hang the med without waking them. Prevents them being tethered during waking hours.  
• Nocturnal tube feeds, they should be taken down BEFORE day shift arrives and the site dressing changed. 
• Some other things like reviewing blood sugars and vital sign trends can fascilitate reducing glucose and vital sign checks. 
•  There are many things the night nurse can do that should support the day shift and lighten the load far more than handing out an omeprazole does.    

[Glycerine82, LPN]

Why kind of treatments do they have you doing on 11-7?