medication strip packs

kcochrane · Jul 2, 2009

We have med carts that are stocked by pharmacy every Wed. Each resident has their own drawer (or drawers if needed), with stock items (tylenol, colace, etc) having their own little drawers. I've never hear it done the way your described, but it seems like a lot of work intially - not so much for the person passing meds.

ajaxgirl · Jul 2, 2009

Pharmacy prepares these strip packs. The nurse giving meds still needs to do her 3 checks though. I find this very redundant-the checking beforehand.

PAERRN20 · Jul 2, 2009

I don't see any problem with 2 RN's checking the meds and then of course the final check before actually giving the med. Wouldn't you want the nurse to check your meds throughly, even if it meant a "very redundant" extra check? As we all know, the pharmacy makes mistakes too.

I'm not trying to be mean or harsh, but that's how I feel.

ajaxgirl · Jul 2, 2009

I don't see any problem with 2 RN's checking the meds and then of course the final check before actually giving the med. Wouldn't you want the nurse to check your meds throughly, even if it meant a "very redundant" extra check? As we all know, the pharmacy makes mistakes too.
I'm not trying to be mean or harsh, but that's how I feel.

OK

I have worked for 3 LTC facilities and they all had strip packs but we never did this step. It can't hurt. It is just a bit foreign to me -I guess.

NotFlo · Jul 2, 2009

I have never heard of or seen either of the two systems mentioned above - the strip packs and the little drawers are totally foreign to me.

We get our meds in the bubble packs. They are placed into the cart, divided by pt. room. They are almost always all mixed up in a big jumble...not separated by med time or anything like that.

Sometimes I try to organize the meds by time but it never works out because of the BIDs and TIDs...the next shift pulls everything out of order during their med passes.

All the stock meds are kept in bottles in the top drawer of the cart.

Honestly, I do think it's a bit unnecesary for two RNs to verify the strip packs, unless the nurse giving the meds was just going to give them without doing her own three checks.

CapeCodMermaid, RN · Jul 3, 2009

We use blister packs. One for each medication. When I passed meds I tried to arrange them in the drawer in the order they were written on the MAR since it saved so much time. Apparently no one else saw the wisdom in that since the meds were always in a jumble the next morning. I did see at an AL meds packed in individual bags...all the 8ams in one little bag, the 12s in one. It looked like a great idea but the chance for a mistake on the pharmacy's part seemed high.

levisandtees · Jul 4, 2009

I have only worked at one facility that did this; actually utilized CNAs to assist with putting meds in the correct order per MAR (by patient with different sections for AM, NOON, PM, HS, NOC). At my current facility everyone dreads refill day because pharmacy stocks the drawers and they are never in order by name, time, etc. and med pass takes much longer (they inevitably forget a container and we're running to contingency throughout med pass, putting meds in order, calling pharmacy with corrections, trading meds between halls because even though a resident switched rooms a month ago they're still being stocked in the other cart, etc.). Maybe the dual nurse check is overkill for normal meds (not a bad idea for narcs) but I would definitely appreciate it if they were in some semblance of order at the start of shift.

NurseKatie08, MSN · Jul 4, 2009

My facility uses bubble cards as well--two nurses to sign in narcs, but regular meds go into their respective spaces after a card with the pt's room number. This strip system sounds like it could cause a lot of errors.

bluegeegoo2, LPN · Jul 5, 2009

We use the bubble cards as well. Pharmacy doesn't stock squat, I do. The meds all come in a big grey "totes" that are zip-tied shut, and I have to go though each one and check them off on the med inventory sheets that come with them to ensure we rec'd everything they said they sent. The narc's are also thrown in there. They are "packaged" in a brown paper sack that is stapled shut with the pt tag on the outside proclaiming it's contents. The count sheet is rubber-banded to the card. I am required to sign an electronic device that the courier carries that simply proves the courier brought the boxes to us. After I check off everything, I sign the inventory sheets and put them in the DHS's box. Then, lucky me, I get to put them all away. Our med carts have the spaces with the room numbers as well. It's especially fun when we've had 3 or 4 admits for the day.

yadda_yadda_yadda, LPN, LVN · Jul 5, 2009

Wow..that system sounds like hospital/acute care almost....and a LOT of man-power/time placed on your pharmacy. :bugeyes:

I worked an acute-care setting in Texas (before moving to WA) that used that system. Their rationale was that 'orders changed frequently' & it also cut down on 'borrowing'; therefore, billing errors.-THe day-to-day system enabled the pharmacy to accommodate frequent changes in orders, without having a lot of waste ---However, more times than I care to even mention, the meds weren't in the cart when it came time to pass...either orders had come across afterhours & the pharmacy hadnt known about it, or some other reason....and we were waiting, tapping our toes, for the pharmacist...who rechecked the ENTIRE CART, drawer-by-drawer...which drove me crazy! Heaven help us if a pharmacist was ever late for work, or called in ..and we were left waiting for their replacement to arrive! :uhoh21:.......and Coumadin was only provided ONE tablet @ a time. No exceptions....because the pharmacy insisted on reviewing PT/INR results before dispensing a dose.

The LTC facility I work @ now uses a large, LTC pharmacy that works with 30-day 'bingo cards' for all routine meds..and are "expected" to initial each dose next to the # we pop out. The prn's/narcotics come in the same style, with either 30-60-90-120 pills to the card, depending on the frequency of use and/or order.

This, too, has it's drawbacks..."borrowing" still occurs...its a reality of LTC, whether 'the powers that be' acknowledge it or not. If "Resident A" runs out of a medication before the date that the pharmacy has in their computer to refill the drug, they WILL NOT send it! Instead, we get a little 'nasty-gram' saying ---"Medication not in cycle for refill..Please reorder as scheduled".

Despite the pain of initialing both the MAR and the cards, it holds less-than-honest nurses accountable in regards to their med passes. It's sad to see how many nurses sign off "Yep, I gave those pills"...and you KNOW that they weren't given...either the resident was being difficult or whatever--and they simply glossed over giving the pills.:angryfire

Most of our OTC pills are house-stock, in bottles from wherever the Central Supply orders them from. Some residents do get OTC's in the bingo cards though...not sure why (or how much their insurance/payment source has to pay for tho$e)

Bingo cards are my favorite...as long as the nurses stay on top of pulling the re-order stickers and everything stays current. :yeah:

kmarie724 · Jul 7, 2009

We use the bubble cards as well. Pharmacy doesn't stock squat, I do. The meds all come in a big grey "totes" that are zip-tied shut, and I have to go though each one and check them off on the med inventory sheets that come with them to ensure we rec'd everything they said they sent. The narc's are also thrown in there. They are "packaged" in a brown paper sack that is stapled shut with the pt tag on the outside proclaiming it's contents. The count sheet is rubber-banded to the card. I am required to sign an electronic device that the courier carries that simply proves the courier brought the boxes to us. After I check off everything, I sign the inventory sheets and put them in the DHS's box. Then, lucky me, I get to put them all away. Our med carts have the spaces with the room numbers as well. It's especially fun when we've had 3 or 4 admits for the day.

That's pretty much the system we have where I work too. Thurday is always the day we get our big drug order in, so I always dread working a PM shift on a Thursday!