Medpass combining and coumadi's place in it

[ceebeeRN]

ok..I admit I combine med passes BUT I am a RN, so i assess, assess, assess. I space out bp meds, depakote doses, put IV ABTs on time, etc. However, some patients have like 2 meds, maybe a shot of insulin at 4:30 and then a coumadin at 9. all coumadin is scheduled for 9pm and it may be silly of me to ask this, but is there any particular reason, coumadin is scheduled so late? is there any reason medically/ heathwise I couldnt give it at 4:30 so that person can be done with their meds and I dont have to bother thm while they are in bed later?

The only practical reason I could think of scheduling coumadin late is so that it gives the staff time to reieve the results of the PT/INR and hold/change coumadin orders in case the results are out of range,

[nurselabrat]

ok..

"The only practical reason I could think of scheduling coumadin late is so that it gives the staff time to reieve the results of the PT/INR and hold/change coumadin orders in case the results are out of range,"

That's the reason. Also coumadin should be taken at the same time every day. We have patients that do take their coumadin at 4:00

[NurseDirtyBird]

Every facility I've worked in has scheduled coumadin at different times. I worked in one where coumadin was at a different time for almost every patient - they just continued their coumadin routine as they had at home.

I don't know any nurses (except brand new ones) that don't combine med passes. Sometimes if you don't, you just spend your whole shift going back and forth, handing out one or two pills to each person, repeat ad nauseum. I don't see a problem as long as you use common sense. Don't put sleepers in the afternoon pass, ABOs/IV at their scheduled times, ect.

[BrandonLPN, LPN]

You're absolutely right about coumadin timing and about combing med passes safely. Med pass combining is the lesser of two evils, the worse evil being so anal about exact med times that you do nothing but pass meds for 8 hrs.

I must say, though, I take a little exception with you saying "BUT I am a RN so I assess". I'm not sure if you intended it this way, but it comes across as if you're implying a LPN wouldn't have the judgement to combine passes safely.

[NotFlo]

Oh well thank goodness you're an RN so you can "assess" if your med combining is safe. Do you mean to imply that an LPN should never combine because they aren't able to determine which meds are safe to give earlier?

[bonster71]

Combining med passes is a tricky practice. We always need to keep in mind that if something goes wrong, we pass early, and then leave the floor for any reason--the one who follows us may not know that a med was given early. Those who use EMR/eMAR charting cannot pass early and document as such or be out of compliance. A big no-no in the eyes of the state.

[ceebeeRN]

Please do not take offence, I was just stating my title. My facility does not really make a differentiation between LPNs and RNs, so I have no reason to make this a LPN vs RN thing.

[ceebeeRN]

No. You're reading way too much into it. If I were an LPN, I would've written the same thing. point being if you are any sort of licensed nurse, you have patients AND a license to protect, so I'm sure you would assess no matter what letters follow your name.

[ceebeeRN]

Yes, I know combining med pass is tricky. However when there is only one nurse to 40 patients, I don't know how 2 med passes can be done especially when new orders, new admissions, falls, etc are subject to happen at any time. I would hope facilities that use eMAR take into consideration their nurse to patient ratio.

[CapeCodMermaid, RN]

Instead of debating RN vs. LPN or debating the merits or pitfalls of combining med passes, your time would be better spent speaking the the MDs or your pharmacy consultant. Review the med pass times with the consultant and have him/her recommend time changes to the MD. Coumadin is given after 5pm in most places because the lab results don't come back till after 4pm.

[bonster71]

Lucky for me, that our facility finally decided to change med pass times on the "longest" hall. Long pass, difficulty getting residents to take, lots of VS parameters, etc. So now...the long hall has a 0800 and 1000 pass. It at least helps us not feel so stressed about staying in compliance regarding times.

Don't you hate when a new order comes in and someone enters it at a time that makes zero sense? i.e., Resident has a 0800 med. And then nothing until Noon or 1400. So they put it at 1000? Folks just don't LOOK before putting a time and eventually you have people with meds at 8,9,11,12,2,4. Goodness!

We need the consultant Pharm visit very much. It is time. We have a new DON, so maybe it's a good time to address the issue.