Medpass at mealtime a dignity issue?

biker nurse · Jul 4, 2011

WHAT?? What about meds that have to be given on empty stomach?? AM can be up until noon! Fosamax ? Synthroid? I'm curious to see how this pans out too!!

GLORIAmunchkin72 · Jul 4, 2011

I'm sure they're going to do a bit of 'fine tuning', like before breakfast, after breakfast, midday, afternoon, etc...

dudette10, MSN, RN · Jul 4, 2011

Your title asks a question that isn't addressed in your post. What is the reasoning behind deeming mealtime medpass a dignity issue? Is it because questions and answers between the resident and nurse can be heard by anyone sitting around the resident, making it a privacy issue?

IowaKaren · Jul 4, 2011

We made a 'culture change' of using AM, Noon, Afternoon, Bedtime, and Midnight (or night time) med passes which did help immensely with the med pass. Times are: Am = 6 AM - 10:59 AM ; Noon = 11 AM - 1:59 PM ; Afternoon = 2 PM - 5:59 PM ; Bedtime = 6 AM - 9:59 PM ; Midnight (or nights) = 10 PM - 5:59 AM. If a resident got their AM meds close to the noon time meds, the nurse would have to act accordingly and not give the Noon meds as close, hold off until closer to 2PM and let the nest shift know to give possibly accordingly but don't think that happened too much. This worked for the daily, BID, TID, QID med's and if ordered every 2 hrs, 4hrs, 6 hrs, 8 hrs, 12 hrs, then those times would be printed in the MAR and placed on the med cards. If there were special orders for giving like the Fosamax, then it would be printed in the MAR and on the cards also. We also made sure to have care planned any resident that took the every 2, 4, 6, or 8 hour meds after 10 PM that they agreed and wanted to be woken up for med (especially pain med's) since we got dinged for giving too many med's and treatments during sleeping hours because most folk's at home wouldn't wake up for medications (or do a foley catheter flush at 4 AM, things like that) on a regular basis.

We are also to give med's in there rooms along with needle sticks and insulin for privacy but think mainly taking BS's and insulin are given in there rooms. Funny how the Government thinks of these privacy issues but most the residents could care less.

GLORIAmunchkin72 · Jul 4, 2011

It is my understanding that dignity issue is the reasoning for the change. There was no elaboration. Maybe they believe it's self-explanatory, for example they don't want you to give insulin in the dining room or maybe they just want the residents to eat in peace so in that case it would not be a dignity issue but a matter of consideration.

Your title asks a question that isn't addressed in your post. What is the reasoning behind deeming mealtime medpass a dignity issue? Is it because questions and answers between the resident and nurse can be heard by anyone sitting around the resident, making it a privacy issue?

cindyloowho · Jul 4, 2011

I don't work in LTC, but if I was a resident, I would enjoy being able to eat and enjoy my meal with friends, in peace, without getting bothered for a med pass. I hope this change suits you all well!

leslie :-D · Jul 4, 2011

whether there's a medpass during a meal or not, i've never interrupted one's meal to give a med...

unless a prn was requested, or something stat.

otherwise, let them be.

leslie

psu_213, BSN, RN · Jul 4, 2011

Where I worked, the facility was cited by the state for giving meds to residents in the dining room. They changed this at the time, but within a month after the state left, they were back to doing it again. I think it is a dignity issue. Imagine you are a resident, sitting at the table with friends enjoying a meal. Nurse comes up to you and says "Here is the pill for your prostate and you stool softener." I see a big dignity issue with that.

eriksoln, BSN, RN · Jul 4, 2011

I'm sure they're going to do a bit of 'fine tuning', like before breakfast, after breakfast, midday, afternoon, etc...

I've seen this attempted. And U R right, you will fine tune it to having names for different, more specific time frames: Early Am, Before breakfast, At breakfast, After breakfast, Before lunch, At lunch, After lunch, Before dinner, At dinner, After dinner, Evening, Late (meaning things that were meant to be late, but shouldn't be given before that time, such as anti-depressants that cause drowsiness) and HS only.

Some of these time frames were rarely used. All the "At" ones were for the most part the insulin coverage orders. But, as you can see, lots of "time frame" descriptions.

In fact...........so many.............that is was simpler to just go back to the old timing. Truth was, all this system had done was rename real time with time frame names. Early AM became the new 0600, Before breakfast the new 0800 blah blah.

It didn't change the way anyone did anything. Oh, and did I mention, we still have the real times mixed in for narcotics and antibiotics.

eriksoln, BSN, RN · Jul 4, 2011

Where I worked, the facility was cited by the state for giving meds to residents in the dining room. They changed this at the time, but within a month after the state left, they were back to doing it again. I think it is a dignity issue. Imagine you are a resident, sitting at the table with friends enjoying a meal. Nurse comes up to you and says "Here is the pill for your prostate and you stool softener." I see a big dignity issue with that.

You say tomato, I say toemato.

I don't see a dignity issue. I see a lack of individualized care. When you mentioned giving meds in the dining room, I couldn't help but assume that means LTC. If any healthcare industry is bankrupt of personable care, it is LTC (not a slam on the nurses, its a system flaw).

Because there are so man patients assigned to only a few nurses and care staff, a systematic approach is the only thing that works. There just isn't time for any other approach, and if there were..............said extra time would be spent on other, higher priority things than worrying about someone is embarrassed because they are on colace (dressing changes that need done, helping the max lift pt. turn and reposition, getting the incontinent patients clean).

For every patient who is embarrassed about being on colace, there is another who only wants it with their meal.

For every patient who takes their protonix first thing in the AM, there is one who likes it last thing at night.

For every patient who likes their pain meds right before physical therapy, there is one who likes it right after.

For every patient who likes their insulin in the abdomen, there is one who likes it in the arm.

For every patient who wants their fiber mixed on OJ, there is one who wants it in water.

Point is, LTC is forced into a systematic approach. And that means the inability to worry about all the things I mentioned above, as much as we'd like to as nurses. In LTC and a lot of other facilities, med pass time is time to take meds or, ah well, you miss out and the nurse has to move on. Only a model of care focused on individualizing the treatments could do better than that, and that takes much better pt. ratios than what most of us work with today.

merlee · Jul 4, 2011

When I get to a nursing home - for myself! - I want all of my AM meds WITH my breakfast. So there!

The newest insulin info I have is that I should eat within 5 minutes after taking my injection. So stick my finger before I go to the dining room, and give my injection when I am seated at the table AND MY MEAL IS ON ITS WAY. I will insist on it, privacy/dignity aside. As it is right now, I take my 'works' with me to a restaurant, order my food, stick my finger, draw up my shot, and give it at the table as inconspicuously as possible.

And I've done it at all types of restaurants, cheap & family & pricey.

I think that MOST residents don't need to be told what their meds are every time they are given, most already know. As if most of the residents aren't telling each other what their health issues are!!! Most residents know more about the other residents than the nurses do!

These med times changes are another way to make things more confusing.