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Medpass at mealtime a dignity issue?

Geriatric   (13,177 Views | 32 Replies)

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FLArn has 20 years experience and specializes in Hospice, LTC, Rehab, Home Health.

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Are you sure that they were referring to your medication pass or were they meaning the supplement called MEDPASS. I can't see how having such open time frames will work with regards to actual medications. Just a thought.

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JenniferSews specializes in Professional Development Specialist.

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I have heard talk about this new med pass system, a friend works in a facility that does this. But frankly it's not about dignity, or any other reason mentioned here. It's simply to avoid being sited by the state for being out of compliance with med times. If you have 30 residents, you flat out can't pass them all the 0800 meds between 0700 and 1000. You start at 0630 when you get in and you are lucky if you can finish by 11am. But if the meds say "am," no citation.

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1,134 Posts; 19,041 Profile Views

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.

To the bolded: heck yeah! I overheard one resident tell other one about her bladder issues and that the Dr. does not know anything and how the herbs she was one were better for her. I just shook my head and grinned. :smokin:

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587 Posts; 8,880 Profile Views

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.

this sounds dangerous. As fast paced as LTC's are with the large number of residents, someone, somewhere's gonna get the meds on top of the other meds.

Plus it seems like a lot of extra work, communication, and we all know communication breakdown happens a lot. I try to be open to change, but this reminds me of the phase where "our residents live here so they shouldn't have to wear name bands." Sign me one freaked out little agency nurse on the 3-11 shift!

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215 Posts; 5,950 Profile Views

Have worked at both type of places and the problem with insanely long medpasses remained. The dignity thing like someone said is coz u don't want to discuss resident health and med questions at the dinner table for all to hear and u don't want to be lifting a shirt up at the dinner table to give insulin. Stuff like that. The only way to solve this problem is to figure out how to reduce the number of meds the residents take on a daily basis.

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robby5313 has 3 years experience.

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I have to say that I agree with the problem of meds getting given on top of each other. How will you know that Mr. Jones took his AM dose at 11:00, so he shouldent get his afternoon dose at 12:01. It just seems like it would be very confusing. I TOTALLY know about med passes. I worked in LTC for many years. I can guarantee that lots of things, (MedPass, Metamucil, Miralax) did NOT get given. How the heck can you pass meds for 35 people, 20 of whom have narcs that you have to sign out in 3 different places, give 99% of them Miralax and probably 50% of them MedPass and get done on time. I would clock in at 6, get on the floor at 6:30, have to do treatments to bottoms (before they got up), do blood sugars, get insulin ready, start to pass those meds before they go to the dining room--yeah no problem! Most of these people need to take their meds at the time of their meal. I wouldn't like to take a whole handful of pills on an empty stomach-I don't blame them. Then AFTER their breakfast, most of them go to therapy. So you have to try to chase them down in therapy-again, not in private and give their meds. I calculated how many meds I was giving in the morning and....no kidding......287 medications. Keep in mind I'm trying to carefully check these against the MAR as I should and follow the 5 rights. Sorry to go off on a tangent-but I just think the only answer to this problem is...you got it.....more nurses! I know for a fact that many meds simply did not get given because of time.

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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

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The reality is that the people know what their meds are or don't care and so trying to do the here is your blah blah ... it doesn't happen or very rarely with someone new. I agree it's just another attempt to be in compliance with time constraints so the facility doesn't get cited by the state. The residents all live together and know everyone takes meds.

Are you going to tell me that management sat down and went over this plan with the residents in mind ... they only serve to keep the place staffed as low as possible. If things keep going like they are and state is forced to recognize that places need to employ more staff ... well they had to do something.

When I worked LTC the CNAs got those people up so fast that I would miss them so I just parked the med cart in the dining room and did my thing. I would try to get as many as possible before they were taken to the dining room but it was not possible. It actually was the only way to do the am pass. Also what about activities ... after am pass they go right to some type of activity; should we do it then? What about snack time ... and on and on.

Dignity in this scenario is code for we need to cover our b u t t s.

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

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We just finished state survey. The surveyor was 'aghast and appalled' that the nurse had given ONE resident meds in the dining room. Come on...one guy? He didn't care. He got the right meds. The surveyor said to me "When you're in YOUR home, you wouldn't want someone disturbing YOUR meal would you." Well...chickieboom, when I am in MY home, some days I take my morning med at 530 and some days 8....so what exactly is your point?!?

We try not to give meds in the dining room. I, too, have heard of places where there is a morning pass and an afternoon pass instead of the strict times most of us use now. It'll all sort itself out one of these days.

If I have to live in a nursing home, I don't think I'll care when I get my meds as long as they remember to give me my big glass of wine with dinner.

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No Stars In My Eyes has 43 years experience and specializes in Med nurse in med-surg., float, HH, and PDN.

1 Follower; 2,469 Posts; 44,065 Profile Views

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.

Jehosophats! This doesn't sound like it would make anything EASIER! It sounds like you'd be pinging around like that little ball in a pinball machine.Ding-ding-ding! TILT! It must've been an awful mess before. You use cards AND and a MAR? I'm not understanding, I guess. How many patients do you pass to?:uhoh3:

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DSkelton711 has 25+ years experience and specializes in OB/GYN/Neonatal/Office/Geriatric.

312 Posts; 5,661 Profile Views

I was a nurse at a dementia facility--which meant they didn't have nurses on staff. Only nurses to come and go at med time. The only place you could find these people were in the dining room! The facility was small, plus everyone loved those tables and hanging out there. Trying to get them to go somewhere they didn't want to be would actually cause distress to these folks. So in my case giving them in the dining room was the best choice most of the time (sometimes just grabbing them on the run when they would pace, too).

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No Stars In My Eyes has 43 years experience and specializes in Med nurse in med-surg., float, HH, and PDN.

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I have to say that I agree with the problem of meds getting given on top of each other. How will you know that Mr. Jones took his AM dose at 11:00, so he shouldent get his afternoon dose at 12:01. It just seems like it would be very confusing. I TOTALLY know about med passes. I worked in LTC for many years. I can guarantee that lots of things, (MedPass, Metamucil, Miralax) did NOT get given. How the heck can you pass meds for 35 people, 20 of whom have narcs that you have to sign out in 3 different places, give 99% of them Miralax and probably 50% of them MedPass and get done on time. I would clock in at 6, get on the floor at 6:30, have to do treatments to bottoms (before they got up), do blood sugars, get insulin ready, start to pass those meds before they go to the dining room--yeah no problem! Most of these people need to take their meds at the time of their meal. I wouldn't like to take a whole handful of pills on an empty stomach-I don't blame them. Then AFTER their breakfast, most of them go to therapy. So you have to try to chase them down in therapy-again, not in private and give their meds. I calculated how many meds I was giving in the morning and....no kidding......287 medications. Keep in mind I'm trying to carefully check these against the MAR as I should and follow the 5 rights. Sorry to go off on a tangent-but I just think the only answer to this problem is...you got it.....more nurses! I know for a fact that many meds simply did not get given because of time.

I am so glad to hear someone else say all this! Add also the fact that some, well, alot of the patients have some kind of difficulty taking meds or are really difficult to give meds to; that can eat up alot of your time! I used to beat myself for skipping some of those things you mentioned; I'd wonder how the other nurses got done with med pass so quickly and have time to sit at the nurses station chatting (not chaRting, chatting!) I think it's criminal to put nurse's license's on the line by setting up a system that just can't work, doesn't work. I'm not saying that there are those of you out there who CAN toe-the-line, but there's more to it than time-management skills. If ALL a person does is pass meds, maybe.......but we all know that it's not that simple. There are alot of places where these ugly little truths are swept under the rug, not acknowledged, or flat out denied. And everybody suffers. You've got the textbook way, and the reality of the LTC . The Emperor is BUTT-NEKID!

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eriksoln has 15 years experience as a BSN, RN and specializes in M/S, Travel Nursing, Pulmonary.

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We just finished state survey. The surveyor was 'aghast and appalled' that the nurse had given ONE resident meds in the dining room. Come on...one guy? He didn't care. He got the right meds. The surveyor said to me "When you're in YOUR home, you wouldn't want someone disturbing YOUR meal would you." Well...chickieboom, when I am in MY home, some days I take my morning med at 530 and some days 8....so what exactly is your point?!?

We try not to give meds in the dining room. I, too, have heard of places where there is a morning pass and an afternoon pass instead of the strict times most of us use now. It'll all sort itself out one of these days.

If I have to live in a nursing home, I don't think I'll care when I get my meds as long as they remember to give me my big glass of wine with dinner.

Managers don't schedule me when the state is coming, I talk too much.:o

My response would have been: "Oh, it happens all the time. Work calls to ask if I can come in, or a co-worker wants to trade days, the manager wants to know if I accidentally took the med keys home with me. I get over it pretty well."

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