Monster Med Passes

[Ms_Interpret]

What's the largest number of patients you have passed meds on in a shift.

I recently took a break from ICU and took a foray into Corrections. They do 8 hour shifts. I'm the sole nurse on evening shift in their behavioral house (tons of psych meds). The house has 4 wings. The way it's set up, you have to -pre-pull meds for each patient in the med room and hand carry them up to the wings to pass them. Last night I pulled and passed meds on 125 patients (including diabetics).

What's your record?

[guest974915]

1 hour ago, myoglobin said:

Keep in mind that if I am confused (having not worked in corrections) then it is quite likely that others who read this might experience the same challenge. When I write something here I do it not only for the benefit of the actual person posing the question (and my own knowledge base ie myself), but indeed for the benefit of posterity. It is conceivable ( perhaps likely) that historians 50 or 100 years (300 years?) from now will review these posts long after we have "passed on" in order to gleam "tidbits" of information about aspects of our civilization. Another example, recently one of my favorite podcasts drew upon posts here for material concerning paranormal experiences and NDE experiences by nurses.

What the OP has described is accurate-this is med pass only. This time is allotted for medication administration, not sick call evaluations, taking of vital signs, or physical assessments. This is possible due to the fact that the majority of these incarcerated individuals are probably relatively young, mostly healthy (with the exception of psychiatric morbidities), and ambulatory.

[Golden_RN, MSN]

The most I've done is 40 in LTC, but of course there are a lot of meds to crush, the residents often take MULTIPLE meds at once, and of course lots of interruptions.

I'm curious - What is the legal time frame for corrections is to complete the med pass?

[TriciaJ, RN]

I worked in corrections and had upwards of 100 people for med pass (I never counted exactly how many at one time; the facility housed 550 inmates). I wheeled a med cart to each cell block and all the meds were on blister cards, arranged alphabetically and according to block. There were occasional inhalers, eye drops and ear drops. The book of MARs was on top of the med cart and I signed for meds as I gave them.

No injectables were given at med pass. Diabetics were brought to the medical department morning and evening for fingersticks and insulin. The only vitals I took during med pass itself was the very rare pulse for digoxin.

I usually got done in an hour and a half and the inmates were expected to step lively with a cup of water in hand.

When I later did LTC it was a very different game. Fewer people but more meds, along with injectables, blood sugars, PEG tubes, skin checks, etc etc all rolled into one shift-long hellacious med pass.

[turtlesRcool]

21 hours ago, myoglobin said:

Still 125 med passes? You still have to do a basic assessment for certain medications (BP/Heart rate for beta blockers) or blood glucose before giving insulin for example. Also, I'm sure that you must document somewhere the medicines that you give. Again, even at five minutes average per patient (total time including pulling the medicine, interacting with the patient, and documenting) you are well over 8 hours. I do not believe there is anyway this can consistently be done safely, but perhaps I am wrong.

Most people out in the community don't monitor themselves the way we do in acute settings. The average person taking metoprolol isn't checking BP/HR before each med; the average person taking Lasix isn't measuring I&O every 8 hours. My mom is on cardiac meds, but only has her vitals checked when she goes to the doctor; she takes her meds daily at home.

In corrections, the nurse is just giving meds the same way someone at home would take them. There's no need for assessment because these are just maintenance drugs in stable people.

Since the corrections nurse's med pass is basically replicating the daily routine of most non-prisoners, it can be done safely. Does that make sense?

[JKL33]

45 minutes ago, turtlesRcool said:

Since the corrections nurse's med pass is basically replicating the daily routine of most non-prisoners, it can be done safely.

That makes sense but then why is a licensed person needed for such a role?

[RNNPICU, BSN, RN]

18 minutes ago, JKL33 said:

That makes sense but then why is a licensed person needed for such a role?

I would guess that the RN has other responsibilities after the med pass. It would not make sense to hire two people as the RN can assume both the role of the med-passer which could be the other duties as assigned aspect of the role.

By the way OP, that is an impressive amount med-pass

[Hoosier_RN, MSN]

On 7/16/2019 at 9:48 AM, Ms_Interpret said:

Every job has it's advantages and disadvantages. You take the good with the bad and keep on rolling.

I think the shear number was a shock. I don't think eyerolling was the intent. I've done 84 in LTC once, with the necessary assessments, and still not sure how I did it, and all by policy, ad managed to get out on time

[Ms_Interpret]

1 hour ago, Hoosier_RN said:

I think the shear number was a shock. I don't think eyerolling was the intent. I've done 84 in LTC once, with the necessary assessments, and still not sure how I did it, and all by policy, ad managed to get out on time

It says "keep on rolling" not "keep eye rolling."

84 is pretty well up there. You never know just how possible something is until you actually do it, sometimes. Maybe not fun. Maybe not leisurely or comfortable...But possible.

[Forest2]

I have done 30-50 in LTC, took a few hours, as soon as you are done you start over, not unusual for folks to get meds 2 hours late. I have done 12 in acute care, but not in these times. The last was 6 acute, took me at least 2-3 hrs somedays depending on IV's, and other good stuff. Talking about the heaviest pass of the day, not the noon one.

[JKL33]

4 hours ago, RNNPICU said:

I would guess that the RN has other responsibilities after the med pass. It would not make sense to hire two people as the RN can assume both the role of the med-passer which could be the other duties as assigned aspect of the role.

I understand. But even though that may be the rationale, there is still a significant side benefit of having this performed by an RN, as opposed to someone who commands a lesser rate of pay while someone else is liable. No it doesn't make sense to hire two people necessarily, but it also doesn't completely make sense to pay someone double or triple+ to do something that an unlicensed/lay person could do.

I'm really not meaning to argue about Corrections as I have very little knowledge of nursing there - although that is not completely relevant because the point is that if an RN is doing something in a professional capacity, the potential exists for all associated actions to be held to a the professional nursing standard - not the standard of what people do in their own homes with their routine medications. We don't hear a lot about RNs successfully maintaining lower standards and then defending themselves when something has gone wrong by saying that it was a duty a lay person could have performed or was the same thing the patient was doing in their home, therefore that was the extent of the nurse's professional responsibility as well.

[TriciaJ, RN]

4 hours ago, JKL33 said:

That makes sense but then why is a licensed person needed for such a role?

Because you still need to know what you're giving and there is still legal accountability. If you mess up your own meds at home, that's your problem. If you are incarcerated and someone else messes up your meds, it's major lawsuit time.

While working corrections, I saw Vicodin given for liver pain, thioridazine and benztropine given to the same person, anticholinergics not get discontinued after the neuroleptic did and a whole host of other prescribing errors that the county or state would be held accountable for, if harm occurred.

But since correctional facilities do not pretend to be health care facilities, the bar is lower and you would not do the stringent checks required in such facilities. We don't purport to cure their conditions (although many people do better incarcerated than on their own) but we are not allowed to let things to worsen for lack of care.

Corrections is its own thing with its own set of rules.

[kbrn2002, ADN, RN]

Med pass for 125 people in a shift! Yep, breaks my record by a ton and here I was thinking LTC ratio's were bad! I'd say that's darn near impossible but since you've done it it's obviously doable.