how much time for AM med pass?

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I have 14 people whom I do AM meds, which includes 3 FSBS, 1 insulin, 2 BP, 1 ted hose, (2) topical creams with one leg wrap, and one inhaler.

I think it takes me about 30 min. just to preset meds if I am not interrupted and the orders are perfect. Is this too slow?

the pass itself depends on morning care. I am med tech/care staff

Specializes in LTC, Subacute Rehab.

I legally have one hour before and after the scheduled time. I start my 9 am med pass at 0800 and (with 12 sub-acute pts) usually finish at 0915 - allowing time for prns, taking phone calls, finding pts who are in PT, etc.

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28 residents, 2 tubes, AM medpass= 3.5 hours!! So much for the hour window. :D

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Specializes in acute care and geriatric.
28 residents, 2 tubes, AM medpass= 3.5 hours!! So much for the hour window. :D

Are yo stopping along the way to answer questions, take phone calls, do dressings? are the tubes patent or clogged?

Do you have difficulty organizing your supplies? do you have to stop to order missing meds?

Try streamlining the interruptions and delaying all activities that are not related to med pass to after. Make sure you have all you need before you start, try organizing your supplies in the order in which you need them.

Hope this helps. :-)

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I feel your pain ! I have been a nurse in LTC/Rehab for almost two years. If I have a full house, my hall has 30 patients. They comprise of a combination of LTC folks with different degrees of dementia, (which include some with bad behavior at times) tube feeders, boluses via tube, IV meds, scheduled pain meds, PRN pain meds, those requiring PT/OT/ST, neb tx's, diabetics (my end I call "accucheck alley") because at one time 1/3 required qid checks, sliding scale to almost everyone if spaghetti was on the meal :uhoh21: most on 9 or more meds, (which do not include the "puffers", eyedrops, (some with multiples, which we are supposed to wait inbetween the dfferent drops)"sniffers" (miacalcin, nasonex, etc) at least 1/3 need crushed, those that require apical pulse due to digoxin, BP prior to med administration, postural BP's, and...while doing this juggling act, writing communications to MD's, pulling barcodes off of medicine packs to order medicine...and the families...

My shift is supposed to be 7am to 3:30. First of all, it is not mathematically possible to accomplish an accurate med pass (most meds are scheduled at 9am, with insulin anywhere between 7:30am - 9am) there are a few at 8am. By the time I get report and stock up my cart, most of the time it is about 7:45am. It does not matter where I start on the floor, at the same time I am in the same place...behind ! LOL. I spent my first 20 minutes with a new pt admitted the night before s/p CABG with some serious pain management issues, plus she did not receive a water pitcher the night before (had to go to central supply for one). My CNA's are in the middle of breakfast, and I will not interrupt meal service. I finally reassured the pt that her pain would be addressed. I gave her the PRN med that she had ordered, had to write communication for the NP who was due in about an hour. Fortunately I know my "pain people", "anxious people", and those that call out when they see me "I need to see you." If we are doing what we are supposed to, which includes assessing our patients when we take the meds into the room, it does take a bit of time. Patients and their needs cannot be put on a time clock. I have been chastized for working overtime, because I cannot get to charting until I have turned my cart over to the next nurse. My "punishment" has been to put me in a float position, because the DON feels that I cannot manage my time. I still end up on the unit that I am speaking about, which I do not mind. I generally finish both 9am and 1pm pass about 1:30. (Providing I do not have 2pm IV's). It is more important to be accurate and thorough. Funny thing, the corporate nurse observed our med passes one day, and I happened to be on another unit (more stressful, do not know the people, most times the patients do not have all of their meds) and she commented that the way the system is set up, it is almost impossible to pass the meds in the hour before and hour after window. I am going to count my pt's meds, including sniffs, puffs, drops, measured liquids, injections, neb tx oh, and the protein powder that has to be added to the applesauce or whatever. I am then going to do the math, to see just how long I am allowed to have for preparation of the meds, assessing the pt, staying with them when they have 15 pills that they prefer to pick up and take one at a time, go to the stat box for meds that the patient does not have.. and take the findings to the administrator. The rewarding part of thriving in the chaos, is that my patients/residents appreciate what I do for them, and there are no complaints, except when I am not there LOL. Sorry so long, I just felt compelled to share. I am a Certified Dietary Manager (which I keep the credential) I am also a fairly new nurse, graduated in 2007 at the top of my class, after surviving 2 heart attacks. Hang in there, remember that your patients needs do not go by the time clock.

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Specializes in Geriatric mostly, but some hospital.

LOL! it should be an olypmic category

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While I never open the package I sometimes do put 0600 am meds in a cup in that pts drawer when things are hectic and staff is down one person. I still double check the med, and never sign the MAR until I actually put it into the residents mouth, so is this a prepour situation or a time saving one? I have been given 3 different opinions, let me hear yours.

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Specializes in Gerontology, Med surg, Home Health.

I believe the definition of pre-pouring is putting a medication in a cup which the resident does not immediately swallow. Ask your pharmacy consultant for help with scheduling meds. I worked at one place where any daily medication which required an apical pulse or a blood pressure was done on the 3-11 shift...not because they had less work but because they handed out fewer pills and usually there are no surveyors watching the med pass after dinner.

Let's face it...most of our patients take far too many drugs. Did you see the latest research on vitamins? They do not much good. Do you need 2 pills when you could find a combination and have to swallow one? Can you increase the dose of a QID med and give it BID or once daily? QID fingersticks with coverage? Not a good way to manage diabetes and not so much fun for the residents either.

As for the one hour before and one after...stagger the meds. When I worked on a busy subacute floor, I had 30 patients. Before I started working there they would write ALL the meds for 8am...please!! So we did half for 8 and half for 9. Most of the time I managed to get things done on time...except of course the day the DPH was there. They watched me for the last few patients. I had one to go and it was 9:55. By the time I popped all the pills, double checked, signed them off and handed them to the resident it was 10:00....the patient didn't finish swallowing them till 10:10 . The surveyor told me I was late and should have told the patient to 'hurry up' and swallow the pills. I couldn't believe it and then thought it might be a trick question. I just looked at her and said, "This woman is 104 years old and I will not hurry her. If it takes her this long to take her medications that's the way it is." They didn't cite me.

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Our facility policy forbids us from pre setting meds.

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Between speech therapy and myself, we finally succeeded in getting one of my patients getting meal trays w/ nocturnal feedings via peg at night instead of the q 4hr boluses he was receiving ! There are definately too many meds, supplements, and protein powders which are not palatable. I have patients ordered miralax, senna tabs, and colace. Needless to say, my alert and cognitive patients give me the "look" (oh no, do not even think that I am going to take all of this medicine for my bowels ! LOL) when I come in with their meds

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Any suggestions on how to streamline the med pass to try and avoid a lot of interruptions? Unfortunately, we experience all of the above, and I still stock my cart to keep from having to go and find something.

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My patients occasionally fuss at me and tell me not to come in their room and give them anything else (hee hee) until I have sat down myself. You know we are hopping !

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I am managing now to get all 20 people done by 9:15 at latest, we need to stagger the MARs but I think that would be a job in itself to get the pharmacy to comply.

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