Situation: I'm working in a skilled nursing facility and the unit/station I'm in charge of has 39 residents. For AM shifts, all 39 residents have scheduled medications due at 9am. We are using electronic medical records so we are allow to give medication from 8am to 10am, all medication given after 10am will be considered as late.
Problem: the management kept on reminding me that I need to pick up my speed, they don't want my med pass to be late.
So am I lacking a certain skill or is there something essential that I didn't learn from nursing school? If anyone actually bother to do this simple math, to get through 39 patients in 2 hours that's 3 minutes per patient. THREE MINUTES PER PATIENT. Each patient has an average of 8+ medications need to be given. On top of that, 2/3 of the patients requires BP and/or apical pulse check before med administration. Furthermore, because it's a SNF, we get mostly geriatric patients, so these patients need time to take their medication. So yea, if any of you are working or has worked at a SNF with similar situation, I will really appreciate it if you could share your experience on how to handle this.
A nurse can change med times if they are not ordered at a specific time. I draw a line through the time and initial and date & note "time changed," write in the new time/s and make a copy for medical records so they can print out the correct times the following month. For example if the order is for a BP med BID it can be given at: 0700 & 1900, or 0800 & 2000 or 0900 & 2100. You can move daily supplements , bowel care, etc. to different times as well. Ideally your patient care manager should be able to go through their patients' MARs & and spread the med passes out better. Just saying... sometimes you have to be the one to make the change. The grass may look greener on the other side but often it is only the distance from where you are viewing it that makes it appear so. (Loose quote, something like that.) I haven't worked anywhere yet where I could get my work done, take breaks, eat, drink and empty my bladder all in the confines of my 8 hours shift.
this may not work, depending where you work. I have worked places where the med times were part of the P+P, BID was set as 9+5, TID as 9,1+5 etc, and you weren't allowed to change them without a doc's order. So make sure you are allowed to do this, before you do.
A nurse can change med times if they are not ordered at a specific time. I draw a line through the time and initial date & note "time changed," write in the new time/s and make a copy for medical records so they can print out the correct times the following month. For example if the order is for a BP med BID it can be given at: 0700 & 1900, or 0800 & 2000 or 0900 & 2100. You can move daily supplements , bowel care, etc. to different times as well. Ideally your patient care manager should be able to go through their patients' MARs & and spread the med passes out better. Just saying... sometimes you have to be the one to make the change. The grass may look greener on the other side but often it is only the distance from where you are viewing it that makes it appear so. (Loose quote, something like that.) I haven't worked anywhere yet where I could get my work done, take breaks, eat, drink and empty my bladder all in the confines of my 8 hours shift.
Like others have said show your math to your manager and Don. Ask the other nurses how they do it. With time you will be able to move faster but in my opinion their expectations are unrealistic.
I have 30 pts and what I did was stagger them. Move some pts from 0800/1200 to 1000/1400. Other pts that generally aren't out of bed for breakfast I switched to 0900 or 1000. Always making sure I could back up my reasoning for moving times better then 'theres too many 0800 meds'. Confer with the day nurse that works opposite of you to get their opinion before switching a ton of times around so you don't step on someone's toes or make a change that doesn't actually make sense on accident
Specializes in Med/Surg, Peds, Geriatrics, Home Health.
There is no need to check a pulse on a resident on digoxin. We no longer automatically hold it if the AP is less than 60 since, as one of my former medical directors put it, they might need the extra 'squeeze'.
I have spoke to all other nurses who had worked or is working at my station and found out that NO ONE is able to finish the morning meds on time. Not surprised at all. What interests me right now is that I remember reading something on the California staffing regulation, and it say something about "facilities should employ sufficient amount of staff to ensure quality resident care." So if not a single nurse is able to give meds on time, that couldn't mean that all these nurses are under-performed, but meaning this facility is clearly understaffed and violates that regulation. Maybe I should file something to the DHS.
We've got a nurse here who LOVES to do that. Accu-checks being changed from QID to BID? 0600 and 2000. Omeprozole qd? That'll be given at HS thankyouverymuch. She is a preceptor and will train everyone she precepts that unless it is SPECIFIED during 066-1400, nothing is to be scheduled in that time frame "I'm busy enough, put it on another shift". Hand to God...'
A nurse can change med times if they are not ordered at a specific time. I draw a line through the time and initial and date & note "time changed," write in the new time/s and make a copy for medical records so they can print out the correct times the following month. For example if the order is for a BP med BID it can be given at: 0700 & 1900, or 0800 & 2000 or 0900 & 2100. You can move daily supplements , bowel care, etc. to different times as well. Ideally your patient care manager should be able to go through their patients' MARs & and spread the med passes out better. Just saying... sometimes you have to be the one to make the change. The grass may look greener on the other side but often it is only the distance from where you are viewing it that makes it appear so. (Loose quote, something like that.) I haven't worked anywhere yet where I could get my work done, take breaks, eat, drink and empty my bladder all in the confines of my 8 hours shift.
Yes, but is "quality of care" being compromised because 0800 meds aren't getting to some residents until 0915? That'll be the arguement, trust me. And then you'll be told to prioritize the residents who HAVE to have their meds in that time frame.
I have spoke to all other nurses who had worked or is working at my station and found out that NO ONE is able to finish the morning meds on time. Not surprised at all. What interests me right now is that I remember reading something on the California staffing regulation, and it say something about "facilities should employ sufficient amount of staff to ensure quality resident care." So if not a single nurse is able to give meds on time, that couldn't mean that all these nurses are under-performed, but meaning this facility is clearly understaffed and violates that regulation. Maybe I should file something to the DHS.
Here's a thought, if management is demanding 39 pts to be giving meds within the 2 hours time limit and these pts have 7 to 9 meds each. The solution is easy. Talk to this manager along with request letter saying the same thing. Request him or her to show you how this task can be done. Tell them you need more training and they can show you how they get this task done in the time frame they are seeking. State without this additional training you don't possess the skills they are seeking and can not be accomplished without additional training.
Put the responsibility on them. Now if they complete the task within time frame , learn from it. If they don't, demand a change in policy.
that has been tried....they come in to find it changed to a more appropriate time...
We've got a nurse here who LOVES to do that. Accu-checks being changed from QID to BID? 0600 and 2000. Omeprozole qd? That'll be given at HS thankyouverymuch. She is a preceptor and will train everyone she precepts that unless it is SPECIFIED during 066-1400, nothing is to be scheduled in that time frame "I'm busy enough, put it on another shift". Hand to God...'
Havin' A Party!, ASN, RN
2,722 Posts
Onwards!
Good luck!