New Job, Need some advice Please!!

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 30, 2005

There are a couple of threads in the LTC forum on this, but I have to agree with the advice you've gotten. Experience is the only thing that will speed you up. Just remember that everybody was new at some point and they went through the same thing. Oh, and if anyone ever tells you to prepour, don't! One time I tried pre-gathering (don't know what else to call it, lol!) where I just got all the meds together in a cup in the resident's drawer (except narcs and liquids) and left them in the unit dose pack. Technically not prepouring, didn't do any good, lol! Good luck to you!!

DianeS, RN · Oct 30, 2005

First of all, congratulations on your new job!!

I had the same problem with med pass when I started out at the nursing home. In time, you will become quicker. After a while, I knew what meds were given at what time for my residents (of course, always checking the MAR as things do change) and I was able to pull their meds out rather quickly.

Give yourself some time, you will get faster.

Best wishes. :)

Thunderwolf, MSN, RN · Oct 30, 2005

Moving to LTC forum.

Daytonite, BSN, RN · Oct 30, 2005

This is an eternal problem of long term care. As you get to learn the patients your memory will help you out. You will also, over time, begin to learn the regular routines of some of the patients. That will help you tremendously in becoming efficient in your med passes.

A few tips. . .you have a hour leeway before and after times the meds are due. Use that time because you will need it. When I began to learn who the ambulatory patients were who went traipsing past my med cart on their way to the dining room, I started flagging them down and giving them their meds as they went by. You need a pitcher of water or juice on your med cart to do this. I also had applesauce and chocolate pudding (our patients were spoiled!) If groups of patients are corralled somewhere (like in the dining room, in front of the nursing station, in the activities room), go there, park your cart and start passing pills. You'll get to know who the patients are by sight after awhile. For now, I know you have to check name bands. We had a little alcove off the dining room that we could push patient's wheel chairs into for privacy when we gave them their insulin injections. Actually, insulin and blood sugars were usually the first thing I looked at coming out of report so that no one had gotten forgotten about. After all that, I started down the hall with the med cart. We three shift charge nurses where I last worked got together and worked out a different time schedule for the meds of the patients with tube feedings because crushing all those pills takes time.

Speaking of crushing. . .make sure you have a good crusher. I used a small pair of needle-nose pliers that I could easily slip in and out of my pocket. I put pills into a doubled souffle cup and cracked those suckers up to dust. It's also a good way to work out some frustration--just pretend you're crushing someone's head! However, the state surveyors didn't like them because they can get dirty, so I kept mine in my own pocket and out of sight, but I cleaned them daily. They were more efficient, I felt, than that huge "thing" sitting on top of the med cart. You have to make sure they stay clean and that they don't break through the paper cups when you're crushing. Another method I've seen (don't laugh 'cause it works) is to put pills into the souffle cup and then place it in the frame of a door (the side the hinges are on) and close the door on them. I saw a nurse do that once and nearly laughed my rear end off. :chuckle Remember that there are certain medications that cannot be crushed or it ruins that extended release matrix the actual medication is held in. That's were pudding sometimes works better. It helps the patient to get those pills to slide down easier.

It is not that hard to change an administration time on medications. You have to show the time change on the MAR. Some daily medications can be moved to the noon med pass. This is where your creative nursing can go to work for you. When possible spread the meds out over the day.

Perhaps some others will have some other med pass suggestions for you. I think that turning your med cards around is a very good idea. We poured from individually packed tablets that were in boxes. When a med was being held or D/C'd we would turn them backwards so that the box opening was facing the back of the cart. However, D/C'd meds really should be taken out of the cart ASAP so someone pouring from memory won't make a mistake.

CoffeeRTC, BSN, RN · Oct 31, 2005

Ask the other nurses what thier system is. For me, I get all the people OOB in the lobby and dining area first, then head down the halls...this is my system. We each have our own that works. You will get to know where your residents are and can plan for it. I also do my tube feeders last and try to get the accuchecks at the top of the med pass

healer_energy · Nov 10, 2005

I think all the ideas are good. I personally cannot do them in any other way that straight from the front of the MAR book to the back. Sometimes I go backwards so I hit the farthest away ones first. Sometimes that fools the phone calls that always happen when I am farthest away from the phone. It also makes it more interesting. I work evenings and I do mark the later ones with the tabs so I can flip around a bit better. But I also like to go straight through and recheck the others too.

I think one thing that has not been mentioned is too stay really focussed and don't get into situations with the aides, or take side trips for checking this and that. I generally don't divert even for pain meds since I will be there generally within 15 mins or so. I usually put a piece of paper and collect requests, information or whatever and then just do all those things after.

And yes, it is really slow at first but it get's better. Honestly.

Sonya

mysticwater · Nov 10, 2005

The toughest part of the med pass is being familiar with your residents and their preferences. Some of mine will not take their medicines before their meal some won't take it after! Some want that"red pill" separate and where is that yellow one I always take at this time? Plus there is the ones who have to have them crushed with thickened liquids and the ones who are just going to refuse! once you are the floor for awhile it will become second nature and you won't think it is such a big deal. AND NEVER pre pour that is when state will walk in and you will have to dump all of them out!!! I sit my cards in the order of my MAR making it easier to double check and the nurses following me have been spoiled to this system as well because it makes their job easier as well:balloons: :cool: