No meds on 11-7

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Specializes in LTC-Geriatric-PPS-MDS.

Opinions please on the following:

1. Is it possible to eliminate scheduled meds for 11-7 shift (GERD, Synthroids,etc) -- do you guys believe these meds could be taken on 7-3/3-11 and still be "effective".

2. We are a 100-110 bed facility -- how many would say "Hell No!" to on 11-7 shift being the only RN with 6 cNAs? No scheduled meds (if we can get rid of them...) except PRNs, no dressing changes, just making sure patients stay alive/deal with emergencies and manage the CNAs

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Specializes in LTC-Geriatric-PPS-MDS.

Addendum: Trying arrange the nursing staff to add 1 extra nurse to 7-3/3-11... we currently have 4 each on 7-3/3-11 and 3 on 11-7(with lots of Meds on 11-7 med pass that could probably move...)

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Specializes in Gerontology, Med surg, Home Health.

It is possible but it will be a huge project. You can't just change med times. Unfortunately, manufacturers state some meds must be given on an empty stomach....Synthroid for example. So if you can't give it at 6 or 630, you'll have to move breakfast to later....or give it at 8 pm if the resident hasn't had a snack. Fosamax has to be given on an empty stomach....no way around that one.

You can try getting the doctors to write progress notes about giving the meds on 7-3 and hope the DPH buys it. It's stupid really. If these people were home they wouldn't wake up before the crack of dawn to take their meds and they'd be fine.

If you figure it all out, please post your results here. I've managed to get rid of 1/3 of the meds on one half of the hallway...working on the other. Luckily my ADON is very persuasive and the NPs and docs are starting to 'get it'.

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Specializes in LTC-Geriatric-PPS-MDS.

I was thinking maybe the "Empty" stomach could be 4pm.. but I guess you run the "risk and probability"the patient had a snack at the activities?

Our new MD director has drastically reduced our CBG checks to mostly before breakfast and dinner....thinking if we reduce our ration from 27-31:1 to 22:1 that the nurses on day shift could manage a few CBG checks prior to breakfast

not to mention- our facility initiated the 30min increment thing for our 9s and 5s (give the nurses 30more min most the time) minus the fact that they forget to follow the card we gave them on their name tag for the times-- so most the MARS dont follow the protocol (i.e room 406 9am meds are suppose to be given at 10am... but the new orders are usualy put in for 9...) management usually goes in and fixes things tho- and floors nurses generally like it.

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Specializes in LTC-Geriatric-PPS-MDS.

....wonder why breakfast is always considered to be a 7am thing...good point...

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Specializes in LTC,Hospice/palliative care,acute care.

The time period between meals is regulated. Can't remember the details but I know breakfast has to be within a certain number of hours after dinner, snacks have to be offered at hs....Someone dreams this stuff up

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Specializes in Gerontology, Med surg, Home Health.

They dream it up and it becomes the stuff of our nightmares!

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Why cant the meds be given between 7-8am with breakfast starting between 830-9?

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Specializes in LTC-Geriatric-PPS-MDS.

Regulation is "No more then 14hrs between evening meal and breakfast, 16hrs are allotted if they are provided with documented HS snacks."

Our dietary directors statement: "if we moved breakfast to 8-9 then that wouldnt leave much time for clean up and prep for lunch at 12-1-- we would have to move lunch and dinner times."

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So you want to put 1 RN on 11-7 with 6 CNA's with 100 residents? What type of facility is this? Do you currently have an RN that actually accepted that patient load? There really should be at least another nurse on shift for backup. I work in a 60 bed facility, 4 suites and on 10-6 we have 2 nurses, 6 CNA's which is one CNA to each suite and two floaters. I Cant imagine having the responsibility of 100 residents on my own no matter if there were not any medications to be given.

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I think what you're proposing is acceptable ONLY if ALL routine medications and treatments are eliminated AND the 11-7 nurse is NOT expected to write any routine nursing notes during the shift (out of parameter occurrences excepted)

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Specializes in LTC-Geriatric-PPS-MDS.

My proposal is no charting except as needed/emergent/prns(all medicare A/B and medicaid charting on 7-3/3-11), no scheduled txs (may have to do a PRN cant rule it out), no scheduled meds. The only hiccup I see.. is the willingness to accept the responsibility AND someone on continous tubefeeding... but it shouldnt be a issue...if your just checking position and hanging a new bottle ....

AND some diaylsis pts (we only got one right now) leave to go at 5am - but thats case by case...

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