nurses not giving meds at correct times

[justwannabanurse]

Ok as I have stated before I am a new nurse graduated in Dec.08, just passed state boards Apr. 3. So I've been working at a LTC facility since a week after graduation. I feel as though I am still in "school mode", and though I complained about some of the things I was taught in school I honestly feel as though I am still doing my med pass, and skills the way I was taught in school. Not to say that the way I was taught was perfect! Working with nurses that have been working there longer than I and have longer experience than I do. I have noticed what they do when they are passing meds, and some nurses have actually told me that I should do this to save on time! I work 3-11, and when they are doing their 3 O'clock med pass they double up there meds on just about each patient except the one's who have to get hs chemsticks & Lantus insulin & coverage if necessary. So at 1600 they are also giving 1900, 2000, & 2100 meds. Now I do my med pass the right way (not saying perfect but I give meds when they are due) My evening med pass since I have all my resident's to do who get hs meds normally takes me about an hour as does the 1600 med pass. When I get back to the nurses station and I get questioned ' what took you so long, you should start giving some of your hs meds earlier" Now I just think this is so unfair to the resident's who are relying on us to take care of them. I highly doubt because I work with these nurses all the time that they even check to see if there are any drug interactions or anything. Does anyone think I am overacting? Do you see any of this going on at your job? I hope that I don't turn out to be a nurse like this as the years go on, just to get my med pass done in 15 minutes so that I can sit at the nurses station and talk about everyone & their mother. There is a reason why I went to school to be a nurse because I am compassionate, and I love taking care of people, not to do them further harm only to convenience myself. I would love to hear your comments on this, thanks!

[AshiPanda]

I just started in a similar place a bit over a week ago as a LPN. And yea... the nurses pass their 5P and 9P meds at 4P atleast. I asked them about it, 'cause I was taught, "Not over an hour early, and you better be done not over an hour late," and the nurse told me, "Well the only thing I make sure I'm on time with is cardiac meds, but crap like vitamins and stuff...hell no, I don't have time for that." So I combine meds like that, because I cannot get everything done if I don't. I technically have 2 med passes to do to 16 patients, PLUS treatments and dressing changes and writing out the doctor's orders... it's just so much work and the med pass takes up SO much time because I'm still new. I am especially careful so far with my cardiac and antibiotic meds especially and I make sure I get my BPs and temps. :)

[llg, PhD, RN]

There is no right answer to the question, "Is it OK to give meds early?" It really depnds on the med and the patient. For example, a vitamin pill might need to be taken with food to avoid nausea. Giving it "off schedule" to coincide with food might be a good idea. A diuretic may need to given at a certain time because of the urine production it stimulates. etc.

Is there anyone at work whose judgment you trust? I would recommend meeting with that person and reviewing the meds commonly given on your unit. Ask him/her to help you learn when it is OK to give meds off schedule and when it is not. If there is no one at work who judgment you respect, then I would keep your eyes open for a new job.

[caroline3]

I give pm and hs meds, but not together. PM I start at 3 pm for 30 resident and hs I start around 7 pm, in between I do some charting and treatments. When I am not able to get somebody at pm, depending on the med, I give them later, but I try to track the resident down and prepare the med to give. I am not giving meds together I mean pm and hs

[Lexxie, LPN]

Maybe the doc can change the orders to read that the resident may have all meds at once? In my former LTCF, there were a few residents who'd get upset when they didn't get all of their meds all at once. We got the doctor to write the order as "resident may take all meds at 2000" or something similar to that. It'll cover you then when the DOH comes in to do their annual inspection.

[calgirl123]

I work the day shift in Ltc and I wish I had time to get all my meds out in time. i have 28 res. My shift starts at 7 I usually dont get startsd until 730 and I HAVE TO GO TO THE DINING ROOM SO i ONLY GET A FEW MEDS IN befor than.Than I dont get back on my way until 815. It takes until 1130 or noon to get our morning meds past and Im a new nurse [8 months] but this is how long it takes all the nurses. Our facility is ridiculously busy and short staffed, well not according to the administrator or don but it is. But if I could I would get my meds out on time because when you dont it messes up the noon meds that need to be given. I hpoe you get some help because I dont think all those meds should be given together theres a reason why the order is the way it is. I had a coworker tell me to mix the morning and noon meds together and i thought that was weird.

[justwannabanurse]

Calgirl123,

I agree with you that's why I don't do it. It seems as though the other nurses would rather take longer during the 1st med pass in order to make their 2nd lighter, and have time to fool around. I think there is a reason why the doctor ordered the meds the way he did!

[NC Girl BSN]

I worked 3-11 when I was a LPN. The way they have the times set up on the cart was basically two med passes. The times were 1600-1800 and 2000-2200. So if I started my med pass at 3:30pm if the patients meds were scheduled up to 1800, they got all their meds from 1600-1800. There is no way your gonna follow that 1hr rule and keep your sanity. I had 30 patients and by the time I finished my last paitent, it was 5:30-6pm. I never gave 2000-2200 meds on my first round. Thats just wrong because most of those meds are sleeping pills, cholestrol and Remeron. I will admit that when I started my med pass at 7-7:30 pm. I would give my meds based on patient request. Some patients wanted their meds early.Two ladies wanted all their night pills at 7:30pm and I gave it to them. Yes it included 9pm pills too. They liked to go to bed early and why would I make them suffer till 9pm or later. I finished my last med pass between 9-9:30.

My advise to you. You will soon learn that shortcuts are not ALL bad, but you will go bonkers trying to adhere to one hour rule.The administration at these facilities know that the nurses are overwhelmed in their med passes but due to the love of money, they are not gonna do anything about it. I know nurses that you describing. I had one nurse that gavel the confused patients ALL their meds at the beginning of the shift which I felt was really wrong. I personally I think its wrong to give meds two hours in advance but in most cases there is no other way around it unless your gonna sacrifice, ALL your dinner time, treatments and charting time.

Another thing I will add. If you have a permentant hall. Some med times can be changed if its not convient for the patient. All you have to do is ask the Dr. Good Luck to you and stay being a good nurse. You may have to bend with your med pass at times but don't give all the pills in one lump sum like the other nurses you describe.

[pagandeva2000, LPN]

I also agree that in LTC, it may be VERY hard to give all of those meds to all of those patients the way ordered. I have not worked in a nursing home as an LPN, but did it as a CNA and even then, I was able to see that the nurses had a hard way to go. Sometimes, one LPN has to give meds and treatments to as many as 60 patients.

[dotherightthing]

Where I worked, past tense, lots of meds were given together. It was not unusal for all evening meds to be given on the first med pass. I personally, tried to look at the meds to see which could or should be given together. As a result, I was always slow and on my feet 7.5 of the 8 hours. Oh well.

That wasn't the worst of it, taking time to know who you were medicating and what their diagnoses were-that's what I didn't have time for. Just looking at the MARS list of diagnoses doesn't necessarily explain why people are getting meds like sleeping pills and sedatives. Could 95 degree rooms make it hard to sleep at night? And why is it that practically every patient, no matter what floor I was on, was getting sedatives? or Benzos? Because they lived in a nursing home? I felt like I was just dumping meds into people, hurriedly.

There were a lot of Filipino nurses there and they can be hard to understand - language and cultural issues. Filipino nurses don't understand the idea of a parent having to live in a long term care facility so the patients looked like throw a ways to them - their words, not mine. Now I am generalizing, all Filipino nurses can't be like this but I have to say that most of the ones I've met are. I saw them doing things that I didn't have the nerve to do, or the desire, I guess but they always had so much free time - for dinner and chatting....I actually saw them pulling meds at the end of their shift for the next day. I know it's hard to beleive and it's also one of the reasons why I don't work there anymore.

The main reason, however, is that you never have any real time for the patients and they need time probably more than they need medication.

[nessa_5555]

I live in Ontario Canada. We were also taught that you were not to give ANY medication more than an hour before it is due. I worked in LTC, and I know that alot of the time it feels like all you do is push pills but it can be very dangerous to give medications hours before it is due. The medications are on a time schedule that was calculated by the Pharmacists and Doctors and should be given at those times for a reason.

[pagandeva2000, LPN]

I say to tell this to the money hungry nursing home owners who are too cheap to hire more nurses to provide safe care. I'm sorry, there is literally NO WAY that one nurse can administer medications on a timely basis to over 20 some odd patients. Does this mean that the nurses have to fill out over 20 incident reports over late meds because she wants to administer safely?

Nursing homes that provide staffing ratios that overwhelm the nursing staff have already shown me that they care even less for the patients who cannot speak up for themselves.