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!
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.
For some of this I'd agree. But with the vitamins why worry usually they aren't on antibiotics?
I've seen patients in LTC get 19 yes 19 pills at breakfast. Most of them vitamins, colace, sennokot, calcium. Nothing life threatening as they stand. Hell, Flomax is better given at hs but how often do you see that happen?
Most patients take their meds when they are ready to take them in the "real world". No way in hades am I giving 20, 21, and then waking them up for 22 hour meds. If the pharmacy won't change the times, cover your rump in the nurses notes as to why you gave them early "patient needs to roused from sleep to take 22hour Tylenol" usually works. It's even better when you wake them up to pass them Ativan or Immovane.
Specializes in Community Health, Med-Surg, Home Health.
Again, as long as the staffing ratios are not realistic or empathetic towards the patients as well as the nursing staff, there will always be someone taking short cuts. It is not that I am advocating for it, but it is a reality. I have seen situations when I was a CNA where there were two nurses on a floor with 60 beds-one is the charge nurse, who does not administer meds, but does treatments and charge duties, and the medication nurse, who has to give to these 60 patients. No matter how it was sliced, they were still giving 9am meds at 12 noon, only to turn around yet again and starting afternoon meds. Some were giving as many as 10 meds to one patient who has to take time swallowing, some had to be crushed, I mean, goodness!!
This lead to horrible behaviors of nurses...some would ask CNAs to go give some meds, others put meds in their pockets and signed for them...I can go on and on. And, that was when I was not a nurse, and made the decision that I would try my best not to work in a nursing home unless it was on a shift that had ONE major med pass that I can handle. I am not advocating for the behavior of those nurses, either, but I can easily see why.
There is a complete difference to giving a med early if the patient is always asleep, then there is to giving it early just because it suits you. If the patient is always asleep by the time they need a vitamin or something of that nature, then yeah, give it an hour or so early and chart why you did it. Then speak to your Charge Nurse or to the Doctor about how better suited it would be to give these meds at an earlier time. You dont just give HS meds a dinner because it suits YOUR schedule better.
Everything all of you are saying is the exact reason I will not work in LTC again. I did things "by the book" so to speak, I was always afraid if I did something wrong and the patient was harmed I would never forgive myself. I worked 2 - 1030 and was still passing bedtime meds at 10 pm. No one is going to step in to help you out, they would rather sit on the phone with one of their friends. Unfortunately there are not many places for an LPN to get a job and the LTC pay is about the best. I just hope I never have to go back. And my favorite time killer was the patient that constantly refused their meds or supplements.
Specializes in Community Health, Med-Surg, Home Health.
Everything all of you are saying is the exact reason I will not work in LTC again. I did things "by the book" so to speak, I was always afraid if I did something wrong and the patient was harmed I would never forgive myself. I worked 2 - 1030 and was still passing bedtime meds at 10 pm. No one is going to step in to help you out, they would rather sit on the phone with one of their friends. Unfortunately there are not many places for an LPN to get a job and the LTC pay is about the best. I just hope I never have to go back. And my favorite time killer was the patient that constantly refused their meds or supplements.
I agree with you...there is no perfect world. LTC is usually a nightmare! How can any nurse work consciencously on a consistant basis when it is one LPN for over 60 residents, sometimes?? You pray that you never have to go back? I pray that I never have to start. I did it as an aide and even then, with no idea that I would ever become a nurse myself, saw it must be hell for a licensed person.
I was always able to get my prescibers to agree to a time change. Do it by the book, but get the book changed to reflect reality. And if your patient with 9 pm meds is asleep by 7:30 get those changed, too.
in LTC the times are frequently not set by pharmacy or docs, at least not directly/solely.....refer to you P+P and usually you will find specific definitions of what QD,BID,QHS,TID, AND QID mean. and exceptions will be noted.....it is up to the transcribing nurse to use his/her CRITICAL thinking skills to make the times fit reality......if a doc orders lasix BID and your P+P says 9+5 with no exception noted for lasix than you need to question the doc and hopefully make it more realistic such as 6+2.......so much of this mess could be avoided if that transcribing nurse took that minute or two to fix it, even better would be to go thru and amend the P+P. However, you would still have nurses transcribing BID lasix as 9+5 because THEY dont look........and dont think......there isnt that much nurses have any power to fix, but this is one!....Also, if you have more than 18 or so patients to pass meds to in the am....have all adm. times advanced an hour on the second half....such as the first half would be timed for 8A, the second half timed for 9A. Effectively giving you 3 hours to do your med pass. I, as an agency nurse, have run into this "i dont get any meds at 9PM" trouble myself. It is a pain in the orifice.....of course the nurses dont warn you about that, because they KNOW they are in the wrong......i did a 11-7 once and started promtly at 5am, didnt finish until 740....that was the med pass, not the shift.....even had the larger cart organized so i wouldn't need to be looking for the pills......the day shifters said"well you havent been here before...." my answer was no, the med pass was obscene, and i would question if the patients were actually getting theirs meds as orderd....they had no more to say......good luck, you arent the only one!
I would like to know how nurses who give HS meds at 1600 are documenting their administration. Do they note that they gave the med four to five hours early, or do they falsify the time at which they gave the med? If they note the real time at which they gave the med, aren't they in trouble when a state inspector reviews those records? And if they falsify the time, aren't they taking a risk that a patient could then be under or overmedicated?
Well when you give a med at my job the time is scheduled say for 2100 and you just go to the 7th for the date say if it was today and sign your initials you don't actually have to put in specifically what time you gave them their meds. So what I have noticed these nurses do is when they are passing out their 1600 meds they are also adding on their 2100 meds and just signing for everything all at once. Then for the 2nd med pass they just save about 4-5 people to do meds on and it only takes them between 10-20 minutes and they are done I guess to cover themselves if the RN supervisor ever comes down at around 2000 they are still passing out meds but they just don't know that they are only giving about 5 people their meds. I just got my evaluation from work yesterday and I was proud because my RN supervisor specifically said that she likes the fact that I am a new nurse because I haven't developed any new habits yet, and that's what I am trying not to get myself into doing by watching these other nurses. Don't get me wrong I don't think I am perfect or better than the other nurses I work with....I am far from that! But, I think these residents rely on us, and we shouldn't be doing things just because it's easier for us. I give all my 1600/1700 meds at supper time, and it takes about an hour for 18 residents that's including 2 tube feeders & countless times that I am stopped by family & staff, or have to answer the phone. I don't think that's too bad, and the second med pass is about an hour- an hour in a half because half of my residents get chemsticks & lantus insulin at this time. I just don't know what the big rush is to get done in 15 minutes!
Respectfully, your employer's system for documentation doesn't sound very safe, and I'm surprised a state inspection hasn't turned it up as a deficiency. Your co-workers certainly aren't considering the patients' safety when they give meds at a time that is convenient for the nurse instead of as prescribed. I find it hard to believe that your employer doesn't know this is going on. I know that where I work, my manager's eyebrows go up when she sees that it takes me 90 minutes to do a med pass but only 20 minutes for a med tech. She demands explanations and makes everyone sign a statement acknowledging the facility's medication policy.
Respectfully, your employer's system for documentation doesn't sound very safe, and I'm surprised a state inspection hasn't turned it up as a deficiency. Your co-workers certainly aren't considering the patients' safety when they give meds at a time that is convenient for the nurse instead of as prescribed. I find it hard to believe that your employer doesn't know this is going on. I know that where I work, my manager's eyebrows go up when she sees that it takes me 90 minutes to do a med pass but only 20 minutes for a med tech. She demands explanations and makes everyone sign a statement acknowledging the facility's medication policy.
sounds pretty routine, the documentation format, and the state wont find anything....as long as the meds ARENT documented as to time.....only if the surveyor picks that nurse to follow....not too many surveyors stay much past 5p that i have seen, and that is doing paper work......even if the surveyor does go with that nurse, she can do it right,and as long as the patients dont ask....still skate.......
So this "pretty routine" system relies on the integrity of the individual nurse, and the OP is telling us that her co-workers ignore doctors' orders and give meds at their convenience. Not a lot of integrity there. If I were giving meds at that institution, I would chart what time I gave them regardless of what the system requires. What happens when a patient is overmedicated? Does everyone pretend that the patient was given his meds at the correct time?
BTW, my facility recently went through a state inspection, and the inspection team was there from 5 a.m. to 9 p.m. They followed med techs and nurses on passes. Our system requires that we document the time at which a med was given. Inspectors pointed out that in some cases, meds were not being given within 30 minutes of the prescribed time. Our med techs' work schedules were changed as a result.
Fiona59
8,343 Posts
For some of this I'd agree. But with the vitamins why worry usually they aren't on antibiotics?
I've seen patients in LTC get 19 yes 19 pills at breakfast. Most of them vitamins, colace, sennokot, calcium. Nothing life threatening as they stand. Hell, Flomax is better given at hs but how often do you see that happen?
Most patients take their meds when they are ready to take them in the "real world". No way in hades am I giving 20, 21, and then waking them up for 22 hour meds. If the pharmacy won't change the times, cover your rump in the nurses notes as to why you gave them early "patient needs to roused from sleep to take 22hour Tylenol" usually works. It's even better when you wake them up to pass them Ativan or Immovane.