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!
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.
if you are giving tid or qid meds you will have NO were to note the time unless you write on the back of the page, after 1-2 days you will have no more room left.....and doing this will cause your med pays to be even longer....mind you, YOU and I are basically on the same page here....i am just trying to acquaint you with the realities in a lot of long term care......that is why my previous post......get times set to agree with reality....some meds may need to be d/cd d/t patients noncompliance with times, docs may need to come up with some other pharm. therapy....etc......also, i am primarily a noc shifter......so i know they can come in at 600am as well! i work agency and was not having a good morning.....they came in the back door, which should have been locked (didnt make that mistake again!) came to the desk and stated who they were, looked'em square in the eye, told i was agency and couldnt help them, the nurse on the other unit was house they would have to go talk to her....and they did! i guess i was emitting a "DONT MESS WITH ME THIS MORNING" aura.....
We are on the same page. For what it's worth, although I am on a skilled unit, my institution houses 200+ LTC patients, and they are on the same medication administration and documentation as the skilled units. The difference is that we chart by computer. The system notes not only what time you gave a med but at what time you documented that time.
We are on the same page. For what it's worth, although I am on a skilled unit, my institution houses 200+ LTC patients, and they are on the same medication administration and documentation as the skilled units. The difference is that we chart by computer. The system notes not only what time you gave a med but at what time you documented that time.
ah, i know of no long term care place in my area that uses that system......alllllll paper presuming you are using a pyxis....they are beatable also if the pharmacy doesnt fill every day.......and if you are not using a pyxis, it would work the same way that paper charting would, it would get signed off at the "appropriate" time and given whenever......
What we do is pass all meds as much as possible at dinner. Except for ... ATB's, Narcs, Cardiac meds, etc.... We will usually call md and get med times changed with the explanation that after dinner most residents race for the room to go to bed and are very resistive to taking meds after they have gone to sleep. The doctors tend to think in alert, oriented terms when assigning med pass times. I HAVE seen nurses pass double narc and B/P meds at the same time. After seing the after effects they tend not to do it again! LOL
I don't know if you have ever tried to wake up a grumpy 90 yr old at 9:00 p.m. to give them a scheduled vitamin, but realistically it ain't gonna happen!
And don't forget the is book nursing and real world nursing. There is a big difference between the 2.
Specializes in Community Health, Med-Surg, Home Health.
We are on the same page. For what it's worth, although I am on a skilled unit, my institution houses 200+ LTC patients, and they are on the same medication administration and documentation as the skilled units. The difference is that we chart by computer. The system notes not only what time you gave a med but at what time you documented that time.
I am surprised that some LTC are actually using the computer system to document medications; I have not heard of that around here, but that doesn't mean that it is not done. And, yes, the computer will show exactly when something was done, even if documented otherwise. I am just trying to get this picture together of a lone nurse or med-tech administering medications to 30+ patients within a half hour leeway...it seems impossible, even for the most organized person.
I am surprised that some LTC are actually using the computer system to document medications; I have not heard of that around here, but that doesn't mean that it is not done. And, yes, the computer will show exactly when something was done, even if documented otherwise. I am just trying to get this picture together of a lone nurse or med-tech administering medications to 30+ patients within a half hour leeway...it seems impossible, even for the most organized person.
if you arent using a pyxis or other computor operated dispensing device....but just EMAR....it is still possible to circumvent the timing......and using a pyxis for 30 patients, i cant even imagine......!
Specializes in Community Health, Med-Surg, Home Health.
if you arent using a pyxis or other computor operated dispensing device....but just EMAR....it is still possible to circumvent the timing......and using a pyxis for 30 patients, i cant even imagine......!
We use EMAR in the hospital, and while we can't personally view what time the medication was actually signed for, medical records CAN in fact, pull out what time was documented and compare it to the actual time administered or signed for. Yes, a pyxis in LTC can probably be a nightmare! Eeek!!
We use EMAR in the hospital, and while we can't personally view what time the medication was actually signed for, medical records CAN in fact, pull out what time was documented and compare it to the actual time administered or signed for. Yes, a pyxis in LTC can probably be a nightmare! Eeek!!
i have never seen EMAR without pyxis/omnicell or what ever.....but, if you are passing meds from a med cart....there will only be the time the nurse puts in the EMAR, which COULD get very creative, is my point....no one but that nurse will know, unless she is followed/monitored....what time she ACTUALLY gave the med, anymore than the nurses who are now giving the 4/5/7/8/9's all together, but signing them off at the prescribed time.....!
Specializes in Community Health, Med-Surg, Home Health.
i have never seen EMAR without pyxis/omnicell or what ever.....but, if you are passing meds from a med cart....there will only be the time the nurse puts in the EMAR, which COULD get very creative, is my point....no one but that nurse will know, unless she is followed/monitored....what time she ACTUALLY gave the med, anymore than the nurses who are now giving the 4/5/7/8/9's all together, but signing them off at the prescribed time.....!
Oh, most certainly. What I have seen in the hospital, however, is nurses pulling out ALL of their shifts medications from the pxysis but administering them within the proper times to avoid running back and forth. Still a problem, because to me, big brother is watching and waiting for the right moment to pounce.
There is one floor that was recently created that never had a pxysis but, still uses EMAR. I suspect that meds should not be a problem because it is an 8 bed unit.
But, they can and have pulled information from EMAR which actually showed what time the meds were administrated versus what time was actually documented by the nurse. Because the powers that be were looking for something else, I guess it was ignored. The issues I see with LTC is the horrible nurse to patient ratios-it is too easy to become distracted and the average nurse may either forget due to those distractions or plans ahead for possible distractors by doing much of the same behavior mentioned in this thread.
I am no expert in LTC; never worked it as a nurse in my life. I do hope that the physicians are more flexible with times to accomodate the patients and cover the nurses legally. I did work in nursing homes as an aide and with my inexperienced eye, it didn't seem as such to me, which may be why some nurses did some of these bizarre things.
I am surprised that some LTC are actually using the computer system to document medications; I have not heard of that around here, but that doesn't mean that it is not done. And, yes, the computer will show exactly when something was done, even if documented otherwise. I am just trying to get this picture together of a lone nurse or med-tech administering medications to 30+ patients within a half hour leeway...it seems impossible, even for the most organized person.
It is impossible, and the nurses and techs in our LTC units routinely pass meds to 42 patients at a time. That's why my employer scrutinized the safety practices of anyone who claimed to do it. We've had work schedules changed to improve flow and increase safety. It's getting better.
We had been using laptops on our mobile med carts for charting. But the institution recently upgraded to a cart with a built-in computer. We can only take out meds for one patient at a time, and the computer documents who pulled what and when. We then have to document at what time the med was given (usually within 2 minutes). If a nurse pulled meds for more than one patient at a time, she'd be caught by chart audit (and yes, that has happened to a tech).
Specializes in Community Health, Med-Surg, Home Health.
It is impossible, and the nurses and techs in our LTC units routinely pass meds to 42 patients at a time. That's why my employer scrutinized the safety practices of anyone who claimed to do it. We've had work schedules changed to improve flow and increase safety. It's getting better.
We had been using laptops on our mobile med carts for charting. But the institution recently upgraded to a cart with a built-in computer. We can only take out meds for one patient at a time, and the computer documents who pulled what and when. We then have to document at what time the med was given (usually within 2 minutes). If a nurse pulled meds for more than one patient at a time, she'd be caught by chart audit (and yes, that has happened to a tech).
Sounds like more problems in a sense. I am familiar with the COW. Document within two minutes?? What about a patient whose meds have to be crushed, has a hard time swallowing more than one horse sized pill at a time?
morte, LPN, LVN
7,015 Posts
if you are giving tid or qid meds you will have NO were to note the time unless you write on the back of the page, after 1-2 days you will have no more room left.....and doing this will cause your med pays to be even longer....mind you, YOU and I are basically on the same page here....i am just trying to acquaint you with the realities in a lot of long term care......that is why my previous post......get times set to agree with reality....some meds may need to be d/cd d/t patients noncompliance with times, docs may need to come up with some other pharm. therapy....etc......also, i am primarily a noc shifter......so i know they can come in at 600am as well! i work agency and was not having a good morning.....they came in the back door, which should have been locked (didnt make that mistake again!) came to the desk and stated who they were, looked'em square in the eye, told i was agency and couldnt help them, the nurse on the other unit was house they would have to go talk to her....and they did! i guess i was emitting a "DONT MESS WITH ME THIS MORNING" aura.....