Nurses and Med Techs: Meds in Asst. Living Facilities

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..

Hi guys -

I started a new job in Asst. living. I am going to be giving meds to about 50 res. as well as doing "charge/supervision" on the evening shift.

The med techs all pour their meds ahead of time prior to giving them out, in the interest of time and efficiency. I am concerned about doing this because it is not the "standard" and there is a lot of room for error. Not to mention that when the State comes in they have to turn themselves upside down and do it the "right way" when they come in.

My concern: I want to do it the "right way" not just because it's the "right way" but also because I don't want to have to turn myself upside down when the state or other auditors come in. Yet apparently the meds are so heavy they "can't" do it one patient at a time.

So is this the wrong position for me? Or do I just have to do it the hard way and see if it's possible?

I have to tell you I've never been one to be able to do meds in a timely fashion, which is one major reason I've always worked nights: the med pass is much more manageable.

Thanks for your input!

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Specializes in Community Health, Med-Surg, Home Health.

One of the reasons why I do med-surg on the weekends is for the same reason...not having to keep up with or chase down orders in a more chaotic environment.

I think that I would see what they are doing before telling them not to; I mean if you supervise it 'their' way, you get a chance to either point out what the possible mistakes can be, or maybe, if it is oral medications, you may see a way that they have actually mastered their task. Are they using the MAR, is it at their side at all times? I would feel better if they were, because this is a final check before administration.

In fact, I do pre-pour medications. When I work per diem on Med-Surg, there is only one pyxis to take ALL medications out of. I have my cart, with the room numbers on each drawer, with the hard copy of my MAR in my hand. Get out the morning medications, do my checks and then, there is a final check at the bedside before I actually administer. It works out fine for me.

I would observe their actions objectively and then, if the need is there, then, make a change. JMHO

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..
One of the reasons why I do med-surg on the weekends is for the same reason...not having to keep up with or chase down orders in a more chaotic environment.

I have observed part of a couple of med passes - the meds come in bubble cards so when they take them from the cards, they pop the pills into the cup, and put the cards back in the drawer. There is no way to see what meds are in the cup - and the MAR is not open for them to check. An hour or so later, they just grab the cups and give them to the resident whose name they have written on the cup.

That was one thing I loved about the last place I worked, we could prepour meds, but we would leave the pill in the individual wrapper, and also had the med sheet in hand to check that we were handing them the right meds.

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while its not the "right way" there is a time frame within to give the medicine and pouring meds to 50 residents doing it the right way will take longer than 2 hours...

most med techs/med aides/nurses know the residents and know what long term meds the residents are on. I say just let them do it the way that works for them, and if state comes in or somebody to audit them, then they will do it the right way

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Specializes in Med Surg, Nursing Administration for SNF.

i am the type of person who wd take rules, and "adjust" them according to what wd suit me, the situation, time, etc. (i still do, actually - but face it some rules are a bit ridiculous) however, sometimes i end up finding out the hard way that there are usually good reasons for the rules and it is not my place to question them. that is the case with me re pre-pouring meds - it will only take one time of giving the wrong pt a whole cup full of the wrong meds to bring on a wake up call. med errors are serious business and although most of the time it's no big deal, it can be - and is it worth it? heck, its too easy to mess up doing things the correct way never mind trying to take short cuts. i used to think it was stupid that we had to get another nurse to witness insulin doses at the large hospital i worked in, until i made a huge error that could have resulted in horrible consequences and gave a pt an unbelievable amt of insulin one eve. it all turned out ok, but trust me, when it comes to med passes, i now follow the rules. btw - the people who switched shifts, etc because of the overwhelming med passes - good for you!! i know and have caught so many nurses that take some really bad short cuts so they can get those med passes done in two hours. (we're talking way worse than pre pouring!!) it isn't always easy (or popular) to do the right thing - but in the end, you'll sleep better. good luck!

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..
while its not the "right way" there is a time frame within to give the medicine and pouring meds to 50 residents doing it the right way will take longer than 2 hours...

most med techs/med aides/nurses know the residents and know what long term meds the residents are on. i say just let them do it the way that works for them, and if state comes in or somebody to audit them, then they will do it the right way

mmm, which is fine but a) i am their supervisor and b) i'm one of the people that has to give meds. :)

i do understand the 2 hr window but if it can't be done in 2 hrs then shouldn't there be another person administering the meds?

i am the type of person who wd take rules, and "adjust" them according to what wd suit me, the situation, time, etc. (i still do, actually - but face it some rules are a bit ridiculous) however, sometimes i end up finding out the hard way that there are usually good reasons for the rules and it is not my place to question them. that is the case with me re pre-pouring meds - it will only take one time of giving the wrong pt a whole cup full of the wrong meds to bring on a wake up call. med errors are serious business and although most of the time it's no big deal, it can be - and is it worth it? heck, its too easy to mess up doing things the correct way never mind trying to take short cuts. i used to think it was stupid that we had to get another nurse to witness insulin doses at the large hospital i worked in, until i made a huge error that could have resulted in horrible consequences and gave a pt an unbelievable amt of insulin one eve. it all turned out ok, but trust me, when it comes to med passes, i now follow the rules. btw - the people who switched shifts, etc because of the overwhelming med passes - good for you!! i know and have caught so many nurses that take some really bad short cuts so they can get those med passes done in two hours. (we're talking way worse than pre pouring!!) it isn't always easy (or popular) to do the right thing - but in the end, you'll sleep better. good luck!

yes - well one of the examples is - i was working in a nursing home and i had 3 people to give insulin to at the end of the shift - immediately before report - and i drew them up and labeled them ahead of time as was the usual practice of those who had oriented me. went around w/ my cute little syringes and grabbed the wrong one, injected it, then as i finished realized - whoops i think i grabbed the wrong one. too late then. no adverse effects but that isn't the point.

i am gonna have to speak to the don about this situation i think - one med tech i spoke to said that pharmacy knows they do this. but i'm very uncomfortable.

i agree some rules have to be bent or broken, can't be super rigid, but when it comes to giving meds (ulp) - have to be super careful. yeah the idea of a cupful being given to the wrong resident makes me ill.

thanks you guys i so appreciate this.

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Specializes in Community Health, Med-Surg, Home Health.

So, you and the med techs are administering medications? Is it that they are giving PO meds and you are doing the rest? Or are you all splitting the duties in half? I can see the concern, now, because I would just take the bubbles with me...they have the name of the patient, the time of administration, the dose, etc...

In that case, for sure, speak to the powers that be and tell them your concerns, because it seems to me that you will be held liable and responsibile for their errors. Sorry I misunderstood the story.

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Mmm, which is fine but a) I am their supervisor and b) I'm one of the people that has to give meds. :)

I do understand the 2 hr window but if it can't be done in 2 hrs then shouldn't there be another person administering the meds?

You'll probably end up stepping on toes...how long has the med tech worked there? and no, somebody else shouldn't be doing it? you will see that to do it the right way with 3 checks and everything it will take longer than 2 hours for 50 people, regardless of who is doing it...

good luck, seems like you are set in your decision and you didn't really want anybody elses feed back

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A couple of suggestions, 1) the med pass in an assisted living can be alot,but once you get a routine down, itll be a lot better, also since your the supervisor, maybe some of the qd meds can be given on a lighter med pass...i would'nt trust anyonw with prepouring, as it is nurses have their own med error incident rate, you don't want to take responsibility for med assist/cna's errors, it would fall on your and the administers' licenses as well could be harmful to the patient... good luck

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I work with some med techs and nurses that prepour. I however will not do it. It leaves WAY too much room for error. Infact, I've seen some of the errors that result. I work in LTC as well, it is not easy having so many pt's to give meds to in a 2 hour window, especially when you have to assess pt's that have fallen during your med pass or the CNAs come to you with something, don't forget the many Dr's calls! I very seldom get done in the 2 hour time slot. My theory is - the meds are being passed correctly and SAFELY! I would rather take my time and get it done right than to have a grave med error!

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..

Thank you guys for your feedback. I didn't go in this am for orientation - there is just no way I can do a med pass that is so heavy it requires pre-pouring - and I would not just be responsible for the meds but for the whole house too.

As to supervision, if I am allowing them to continue to pre-pour then I am condoning it - and I am responsible for their errors.

This has been kind of a "thinking out loud" exercise but I also needed validation that I am not being a noodge. I truly do appreciate and did need your feedback and it did help me make a decision (no I had not already decided when I started this thread).

I do plan to ask if she has any night shift positions in which the meds would not be as heavy - if I could do it correctly I wouldn't have a problem w/ working there. I hate that they spent all that money training me for nothing, and I do feel that I have something to offer them, too.

Anyway - thanks guys - any more thoughts or suggestions about assisted living in general would be helpful cuz if I don't work there I am going to apply to other facilities, perhaps some smaller ones.

For example: Any of your facilities NOT require employees to be certified in CPR? Ours doesn't require it. Big surprise to me. But I'm accustomed to nursing home and hospital care.

Take care!

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amen, thats what I believe too and hopefully we are "on time" when state comes in:)

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