Nursing Home: Tips on how to be faster in med pass?

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I'm a new *new* nurse, fresh out of school. Just passed my boards in march. This is also my first job. Ever.

I work the 7a-3p shift in a nursing home. We have a front and back hall. I'm in the back hall. It's not as busy as the front. I've done clinical in a nursing home before, but I was only looking after two residents. Now I have 25-30 residents.

According to the state, I have an hour before nine and an hour after to pass meds. But in all honesty, I give out my first meds of the morning at 7:30, and I don't finish til about 130. I have about 25-30 residents with meds ranging from 1 to 15 pills. I'm aware of the factors that affect med pass. I.e., emergencies such as falls or incidents, a resident taking more than 5min to take meds, a family call, a doctor wanting updates, new orders to be added or d/c'd. But for the month I've worked there, I still can't get all my meds out before 1200. I've only taken a lunch break four times in the three weeks I've been on my own medical. I'm stressing out cuz I'm worried about not giving meds on time, and we all know the stress on an empty stomach is a no-no.

I've learned some tips from nurses who've worked in my hall on how to be faster in med pass; start with the people nearest the nurses' station. Then start within the back and work your way forward. one of them also told me, which is probably not good. She told me that if they have one little pill in the afternoon, say like a vitamin, it wouldn't hurt to give it with morning meds. So it kinda cuts down my 12 pm meds. But heart meds and things like Plavix and insulin need to stay at their designated times, right?

I have six Accu-Chek PPL and two who need insulin at specific times. Maybe I should remember what time breakfast and lunch are served so I can know where to put my insulins.

Sorry, this is long, and IDK how you can help me if you're not where I work, but if you have any tips, that'd be great.

I just wish they'd let me stay on the floor after shift change so I can learn my resident's meds. During med pass, that's the only thing on my mind: pass meds, pass meds, pass meds. I have learned from repetition but not from memory yet. I know it takes time, but I wanna get my routine down now. There are not enough hours in a day, LOL.

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Specializes in adult psych, LTC/SNF, child psych.

Wow, I'd like to see responses to this! I'm about four weeks into LTC, and thank goodness I'm still on orientation because it takes me forever to pass meds to only 16 residents! Like, I start off fine, but the last four patients seem to take forever, no matter how I prioritize it. I've tried the "easy" residents (walky-talky) first, and I've also tried the crushed in apple-sauce residents first, with almost the same results!

Something that just dawned on me today was to make sure all of your meds are in alphabetical order in the cart, so you can just go straight down the Kardex and straight across the drawer. Also, make sure your cart is stocked before your shift starts (if the night shift doesn't do it for you).

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Specializes in retired LTC.

One month is hardly any length of time to become speedy!! It takes time, esp because EVERYTHING is new and is also time-consuming (phone calls, MD interactions, families, emergencies, etc., and esp eye gets and GTubes). And all the BP parameters you have to do. And what do the stock Colace bottle and stock EC baby aspirin box look like? It takes time, even for us ancient ones!

One thing concerns me about your post - your comment about giving meds by memory. You're giving meds acceding to the MAR. I'm guessing you just worded your post funny. Just don't get into a habit of just giving meds by memory. Things change, and then there'll be errors. I know there are nurses who probably do give meds by memory. Bad habit.

Remember your training's good technique. And there's no award or prize for 'Fastest Med Pass Nurse.' No plaque to hang on a wall!

You'll be OK - but since you did ask for tips >>>>>> Make sure your med cart is super-well stocked, you know all your supplies!

That's where I lose time, like I need Glucerna or tissues, lancets, preps, etc.

:madface:PP reminded me that I also lined up my med cards, not alphabetically, but by the order on the MAR. Granted, someone else may pop back THEIR med cards into my sequence, but by and large, they would be pretty much in order.

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Certain meds do have to be given at certain times, but if you have a lone vitamin, I would see about changing the time on it. We can change the times provided the doctor doesn't give specific orders like give at bedtime, etc. I regularly go through meds as I'm passing to see what could be moved to a more convenient med pass time and then go thru the proper procedure (which sometimes does involve asking the doc and getting an order).

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dolcebellaluna said:
Like, I start off fine, but the last four patients seem to take forever, no matter how I prioritize it. I've tried the "easy" residents (walky-talky) first, and I've also tried the crushed in apple-sauce residents first, with almost the same results!
Something that just dawned on me today was to make sure all of your meds are in alphabetical order in the cart, so you can just go straight down the Kardex and straight across the drawer. Also, make sure your cart is stocked before your shift starts (if the night shift doesn't do it for you).

Dude, same here! I know you're supposed to leave work at the door and vice versa, but when I get home, I can't help but think, who should I give meeds out to first and in what order? ANYTHING can happen during med pass. one of the LPNs told me to act as one of those things will happen during the med pass. And maybe that'll help speed things up. IDK.

amoLucia said:

One month is hardly any length of time to become speedy!! It takes time, esp because EVERYTHING is new and is also time-consuming (phone calls, MD interactions, families, emergencies, etc., and esp eye gets and GTubes). And all the BP parameters you have to do. And what do the stock Colace bottle and stock EC baby aspirin box look like? It takes time, even for us ancient ones!
One thing concerns me about your post - your comment about giving meds by memory. You're giving meds acceding to the MAR. I'm guessing you just worded your post funny. Just don't get into a habit of just giving meds by memory. Things change, and then there'll be errors. I know there are nurses who probably do give meds by memory. Bad habit.

Remember your training's good technique. And there's no award or prize for 'Fastest Med Pass Nurse'. No plaque to hang on a wall!

You'll be OK - but since you did ask for tips >>>>>> Make sure your med cart is super-well stocked, you know all your supplies!

That's where I lose time, like I need Glucerna or tissues, lancets, preps, etc. PP reminded me that I also lined up my med cards, not alphabetically, but by the order on the MAR. Granted, someone else may pop back THEIR med cards into my sequence, but by and large, they would be pretty much in order.

Okay, so it's not uncommon for a med pass to take forever. Got it. I'm not trying to be the fastest med-pass nurse, LOL. I'm just having trouble finding my judgment on when to take a break off the floor. It seems crazy for me to never have time for a break in the three weeks I've been on my own cart. But I guess that's a nurse's life story, right? Like how nurses will be lucky if they find time to pee.

Another thing I have trouble finding time for is charting the ones who need it q shift. I have three. We chart by exception at my facility. it doesn't seem bad, but the other day PT wrote in like seven new orders that I needed to transcribe.

My staff manager keeps reminding me YOU CAN'T DO EVERYTHING ON YOUR SHIFT. Somethings you have to pass on.

I'm the kind of person who will bend over backward for my patients. I feel bad passing on my tasks during MY shift to the next nurse. I could go on about an LPN who didn't accept the task I gave her. I'm an RN, so, um, nope, I'll keep this comment short.

And passing meeds by memory. Yep okay. Bad me. Won't do it.

IaCountryGirl said:
Certain meds do have to be given at certain times, but if you have a lone vitamin, I would see about changing the time on it. We can change the times provided the doctor doesn't give specific orders like give at bedtime, etc. I regularly go through meds as I'm passing to see what could be moved to a more convenient med pass time and then go thru the proper procedure (which sometimes does involve asking the doc and getting an order).

Basically, I just want to try and finish med pass so I can find time to do important RN things, discharge/admit/readmit residents, charting, etc., and also LEAVE ON TIME. I stayed 4 hours after my shift one time to finish charting. My work doesn't like paying me OT, LOL.

But thanks for the help, guys!

I hope this weekend will be better.

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Specializes in Geriatrics, Dialysis.

LTC has a wicked learning curve, as you are quickly finding out! Suggestions made above about making sure your cart is stocked will definitely help. It will save a lot of wasted time looking for supplies and stocking as you go. Also, as you learn your resident's routines, it will be easier to prioritize who gets meds when simply based on who is in their room and easily accessible. It will really slow you down, having to track residents down to give them their meds. The suggestion of changing med times for those single meds also makes good sense; just make sure there is not a good reason for that med to be given separately, I.e., a possible adverse interaction with another med. I know you probably don't want to hear this, but if you decide to stay in LTC, get used to a med pass taking more than the 2 hours allowed; if it is done right, it is about impossible to pass meds to 20+ people in 2 hours, especially with all the interruptions. On the plus side, don't stress that too much as I have been in LTC for over 15 years and haven't ever heard of a nurse getting in trouble for going over 2 hours for a med pass or state citing the facility for the same. Good luck, and please let us know how it is going!

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Specializes in Med-Surg/Neuro/Oncology floor nursing..

You will definitely get the hang of it. I don't work LTC(I never did), but I remember when I first started at the job I am at now(I started out in oncology), thinking that it would be time for afternoon meds by the time I finished giving out the morning meds! I don't have to tell you oncology patients tend to be on A LOT of medications, and our hem/onc unit is very big; people were constantly getting admitted and discharged, and while I didn't have 15+ patients to give meds out to it still took up a lot of my time. Once I got used to my patient's routine, they would be discharged(or, very sadly, they would die). Plus, on the oncology unit, pain is a big issue, so I was constantly being called away to give patients so and so their PRN Dilaudid or Morphine...OR patient so and so's PCA was empty and needed to be refilled, and well, you get the picture. When I first started out, I couldn't even think of a time that I wouldn't get the hang of it, and guess what? I got the hang of it. Just like when I was first starting out, I never thought I would get the hang of starting an IV...now some of my co-workers come to ME if they have a patient who's a hard stick and they can't get the IV started.

I used to get the easy patients out of the way first. The patients that were cooperative just needed their morning GSCF shot, their dose of oxycontin, etc. Some nurses do it the opposite way and do the patients that take up the most time first. Everyone is different. But just remember, you will get the hang of it; of course, it's going to take you some time at first. Try to remember your patient's habits. I had a patient that would ONLY take his meds with red Gatorade...that's it..nothing else..not orange Gatorade, no water, not ginger ale..but red Gatorade. So you can be sure I remembered his red Gatorade BEFORE I started...having to run and get it while it seemed like it would just take an extra minute all those extra minutes turned into extra hours and fast!

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You save time when you finally get all your residents special likes memorized. Mr. Jones hates taking pills, but if you offer them with OJ, he is a lot more willing to take them. Mrs. Williams likes her meds right after breakfast; otherwise, she tends to get a grumpy stomach before she eats and then won't eat anything at all. After a while, you just get it down. I have a couple do not do's that some people may tell you to save time. Don't sort out meds in a med cup ahead of time; even if you initial the cup with the resident's name, it always is a catalyst to a mistake. Always check the MAR even if you have had the same resident with the same meds for five years. Unless you are on duty 24/7, you never know when a med may change. And if someone's advice seems wonky, follow your gut because chances are it's not a good idea.

I always stayed on track with the flow sheets I made at work and left them at work to not violate any privacy laws. Eventually, I was able to complete morning meds for 30-ish patients in the time frame given.

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Never memorize meds, but double-check to see if orders were changed. And yes, know your patient's habits, especially in LTC; sometimes, reasoning or logical discussion (I.e., you need this for your infection) will not help. If you know so and so, don't take his meds unless he's in a certain chair, with a certain snack and the sun at a certain location in the sky. Do not bother trying to get him to take it because you will delay everyone else's meds. Make a note and go back to him. As time goes on, you will get to know your residents, love most of them like family, and you will be much more efficient. Sometimes following the textbook: crushing each pill in a separate cup and mixing it with a separate spoonful of applesauce is too idealistic. Also, it can get applesauce spit in your face (personal exp LOL). Use your nursing judgment. There are no cutting corners, but increasing efficiency is always possible. Every minute you shave off adds up, and before you know it, you saved an hour! I was also able to pass meds to 30-40 res within the designated times. It's definitely possible! ?

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Insane. I had this same type of job, but with max 18 patients, I made a med error (ya think!!) and was thrown under the bus (not fired, but I quit soon after). Insane. Not safe. Do you feel safe? It is not fair to those residents that the ratios are so bad. I feared for my license every shift. I really admire any nurse that can make it work.

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I have worked in the short-term unit of a nursing home from 11p-7a and have roughly 30 patients. One of my halls is always heavier, and I've found that doing those patients first works better, and then I can breeze through the other hall. I also flag my 6 am meds in the MAR so I'm not flipping through the entire book in the morning, and then I'll double-check I got everything later. I don't give meds from memory, but I will remember that a certain pt is on Vanco, so I get that out of the refrigerator before starting the med pass; one pt will only take meds with applesauce and another with pudding, so I make sure they're on my cart, and that everything is stocked. I've been there for about three months and am just starting to feel like my med pass isn't completely stressful, and I've been able to leave on time, mostly every day. A lot of it depends on the patients (I used to have two IVs to hang at 6 am and a bolus PEG tube feeding to give), but I try to just be really organized and stay focused. I start at one end of the hall and just work my way down, moving the med cart as I go. I see some nurses move the cart from room to room, but that doesn't really work for me. Practice will make perfect, and you just have to find the routine that works best for you. I constantly watch the clock and am still trying to figure out the best way to do everything. Good luck!

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RNmo said:
Insane. I had this same type of job, but with max 18 patients, I made a med error (ya think!!) and was thrown under the bus (not fired, but I quit soon after). Insane. Not safe. Do you feel safe? It is not fair to those residents that the ratios are so bad. I feared for my license every shift. I really admire any nurse that can make it work.

It depends on the facility. Last year I got a job at an LTC (horribly organized and on strike-I realized why, really quick!) where I was thrown under the bus. I felt horrible for the residents, and the workers were "for themselves." I now work at a great LTC; the residents are greatly cared for, the workers are "team players," and it's a great place to work. It's not easy work, as the OP is learning (I, too, am a fairly new nurse). My only advice is to try not to pick up bad habits. I took what I could from the different people I oriented with and found a few tricks from all of them that work for me! (It still takes me 5 hours to do my morning med pass! They say, "I was the same when I was a new nurse," and "you're doing great! You'll be fine"). Just remember, if you're doing well and you keep doing the same routine, you WILL get quicker!

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