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

[itsdebraanne]

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.

[baumgardner229]

I'm a "new" nurse as well. I just started working in LTC back in mid-August 2017. I'm learning the administrative part, OK, I think (admissions, new orders, etc.), the I struggle with the med pass. Usually, 17-plus residents are on the rehab floor. The rehab floor also excepts those residents that are more long-term and require more assistance and those waiting for the memory unit. Many of the residents on this floor have many meds, peg tubes, and IVs, and I really did not see most of this in school and feel that the nurses have to teach me everything. I feel somewhat awkward or embarrassed when I have to say I do not know this or that. Some look at me like, really?? I do my best, but seeing something once does not make me a pro. I need to build that confidence up and really know it. I do not want to hurt anyone. I always go and ask or ask if the nurse will watch me do something to ensure I am doing it correctly. I always start med pass off good, but then as everyone mentioned, "stuff" happens, or it takes me forever to be able to figure out what is written; the writing on the MAR is horrible...I waste so much time trying to understand what is written (an error waiting to happen). I seem to get comfortable with the residents that just have pills and take them with water. I can get the BS and insulin done as well. But those that need nebulizer treatments, eye drops, crush w/applesauce, or the peg just throw me off. I do not know the MAR well enough, but I think I need to know these residents and either do them first or last since they give me the most trouble. I am still trying to find my "way" of doing things. The school did not prepare me for this, LOL I will take note of all the tips that were posted as well. Good luck to you!

[SteveNurse]

I saw in the responses many good tips on how to pass meds faster.

In nursing school, they said you get 1 hour before and one hour after the med is due to be in the acceptable safe window. Some of the Facilities I work at have a 5-hour med pass, two of them! So I finish around 1:30 AM.

OK, so let me put my two cents in. Not surprisingly, some Nursing homes and some units in the same nursing homes with the 5-hour med passes have a more reasonable unit where you can finish the group within 2 hours, or at most 3 hours. I always say a prayer of thanks when I'm assigned to one of the groups that I can finish within 3 hours; needless to say, I know them by heart.

Also, we have a few Nursing Homes in the Orlando area where the med passes are reasonable and even pleasant. So, I actually would advise you to do some research about nursing homes in your area and gravitate to one where the management is not so greedy as to make patients suffer and endanger nurses' licenses.

[amoLucia]

LPenaRN said:

And the facility will continue to do business as usual. (Or, after a bad enough reputation, change the name of the business and then continue on.

Just re-reading this post after a long time passed when I came across this comment. I had NEVER thought about this before. But it seems to ring true regarding LTC facilities with problems, esp for new nurses trying to acclimate themselves to crazy med passes.

I've worked some TOUGH places over my long career. And some of them have had numerous name changes. Yeah, I know some places have been bought out, but the name changes always seem to occur with the problematic facilities.

Never thought about it, but there seems to be some credence to it.

[Dudeas]

Also, something to keep in mind is if you are late every day and give the meds in the same order every day, then the patients who are getting late meds every day are getting them late every day, making it well timed.

For example, if you reach your 20th patient at 11 am and you go in the same order every day that the same patient gets their meds around 11 am every day, then the patient is indeed getting a daily med at approximately every 24hrs, right? So keep that in mind.

That is why I always felt there should be a universal order for each shift to follow when giving out meds to patients.

Or the software should recognize to limit the number of people each hour for med pass and automatically bump patients to the next hours with each limit.

[stockmanjr, BSN]

Dudeas said:

Also, something to keep in mind is if you are late every day and give the meds in the same order every day, then the patients who are getting late meds every day are getting them late every day, making it well timed.

For example, if you reach your 20th patient at 11 am and you go in the same order every day that the same patient gets their meds around 11 am every day, then the patient is indeed getting a daily med at approximately every 24hrs, right? So keep that in mind.

That is why I always felt there should be a universal order for each shift to follow when giving out meds to patients.

Or the software should recognize to limit the number of people each hour for med pass and automatically bump patients to the next hours with each limit.

Do you believe most LTCs would spend money on software like that?