OA + 4 +4 +4 Med Pass???

[stdntograd06, BSN, RN]

Has anyone seen these new medication administration times where they work?? I went to work at a facility last night and was told this is the new "culture change" mandated by the state dept. of health.

Previously, meds had a specific time they were to be given (ex: 0600, 0900, 1200, 1600, HS, etc..). Now, apparently, for resident safety, meds are to be given OA (on arising- for the day), and then every 4 hours post the first dose. There are meds still ordered at 0630 (like the antacids, thyroid meds). They are not to be woken up after they are asleep to give a sedative/hypnotic, even if it is ordered at that time.

I have a real concern with this because I feel it sets up the nurses to make med errors. They are already seeing them because the night shift nurses are giving residents their "ordered 0630" meds and if they are awake, giving them all their "OA meds", then forgetting to mark them off in the MAR, leaving the day shift nurse to ultimately double-dose the residents. My thoughts on this: If we are to wake them up to give them their ordered 0630 meds, then are we, in effect, contradicting the policy that we are not to wake them up to give their OA meds? (We are supossed to give them only when they wake up for the day).

Also, BGM's were done previously by the 11-7 nurse at 0630 (knowing that breakfast comes about 0730. Now, they are to be done 15-30 minutes prior to going for breakfast, leaving the day shift nurse to rush and "catch the resident before going to dining room". Night shift cannot do them due to accurate monitoring and coverage (all of which I fully understand).

Any thoughts on this are appreciated. I've just not heard or seen this before and if it is indeed something new the dept. of health is doing in regards to patient safety, I want to be ready for this at my full-time job. By the way, the nurses at the facility I worked at last night told me they absolutely do not like this new change. They (as I do also) feel it sets nurses up to make mistakes and puts residents at risk of overdose. (I am not insinuating that this is the motive by the dept. of health).

Thank You.

[canoehead, BSN, RN]

It sounds like you might needs a new way to document. And a new way to remind the nurse to give the meds at the 4 hour mark because every day would be different. The old med card system would work better for that- you make a card out for each med to be given and put the card in the correct time slot. when each dose is given the card is moved ahead to the next time it needs to be given.

[NotFlo]

So this is in a LTC/SNF? I can't see how it would work.

Say I'm on the LTC floor with 30 patients...I am supposed to keep track of when each of them wakes up and then of the +4 time for thier "noon", evening and bedtime med passes as well. I could have people getting meds at all different times all through the day and night. Sounds totally unmanageable with a typical patient load in LTC.

As far as the blood glucose checks to, yeah it sucks, but anyone getting rapid-acting coverage is done at 7:45 (fifteen minutes before breakfast). That means that on my current list of 15 SNF patient I am doing accuchecks and coverage on 9 of them right now. Sometimes it's down to a couple, sometimes it's almost everyone. It takes a significant chunk of time to get that done before I can even begin the med pass, but checking an hour and a half before the coverage is to be given just doesn't make sense either.

[delilas]

The LTC I last did clinicals in did it this way and it bothered me. They had 'on rising meds' and most other meds except narcotics were given at 'lunch' and 'dinner'.

So some patients didn't get 6's until 9's, and then got another dose at noon - which would have been scheduled as a 4 a day dose (so 6 hours apart) and was instead given three hours apart.

It's just wrong.

[JB2007, ASN, RN]

They are talking about starting this at my facility. I am against this, but in the end they will not listen to me. I feel that it will set us up for med errors and it will be impossible to do with the pt load.

However, all of my protests are falling on deaf ears. I have been praying dly that I will find a job outside of LTC before this change is made, but so far nothing. In the end I feel really bad for the residents that count on us to keep them safe, but the state and management is making this impossible in my opinion. It is sad and I do not want to chance hurting someone because people who do not pass meds in LTC wants to tell me how to do my job!