Old Fashioned Med System

[abundance56]

I have recently accepted a position at a hospital who uses the old fashioned med system of meds in drawers, and a ledger sign out system for narcotic.

On one unit, I have to give 30 patients meds every two hours throughout the shift, with large doses of narcotics at HS. Probably numbering around 200-250 different meds a shift.

I am systematic and organized, but so far have not come up with a "system" that works for me, with multiple interruptions, emergencies, etc. I have tried pre-pouring them, leaving the blister packs on the pills, to allow a double check when I give them. But I never can pre-pour more than about 12-15 patients before it is time to give them. The patients come to the window to get their meds, and always want additional prn's. etc. It takes me 2-3 hours to give HS meds.

Does anyone have suggestions for the old fashioned system? And how to get this done more efficiently, but safely? The med drawers for each patient have blister packs inside labeled plastic sleeves, with the dose, the brand name, and the generic name. I want to be quick, efficient, safe, but not spending the whole shift giving meds, as I have other duties also.

[HollyHobby]

Wow, this sounds like a nightmare. The hospital where I work was on the same old-fashioned system as yours, but eventually we got a med-select (like a cheap Pyxis) for narcotics and a few of the commonly used PRNs. Most of the time, the extra meds we need (say, enalapril or coumadin- this is an ICU) are not stocked in the med-select, so the house supervisor has to obtain these from the pharmacy. We don't have a pharmacist on night shift. Because everybody knows you don't need a pharmacist on night shift.

So except for narcotics and a few PRNs, we use the drawer system too. I find that in order to prevent med errors, I have to check and check and check those meds to be sure I won't make a mistake. But unlike you, I have a max of 4 patients. I hope you're getting paid well.

When I'm getting out my meds, I do everything I can to minimize interruptions. If I'm interrupted while I'm preparing my meds, I start over from the beginning with that patient's meds. To minimize interruptions, I take care of whatever potential emergency I anticipate could crop up at that time beforehand. Of course, this isn't always possible. If I'm preparing meds for a patient and an "emergency" crops up that's not a life-threatening emergency, I will finish preparing that batch of meds before I respond to the emergency. For example, if a patient NEEDS a cup of orange juice right this second, he will have to wait thirty seconds. There are emergencies, and there are "emergencies".

Another thing I do is to sort out each patient's meds, then put them in a cup inside the med drawer, so all the HS meds are in that cup and properly checked. I leave the meds in the blister packs until I actually give them. (It's really difficult to explain what each pill is or determine if a certain one shouldn't be given if they're not labeled.)

I try to anticipate when a patient will want a PRN med. For example, while I'm doing my assessment, I'll ask him if he'll want a sleeping pill or a pain med; then when I pull his meds I'll know to include the PRN med. If I have a patient who always or even usually wants a pain/sleep med at bedtime, I include it in his cup. If it turns out he doesn't want/need it, I can always put it back.

With or without an automatic system, it sounds like there is no way around your problem except to keep being diligent. There are no good shortcuts, really. When you're giving meds, it's better to take too long than to take a shortcut that would result in an error.

I think concentration is the key. When you're dispensing meds, you really should have a quiet area where you can focus on what you're doing. If necessary, ask other staff to move elsewhere if their conversation (or whatever) can interfere with your concentration. If possible, have another staff member take care of the "emergencies" (i.e. not REAL emergencies) while you prepare your meds. Have it understood that you are busy, by god, and you should only be interrupted if there is no other option.

[loriangel14, RN]

No suggestion except maybe to give it time.I work with the same system except we don't have blister packs.Each patient has a drawer with pill bottles and we pour the meds.We have a MAR we sign and a narc log we sign for narcs. The larger top grawer holds the stock meds and the narc drawer is on the right hand side.