OMG! The State is coming...

classicdame, MSN, EdD · Feb 19, 2009

Injections and fingersticks are two separate things. I think the rule is there to protect the patient's confidentiality and so you will have a sharps container nearby. It will be interesting to see what you report on the State's viewpoint.

CoffeeRTC, BSN, RN · Feb 19, 2009

I'll admit...I do finger sticks in the hallways and will give a quick sub q in the arm. Most of the residents hate being torn away from an activity and wheeled all the way to the room or bathroom for this. Of course, I remind them that the state likes to see it done in private and still, they hate it and some refuse. I do remember having one person refuse leaving an activity and said...do it now or don't do it at all and turned to the state person and said..I know what the book way is, but I want it this way..too bad for you. We didn't get cited on that.

Eye drops and I think inhalers are to be done in private too. Make sure the door or curtain is pulled when you do those g tube feeds and meds.

Getting back to the regs...you should have been trained on the proper way do do things. Your pharm P and P should have it listed too. Now....I'll be honest..most g tube meds get crushed all together and flushed, finger sticks where ever I can get them in, inhalers etc. Make sure you are locking the med cart when you step away and keep the MAR covered too. Keep all meds off the top of the cart including IV bags.

Inquisitive one · Feb 19, 2009

This is not something new and you should have been oriented properly from the beginning. From your resident responses it seems that this protocol isn't followed by staff on a daily basis. You will get dinged by the state if you're noted to do fingersticks, injections, eye drops, inhalers, gtube meds/flushes etc in public areas. An ombudsman may take notice as well and report it. It's a dignity issue and I'd assume an infection control issue as well especially if they're being administered in a dining area. I would like to hear the states response to your question but I'm wiling to bet you don't get one. All g-tube meds need to be crushed and given separately by gravity method not pushed. I don't think po meds need to be crushed separately unless it's contraindicated. Make sure that you're disinfecting your hands after each patient and washing them after every 3-5 patients I believe. Always wash after eye drop administration. I've also seen resident's Roxanol syringes (labeled with their name) being kept together in a cup on the med cart. This to me is a big infection control issue and I do my best to keep educationg staff on this. Always keep your cart drawers locked as well as the cart's wheels, no meds on top, all drinks and food are covered. labeled and dated. No personal drinks on the cart, sharps containers not over the fill line, Keep the MAR closed or covered when you walk away. Identify your residents and follow all parameters before you draw up and administer the med. Don't crush meds unless there is an order to do so and there is no contraindication. Give each med in the form as indicated on the MAR, capsule, tab etc. Oh there's so much!!! Any other suggestions?

Ms.Smart E Pants · Feb 19, 2009

Take a deep breath.....and for gosh sakes don't have ANYTHING in your pockets to include flushes, meds, etc. Alcohol wipes and such are ok.

It made me a bit nervous that you are only being asked to follow P&P when the state is coming. I agree whole-heartedly with the other posts reflecting you should have been trained the proper way from the get-go. You have been given great advice from the other postees. Just remember, everything you are expected to do requires one single thing....common sense. Follow your gut and you'll be fine.

You are lucky you had warning the state was coming. Jhaco nor the State gives us any warning.

Good Luck!!!

grandee3 · Feb 19, 2009

Gotta love those state visits. ha ha

It always amazed me that when state was due, new sheets, updated equipment, even better food instantly surface.

I no longer work LTC, I now work LTAC, was at work one night last June and we had a surprise visit from state. They came knocking about 2100 on a Monday night. OMG, the charge RN (bless her little heart) was very calm. She asked them it they had a problem with her calling our DON and Admin., they said that was fine. Well, when the DON and Admin got there, it was pure hell. We were already short a nurse, and Monday night is a big MAR night, (we use same MAR for for Sa, Su, and Mon.). State stayed about 3 hrs. and said they would be back in the am. DON had the CNA's cleaning everything, we threw away a big 50 gal garbage can of tube feeding, tubing, IV stuff etc. that was outdated. I would not even want to guess how much money went down the drain with that spring cleaning. Anyway, we were ok, they finally finished late Thurs night. I think they came because there was a complaint about the food and a few other things. Has anything changed after 8 months? NOPE! :bugeyes:

ktwlpn, LPN · Feb 19, 2009

Working in LTC for 3 months and I am asked to do ALL injections (incl. FINGERSTICKS) in pt's room. I'm also told to crush all meds SEPERATELY. ARE YOU KIDDING ME!!!! Why couldn't they teach me the right way from jump then I wouldn't be able to compare "the rules & regulations" to anything better?!!!
So, I've been doing injections in their rooms now and the residents HATE it. They are SO annoyed that I am wheeling them sometimes just to stick their finger! A few of them told me to start a petition....so I called the state myself to see if PATIENTS HAVE A RIGHT TO HAVE INJECTIONS IN THE DINING ROOM IF IT'S THEIR WISH.
I'm waiting for a call back from the state...I don't think I'm gonna win this one...!!!!I'll keep you posted. :icon_roll

When the state comes they have already decided how many meds by each route they need to observe being administered.I have been observed ONCE since 1991...hehee.We were just reminded that finger sticks and injections cannot be given in any common areas-we have several residents care planned for this but I guess we can't do it that way any longer.It's a shame-the DOH needs to remember that this is a big control issue for these people-so much of their life is out of their control in LTC-if a LOL wants to come to the desk before a meal for her fingerstick or have it done in the dining room ,why not? I suppose it COULD endanger her table mates-can't be splashing blood/body fluids. The surveyors are so far away from bedside nursing-they are clueless....

travel50 · Feb 19, 2009

At our nsg home, if the resident insists on having their finger stuck where they are, then that is where we do it. Same with insulin. But we always offer to take them to their room. My state surveyor told me this was acceptable, as long as we offered to take them to their room. We crush all pills together. State has never told us not to. We give liquids seperate from the pills...say in a peg tube. Whichever one we do first, we flush afterwards, then do the other. And my crew think I am mean for making them do it right all the time. But if you don't do it right when state is not there, you'll forget to do it right when they are.