please help!!!

Hellllllo Nurse, BSN, RN · Mar 7, 2004

yes there is a such thing. coumadin is a BLOOD THINNING medication. this resident had a heart condition, the blood flowing to his heart was thicker than should be, which is why he was put on the blood thinning medication, to thin out the blood flowing to his heart.why else would he be put on blood thinning medication??ive been working here for well over 2 years and weve had several instances where someone has been put on a blood thinning medication for several different reasons. some residents are on water retnetion pills because their bodys retain water and it makes there legs and feet swell up, which is why they are on water retaining pills. are you gonna try and tell me theres no such thing as water retention?im not trying to be mean but i know what i am doing. he wouldntve been put on a blood thinning medication if he didnt know it. and his wife is the one who called and said she took him to the hospital and was told his blood was thicker than it should be.

Coumadin is an anticoagulant, not a blood thinner. Blood thinner is what lay-persons call it. I stick by my statement that CNAs should not be passing meds.

Hellllllo Nurse, BSN, RN · Mar 7, 2004

From WI cna-

i pass meds,am not a cna

--------------------------------------------------------------------------------

"i work at an assisted living facility in WI im not even a cna and all i had to do was take a medication training course(course was 8 hours) and i pass meds. we have narcotics(although the residents dont ever take them) that we have to count at the end of EVERY night. i havent had a problem with it. we dont pass out that many meds really, but i am very careful with what i do.i learned alot in that class about side effects, dosages, dr. orders and the such. ive had to do telephone doctor orders before to discontinue a med and whatnot. i admit its alot of work, making sure everyone gets there med on time, keeping a close eye out for possible side effects and calling the doctor when there is a problem but i love the work i do and i would do anything to make these residents' lifes' better,which is why i feel comfortable passing meds because i have confidence in what i know and have learned."

An 8 hr course, and you can pass meds? Lord, help us. And in your post, you say you are not a CNA, but your screen name says you are.

Nurse Ratched, RN · Mar 7, 2004

I believe the question those with a license to lose are asking is, why is someone *without* a license passing meds? I understand that there are QMA's in certain settings, and the rules governing ALF's are another animal altogether since most of them do not claim to be medical facilities. However, there are clearly not adequate policies/procedures in place if there is some question of whether the pt is getting his meds. If the dosage has changed, the old dosage shouldn't be laying around to potentially be wrongly given. Many ALF's don't even technically "dispense" meds (they can "remind" the patient to take them, but staff may not necessarily be permitted to take them out of the bottle and put them in the resident's hand.

Bottom line is, if your facility is bearing the responsbility for giving the med (as clearly you are given the reaction of the patient's wife) then there needs to be adequately trained personnel doing so, who know not only what meds to give, but why they are giving them, when NOT to give them, evaluation of potential side effects, toxicities, how to appropriately document (I could go on and on, but you see why there are concerns about an 8 hour class being considered sufficient preparation for this HUGE responsibility.) There should be a nurse on staff doing this.

I say this not to be unkind or to question your good intentions, but this is a nursing task.

Megan-Cho · Mar 7, 2004

I say this not to be unkind or to question your good intentions, but this is a nursing task.

I'm just thanking God this poor resident didn't get both strengths! I imagine they aren't getting regular labs in this situation.

I'm also picturing Not-quite CNAs diagnosing "Thin blood" on the families say so. Then prescribing, and administering Corn Starch injections for too thin blood.

EEEEEGHADS!

CCU NRS · Mar 7, 2004

Coumadin is an anticoagulant, not a blood thinner. Blood thinner is what lay-persons call it. I stick by my statement that CNAs should not be passing meds.

You are entitiled to your opinion, however you did not just say CNAs should not pass meds but you were less than kind shall we say, your original comment was: ""Thick" blood? No such thing. Another example why CNAs should not be giving meds."

Apparently th State of Wisconsin feels differently, possibly due to the nursing "shortage" or the inability to get nurses to work in the field.

CCU NRS · Mar 10, 2004

BUMP for WI_CNA please don't let the harsh responses offend or frighten you away

WI_cna · Mar 11, 2004

BUMP for WI_CNA please don't let the harsh responses offend or frighten you away

im not even quite sure why ALFs' have non certified people passing meds.ive never had a really big problem with it but i can understand from RNs' and LPN s' point of view,they know quite a bit more than cnas' do.i do trust myself in passing out meds and if i ever have a question or a doubt, i do not hesitate to call the charge nurse(our boss is a nurse)

CoffeeRTC, BSN, RN · Mar 11, 2004

I know in PA they have Med Aid in ALF who are trained for about 8 hrs in med pass.... yes this is scarey..but this is assisted living, not skilled nursing. They can do this because an assisted living facillity is just like a persons home... where a relative with no medical training can assist in giving the person their medications.

What I want to know is how medication changes are communicated to the person in charge of passing meds?

Megan-Cho · Mar 11, 2004

just like a persons home... where a relative with no medical training can assist in giving the person their medications.

Michelle, you make a good point here. We sometimes forget what ALFs are suppose to be. Some of us old timers have seen acuity levels just go up and up. What was in a nursing home 10 or 15 years ago is now in an assisted living facility. What was never done in the patients home and required a 2 week hospital stay is done on an outpatient basis with in home I.V. antibiotic.

I hate to stereotype based on education because it's true a conscientious Aide can do a better job than a sloppy LPN or RN that doesn't care. The multidose packaging is also suppose to have a full description of the meds on the label. So in theory if it doesn't look like that, someone should question it. But think about it. A night shift person questions it and an on-call pharmacist that may or may not even work in the dispensing area on a regular basis takes the call. Do you know what they will say 99% of the time? "Oh it's probably just a different generic brand."

I've talked to a corp nurse at an ALF chain just today about this packaging and she said they had problems with their pharmacy sending the wrong meds in the packs.

It can happen to any pharmacy and any facility. The difference between life and death is the person that actually is handing the med to the patient.

WI_cna, I hope you seek further training. It sounds like you are a caring person and that is something this industry is always short on.

Good luck to you!

- Megs :)

WI_cna · Mar 12, 2004

Michelle, you make a good point here. We sometimes forget what ALFs are suppose to be. Some of us old timers have seen acuity levels just go up and up. What was in a nursing home 10 or 15 years ago is now in an assisted living facility. What was never done in the patients home and required a 2 week hospital stay is done on an outpatient basis with in home I.V. antibiotic.
I hate to stereotype based on education because it's true a conscientious Aide can do a better job than a sloppy LPN or RN that doesn't care. The multidose packaging is also suppose to have a full description of the meds on the label. So in theory if it doesn't look like that, someone should question it. But think about it. A night shift person questions it and an on-call pharmacist that may or may not even work in the dispensing area on a regular basis takes the call. Do you know what they will say 99% of the time? "Oh it's probably just a different generic brand."
I've talked to a corp nurse at an ALF chain just today about this packaging and she said they had problems with their pharmacy sending the wrong meds in the packs.
It can happen to any pharmacy and any facility. The difference between life and death is the person that actually is handing the med to the patient.
WI_cna, I hope you seek further training. It sounds like you are a caring person and that is something this industry is always short on.
Good luck to you!
- Megs :)

thankyou:) i am looking into further training,i will be taking the cna course soon, and after that, maybe more training, RN or LPN in the years to come, who knows. well see.

Twright49015 · Mar 22, 2004

Well I too work in a assisted living facility and took a 8 hr course and I am certified to pass meds. I am a CNA as well, but in the LTC Facility I work at the "Med Tech" can pass meds in assisted living but not downstairs in the SNF, you have to be LPN or RN for that.

ktwlpn, LPN · Mar 22, 2004

Here in Pa in assisted living the aides are only supposed to "assist" the resident in taking their meds...by law the resident is supposed to be with-it enough to know what to take...That's how they get away with non-licensed staff doing this....and that's why I have turned down a Monday through Friday clinical co-ordinator postion in a local ALF...the regs are too loose....It can't compare to LTC and it is scary...Around here they will stretch the rules and keep you in ALF until you run out of money...then-down the road you go....Minus your thousands of dollars you spent getting into the community....I don't think the poster has anything to worry about-there is no way to prove that anyone gave the wrong dose of coumadin and lots of pactors can effect the patients PT/INR-that's why coumadin must be closely monitored...UAP's are doing "technical" nursing tasks in many settings-different regs apply...Groups homes,ALF's.....It is unbelievable how some of these places are run and with little or no supervision by a nurse...