Pre-pulling Medicatons

SuesquatchRN, BSN, RN · Oct 25, 2009

I know I'm going to get bashed for this, but really...what is so horrible about pre-pulling medicatons?

That it will get the facility cited.

I used to but was "untaught" the habit.

caliotter3 · Oct 25, 2009

I learned about pre-pulling from the lazy nurse who slept all night long. She was good about anything that made for less work on her part. She also made up finger stick data as well as any other monitoring data. She would hide the prefilled medicine cups in the top drawer of the med cart. She even did this when state was around and there was the possibility of them visiting night shift early in the morning. I can't say I agree or disagree with the practice.

skittlebear · Oct 25, 2009

OK...I understand that you could get "cited" for this but...usually you know when state is coming and when not to pre-pull. Also, you can easily hide the medications that you pull. I know of a few lazy nurses myself. But...sometimes I think it may BENEFIT the patient if you have more time on your hands and you are NOT being lazy. Of course you wouldn't pre-pull narcotics. Say, for example...you get terribly behind and and a patient has to go to the emergency room or someone falls, etc. You could spend more time tending to that patient and all your other patients wouldn't get there medications late because of the time it took you to pull them.

CASTLEGATES · Oct 25, 2009

I made a med error doing that and will never do that again as long as I live. Luckily he wasn't allergic. I tattled on myself immediately to the patient and the doc; it was an antibiotic.

I will never ever ever do that again and haven't. Only exception is when it's clearly labeled so I can bring the container with me but never a naked pill or unlabeled syringe.

The reason it's a no-no? I've seen some bad things happen this same way. There's a really good reason it's prohibited. This is called cutting corners and the people we care for are someone's wife/husband, child....would you want that to your loved one's knowing the risk?

If you've got labeled pill packets, OK ONLY if you do your triple checks before and we really need to do triple checks every single time (every med error lacks one of those checks).

SuesquatchRN, BSN, RN · Oct 25, 2009

If you've got labeled pill packets, OK ONLY if you do your triple checks before and we really need to do triple checks every single time (every med error lacks one of those checks).

That's not possible in LTC, CG.

I used to pop them into a little cup, put another cup labelled with the patient's name on top of it, and lock it up. If someone required vitals I wuld put those pills separately, and pre-pour only if I knew the patient to be stable and unlikely NOT to get the pill. I actually had fewer errors that way. As the OP says, more time. And I can't check wristbands when patients don't wear them.

A reason not to pre-pour where I am now if the DON will write you up if she catches you.

squirtle · Oct 25, 2009

Just out of curiosity, I have only worked in the hospital setting, can someone give me a quick run down of how med pass is performed in LTC? I keep seeing posts with regard to the nurse: patient ratios and it seems so crazy to me.... maybe I am confusing the nurses with the CNA's, not sure. But I am picturing you going to a pyxis type dispenser and pulling meds on one pt, dispensing them, then returning to do it all over again. It seems very time consuming! Also, when having so many pt's, it seems lack of time available to pull meds and distribute would increase the amount of errors and would negate the supposed prevention of error by pulling them one at a time. I hope I am making sense here... I just woke up :yawn:

SuesquatchRN, BSN, RN · Oct 25, 2009

Squirtle, most LTCs have "med carts," which contain vlister packs filled with 30 tablets per patient and set in between dividers with names/room numbers. The bottom drawer holds liquids, etc, and there's usually an easy spot to reach insulins, needles, etc.

You go along the hall pushing the cart and checking off the MAR as you pop the pills in front of each room.

It can get frantic, but remember, the patients are chronics, not acutes, and orders don't change quickly. Coumadins change a lot, ss insulins obviously change based on BG, dig and toprol get held based on bp or apical, but otherwise, I can pretty much pop my residents' meds in my sleep. At do, starting at 0400.

:)

FLArn · Oct 25, 2009

The Hardest part of the LTC med pass for me always was running to the supply closet when I found the empty bottle of test strips, ... then to replace the tylenol bottle with 1 tab in it, etc., etc......:selfbonk:

SuesquatchRN, BSN, RN · Oct 25, 2009

The Hardest part of the LTC med pass for me always was running to the supply closet when I found the empty bottle of test strips, ... then to replace the tylenol bottle with 1 tab in it, etc., etc......:selfbonk:

It infuriates me when I follow someone that inconsiderate. I always make sure the cart is stocked and NEAT for the next person.

cardiacmadeline, RN · Oct 25, 2009

My mom is a CNA in assisted living. She was ready to pass meds to one of her residents, but the resident was busy. So she got the meds ready for her next resident. By that time her first resident was ready for his pills. She grabbed the pills intended for the second resident and gave them to the first resident. All of them, luckily there wasn't anything in there that would harm the resident. I know this isn't exactly the same situation you are speaking of, but I still think it is a good example of why not to pre-pull medications.

sharpeimom · Oct 25, 2009

ok...i understand that you could get "cited" for this but...usually you know when state is coming and when not to pre-pull. also, you can easily hide the medications that you pull. i know of a few lazy nurses myself. but...sometimes i think it may benefit the patient if you have more time on your hands and you are not being lazy. of course you wouldn't pre-pull narcotics. say, for example...you get terribly behind and and a patient has to go to the emergency room or someone falls, etc. you could spend more time tending to that patient and all your other patients wouldn't get there medications late because of the time it took you to pull them.

sounds to like a whole series of excuses just to make things easier for a lazy or unmotivated nurse. the very ideas of "you can easily hide the medications that you pull..." or "... you know when the state is coming and when not to pre-pull..." make my skin crawl. :eek:

the med error rate would climb too, i would think with pre-pulling, which does nothing to help the patient whatever. :down:

one big vote no! from here.

kathy

sharpeimom:paw::paw: