Pre-pulling Medicatons

JaneyW · Oct 25, 2009

I don't work LTC and probably never will. The part of the OP that jumped out at me was that passing meds was the 'easy' nursing function. I completely disagree. If you are being careful and paying attention, this is not an easy thing and should never be so. I understand that orders and patient status don't change often, but you can never become complacent in your duties as a licensed nurse. When that happens, mistakes follow.

skittlebear · Oct 25, 2009

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.
the med error rate would climb too, i would think with pre-pulling, which does nothing to help the patient whatever.
one big vote no! from here.
kathy
sharpeimom:paw::paw:

oh gosh, i knew this was going to happen. i respect your opinion but have you ever worked in a long term care setting taking care of 30-40 patients? if so, i would like to know how you survived. i bet some of the patients didn't get there meds if something horrible went down (like a patient falls or you have to send someone out to the emergency room, family crisis, etc) as they so often do in a nursing home setting. it would be completely different if you had 5-10 patients in a hospital setting...well, in a nursing home you have a higher patient load; hence,more interruptions.

sharpeimom · Oct 25, 2009

i don't work ltc and probably never will. the part of the op that jumped out at me was that passing meds was the 'easy' nursing function. i completely disagree. if you are being careful and paying attention, this is not an easy thing and should never be so. i understand that orders and patient status don't change often, but you can never become complacent in your duties as a licensed nurse. when that happens, mistakes follow.

i couldn't agree more with this post!

kathy

sharpeimom:paw::paw:

MedSurgeMess · Oct 25, 2009

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

I wish you worked with me

sharpeimom · Oct 25, 2009

oh gosh, i knew this was going to happen. i respect your opinion but have you ever worked in a long term care setting taking care of 30-40 patients? if so, i would like to know how you survived. i bet some of the patients didn't get there meds if something horrible went down (like a patient falls or you have to send someone out to the emergency room, family crisis, etc) as they so often do in a nursing home setting. it would be completely different if you had 5-10 patients in a hospital setting...well, in a nursing home you have a higher patient load; hence,more interruptions.

first of all...

no need to yell at me! why the heavy sarcasm?

i have never worked in a ltc setting but i was a staff nurse and supervisor in a state mental hospital with equally high patient ratios and never ever -- not one time -- preassembled my meds. it was illegal, easier to make a mistake, easier to give a patient the wrong med or meds, plus which, my patient population was legally able to refuse their meds (unless they had been court committed) which many did. for many of the years i worked there, virtually all of the meds were bulk and were stocked in bottles of 1000 pills or as liter or pint bottles. can't pour it back once it's out...

kathy

sharpeimom:paw::paw:

MedSurgeMess · Oct 25, 2009

oh gosh, i knew this was going to happen. i respect your opinion but have you ever worked in a long term care setting taking care of 30-40 patients? if so, i would like to know how you survived. i bet some of the patients didn't get there meds if something horrible went down (like a patient falls or you have to send someone out to the emergency room, family crisis, etc) as they so often do in a nursing home setting. it would be completely different if you had 5-10 patients in a hospital setting...well, in a nursing home you have a higher patient load; hence,more interruptions.

skittlebear, 5-10 patients in the hospital is no walk in the park either....believe me, many interruptions from mds, families wanting to know how patients are doing, other departments wanting to clarify orders and set up treatment schedule, etc. when they are in the hospital, they usually have emergent things going on, so it's not any easier for us either. are you new? it sounds like you need to learn some time management skills before you really hurt someone, albeit unintentionally. and yes, i have worked in ltc before. yes, it can seem like all you are doing is passing pills and filling out paperwork, but there is a time manangement component that can make things go smoother. ask your coworkers for tips to make things go a little faster, because some facilities, like suesquatch mentioned will write you up for pre-pulling, and after a few write ups will show you the door, and possibly notify your state bon, which could affect your license status. there are waaayyy to many things that can go wrong with this scenario.

skittlebear · Oct 25, 2009

i don't work ltc and probably never will. the part of the op that jumped out at me was that passing meds was the 'easy' nursing function. i completely disagree. if you are being careful and paying attention, this is not an easy thing and should never be so. i understand that orders and patient status don't change often, but you can never become complacent in your duties as a licensed nurse. when that happens, mistakes follow.

you've never worked in a ltc setting so please don't be judgmental until you do...until you are taking care of 30-40 patients on your shift and trying to stay afloat by not pre-pulling. you took my "giving meds is an easy nursing function" a little out of porportion. sorry i didn't explain myself better. i was going on 24 hours without sleep. i understand that medications is a very important part of nursing and that precautionary measures must be taken before you administer certain medications (take b/p prior or bs prior, see labs prior, etc). but...it is easy to actually pull and give the medication, isn't it? if you get to know your patients inside and out, you know what meds they are on, you know which one needs their bs, and you know which one needs their bp, etc. if you didn't, you could make a note on the med cup and flag the mar.

benefits=you would have more time to spend with your patients (yes, all 30-40 of them). you could pre-pull during a time when it is less busy

also, for a nurse that doesn't pre-pull medications, i could see that nurse make a med error much easier than someone that does. for example, you pre-pull at a time when things aren't busy. if you don't pre-pull and are going strictly by the book and something happens to one of your patients...what's more important? finishing the medication you are pulling at that time or running to go see what's going on with your patient? you can easily get flustered and behind! when a nurse is flustered and behind and pulling medications at the same time trying to catch up (b/c they didn't pre-pull), a med error can easily be made.

MedSurgeMess · Oct 25, 2009

also, for a nurse that doesn't pre-pull medications, i could see that nurse make a med error much easier than someone that does. for example, you pre-pull at a time when things aren't busy. if you don't pre-pull and are going strictly by the book and something happens to one of your patients...what's more important? finishing the medication you are pulling at that time or running to go see what's going on with your patient? you can easily get flustered and behind! when a nurse is flustered and behind and pulling medications at the same time trying to catch up (b/c they didn't pre-pull), a med error can easily be made.

a med error could be made just as easily being pre-pulled. if you're in a hurry, you could accidentally grab the wrong cup, or go to wrong patient room. you can justify it all you want, it's still wrong!

skittlebear · Oct 25, 2009

skittlebear, 5-10 patients in the hospital is no walk in the park either....believe me, many interruptions from mds, families wanting to know how patients are doing, other departments wanting to clarify orders and set up treatment schedule, etc. when they are in the hospital, they usually have emergent things going on, so it's not any easier for us either. are you new? it sounds like you need to learn some time management skills before you really hurt someone, albeit unintentionally. and yes, i have worked in ltc before. yes, it can seem like all you are doing is passing pills and filling out paperwork, but there is a time manangement component that can make things go smoother. ask your coworkers for tips to make things go a little faster, because some facilities, like suesquatch mentioned will write you up for pre-pulling, and after a few write ups will show you the door, and possibly notify your state bon, which could affect your license status. there are waaayyy to many things that can go wrong with this scenario.

thanks for your input : ). as i mentioned earlier, i'm not for or against pre-pulling. i just want to debate and see the possibilities of both sides. by arguing against, i can see that side. i would like to see the point of view of every nurse here in regards to working in a long term care facility. i know "per state regulations" pre-pulling is a huge no, no. but in some instances i just feel that it would benefit, rather than hinder.

yes, i am a little newer to the nursing home setting and probably will not last at this certain nursing home i am training at. for one thing, they don't give you much training. for another, they are understaffed (as it seems most nursing homes are) and you are taking care of way too many patients at one time.

i know in a hospital setting it can be even more stressful at times than working in a nursing home (the only hospital experience i have is my clinicals). i will not judge that since i haven't actually worked in this setting. i assume that have many more things going on with the patients other than administering their medications due to their acuity level.

skittlebear · Oct 25, 2009

first of all...
no need to yell at me! why the heavy sarcasm?
i have never worked in a ltc setting but i was a staff nurse and supervisor in a state mental hospital with equally high patient ratios and never ever -- not one time -- preassembled my meds. it was illegal, easier to make a mistake, easier to give a patient the wrong med or meds, plus which, my patient population was legally able to refuse their meds (unless they had been court committed) which many did. for many of the years i worked there, virtually all of the meds were bulk and were stocked in bottles of 1000 pills or as liter or pint bottles. can't pour it back once it's out...
kathy
sharpeimom:paw::paw:

sharpeimom, i wasn't trying to be sarcastic. i am sorry if i sounded as such. it's hard to interpret what someone is writing because you can't see any facial expressions or hear their tone of voice. promise i wasn't yelling . thanks for your opinion.

MiaLyse, APRN · Oct 25, 2009

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this is what needs to change. i've worked ltc and in the hospital. i know you can be unsafe with 6 pts in the hospital as well as the 30-40 in ltc but even when talking about nurse-pt ratios you see nothing mentioned about the ratios in ltc. the ratios are absolutely ridiculous and unsafe, imo.

sharpeimom · Oct 25, 2009

i wish you worked with me

it infuriates me when i follow someone that inconsiderate. i always make sure the cart is stocked and neat for the next person.

i positioned my quotes backwards... i'm sorry.

it makes it so much easir when you don't follow either an untidy or outright slob when you have to pour or pass or even just get a med for a patient or patients -- i.e. when you need a liquid prn psych med that's sticky, it's maddening to grab the large bulk-sized bottle only to discover that it was never wiped off before the numbskull -- i mean nurse -- ahead of you couldn't be bothered to either wipe it off or put it away when she was done. :angryfire:down: :eek:

ditto for getting rid of her trash, empty cans, bottles and other assorted crappola!!

kathy

sharpeimom:paw::paw: