Pre-pulling Medicatons

pinkiepie_RN · Oct 26, 2009

We put the patient's sticker on a medicine cup and pre-pour, but never open the packages ahead of time. I know we're not supposed to, but I feel like especially with our patients out and about it would be hard to wait to pour meds.

Oh and I should add, we have these stupid MedConnect scanner things so we scan their bracelet and then scan the meds and give it to them so we're being "extra safe". Not that it usually works that way. But here's to trying!

FLArn · Oct 26, 2009

As long as the meds are in sealed labeled packets and you finish the rest of the safety checks at the time you give the meds , I wouldn't consider this a true "pre-pour" situation.

cardiacmadeline, RN · Oct 26, 2009

Oh and I should add, we have these stupid MedConnect scanner things so we scan their bracelet and then scan the meds and give it to them so we're being "extra safe". Not that it usually works that way. But here's to trying!

Facilities use bar code scanning for safety reasons. How can being "extra safe" be considered stupid?

pinkiepie_RN · Oct 28, 2009

Facilities use bar code scanning for safety reasons. How can being "extra safe" be considered stupid?

We're still trying to work out bugs of meds not scanning properly, patients taking their bracelets off and other things beyond our control. Bar coding does add to safety, but when there are still bugs it turns into nurses ready to throw the scanners out the window. :)

skittlebear · Oct 28, 2009

sorry, i don't mean to bash, but i simply don't agree with your statement concerning "a nurse that doesn't pre-pull medications, i could see that nurse make a med error much easier than someone that does." sadly, i find some nurses pre-pouring and they mostly are sitting at the station for most part of the shift. i think it's a lazy practice. the facility could be cited, the pharmacy is against such practices. in fact, in one recent incident, a cna took a picture using her cell phone camera, of a nurse pre-pouring and handed it to the don. the don, of course, acted upon receiving it. besides that, why on earth will a competent license nurse not want to practice the 6 rights of med pass, i strongly believe med pass rights are there for guidance & for safety reasons. med-errors is very easy to make, whether you pre-pour or not. though, there's a higher risk if you make pre-pour your practice.

how the heck can any nurse working in a nursing home even have time to be lazy??????? sorry, i'm not yelling : ) there's just so much stuff going all in all different directions! i understand that pre-pulling is considered lazy to some but say, for example, you pull mrs c's medications at the time it is time to give that medication. you go to mrs. c's room and she's suddenly not ready to take her meds. now, miss k's got a bs check and you need to go check in now. oh no, mr a fell out of his bed. crap, the family in room 35 needs to talk to you. i know, i know...prioritizing is the key here. but seriously, how can someone be lazy in a nursing home?

caliotter3 · Oct 28, 2009

how the heck can any nurse working in a nursing home even have time to be lazy??????? sorry, i'm not yelling : ) there's just so much stuff going all in all different directions! i understand that pre-pulling is considered lazy to some but say, for example, you pull mrs c's medications at the time it is time to give that medication. you go to mrs. c's room and she's suddenly not ready to take her meds. now, miss k's got a bs check and you need to go check in now. oh no, mr a fell out of his bed. crap, the family in room 35 needs to talk to you. i know, i know...prioritizing is the key here. but seriously, how can someone be lazy in a nursing home?

quite simple. if on night shift, sleep most of the night. only do those things that make it look like you are working, at the beginning and end of the shift. when you are going down the hall, supposedly when you walk into the room to do a bs check, realize that no one is walking into the room to see what you are doing, so write down a number in the book instead of doing the procedure. makes your room visit last 10 seconds instead of, maybe, four minutes. pre-pour your meds at the beginning of the shift. that allows a longer sleep period so that you can begin your am med pass 15 minutes late instead of 15 minutes early because you have the hallway with 80 residents instead of 19. never answer a call light or cna request in between your mandatory "beginning" and "end" med passes, because you know that the cna will learn to ask the nurse(s) that really care about the residents and who are not there to sleep for their paycheck. kiss up to the don and the floor managers and supervisors at all possible times. this helps to insure that their eyes stay closed to your lack of effort. i worked beside such a sorry nurse for quite some time so picked up a lot of what the cnas said about her and made my own observations.

jjjoy, LPN · Oct 28, 2009

I think it's good of you to ask this question Skittlebear. The reality is that many nurses in LTC facilities do pre-pour meds. It's not just a "few bad apples"; it's the case in many facilities with many of the nurses. Sure, some are just lazy and would cut corners in even the cushiest of jobs. I do think, though, that many would rather do things differently but fear losing their job (it's easy enough to pick apart one's work and justify termination) if they were to significantly veer from the standard practice in their facility. It's not just the steady paycheck, but also the hours, location, local job market, and loyalty to one's patients that may make a worker very loyal to facility despite its compromises.

My experience in LTC had med passes for appx 30 patients, which averaged 4 minutes per patient. That's not much time for checking the MAR, pulling and pouring the meds, crushing if necessary, administering the meds (slow patients, g-tubes, eye drops, etc), & signing off on the MAR. Not to mention, hunting down patients who aren't in their room, interruptions from residents, family & colleagues, etc.

Maybe the question isn't "can pre-pouring allow for better overall nursing care in environments of stable patients and very high ratios?" Maybe the question is "how does a conscientious nurse provide quality nursing care in LTC without compromising or leaving the field?"

There does exist the reality of heavy med passes to stable patients in LTC and the reality that these nurses often have little chance to do more than toss pills at patients (med passes could easily take 5 hours of an 8 hour shift). What's a conscientious nurse to do? Continue doing things the right way which then means administering meds out of their time window and barely eye-balling each resident, perhaps placing the resident at higher risk for some other problem? Wait til one is asked to leave for not completing their work on time? Quit the job so it can be taken by someone else who is willing to compromise? If one wants to get into administration to try to make changes on that side, how do they survive as a quality practitioner during their time in the trenches?

Thankfully, not all places are like that; but it does seem that MANY are. And if all nurses simply refused to do it, would it really force change? Wouldn't the facilities instead plead 'nursing shortage'; that US nurses feel LTC work is 'beneath them'; that if US nurses won't work for them that imported labor is the answer; that expansion of UAP functions is both necessary and cost-saving; etc?

FLArn · Oct 29, 2009

Caliotter,

As a longtime night shift nurse, I am So insulted by your post that I can barely type this reply. YOUR attitude in that post is the biggest reason for the between shift fighting. I am so busy on my shift I barely have time to toilet and eat while I chart. In addition to the patient care my shift is also responsible for calibrating the blood glucose machine, chart checking the day's new orders, maintaining the crash cart, writing nurse's notes on the patients that days and evenings didn't get to do (sometimes half or better of their assigned charting) preparing the MAR's and TAR's for the next month, reordering patients meds, lab draws, preparing the paperwork for the day's MD appointments if any patients are going out to appointments and the paperwork for any dischrges that are pending. Before any day or evening people flame me , I wish to acknowledge that all shifts are busy in their own way. But to state that night shift nurse's are lazy and SLEEP on their shift is beyond rude and insulting!:angryfire

Nancy2009 · Oct 29, 2009

caliotter,
as a longtime night shift nurse, i am so insulted by your post that i can barely type this reply. your attitude in that post is the biggest reason for the between shift fighting. i am so busy on my shift i barely have time to toilet and eat while i chart. in addition to the patient care my shift is also responsible for calibrating the blood glucose machine, chart checking the day's new orders, maintaining the crash cart, writing nurse's notes on the patients that days and evenings didn't get to do (sometimes half or better of their assigned charting) preparing the mar's and tar's for the next month, reordering patients meds, lab draws, preparing the paperwork for the day's md appointments if any patients are going out to appointments and the paperwork for any dischrges that are pending. before any day or evening people flame me , i wish to acknowledge that all shifts are busy in their own way. but to state that night shift nurse's are lazy and sleep on their shift is beyond rude and insulting!:angryfire

"words" as they say are open to many interpretations. i read the post over, and over again, quite honestly, i don't get any sense that the statement was speaking generally to "night shift nurses." if you read the last sentence, you could deduct from it that, the post was in reference to a "sorry nurse....." i work the night shift, and i can not agree with you more that it has its own share of work load. i'm familiar with all the responsibilities you described. however, these responsibilities are done by conscientious nurses only. i have worked with many nurses who choose to do the task they want to do. they design what needs to be done on their watch, ignoring other tasks that really, are part of the shift. sleeping? sure thing, these nurses sleep, and sleep for most part of the shift. as i read the post, i was amaze, amaze because it seems like the poster had worked at facilities, i had worked, and all she did was observed. as a night shift nurse, i didn't find the post directed to all night shift nurses, for that, i don't feel insulted or disrespected in any way. again, "words" are open to many interpretations.

Nancy2009 · Oct 29, 2009

how the heck can any nurse working in a nursing home even have time to be lazy??????? sorry, i'm not yelling : ) there's just so much stuff going all in all different directions! i understand that pre-pulling is considered lazy to some but say, for example, you pull mrs c's medications at the time it is time to give that medication. you go to mrs. c's room and she's suddenly not ready to take her meds. now, miss k's got a bs check and you need to go check in now. oh no, mr a fell out of his bed. crap, the family in room 35 needs to talk to you. i know, i know...prioritizing is the key here. but seriously, how can someone be lazy in a nursing home?

you opened a thread with a title "pre-pulling medications," and at the same time you have declared you are not, for or against. sadly, as i read through each of your posts you tend to be "for" such practices. this is the practice i consider "lazy." i stand by my statement. i don't care how you want to slice all the event(s) that could or could not happen on a given shift. you still "must" make med pass practice a safe one. i'm very familiar with all the events that you have described, that could happen on a given shift. i have worked full-time on 2nd & 3rd shifts. from your posts, it seems like you are describing the events for the 2nd shift. well, let me also add that i have had such days with some of the events you described including having to admit a new pt/transfer/and or discharge. like you said, prioritization is the key. i think you should get help from other nurses, if you find your work load overwhelming rather than trying to get everything done at the expense of pre-pouring your medications, if this is your practice. there's no doubt that pre-pouring medications is a dangerous practice! there's is no reason that justifies such a practice by any licensed nurse. i generally do not pre-pour, i have/had 35-40 pts, and i take out the meds as i'm ready to give the pt. it has become part of my practice; the other nurses who make pre-pour their practice, don't finish quicker than i do. in any case, where is pt safety in all of these talks about pre-pouring/pulling medications? as you will judge from the number of responses to this thread, nurses who are "against" such practices tend to be more, however, you have responded to some posts, such as mine, by opening the debate of "shift events vs pre-pulling medications." where is pt safety in any of these?

skittlebear · Oct 29, 2009

quite simple. if on night shift, sleep most of the night. only do those things that make it look like you are working, at the beginning and end of the shift. when you are going down the hall, supposedly when you walk into the room to do a bs check, realize that no one is walking into the room to see what you are doing, so write down a number in the book instead of doing the procedure. makes your room visit last 10 seconds instead of, maybe, four minutes. pre-pour your meds at the beginning of the shift. that allows a longer sleep period so that you can begin your am med pass 15 minutes late instead of 15 minutes early because you have the hallway with 80 residents instead of 19. never answer a call light or cna request in between your mandatory "beginning" and "end" med passes, because you know that the cna will learn to ask the nurse(s) that really care about the residents and who are not there to sleep for their paycheck. kiss up to the don and the floor managers and supervisors at all possible times. this helps to insure that their eyes stay closed to your lack of effort. i worked beside such a sorry nurse for quite some time so picked up a lot of what the cnas said about her and made my own observations.

omg!!! :eek: that is very scary!!!! such a nurse should not only have their licensed revoked but should also be charged criminally! :eek: :eek: :eek:

skittlebear · Oct 29, 2009

you opened a thread with a title "pre-pulling medications," and at the same time you have declared you are not, for or against. sadly, as i read through each of your posts you tend to be "for" such practices. this is the practice i consider "lazy." i stand by my statement. i don't care how you want to slice all the event(s) that could or could not happen on a given shift. you still "must" make med pass practice a safe one.
i'm very familiar with all the events that you have described, that could happen on a given shift. i have worked full-time on 2nd & 3rd shifts. from your posts, it seems like you are describing the events for the 2nd shift. well, let me also add that i have had such days with some of the events you described including having to admit a new pt/transfer/and or discharge. like you said, prioritization is the key. i think you should get help from other nurses, if you find your work load overwhelming rather than trying to get everything done at the expense of pre-pouring your medications, if this is your practice. there's no doubt that pre-pouring medications is a dangerous practice! there's is no reason that justifies such a practice by any licensed nurse. i generally do not pre-pour, i have/had 35-40 pts, and i take out the meds as i'm ready to give the pt. it has become part of my practice; the other nurses who make pre-pour their practice, don't finish quicker than i do. in any case, where is pt safety in all of these talks about pre-pouring/pulling medications? as you will judge from the number of responses to this thread, nurses who are "against" such practices tend to be more, however, you have responded to some posts, such as mine, by opening the debate of "shift events vs pre-pulling medications." where is pt safety in any of these?

um...never said i was for pre-pulling meds. i see this practiced by a lot of my co-workers. have i done it in the past? yes, i have. sorry. am i a lazy nurse b/c of it? no! i never sit once during my shift. i am constantly on the go. i posted this b/c i am trying to justify this. i know deep, deep down that this is the wrong way to practice so i now pull one medication at a time. do i think badly of nurses who pre-pull? no, as long as they are "not sleeping" and actually doing their job. i wasn't trying to start a fire. it's great that you can pull meds one at a time and get everything done in your shift with 40 patients. yay for you. i'm new to this ltc facility and several nurses i work with do pre-pull. it is extremely busy.