Pre-pulling Medicatons

skittlebear · Oct 29, 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?

i totally agree with this. thanks for replying.

SuesquatchRN, BSN, RN · Oct 29, 2009

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.

really? what other nurses?

Nancy2009 · Oct 29, 2009

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.
really? what other nurses?

well, i think it all depends on where you work and how you relate to other nurses and cna’s. it also depends on how the don of the facility runs the place. if you work on a floor with say 60 or more residents, the floor is usually covered by 2 staff nurses. nurses in places i have worked, tend to help each other out. situations that the op indicated, are not unique. it should be anticipated by any experienced nurse. the work load can be enormous at times, so you can get help, if you ask. i don’t know any licensed nurse that will turn down another colleague seeking help when it comes to pt care. tomorrow, i could also be returning the same favor. i’ve worked in many ltc facilities were they have supervisors, and places without nursing supervisors, but then, there would be a charge nurse, the charge nurse is usually assigned to a unit and will help out, as needed. i’ve also worked in places where nurses take turns to supervise as well as having their assigned units. generally, when seeking employment in any facility, i always consider these factors, knowing that the nurse-pt ratios could be high, in most cases, i’m told of what to expect at the interview. i then decide if this is the right fit. i generally will not accept any employment offer were i know i will not succeed as a nurse. unfortunately, there seems to be many of these types of facilities operating, were staff turnover is high, and lack adequate support for their staff, let alone talk about retention.

Nancy2009 · Oct 29, 2009

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.

i don’t think anyone on this thread is “trying to start a fire” either. neither, have i implied that nurses who pre-pour are bad nurses. in fact, most of these nurses are great nurses, except that i simply disagree with their choice of pre-pour practice. do i consider this a lazy practice? you bet! like i indicated in my previous posts on this thread, the nurses, i’ve seen pre-pouring, in many of the facilities i have worked, spend most of the shift sitting at the nurses station, having pre-poured the medications at the start of the shift. neither, do i despise a nurse that sleeps at work, if he/she wants to. quite frankly, if a nurse feels the need to nap in order to practice safe, so be it.

the situations you described in your post are not unique. it should be anticipated by any experienced nurse. therefore, i see no justification in making pre-pour a practice.

sharpeimom · Oct 29, 2009

i don't think anyone on this thread is "trying to start a fire" either. neither, have i implied that nurses who pre-pour are bad nurses. in fact, most of these nurses are great nurses, except that i simply disagree with their choice of pre-pour practice. do i consider this a lazy practice? you bet! like i indicated in my previous posts on this thread, the nurses, i've seen pre-pouring, in many of the facilities i have worked, spend most of the shift sitting at the nurses station, having pre-poured the medications at the start of the shift. neither, do i despise a nurse that sleeps at work, if he/she wants to. quite frankly, if a nurse feels the need to nap in order to practice safe, so be it.
the situations you described in your post are not unique. it should be anticipated by any experienced nurse. therefore, i see no justification in making pre-pour a practice.

no one is tyring to "start a fire" or fan the flames of the discussion. when you post a topic on a bb, whether about cooking, nursing or the proper care of your beloved shar pei, you must anticipate a lively discussion, know that there will be some alternate opinions, some pretty radical ideas, and have the awareness that some diverse ideas will be presented, but what you should not do is take offense. think of some of the lively and heated discussions that border on becoming arguments:eek::angryfire:uhoh3: :banghead: :argue::trout::cheers::chair: that happen in your own living room and kitchen when friends and/or family gather. we at allnurses.com are another kind of family.

kathy

sharpeimom:paw::paw:

skittlebear · Oct 29, 2009

no one is tyring to "start a fire" or fan the flames of the discussion. when you post a topic on a bb, whether about cooking, nursing or the proper care of your beloved shar pei, you must anticipate a lively discussion, know that there will be some alternate opinions, some pretty radical ideas, and have the awareness that some diverse ideas will be presented, but what you should not do is take offense. think of some of the lively and heated discussions that border on becoming arguments:eek::angryfire:uhoh3::argue::trout::cheers::chair: that happen in your own living room and kitchen when friends and/or family gather. we at allnurses.com are another kind of family.
kathy
sharpeimom:paw::paw:

no offense has been taken on my part. : ) this is exactly why i had posted this thread to begin with, to see the diverse opinions of others. thanks to everyone for responding. :smokin:

dscrn · Oct 30, 2009

I honestly don't see how pre-pulling your meds saves any time whatsoever. In all actuality, it actually INCREASES the amount of time you spend w/your med pass. You have to go through the MAR, pull the meds for that person, label that cup with a name, and hide it in the drawer of the med cart. AND THEN, you have to actually go down the hall, open said drawer and spend time FINDING the right cup of meds. And, hopefully, your hand doesn't bump any of the other cups sitting there b/c what would you do if you knocked over more than one cup of pills? Would you guess who gets which "little white pill?"....Sorry, but in my honest opinion, not only is pre-pulling your meds a huge waste of time but it is completely unsafe.

Yes, even if the meds were unit doses...I can see some spilling and mixing...

Raine1566 · Feb 25, 2016

Is pre- pulling medications ok or even legal?

LadyFree28, BSN, LPN, RN · Feb 25, 2016

Is pre- pulling medications ok or even legal?

In most places, it is against policy to pre-pour meds as a risk for medication errors; as far as the legalities, I don't remember that as a specific part of the nurse practice act, however there is a a provision about safe, effective practice; and I'm sure anything that would potentially affect that part that nurses is supposed to uphold would not be permissible.

Raine1566 · Feb 25, 2016

I work at a psychiatric hospital and many of the nurses pre pull, i.e., they put the unopened blisters in a pill cup and put it back in the draw for med time later. I personally find this practice to be dubious at best, and I don't do it all, but last night I was kind of harassed by another nurse to do so. Last night I worked on a children's unit, and I full on refused and that created some tension. Then I searched the internet for awhile, but there does not seem to be a specific rule against it. My problem with it is is that as soon as you open the med draw half of everything falls out, and if by chance you are doing correctly, then it takes twice as much time because you still need to double check every pill. Thoughts?