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Pre pulling meds

Psychiatric   (590 Views 12 Comments)
by Riegelbeagle Riegelbeagle (New Member) New Member

370 Profile Views; 10 Posts

I’m still in orientation and one my preceptors chewed me out because I refuse to pre pull meds. I work with kids. Bedtime is 9 and meds are ordered for 9. To me it seems more pragmatic to change med time to 8 but I was chewed out for that too. As med nurse I can have up to 32 kiddos. To me this seems unrealistic to give meds to that many kids and pre pulling dangerous. Am I just wrong ? I have always been told pre pulling set you up for mistakes.

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Snatchedwig has 11 years experience as a ADN, CNA, LPN, RN and specializes in Medsurg.

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Depending on medication and company policy you may have the option for 1hr a head and 1 hr after to give the medications. Which in turn gives you three hours.

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Snatchedwig has 11 years experience as a ADN, CNA, LPN, RN and specializes in Medsurg.

2 Followers; 310 Posts; 2,357 Profile Views

2 hours ago, Snatchedwig said:

Depending on medication and company policy you may have the option for 1hr a head and 1 hr after to give the medications. Which in turn gives you three hours.

1hr before and 1hr ahead. Would not allow me to edit. But ya can totally sympathize, orientation sucks.

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TCASII has 7 years experience as a ADN.

189 Posts; 3,827 Profile Views

I pull my meds around 0730, med pass is a 0900.  I can give between 0800 and 1000.  Same goes for midday meds - One hour before, one hour after.  The only reason I can see not to pre-pull is impending order changes.  Our meds go in a book with pockets containing the patient's photo and MRN sticker.  Unless I'm afraid the meds will be lost or taken, but I can leave them in the med room and we have a camera.  Seems odd not to pre-pull.

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10 Posts; 370 Profile Views

Psy is still new to me I am used to ICU where I had 1 -2 patients. I’m definitely still learning . Thanks for letting me know how it works at your facility.

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Pre-pulling is fine as long as your med cups are labeled and the meds are in a secure spot. I used to pre pull and then double check the orders as I gave the meds to the kid. 

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verene specializes in mental health / psychiatic nursing.

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16 hours ago, penelopelp said:

Pre-pulling is fine as long as your med cups are labeled and the meds are in a secure spot. I used to pre pull and then double check the orders as I gave the meds to the kid. 

This is how we do it were I work as well. It was a bit of an adjustment from nursing school were you are told NEVER pre-pull, but pulling at 0700, and verifying meds/orders as they are given during 0800-1000 med pass window is actually safer than trying to pull with a highly tangential patient chattering non-stop at the window, phone ringing non-stop, and needing to prep for admit/discharge during med-pass window.  I don't pull pre-pull controls, but I put a flag on both the labeled cup and on the MAR (we still use paper) to remind myself of controls, insulin, inhalers, creams etc.

 

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Current pediatric psych RN here. Although it's not what they taught you in nursing school, realistically, it's good practice and time management, esp. if you have a hectic day with admissions and discharges. As long as you check your orders and follow the rights of med administration, you should be fine. Once you get the hang of administering psych meds and you've had the same patients for a while, you'll already anticipate what you're going to give, at what time, and to who and what to watch for (e.g. cheeking, first dose rxn, EPS, etc.) I like prepping all my meds before they're due in little cups, writing initials on each cup, and ordering them in accordance with my patent list. So for you, you can start prepping around 7, administer at 8 to until 10 to finish.

As for your preceptor, he/she needs to chill tf out. There's no need to "chew" anyone out, esp. when you're on orientation LEARNING the ways there... Dumb*ss preceptor. 😒 Apologies in advance if you end up liking and becoming best friends with your preceptor. I just can't stand some of the unnecessary harshness during orientation when you're just trying to learn.

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verene specializes in mental health / psychiatic nursing.

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35 minutes ago, Riegelbeagle said:

Thanks for everyone’s input. I feel like I’m learning so much at once that I am overwhelmed.

It's normal to feel overwhelmed when first starting out and 32 kiddos is a lot! As you gain experience in this setting and get down a flow for the shift it will get easier.

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I've worked as an RN across multiple states and specialties and have always been told: Pre-pulling meds is against JCAHO and against most (if not all) state boards.  If anyone is found pre-pulling during audits/visits, discipline will be given to the particular nurses involved and to the facility.  I left one facility after only a few months because they told me pre-pulling was the only way they did med pass.  It felt wrong to me.  They lost accreditation the following year - this was among the reasons why: unsafe medication preparation and administration practices.

Pre-pulling is also found to increase errors. Labeling medicine cups is not allowed (HIPAA).  Pulling one patient at a time and then immediately administering to that patient is Best Practice according to pretty much every resource out there.

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