Pre-setting meds....

[mtgirl63]

Do you pre-set your meds? Why or why not?

I personally do not pre-set meds and think it's a very unsafe practice. I've worked with a nurse who pre-set meds right in the hallway -- she might have as many as 10-12 cups of meds sitting on top of her med cart at once. Her logic was that it was ok because she never left her cart. My thoughts is that all it takes is for her to turn her back to the cart to give a resident meds, and although she's still right there, it would be way too easy for another resident to grab the pills and take them before she knew what was happening. We have too many wandering, curious, confused residents for that to be safe. Another nurse thinks it's ok to pre-set if she does in the med room. My problem with that is the time you are taking in the med room pre-setting pills for 15-20 residents you are totally oblivious to what's going on outside the med room. While she was in there once pre-setting pills the other nurse was going on her dinner break but had not left the nurses station yet when a CNA called to her that a resident was choking. By the time the nurse that was supposed to be on break got to the resident, she was turning blue and required the heimlich (sp?). The nurse pre-setting the meds --- she didn't have a clue any of this was going on until she came out of the med room and the other nurse told her!! In my opinion there's just too many chances for med errors to pre-set. How do the rest of you feel about it? Our DON doesn't like it, but apparently there's no policy against it --- and I wish there were.

[robinrdrn]

Hmmmmmmmm...........okay here is reality........you ain't suppose to do it.....but, when working a shift where I happen to have 20+ of the same meds suppose to be given at 6:30 am and your have to check blood sugars too.....well lets just say I label, label, label, and pull up everything earlier in the shift when I'm more awake. I certainly don't make a habit of it when "State," is around. Call it nursing judgement or stupidity.....luckily I don't often have to work those shifts.

[2amigos]

I'm not in the Nursing Program yet, but when I worked as a PCA in a group home with four residents, we would do their meds up early in the shift when it wasn't so busy and mark the cups and lock them up. It was against policy, but I don't know anyone that didn't do it....it was just a necessity and actually was safer than having to do it with all the distractions. We usually worked by ourselves and rarely double staffed. Just my 2 cents.

Cheryl Moore

[jevans]

In our unit we use a system called POMS [patient own medication system] On the locker there is a locked cabinet with pt meds, dispensed by pharmacy. It is a fantastic system

* Saves time

* less meds errors

* pt learns about their own tablets then graduates to giving own meds

I am such a fan of this

j

[cargal]

Originally posted by jevans

In our unit we use a system called POMS [patient own medication system] On the locker there is a locked cabinet with pt meds, dispensed by pharmacy. It is a fantastic system

* Saves time

* less meds errors

* pt learns about their own tablets then graduates to giving own meds

I am such a fan of this

j

Jevans,

Could you explain this a little more in depth. It sounds great, but in the ole USA, the gov't would never let us do this, I fear.

[sassynurse78]

We are not supposed to, but most people do one way or another. I usually set my meds up, I put them in the pts drawer of the med cart. and I double check that they are all given after the med pass. If states around I don't of course. I don't understand how this can be considered unsafe, if you set one med up at a time and place it into the proper pts drawer. It gives me a few more minutes to actully spend in the pt.'s room talking with them or assessing them, anywhere you can find some spare time in LTC is wonderfull!

[Ragin Cajun]

Pre-setting is against state regs in this state too, and also against policy in all facilities where I've worked. I can see the rational behind this, and med errors is the greatest reason. To eliminate the confusion and cut the time for med passes, we changed our times on the meds. Nothing says every med has to be given at 8:00 a.m. (qd meds). By spreading out the times, patients actually did a lot better too. Most of those little old people cannot take being hit with the bomb we give them at once. Spreading them out has contributed to better B/P control, more alert residents, decreased falls, improved moods, and general overall sense of well-being. The catch is that the facility has to agree to have medication nurses since this schedule means that you are passing meds "all the time". You can't have a patient load and do this. The other benefit, besides to the patients who do better, is decreased med errors. You are not constantly interrupted to do other things during a med pass. I hope you can sell the idea to your facility. Maybe it would help to mention all the monetary fines saved from med passes not w/in the accepted time frame, med. errors, contamination, safety, etc. A happy staff (relieved from undue stress) helps too !!! RC

[karenann]

We're doing the 3-day on, 3-day off thingy...again, and I'm presently 1 of the 2 NOC nurses working ... so, yup, I'm pre-pouring for a variety of reasons already mentioned: even in 12 hours in the middle of the night, I'm going to be passing them an hour late (48 residents, 3 meds each at least) in the morning and I'm getting kind of tired by then, so the risk of a med error is higher, if something happens during the shift the meds are already done (basically). Our meds are sent from pharmacy in BOTTLES, no med dispensers or cards here...just open and pour the way you would at home. Our policy states "Pour, chart, pass" so, technically it doesn't state we have to pass right after we've poured, and we're all doing it (even the day shift). With the meds and treatments being done by me...that's just the way it is. As far as changing the med pass to a more convienient time for US...our med pass is time-ordered by the corporation that owns us. We haven't got the option to change it. The cups are marked and put in the locked cart. Anybody goes near those carts (I handle two on the NOC shift)....well...shame on em!

[Rohb]

Guilty Here.I don't think there is anyway around it.In my ward we got a policy of Pre-setting meds and any patient manage to self meds are encouraged.Everything is Routine

[oregon-rn]

I never heard of pre-pouring meds until in a facility until I came to Oregon. Scary, Scary, Scary but I am slowly learning I can't change things even if it involves patient safety. Unfortunately things will only get worse. Not enough nurses and very difficult to get in nursing school here. A PE class is worth more than a degree in education as far as nursing programs are concerned.

Disgruntled today in Oregon.

[zuchRN]

Pre-setting meds is always a bad idea. It is the cause of more med errors. For those of you unable to complete a med pass in the allotted time, have you talked to your DON about changing med pass times so that half the cart would be 8-12-4-8 and the other half being 9-1-5-9? This is a very easy thing to do. The pharmacy consultants should also work with you to decrease the number of meds being given (by eliminating duplicate therapy and unnec. meds). It is also a function of pharmacy to help you to redistribute meds over the day to help even out the med pass.

Pre-setting meds is considered a bad practice and against regulations for the following reasons>>> as the nurse passing the med, you have to be able to identify all the pills that you are giving with name dosage and expiration date at the time you are going to pass the medication, pre-setting the meds 3 hours ahead of time ensures that you are not able to identify those 3 core items at the time you are giving the med.

[nursedawn67, LPN]

When i pass meds, I take my med cart and go to each residents door and pop the meds out of the cartridge into the cup and go directly to that resident and give it to them. If it is in the middle of the night or early morning and I have 2 residents that share a room, I will mark their cup with their name and pop their meds into the appropriate cup and take both to them. Never to I oreset the meds...too much room for error. And I don't want to lose my license over that.

[deegal.lpn]

I think most people have been guilty a time or two even if they don't want to admit it. It is unsafe it increases your risk for med errors. When you have 30 or 40 res. to give pills, tx, inj., inhalers, eyedrops to it does sound like a shortcut. Although illegal I'm not saying if it's right or wrong. just never let a state surveyor see it.