Is 0900 considered your "heavy" a.m. pass? If it only took you 3 1/2 hours to pass a.m. meds to 29 people, you are doing phenomenally. I wouldn't be any faster myself. I always take my time, especially with the a.m. pass since there is SO MUCH to give. I really don't care if I'm "late" with meds, because, in my opinion, 90% of the meds given in LTC facilities are completely unnecessary. I will never understand why we are giving, for instance, calcium and vitamin D TID to end of life residents to prevent fractures, or why blood pressure meds need to be split up into 3-4 daily doses. Doctors don't usually prescribe such frequent regimens to people at "home," so why in the world do they bother to do this to LTC residents in the place that has become their home? I think they just want it to look like we are really trying to "cure" all of the resident's ailments to make families happy (who don't want to face the fact their loved ones will not be getting better). Why is it such a big deal if you are 30 minutes late with something? People at home don't flip out or face loss of life or limb if they don't take their meds at 0900 on the dot. Why is LTC any different? Nobody will die if they have to wait a few extra minutes for their Tums or Lasix. It's LTC, for goodness sake, not an ICU! And if they do face that imminent danger, then they obviously have no business being in LTC and need to be shipped to the nearest acute care facility STAT!
As far as flagging goes, what are your MARs put into? Every LTC facility I have been to uses 3-ring binders. If this is the case in your facility, I would just pop open the rings, and move the paper off to one side, so that it will be sticking out the top/bottom, and only two of the metal rings will be holding it into the binder. You have to come up with your own system as to what to flag versus how to flag it. For instance, flagging the individual resident tab divider if you haven't given them any of the meds for the resident that pass, or flagging individual pages for PRN reassessments, breathing treatments, etc. Post-its are also great for flagging as they are abundant and inexpensive.
I hate popping meds out of the bubble packs, too. I still get callused thumbs from it. Medication storage seems to be a no-win situation: bubble packs are difficult (and painful) to manipulate, and bottles make it difficult to find quickly or easily get the correct number of pills out. Ahhh.
I'm glad you became a med aide. It's nice to have someone else on here that does this too!