Plagueis

For PRN orders, our consult pharmacist discourages orders without a specific time frame. If an order is BID PRN, it should be written every 12 hours, or for TID PRN, every 8 hours. This is to prevent confusion about exactly how much time should pass between PRN doses. (I work in LTC.)

The midnight shift is responsible for chart checks where I work, and that is a 24-hour check. In LTC, nurses often have 30 or more residents. When do they have the time to check 30+ medical charts for every single order before the med pass? Plus, I've never heard of a state inspector failing a med pass because the nurse didn't check every med on the MAR against the orders in a resident's chart before starting the med pass.

I've never heard of artwork being considered a state violation. Every LTC facility I've been in displays the resident's artwork. I would think there would be more serious things for state inspectors to worry about.

And I'm sure that at some facilities, the nurse who confronted the DON and wrote the complaint would be fired for insubordination, or for some other reason.

I was interested in the studies regarding taking a nap while at work that was previously posted, and how it can be beneficial. However, every place that I've worked (in LTC) at had rules that prohibited sleeping at work, even on breaks, and that sleeping would be grounds for termination. I don't know if one would be able to sue successfully if she were fired for napping on the job, especially if there is a rule against it.

I can also add the following assessment sheets that my old LTC used: Braden scale, pain, wander risk, and physical mobility. Also, we had to send the diet slip to the kitchen and weight the resident. Plus, sometimes there were consults for follow-up visits with specialists that required filling out a consult sheet to arrange an appointment and transportation.

I work in LTC, and I've worked every shift. From a work standpoint, I would prefer to work the overnight shift over day shift anytime. I admit, I found it nearly impossible to sleep in the daytime, and noisy kids, neighbors, and insensitive phone calls from friends/work at 11 am didn't help matters. I was totally exhausted from night work; I always felt "off." Moreover, my former workplace didn't pay a shift differential. However, on nights I didn't have to deal with admissions, family members, labs coming in, orders, dining room duty (which ate up almost an hour of the shift), answering the seemingly nonstop ringing phone, and managers finding new tasks for me to do.

In my experience, most issues with meds involve the pharmacy not sending refills in time, even if they are ordered. Just yesterday, for instance, two meds I pulled the refill label for last Thursday were still not in. (I was off the days in between.) Thankfully, the resident still had a few days supply left, and I called the pharmacy about the meds. Of course, the response was the standard we-didn't-get-the-fax. However, at least this facility has an e-box with plenty of the most commonly ordered meds in it.

Correct me if I'm wrong, but I'm assuming the Mucinex you're referring to are the granules, since the pills are extended-release. How well do the granules go through a peg tube?

First, thanks to everyone who responded. And, no, our orders aren't computerized. Diet orders here, or so I thought, just list the kind of diet (ie. regular, puree) the resident is on. It just killed me when I saw the POS with these food preferences orders. I have to add that despite the MD order and diet request slip, the one resident still gets peanut butter sandwiches with jelly.

I understand that resident's need a physician's order to apply ice, heat, or even for Vaseline, for instance. However, recently I've seen orders to D/C particular food items from a resident's diet. For example, one order was to D/C waffles with breakfast (the resident doesn't like waffles), and the nurse had to get permission from the MD to do so. Another was to D/C jelly with the resident's afternoon snack, as the resident only wanted peanut butter sandwiches. I always thought that a diet slip would be the only thing to fill out for changes such as these, as these aren't orders to change the diet (i.e. from puree to mech. soft), or to add fluids to a fluid-restricted diet. To require a MD's permission for this seems odd to me (my previous facility didn't require that), but I was wondering: is this a common practice in other LTC facilities?

Unfortunately, I know a few nurses who were written up for not giving a PRN pain med at the family's request, despite the fact that the nurses assessment didn't warrant a PRN. So some places may "punish" a nurse if they don't please the family. t

Hmm. I think I worked with the clone of that guy you mentioned. The nurse I know would finish his two meds passes in less than an hour. However, when anyone else (including me) worked that section, it would take almost 2 to 3 times as long to finish.

I've been hearing stories from my fellow nurses about not having enough equipment (or it goes missing) at work, so they end up buying their own, such as personal pulse oximeters or wrist blood pressure machines. I would then ask if they made management aware of the missing or broken equipment, and they said that when they did, they were blamed for the missing or broken equipment, so the facility wasn't going to get new equipment, and that nurses would have to share what was left. I even know a couple of nurses who bought their own thermometers for work because there was only one available for over 150 residents in the facility. Another even mentioned that her facility (she works LTC) recently spent over $600 on new phones for the facility and bought flat-screen TVs for the rehab sections, but then claimed they couldn't afford more Criticons. I guess I'm fortunate that I work at a place that actually has enough equipment to go around. I just don't get it. Why should nurses have to buy their own pulse oximeters or thermometers to use at work? Is it really more important to have tricked-out phones and TVs than to have enough working equipment so that nurses can actually take vital signs?

I've had pharmacy reps follow me and my coworkers (not state surveyors), and there were a few things that they flagged that may not seem like biggies, but were important to them: Make sure all spoons on the cart have their handles up; don't use the gloves on the med cart; use the ones in the patient's rooms for eye drops, each eye gets one tissue don't crush meds unless the MAR specifically says you can potassium has to be given with a meal, so the food tray should be there when you give it no blood pressures in the hallway