Pt in meeting when time for meds/ and ID pt with no bands on

chenoaspirit, ASN, RN · Dec 4, 2009

i dont care what kind of meeting is going on, if i have a job to do, i do it. i mean there are exceptions, but it would have to be something very important before i would postpone something the patient needs. i even go in when the doc is in the room, but we all work well together.

chenoaspirit, ASN, RN · Dec 4, 2009

oh, as far as the armbands, i would replace them and insist the patients leave them on. i would also explain to them how dangerous it is to not have proper id and how mistakes could happen.

Plagueis · Dec 4, 2009

Well, my workplace doesn't allow us nurses to pass meds to residents in the dining room, or in physical therapy. If it's time for their meds, we have to get them from the dining room and bring them back to the floor. (They also do their activities in the dining room.) However, we aren't "allowed" to take them out of therapy to give them their meds.

On the 3 to 11 shift, therapy isn't a problem, but when I was on orientation on the 7 to 3 shift, it was a problem. Therapy usually ran from 9 to 1130 am, so the 9 am med pass had to be done before 9. And in LTC rehab that was difficult!

I usually ask another nurse if I don't know a resident is. Most of our residents have ID bands, but there were a couple of times that they had on the wrong ID band, so that isn't always a foolproof method, either. Plus, sometimes the residents no longer look like the picture in the MARS.

classicdame, MSN, EdD · Dec 4, 2009

If I worked where therapy consistently interferred with meds I would have to ask which takes prority. I would then chart that patient was off the floor. Also, is there a chance the chart could be tagged with "MEDS DUE" and the therapist take another patient first? Sounds like a little coordination is in order.

NEVER do anything with a patient who is not wearing an ID band, even if you know them. It will come back to bite you.

BreeLPN2RN · Dec 4, 2009

We can give meds in the dining room & can usually catch a resident prior to rehab. If not, our rehab staff doesn't mind us going in and giving meds or doing accu checks. None of the 100 residents in our LTC/SNF facility wear ID bands due to HIPAA regulations. At first, I had an awful time identifying people when giving their meds - I now know everyone by name. Their only ID is a photo in the MARS, which, thank goodness is updated regularly. Their name is on the door to their rooms, but you can't rely on that. When I wasn't sure, I always asked another nurse to confirm the identity prior to giving meds.

ktwlpn, LPN · Dec 4, 2009

I am in day 2 of clinicals in a long-term/sub-acute care setting. I was given the task of doing accu cheks for a list of patients. It took me awhile to find them all, as some were mobile and not easily found in their rooms or the hall. The last one on my list was a pt who I finally found in a meeting with her family and a social worker. Her glucose really needed to be checked by that time, but I did not want to intrude on the meeting. It was decided that she could get checked later, but it got me thinking-- when is it appropriate to hunt down a pt to give scheduled meds or tests even if they are in a conference, meeting, or whatever that could take awhile? What do you do if the pt leaves the unit or can't be found at med time??
Also some of the pt were not wearing their ID bands. I suspect the pt removed them because most had them on. It was difficult to verify the ID of the pts who were not able to talk or had dementia. The nurses confirmed that's who they were, and the pts all had photos in their files. I just didn't feel comfortable with that. One pt was in the wrong room and looked similar to a photo of another pt who was supposed to be in there, and had no ID. Luckily we insisted on ID'ing them before giving meds or it would have been the wrong pt getting the meds!

We update the pics on our MARS frequently.We do have some folks who refuse to wear a wrist band.If we can we'll put it on an ankle.If that fails it goes on the wheelchair ,walker or overbed table. No system is foolproof-always check with a regular staff member when in doubt.

Nurses coming to LTC with acute care experience can get into trouble by forgetting that the nursing home is the RESIDENT'S HOME. The department of health wants us to individualize everyone's care plan-that includes meds.That said-our transport staff will ask us if a resident needs meds before taking them off of the floor for therapy.We also post the therapy and appt schedules so we nurses can try to get to these residents first. Activities,therapy,meetings all come first-no matter what kind of chaos this throws the nursing staff into.We have to be flexible (the dept. of health also expects our meds passes to be completed within the legal time frame-incongruous,isn't it?) The meeting you mentioned involving the family and social worker is not something I would interrupt. I would wait until it was over and grab the resident before she ate. We will ask residents to return to the unit for meds via paging. If they refuse we document. Med times can be changed to accomodate that resident,a once daily med can be admin at anytime,etc. We have to show that we have made an effort when we chart a med refusal-and the doc needs to be made aware of each and every refusal. Check the residents careplan to see if this is a regular behavior or not and go from there.