Question for those of you who work in a LTC?!

Good luck on getting your meds out on time. :chuckle I am an ex LTC med nurse and I think it is most important to concentrate on giving your patients the right meds. When I worked LTC the patients would usually have their "falls" when I was busy trying to give out meds. My patients rarely got their meds on time but at least they got the "right meds." You do the best you can do and that's all you can do. With practice, you will get faster with your med pass. The first week is the absolute worse. If you can survive the stress of the first week you should be OK. :)

So you just got this job... Give yourself some time! You've got a lot of patients there also... my load is 30 max but have worked in facilities where I had 45 average and in another facility they'd work us short and sometimes would have over 50 to 60 patients! The more experience you get as an LTC LPN the easier it becomes to see when you are being taken avantage of.

Okay so how do you organize your med pass...

Well to begin with get report from off going nurse, count, give your techs report get your med pass started as soon as you possibly can! You'll figure out where everyone eats, how they want to take their meds etc as you gain experience. Try not to spend a lot of time chatting with them just get it done! Don't take short cuts with med pass, you'll make a mistake! Just do it the way you were taught and know that as you get more experience it will go smoother... takes a good couple of months to really feel comfortable and that's if they put you on a unit and leave you there!

One of my 1st nursing jobs was working in a long-term care facility. One of the things I used to do to organize my time was to make a time chart. There were a few things I'd document to make certain they were done on time such as who was to receive insulin and when, who required CBGs, who required their tube feeding bag to be disconnected or started...etc.

Example:

0700 - Insulin - Mr A. ___ Mr. B ___ Mrs. C ___ Mrs. D ___

CBGs - Mr. E ___ Mrs. F ___ Mrs. G ___

Tube feedings - Mrs. H ___ Mr. I ____

AC meds - Mr. J ___ Mr. K ___

0800 - Call Dr. Smith with Mrs. M's lab results

Pulse ox - Mrs. N ___ Mrs. O ____

Disconnect Mrs. P from tube feeding

Hope this helps!! :)

I agree with KRYSY organize by hour. A "cheat sheet" helped me a lot. Of course, you still have to give meds by the MAR, but if you break it down into hourly time frames then you will have a clear picture of what you need to do when. My facility is broken down into two major med passes per shift, and only a few meds to be given at off hours, so once my routine was down, it didn't take long to get it going on time. I'd cluster meds into a two hour time frame: make a list of all 7, 8 and 9 o'clock meds, then start the med pass at around 8 and give all meds that have to be given at 7, 8 or 9, that way you are within the one hour window on either side of the scheduled med time. Fortunately,(if your facility is like most) on a daily basis, there isn't all that much that will change as far as your med pass goes, so once you've made your cheat sheet, it won't change much from day to day. Most changes will occur on days when the MD visits. Your first hour of your shift should be spent organizing yourself for your med pass. After you get report, count the narcotics and get control of the MAR, go through each resident's MAR pages to make sure no one has any new or d/c'd meds. Make note of any changes on your cheat sheet. Then, get to work. Quite obviously, there will be days when everything happens and nothing is on schedule. Then you have to priortize your care and med pass. Obviously, you'll take care of your diabetics who get scheduled finger sticks and insulin before you give a bolus feed to a non diabetic.

There is a lot of controversy over pre pouring meds. Some nurses do it and never have a problem with it; others have had med errors due to pre pouring. I don't pre pour, but I work with nurses who do and I don't see where they get their med pass finished any quicker than I do. Due to facility protocol, all insulin must be drawn up in the med room, so I do pre draw my insulin injections. However, I label each syringe with the resident's name and number of units BEFORE I draw up the next syringe of insulin.

Hey, and welcome to the wonderful world of long term care.....I hope you like it. I think it is like every other field in nursing. You will either love it or hate it. But on the subject of meds on time. I first, when I get onto the floor is check blood sugars and insulins. Those are my priority. Remember, you have 1 hour before the assigned time and 1 hour after the assigned time to actually administer the medications. I do my insulins first, then just begin in Room 1 and so forth. In a perfect world, you should get them done within 2 hours, but as you may know already from working ALOT could happen for instance all you need is for someone to fall within that time and there goes your 2 hours. Don't worry about it. Just try to keep on task and remember that giving the CORRECT medication is far more important that what time they get it. We had one nurse that was one patient off in the kardex and never checked name bands. She too, was a new nurse and ended up giving almost the whole unit WRONG MEDICATION. So give yourself time. Eventually, you will find that if you keep working the same unit you will learn who gets what and how so that it goes much faster for you, but again, make sure you are giving the right medications. They won't die because you have them their Lopressor or Lasix at 10:30AM instead of 9:00AM.

Good luck and again, welcome to LTC......

As a LTC Lpn for 3 years and a med aide for 3 before that I always made a sheet that hourly listed meds and other things needing to be done. We had usual time for med pass and in the beginning I would write out all the room numebers at all the passes that recieved medication. Eventually I learned tem all. Unfortunatly by then things would change:)

Good luck!

Wow great suggestions.....:blushkiss