Questions for those who Don't Pass Meds in the DIning Room

Coriander, BSN, RN · Apr 26, 2009

hiya.

that's a very interesting change. why are they moving the carts out if i can ask? are the residents going after the cart when the tech isn't right near it? at my facility we would usually have another staff member keep guard while the nurse or med tech handed out meds.

i'm not a nurse, however worked for some time in a ltc facility as a supervisor.

what about the ones who want their meds with their meals? do you just need to care plan it? - if you don't have a large number of requests like this, maybe a tray with the meds could be brought around with the meals. this way everyone is happy and orders for the meds that need to be given with food are followed out. if this just won't happen where you are, then save these meds for after the meals and go room to room (if you can't catch them afterwards).

do the residents like it better than getting their meds in the dining room? - we had some residents that really did not want to have their meds in public. some saw it as a non-verbal sign that they were ill, and some just wanted the privacy. some of our residents took their meds together as a group... they called it "vitamin time". :)

how do you adjust for time? - some mornings we would start early, and go around the rooms while residents were getting dressed. come to think of it, the timing actually seemed faster this way instead of wandering around a dining room.

i think we are so used to passing meds in the dining room that we are going to freak when we make the change. - i understand how you feel about this. i don't know how many pts you have, but i think it will go smoothly once everyone has had a few days to get used to it.

all the best!!!!

noc4senuf · Apr 26, 2009

Not only the the surveyors frown on the med pass in the dining room because it takes away from their dining experience but, my nurses and TMA's need to lock down the carts when it is time to assist in the dining room. They may pass to those that request or are asked if it ok "before" the meal has begun to be served. The carts are never allowed into the dining room, they remain outside it at all times.

ktwlpn, LPN · Apr 26, 2009

In the am most of our residents prefer to eat in their rooms-that solves one problem.For noon and evening meals we had to change the meal and med pass times and also the night time snack time to stay compliant.On our largest units (40 to 42 residents) we have 2 med carts-we had to do that few years ago for compliance. We have med pass at 9-1-5-9 and out meals are 7-12-5 with 9 pm snack.Each unit has to stagger the med pass times to accomodate the dining service ...We did care plan for residents who insisted on getting their meds in the DR or hallway-we no longer do so.As long as all staff remain consistent they have accepted the change eventually.Meds admin "with food" and eye drops are ordered for 7:30,11:30,4:30 and 8:30.. I generally pass mine from the hall-the light in some of the rooms is not good for me.I just make sure to always lock the cart and cover the MAR.IMHO going in sequential order from room to room makes for a more efficient med pass.I hated running around the D/R--"Nurse,Nurse-am I next? " Nurse-I need my meds,now" I also keep my med cart (no pyxis-still manual) with the boxes of meds arranged per the order on the MAR-also makes my pass more efficient-it's so easy to check,double check and then check again...Some nurses don't bother doing this and it drives my batty...

sweetlvn · Apr 26, 2009

This prob. wont make it any easier for you, but we can't pass meds in the dining room. So what I try to do is make a pass up the hall before meals and get who I can and try to make it to the dining room toward the end of the meal. I park my cart right outside the dining room and try to get the residents as they come out. Yeah it does get a little busy and some I miss, but when I get those done I turn around and go back down the hall and get the ones that went on to there rooms. Like I said this is not a good routine, but it does help me.

achot chavi · Apr 28, 2009

SWEETLVN has it right, it takes more time and you have to go over the list a few times to minimize mistakes, but what can you do,

Obviously you cant expect the pts to come to the nursing desk like we do at the ALF,

You need the cooperation of your CNA's.

You might want a pt list and check off each one you gave to so that you dont miss anyone!!

BTW you have to take into account meds that are given ac and those pc, NPO and those that you cant give together as well

Noone promised you a rose garden!!!:dncgbby:

CapeCodMermaid, RN · Apr 28, 2009

So Coriander...if you're not a nurse then how could you be a supervisor? We do not allow the med carts in the dining room. We will give meds with a meal if it's a doctor's order.

retread71 · May 2, 2009

I was the one who posted initially about this change. We have a central medroom with the cart in it. We use the mars there and pop pills for certain residents based on urgency and personal habit. We put the pill cup in a tackle box thing and grab their treatments and head to their apartment. we do this for about 6-8 people at a time, making mini rounds.

With food gets their pills scheduled for 9 and so they have them after breakfast.

Keep in mind this isn't a SNF so we have different rules. We are allowed to pre pour meds up to 24 hours in advance, but our company limits this to your own next pass only, and you have to be the one passing if you are doing the pre-pouring.

NCIANurse · Dec 31, 2009

Our facility is talking about moving towards this...we are all frantically trying to stop it...

99% of our evening pills are scheduled at 1700.... so we can pass them between 1600-1800. I work second shift (1400-2230). The way it works for us, is (unless state is there) we get blood sugars around 1530, draw up insulins and then start pill pass.... Our first meal shift starts at 1700, second shift meal starts around 1745. I can usually hit 20 of my 38 residents before they get to dinner. I do have to resort to pulling meds and passing cups off to OMT's to give, or pulling 2-3 peoples meds at a time and getting them all at once (like if they sit at dinner table together).

Unless my facility changes the time that pills are due (ie: "1 hr before evening meal" instead of all labeled as 1700) there's no way we could avoid serving pills with meals. It's already hard enough to give insulin before meals, while patients are still in their rooms before the CNA's bring them out to the commons area. Very curious how this would work out....

As for those with pills such as Lactase, that are labeled as "give 15-30 min before meal", we usually just wait to pass those pt's pills until we fit that time frame....