"Right" way to pulls meds from cards?

[Pat_Pat RN]

Is there a right or wrong way?

Tell me how you do it.

[Pat_Pat RN]

The problem is getting them to stay that way.

If everyone did their med pass the way I do it isn't a problem. The card never leaves the drawer.

[txredheadnurse, BSN, RN]

If everyone did their med pass the way I do it isn't a problem. The card never leaves the drawer.

The problem with your method is in the popping pills from the blister packs while the packs remain in the drawers. Having audited literally hundreds of med carts for years as part of my job I found more loose pills in the carts where staff popped from the card while it remains inside the cart. I have literally removed in excess of 100 loose pills from a single cart. Upon questioning the staff as their methods of pouring meds and/or observing them I saw that the majority of the staff was not removing the card from the drawer.

The bending and twisting of the card to remove the pills further down the pack results in pills bouncing off the cup or missing the cup entirely. I understand and applaud your desire to have all the meds in a particular order but you can achieve the same result by only removing a few cards at a time, popping out the meds over the top surface of the cart where the cup is securely against the surface of the blister pack and returning the cards, in order, back into the cart.

YMMV

[Pat_Pat RN]

1. If a pill pops free you find it in the drawer right then.

2. Taking cards out and putting them back in doubles the work, I'm trying to save time.

This is how I do all my pills and only RARELY does a pill get away from the cup. I always find it before moving on. In fact, to my knowledge I'm the only one that does pills "my way" and I'm always finding loose pills in the cart drawers.

[Eleven011]

Our med cart is set up similarly to NurseQT's. Each resident has a section. Behind their section, their cards are separated by med times with colored stickers - AM meds have yellow stickers, Noon meds green, etc. When I go to give resident #1's meds in the AM, I pull all her yellow cards, pop them out, then move them to the back of her area, so as her noon meds are now in front. Cards are also kept in the order that they appear in the MAR. We pop them out of the pack matching up the day of the month with the number on the card. So today, every card I punch would be the # 14 spot.

I don't know how you can leave the cards in the cart to punch them out. I have a backache just bending over to pull out all the cards from the bottom drawer, I can't imagine trying to bend over to punch them all!

[Pat_Pat RN]

What about meds that are BID or TID?

[Eleven011]

BID meds get two cards, TID get three, etc.

[CapeCodMermaid, RN]

If you have someone who gets Lasix twice a day you have two cards of lasix? It seems the med carts would be overloaded.

[Eleven011]

If you have someone who gets Lasix twice a day you have two cards of lasix? It seems the med carts would be overloaded.

Yep. K+ QID takes up alot of room! Three large drawers are full of med cards, top smaller drawer has creams/eye gtts, etc. and side drawers have narc box and big bottles. 30 residents for the whole cart.

[heron, ASN, RN]

Yep. K+ QID takes up alot of room! Three large drawers are full of med cards, top smaller drawer has creams/eye gtts, etc. and side drawers have narc box and big bottles. 30 residents for the whole cart.

Sounds like my cart - 24-ish residents and only one card per med. I can't imagine having multiples per med - I'd need two carts and would have to keep back-up cards in the med room.

[RNBearColumbus, BSN]

Med carts at my facility are arranged by room number, then by med pass times. (We do a BID med pass, so there are usually only AM or PM meds. TID meds are filed under the closest time, for example, 12noon meds would be labeled as such and filed behind the AM cards.) We also punch out the pills by date. (Spot #1 on the first of the month, #2 on the 2nd and so on). This comes in handy at times when a resident claims to have not gotten a med. If the pill for that date is still in the card, chances are they didn't get it.

PRN meds are labeled as such, and filed at the very back of that resident's meds.

[NutmeggeRN, BSN]

Has anyone ever heard of signing the bubble card in marker to show that you gave the med? Date and initial? I was told by one nurse it is illegal to mark up the cards.

To me it seems like you can only "sign" that you popped out the med , there is no guarantee it was given correctly to the correct person, or at the correct time....

And we are documenting the the MAR as well.

[heron, ASN, RN]

Explain how taping an accidently popped pill back where it goes has anything to do with stealing drugs.

Substituting a "look-alike" pill or liquid is a time-honored method of diversion that avoids throwing off the count or fudging a MAR. Works best with injectables.