Reducing med pass distractions

[JBMmom]

We switched from paper MAR to eMAR within the last year and a half. It's coming up to the dreaded state inspection window and some nurses are getting slammed for signing off meds out of the hour before/after window. In some cases it's becaused a single resident's meds are ordered for 4p, 5p, 6p, etc. and we're trying to get all that straightened out so meds are grouped together and residents are getting them at the same time based on room assignments. And in some cases there are emergencies that require attention and get nurses sidetracked. I know that I have seen a small sign on med carts in another facility alerting residents/family that nurse is doing med pass and to ensure safety questions should be directed to other staff. Anyone else seen these? Anyone have other ideas? I'm just thankful that I'm rarely on a med pass anymore, I'm slow.

[Forever Sunshine, ASN, RN]

I am slow, (and not ashamed by it) and thorough with my med pass and if anyone tries to tell me I take too long.. I will simply say that the of the amount of medications, blood pressures, eye drops, supplements, patches, etc... is way too much to be given in a 2 hour time frame.

As for the interruptions.. sometimes you just have to deal with it or tell them.. "I need to be giving out medications right now.. I can get back you when I am finished. "

[CoffeeRTC, BSN, RN]

Interuptions will never go away. If I am the only nurse down my hallway and we have one more down the other hall and none at the desk...who will answer the phones? Who will check in the meds from pharmacy? Who will meet the EMS when they bring a new resident? Who will ?????? Yes, there are CNAs that can help with some of the interuptions, but it is just a fact of nursing in a small facility (even the larger ones that I've worked at)

So....what do you do?

When passing meds, keep to your routine. Pull meds out, do your checks, pour meds etc....if you get interupted at one point you should have a good idea where you need to pick up.

Prioritize and delegate appropriately. Can a free CNA answer the phone? Can you let Mrs Smith's dghter know you will be in to see her later? Those type of things.

If you get interupted, keep a note on a sheet of paper on your cart. Write it down, flag your MAR etc. Do what ever works for you.

[benegesserit]

I refuse to be interrupted for anything short of a true emergency when I'm actually in the process of pulling an individual's medication and delivering them to the patient. I've learned from experience that this is where I'm most likely to make mistakes. I'll explain to the person that I'll get to them as soon as I've finished, but can't stop in the middle for safety reasons. There is very little that can't wait the two minutes this takes.

With our eMar, it is very easy to see who still has meds due, so stopping between patients isn't a problem. Before we went to eMars, I marked down the side of my brain sheet who had meds due at what time during the first med pass (when virtually everyone had meds due), and then crossed it off as I went along, so keeping track wasn't a problem.

[OldGrayNurse]

You can ask your DON, Admin, and Medical Director to agree to have a policy placed in your operating manual that states something like this:[TABLE=class: main]

[TR=bgcolor: #FFFFFF]

[TD][/TD]

[TD]""Flexible medication times: In order to provide quality of life and honor this resident's normal rhythm of the day, it is not necessary to adhere to the manufacturer's recommendations of some medications as long as the resident's conditions is stable with not adverse side effects or symptoms. Appropriate labs will be monitored and medications adjusted accordingly.""

[/TD]

[/TR]

[/TABLE]

This is listed as a "standing admission order" and has been approved by all our attendings.

We set our routine am and pm meds to 7 am to 11 am and from 7 pm to 11 pm. It's not perfect, as you may have sliding scale insulin or other meds that may need to be given prior to meals, etc., but the list is pretty short and by 11 am, if I'm not done, I just go ahead and give it and when the EMR asks for the reason it's late, I simply write "prioritizing care".

Then, a compilation of exceptions (ie Warfarin is one that must be given the same time every day without exception) added to the policy should be approved by all the docs and the list should be placed on every cart and at the nursing station.