Residential Psych Treatment - Med Administration

Bjo · Feb 25, 2005

Every facility has their own policies and protocol. However, I don't think you can open all of the packages and put them in little cups prior to medication administration according to JCAHO standards. You need to identify the patient using two identifiers. We use name and date of birth. Compare that to a picture ID or something similar on the MAR and then open the medication. I think it is ok to put the medication in the cups prior to giving them as long as they are unopened but you should ask your supervisor first. If you are using bubble packs, you probably won't be able to do it.

melissa_rn · Feb 26, 2005

Every facility has their own policies and protocol. However, I don't think you can open all of the packages and put them in little cups prior to medication administration according to JCAHO standards. You need to identify the patient using two identifiers. We use name and date of birth. Compare that to a picture ID or something similar on the MAR and then open the medication. I think it is ok to put the medication in the cups prior to giving them as long as they are unopened but you should ask your supervisor first. If you are using bubble packs, you probably won't be able to do it.

The sad part is that I AM the supervisor! Yes, they promoted me to supervisor with less than one year nursing experience (I graduated BSN in Dec '03 and was promoted Dec '04). I'm doing my best to learn JCAHO standards for BHC as well as health dept. and legislature behind everything...but it is complicated and JCAHO comes March 9th!

In other words, we should wait till the kid comes to the window and states his/her name, compare it to the photo on the MAR, then go through the bubble packs and pop out all the meds.

Hope the kids learn to be patient!!

Bjo · Feb 26, 2005

Congrats on the promotion. Try the following link. It has some great sample policies and a multitude of questions that you could be asked by JCAHO.

www.4nursingmanagers.com

If we can help you out at all, just post!

happy&healthy · Feb 26, 2005

Hi Everyone, JCAHO is coming March 9th! to the residential treatment facility for children and adolescents with mental illness where I work. ...In other words, we should wait till the kid comes to the window and states his/her name, compare it to the photo on the MAR, then go through the bubble packs and pop out all the meds.
Also,
when med orders change (making the pharmacy sticker on the bubble pack incorrect/not current), is it legal to cross out the wrong orders and write the new orders? Our pharmacist is saying that it's legal, and I beg to differ. :uhoh21:[/quote
"
Hi Melissa,
out of curiosity, may I ask where you work as supervisor? - I ask as I resigned from a "residential treatment facility, in Seattle" some years back, and am just wondering if it is the same one.
If we're talking about the same place, then have procedures changed for dispensing the meds in the 'other' building ?, as there is no "Med-room" over there and meds were hand-carried there in 2000.
When the "med-label" is wrong, the Pharmacy must supply you a correct one. Don't let them bamboozle you. Doing so, will leave you open to Med-"errors", and
I don't think you want to risk harming those poor kids anymore than they, already, are - right?

melissa_rn · Feb 26, 2005

Let's call the facility "SCH" - is that where you worked? Currently there are med rooms at each building, but the med carts weren't there until this week (we were still hand carrying them over---scary!). Do you need a job? We're desparate for nurses with this type of experience.

melissa_rn · Feb 26, 2005

Congrats on the promotion. Try the following link. It has some great sample policies and a multitude of questions that you could be asked by JCAHO.
www.4nursingmanagers.com
If we can help you out at all, just post!

That link is great! Thanks!

(As an added bonus, I got the title of "Infection Control Officer" today. Apparently the HR guy had the title for the last couple of years--why??--and now 1.5 weeks before the survey, I get to try to figure out what was documented--and sadly very little is...)

happy&healthy · Feb 26, 2005

Let's call the facility "SCH" - is that where you worked? Currently there are med rooms at each building, but the med carts weren't there until this week (we were still hand carrying them over---scary!). Do you need a job? We're desparate for nurses with this type of experience.

Hi Melissa,

yes, "SCH" : our medical-Director/Chief psychiatrist (at the same time) was impressed with my teaching the children *successful choices :balloons: * that she recommended me for teaching the youth "ongoing classes". And I was prepared and quite interested in doing so... for I love children truely, and have served as an enthusiastic advocate for each of my patients the past 30 years, as recommendations clearly state.

But there were a several dysfunctional elements continually de-railing the progressive steps we were making in right directions. and so with sadness I ended-up resigning there, with

a wonderful recommendation letter from my Nursing supervisor as well.

If you'd like we can "email privately": just registered here, a few days ago.

CharlieRN · Feb 26, 2005

Melissa,

You were recently promoted to supervisor? And, recently made infection control officer? And JCAHO is just around the corner?

Watch your back, dagger coming soon! Sounds like a set up to me. Someone has already checked the regs and found that they need a supervisor in place with your credentials. Jcaho comes and they say, "Why yes, there is a qualified supervisor with a BSN, her name is Melissa, I'm sure she can explain all these little problems." Your lack of experience is not going to help much.

As something of an old hand may I suggest that you stop trying to correct problems and just identify them, in writing. In the time you have availible that is the best that can be done. JCAHO will often accept that kind of evidence of positive change being planned. Do document everything and inform your supervisors at every opportunity. Keep a record of everything for your own files. If your concerns are not being addressed by your superiors, document that and respectfully go over their heads. To cover your own -ss you need a paper trail that proves you were doing everything in your power to correct the dangerous situation.

Do stay focused on actual dangers. If the med card issue has not generated a string of med errors already then it is arguably not as dangerous as it looks. You can't keep JCAHO from nit pcking. That's what they do. They once nailed a unit I worked on for having a popcorn popper on the unit!

melissa_rn · Feb 28, 2005

Melissa,
You were recently promoted to supervisor? And, recently made infection control officer? And JCAHO is just around the corner?
Watch your back, dagger coming soon! Sounds like a set up to me. Someone has already checked the regs and found that they need a supervisor in place with your credentials. Jcaho comes and they say, "Why yes, there is a qualified supervisor with a BSN, her name is Melissa, I'm sure she can explain all these little problems." Your lack of experience is not going to help much.
As something of an old hand may I suggest that you stop trying to correct problems and just identify them, in writing. In the time you have availible that is the best that can be done. JCAHO will often accept that kind of evidence of positive change being planned. Do document everything and inform your supervisors at every opportunity. Keep a record of everything for your own files. If your concerns are not being addressed by your superiors, document that and respectfully go over their heads. To cover your own -ss you need a paper trail that proves you were doing everything in your power to correct the dangerous situation.
Do stay focused on actual dangers. If the med card issue has not generated a string of med errors already then it is arguably not as dangerous as it looks. You can't keep JCAHO from nit pcking. That's what they do. They once nailed a unit I worked on for having a popcorn popper on the unit!

To make my situation even worse, I got a call about an hour ago from the nursing manager (started January 11th) telling me she is resigning her position--very nice, JCAHO comes in 10 days.

Is it possible to have burnout after only 3 months of this? I'm freaking out--the psychiatrists at work may have to prescribe ME something for anxiety. :crying2:

happy&healthy · Feb 28, 2005

Hi Melissa,

To make my situation even worse, I got a call about an hour ago from the nursing manager (started January 11th) telling me she is resigning her position--very nice, JCAHO comes in 10 days.
Yes, but even with 2-weeks' Notice: she'll still be there, right ?.
Agreeing with what CharlieRN suggested to you, I would add: Sit-down with each Department-head so involved, and write-up the "Deficiency-LIST" , at minimum. How are you progressing on that, Melissa ?
It would be better were I there, so I could help you *cinch this Survey-chore*...
you said: Is it possible to have burnout after only 3 months of this? I'm freaking out--the psychiatrists at work may have to prescribe ME something for anxiety.

naw, how would being doped-up ?, help you

teach the children about how they are 'at Cause, with their own State-control'.

You are their *behavioral-Example*. They imprint off you, so -

How about you change this useless ole' anxiety-strategy into

*a Happy resource-anchor* for yourself, Melissa - one that

you can take fire-off repeatedly during the next 10-days.

(SELF-created, it's totally FREE of nasty drug-side-effects)

Here's the Recipe, on how to do it:

1. Think of a resource state you want more of in a future

situation. (Confidence, Creativity, Fun, Joy, Compassion, etc.)

2. Allow yourself to enter into a relaxed state.

The more relaxed you become the more powerful the rest of

the exercise will be, so enjoy becoming more relaxed.

3. Remember a time you felt the chosen resource state

strongly. Or imagine a situation in the future that would

allow you to feel that resource state.

4. Fully associate into the experience and see what you saw

at the time, hear what you heard and feel those feelings.

Make the colours brighter, turn up the sounds and amplify

the feelings. Anchor this feeling by squeezing your finger

and thumb together.

5. Notice where those feelings are in your body. What colour

would you give these feelings? Imagine spreading that

colour/feeling up and down your body, amplifying the

feelings. When the feelings are amplified, again squeeze

your finger and thumb together to capture that feeling.

6. Break state. (Look around the room or remember your phone number.)

7. Test Anchor: Squeeze your finger and thumb together. If

you've done the above steps correctly you should feel those

feelings coming back. Congratulate yourself (This is very

useful as it re-enforces the idea in your mind that you can

do these exercises and they will become even easier to do!)

8. Treat yourself and make a 'Super Resource State'? Go

back to step one and stack another state on top of the first

one. Squeeze the same finger and thumb together! Cool or

what? (Example: Confidence AND Creativity.)

9. Now think of a specific situation where this *supreme

resource state* would be useful. Example: the JCAHO-survey (lol)

10. Imagine what you will see/hear just before you want this

state to kick in.

11. Now fire the resource anchor by squeezing your finger

and thumb together whilst imagining being in the "JCAHO-survey" situation,

unfolding as you desire it too.

12. Well done, you can now look forward to that future situation even more.

Where else and how else can you use the above technique?

(Hint: The possibilities are virtually unlimited!)

Each time you practice the technique with another resource

state/situation you will condition your mind to make the

procedure even easier next time...

ENJOY, Melissa :Melody:

and you can teach this FUN to the children there, also

Bjo · Feb 28, 2005

You may want to check about a waiver. I know there is such a thing when there is a survey coming up and you have extreme circumstances that can effect the outcome. Look on the JCAHO website for some info. They may have something posted there.