Speedy med pass

[sbostonRN]

I am a new grad and I've been working on a subacute rehab unit at a LTC facility for 2 months now. I really love it and I'm well supported by my coworkers. On a typical day, my unit has about 36 patients (up to 40), 2 med/treatment nurses, 1 charge nurse and 1 to do admissions and discharges. So I'm typically responsible for the morning med pass for about 18 patients. I'm curious how other med nurses arrange their morning schedule to gain speed. I come in at 7, generally start my pass around 7:30 (after getting count, stocking my cart and getting any blood sugars), and I finish around 10 or 10:30. So it takes me about 3 hours to do a med pass. I've seen others at my facility finishing their med pass at 9...how is this possible when each resident takes 10-15 meds?

Please, if anyone has tips or tricks for time management, it would be much appreciated. Since I'm on a rehab unit, I do have therapists coming at me constantly wanting to take my patients down to therapy, so I would love to start finishing earlier than I have been!

[tainted1972, ASN, RN]

I pass meds to 22 residents, after passing the same meds to the same residents for a few months, I began to memorize them.. I still look at the MAR but it is just quicker now because I already know what meds I am giving to who. I found that in the beginning most of my time was spent reading the meds and comparing them to the MAR.

You will get faster too, but remember faster isnt always a good thing, more mistakes can happen if you do not take the time to do your 3 checks.. and many nurses don't.

[CrazyGoonRN]

One tip I learned from a seasoned nurse: Go ahead measure and pour all your Miralax powder before you start passing meds. Then just stack the cups inside each other. If you know that you will have 8 pts taking mirilax then you dont have to waste time pouring. Just grab a cup and fill with water/gatorade. :-)

[tyvin, BSN, RN]

One tip I learned from a seasoned nurse: Go ahead measure and pour all your Miralax powder before you start passing meds. Then just stack the cups inside each other. If you know that you will have 8 pts taking mirilax then you dont have to waste time pouring. Just grab a cup and fill with water/gatorade. :-)

Isn't that considered pre-pouring? What's the difference if you have a bunch of ativan in one wing or everyone takes the house multivitamin ... could you stack em up?

[CrazyGoonRN]

Isn't that considered pre-pouring? What's the difference if you have a bunch of ativan in one wing or everyone takes the house multivitamin ... could you stack em up?

Yeah it probably is considered pre pouring but it makes things a lot quicker. There is no need to be so dramatic. I never pre pour pills. Especially narcs!! There is a difference.

[tyvin, BSN, RN]

Yeah it probably is considered pre pouring but it makes things a lot quicker. There is no need to be so dramatic. I never pre pour pills. Especially narcs!! There is a difference.

Dramatic ... would it be dramatic if a new nurse lost a job because they took advice from this board that guided them to do things that aren't right? This board has great influence on those people who come and read these posts. I take it very serious and don't want anyone walking away thinking it's OK to pre-pour anything; of course unless the facility, JCAHO, and state inspectors have changed their minds about the subject. So yea, I guess it could be considered a little dramatic when I believe in guiding young nurses in correct procedures concerning a med pass and actually take it serious.

[supervisorhatchet]

Some of the speed comes with experience and organization. The other thing I have found is often the nurses that pass meds the fastest are not giving OTCs, eye drops, or other meds where it is more difficult to catch than if it is coming out of a bubble pack. It is easy to see who does this when you follow them. It sounds like the nurse that helped you had some great advice and helpful tricks for you - and thankfully was kind enough to share them!

just keep at it and do what is right

I see other nurses that finish their med pass hours before I do. And I know that if they have done it by the book, and given all the meds and checked all the BPs before giving BP meds, and done everything the way I would do it....There is NO way that they could get done that fast.

I only act as a nurse, in a manner that I can sleep with at night, AND I can defend in a court of law.

I keep my stereoscope around my neck

I keep my wrist BP cuff on my wrist, so that it is always with me (my DON always comments on my stylish bracelet)

I actually wear a watch on my wrist (the same one with the BP cuff) LOL

I keep my scissors and pen light in my pocket at all times

I stock my cart, with everything BEFORE I start

I change the battery in my netbook after each med pass (even if the battery is not dead, because it will go dead during my next pass)

I use spoons for crushed pills with pudding, instead of the wooden paddles (I can usually get it all in one bite this way)

I have learned my residents, the ones that will take 2 hours to eat their lunch...I make sure they get their noon meds & breathing tx before the meal tray is passed, otherwise I am going into that room 10 times to see if they are done yet

I keep my cart organized, with residents in order, meds in order.

When I change out OTC meds/get a new bottle: I put the old lid on the new bottle (because I have been looking at that color of sharpie, that handwritting, etc)..It cuts down on time searching the drawer

I hope this helps

I worked in a facility for over a year on the same unit with 64 skilled beds all to me! My supervisor always said it took me twice as long as other nurses. And she was hateful and said I needed to do better.

I always said, if they can do it faster, it is because they are leaving something out! They make it look good on paper, go look at the residents that they have "cared" for in such a hurry. And it does show. Keep your chin up!

[pixie120]

just keep at it and do what is right

I see other nurses that finish their med pass hours before I do. And I know that if they have done it by the book, and given all the meds and checked all the BPs before giving BP meds, and done everything the way I would do it....There is NO way that they could get done that fast.

I only act as a nurse, in a manner that I can sleep with at night, AND I can defend in a court of law.

I keep my stereoscope around my neck

I keep my wrist BP cuff on my wrist, so that it is always with me (my DON always comments on my stylish bracelet)

I actually wear a watch on my wrist (the same one with the BP cuff) LOL

I keep my scissors and pen light in my pocket at all times

I stock my cart, with everything BEFORE I start

I change the battery in my netbook after each med pass (even if the battery is not dead, because it will go dead during my next pass)

I use spoons for crushed pills with pudding, instead of the wooden paddles (I can usually get it all in one bite this way)

I have learned my residents, the ones that will take 2 hours to eat their lunch...I make sure they get their noon meds & breathing tx before the meal tray is passed, otherwise I am going into that room 10 times to see if they are done yet

I keep my cart organized, with residents in order, meds in order.

When I change out OTC meds/get a new bottle: I put the old lid on the new bottle (because I have been looking at that color of sharpie, that handwritting, etc)..It cuts down on time searching the drawer

I hope this helps

I worked in a facility for over a year on the same unit with 64 skilled beds all to me! My supervisor always said it took me twice as long as other nurses. And she was hateful and said I needed to do better.

I always said, if they can do it faster, it is because they are leaving something out! They make it look good on paper, go look at the residents that they have "cared" for in such a hurry. And it does show. Keep your chin up!

While I agree for the most part, I do take exception to the time part, as the most crucial adjustment is change the times of the medications due, to match what is being done, and that means not all the meds are set at 0800, I also am very skilled and proficient at organizing my med pass to accomodate, as you do, the residents so that I hit the bulk of them, before breakfast, after breakfast, before lunch etc and in some cases, all the am meds are moved to 1200 or 5 pm, especially for dementia residents. I then review the MAR and get those pulses and b/p's changed to weekly and monthly as there is no data that says we need to do BID B/P's for people who have taken those B/P meds for years without B/P issues. A lot of stuff on the MAR, when it gets to the LTC part is left over hospital "best practice" for new medications. THe only one you cannot and should not alter would be of course apical on Dig, and some of the "hold for b/p lower than" but if the person has been stable for 6 months, with bid B/P's it makes sense to save the patient the annoyance of so many B/p's as well as reduce med administration times, if ok with MD/Family and facility. A lot of changes can be made to the MAR that affect nursing time, a lot of eye drops, in elderly, unless for specific eye diseases, may be unnecessary. A good example: a patient has dry eyes, gets eye drops or lubricant prescribed, refuses them, over a course of 2 years, when I arrive, those eye drops have been consistently refused for months, why not get an order to d/c? Patient has a right to refuse, d/c unnecessary med.

Look at those OTC's, are they really necessary to get 8 vitamins, maybe a Multi-Vitamin wiht Minerals/Iron will substitute nicely at BID, and d/c all the rest of the seperate vitamins.

Doss BID can be Doss QD. There are lots of ways to skin the cat, gotta whittle the meds down to focus on the patient, quality of life, shoving pills down elderly is not always the best course.

[supervisorhatchet]

I do agree with previous post, about cleaning up the MAR. I am working on that now on my med pass. But our medical director is horrible. He is the PCP for 90% or our residents and he won't change anything. He won't d/c meds on a resident that has not put a pill in his mouth in over 4 years! Now isn't that crazy.

And as far as checking BPs, we have a ton of them at our facility that do have orders to check BP and/or HR prior to, and hold med if ....It is time consuming...

And when I said, I knew some nurses weren't doing it. I really do know that they are not doing it. During my orientation, one nurse actually had the nerve to say to me "I don't have time for that. Make something up"

And that is why I always act in a manner that I can sleep with at night, AND can defend in a court of law.

Just saying....For the original post....

It will get better, it just takes time. And learning your peeps is part of it.

Good night all!

[pixie120]

I do agree with previous post, about cleaning up the MAR. I am working on that now on my med pass. But our medical director is horrible. He is the PCP for 90% or our residents and he won't change anything. He won't d/c meds on a resident that has not put a pill in his mouth in over 4 years! Now isn't that crazy.

And as far as checking BPs, we have a ton of them at our facility that do have orders to check BP and/or HR prior to, and hold med if ....It is time consuming...

And when I said, I knew some nurses weren't doing it. I really do know that they are not doing it. During my orientation, one nurse actually had the nerve to say to me "I don't have time for that. Make something up"

And that is why I always act in a manner that I can sleep with at night, AND can defend in a court of law.

Just saying....For the original post....

It will get better, it just takes time. And learning your peeps is part of it.

Good night all!

My question is,...as nurses...and as nurse managers...and DON's, we KNOW nurses aren't doing these things.....yet we do not act on FIXING the problem. If the medical director won't d/c meds, I would have the DON speak to him. IF the MAR is NOT what we are really doing/giving the resident?.....Scary nurse practices. The golden rod is...what would a prudent, reasonable nurse do in any given situation? My second question is...why are we bothering our LTC clients to take B/P twice daily, or pulse twice daily, or supposedly HOLDING meds based on paramaters that we aren't "really using"...when this problem can be easily fixed? The second advocate is the consultant pharmacist, get him/her to put the reccomendations in the pharmacist monthly report, the MD will/should and /or the DON will follow-up for all the unnecessary nursing time used for no quality of life for the resident.

[tiroka03, LPN]

I don't know how helpful this will be, but it is what I have been doing for years. Each day when you get home, think over your shift. Deciede on one thing that you could do faster. It might only be a few seconds faster, but it is faster. Then implement that. a few seconds faster on each pt can transulate into minutes. It might be with med pass, or it might be with charting, or gathering supplies, dressing changes, tube feeds, iv's, trachs, ect. Over the years it really adds up.

When I first started nursing, I followed a nurse who was retiring, she was in her mid seventies and had a pronounced limp. - I couldn't keep up with her no matter how I tried. I knew the reason was I wasn't experienced, and she was. So, I have made it my business to become like her.

[FarrellGirl,RN]

When I started, I was passing 9am meds for 38 residents because I was the only one WORKING on my unit while the other 3 nurses stood around doing nothing and calling it "supervising", arguing about who had what administrative position. It was pure hell. But I did pick up a few tricks that are legal and cause no errors.

1. Pre-pour waters: set up like 4 or 6 cups of water at a time so you're not constantly pouring and you don't forget to pour water. Just don't forget to pitch the cups after they drink from them.

2. Do those with PT first and premedicate if appropriate (say on someone with an amputation who's going to be working with a prosthesis). That way you're not faced with a lot of PRNs at once, and keep it in your mind who's likely to ask for their PRNs as soon as they can have them (ie "clock watchers").

3. Figure out who's a fingerstick and highlight your census so everyday you know exactly who to get and when (I used to use orange for only 8am, blue for 11am, and green for 8am and 11am).

4. Do all your blood pressures/pulses/temps first so you know gets b/p meds and ABTs and you'll be able to assess who you may need to monitor closely for falls and possible calls to the physician that way you can prevent incidents from interrupting your pass.

5. Make sure you have EVERYTHING you'll need on the cart. You'd be surprised how much time it eats up to run get supplements, OTCs, thickener, thermometers and other equipment.

6. EAT BREAKFAST!! Seriously. When I first started on the floor, I never ate breakfast and by 8:30 I was sluggish and moving and thinking slower.

Also, don't gauge how fast you are by how fast other nurses get it done. It has been my experience in my year of nursing that those who get the most praise for being efficient aren't really giving all their meds. I have come behind nurses who signed that they gave eye drops from unopened bottles, meds that were unavailable, signed for uncommon meds for days and not a single pill was popped out of the packs. I've seen nurses write in O2 Sats when there wasn't an oxymeter in the building, so I don't doubt some of them make up vitals and write them in. I try to practice nursing as if it were my loved one or myself I am caring for. I would rather give them all their scheduled meds late, but safely without lying or making errors than for them to not get some or any or receive them in an unsafe manner (like getting B/P meds when their B/P is too low).

It really does get faster with experience. Just try to avoid bad habits like prepouring. I won't lie and say I've never done imperfect things and we're all human. But I have made errors before doing those types of things, including wrong med to wrong patient. Personally, whether harm results or not, I always regret those kinds of things and feel terrible when I make a mistake like that. You'll get it. Just stay at it. :)

[pixie120]

I love your reference to the administrative staff standing around arguing about who will be in charge, it is so true, when I was passing meds, I would half-listen and watch what the "managers" were doing, and it was tremendously ridiculous. Often, they did nothing. I remember as a new grad, working eve charge Medicare, state surveyors walked in at 7 pm 3 of them. I called the powers that be, they all came in, a few dragging, it was summer, it was late. 2 of them stood at the nursing station, didn't address the ringing phone, the ringing doorbell or follow any of the surveyors. It was the least pro-active manager team we ever had, and although the survey wasn't that bad, it seems odd to me that they wouldn't address the ringing phone or door.