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Speedy med pass

Geriatric   (53,979 Views 66 Comments)
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I take my census sheet and, in red, write who needs their meds crushed and mixed (abbreviated C/M for myself), GT feeders, and I put little red boxes on the right side for FSBS. If I don't know who has FSBS or not, I go through the entire MAR before I begin my med pass. I also use that time to get a "snapshot" or who I have. I look for BP meds and anything else with a parameter. I also put little boxes for GT feedings. All that kind of thing gets put in red so I can see it easy.

I use blue for when I'm receiving report. Again, it's so I can easily see what the nurse before me said I needed to be aware of, but isn't routine, everyday things.

After I'm done with the med pass for one resident, I mark the right side with a large X for the first med pass, and XX if both med passes are done. This lets me see at a glance who I still need to give meds too. Everything that happens in my shift is in black pen.

Each part of my census sheet is used for something specific, so I know where to look for what. BPs are written in one spot, ATB in another, FSBS in another. I call it my brain, cause without that paper, I'd be lost! It really does help, no matter how you set up your "brain", to do it in the same way every time.

Also, know what you can deligate. Let your CNAs know who needs BPs done for the first med pass, and they can do them when they get vitals done at the beginning of the shift and report them to you.

It does get easier. I used to cry because I was so frustrated at being slow and I felt I would never get it! But eventually you pick up little tricks here and there. Always be safe, though, because the frustration you feel at being slow is nothing compared to the fear of harming a resident cause you went too fast. I've seen too many good nurses make too many mistakes because they got frustrated and went too fast.

Hope this helped and good luck!

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You are so lucky!!! I am a new grad in LTC and I have 36 pts in a skilled unit with treatments, new orders and three med passes and 11 a and 4p FS! And this is prn on a new floor q d!!!

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You are so lucky!!! I am a new grad in LTC and I have 36 pts in a skilled unit with treatments, new orders and three med passes and 11 a and 4p FS! And this is prn on a new floor q d!!!

You work 12s? That's rough! You don't have noon FSBS?

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Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!

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Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!

I hate the idea of working off the clock. I wish I could get admin and the "money men" to see that do give proper patient care, we need more nurses on the floor! Not more time clock monitors :p

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Yes my shift is 12 hrs and I have usually 11 a and 4 pm FS most of the time. I do work prn and yes I will have a noon and a 5 pm every now and then depending on hall but how I remember which times I highlight in yellow by their names a 11, 12, 4 or 5. Then when I stick them I cross out that number and chart the score in their box on my paper. But I have no time to chart the whole shift and even to take a break which they dock me for anyway. I have to come back off clock to finish the holes!

I work 12s too, but my patient load is smaller on average. On the skilled unit I have between 9 and 25 patients depending on which hall and the census... the LTC end of the building, the pt. load is more like 30 patients, but on that end they have a treatment nurse/CMA who helps with applying all the butt creams, ace wraps, dressing changes/bandaids/skin checks/incident reports for when someone bumps their knee;.... on the skilled end we don't have any of those- just four nurses, (and often I'm the only RN) to take care of our own hall's dressing changes, meds, treatments, orders, admissions, and whatever else comes up. Every once in awhile when the census is high we get a 5th nurse to help with admissions- but that happened for about the first month I was working at the facility, and then it stopped.

Our facility takes vent patients, and it's quite crazy if one gets scheduled on a vent hallway- I don't get scheduled on those very often though. One of the vent patients has a patent dislike for new nurses, and won't let me care for him, which makes everything crazy for the other nurses if i can't manage my whole hallway!

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How long it should take to complete a med pass on 2nd shift in a long-term facility on a dementia floor with about 35 residents? I wonder if I should take this job if I am offered it. Thanks for your input.

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That's my shift and load of patients...depends on what kinda hall your working. On the memory care unit 8 pm med pass takes 7 pm to 9:15 pm, trying to get it under 9 but I have to help the understaffed aides at times. This is assisted memory care though so we have no tx's, no g tubes, no iv's. my 5 p pass only takes about an hour. On the actual long term care side I have residents on 8 and 9 p meds so I start my tx's directly after dinner at 6 pm those usually take me an hour, then start my 8's at 7 p and finish my 9'a right at 10 usually so 3 hours if all goes to plan. This includes my g tubes, assessing their bowel sounds etc. my 3 skilleds right now stay up late so I do my 2 complete assessments from 10 to 11 then I do the other before at 4 pm right before dinner. I give report around 11:15 then do charting till about 11:45...have to detail chart on skilled with full vitals as i am sure you are familiar! Day goes by fast in the blink of an eye. I actually like second shift over any other.

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As many have said - the nurses that get done extremely fast aren't doing their job and it is so easy to tell once you follow them. Another thing I have noticed - many facilities write the time the med is due on the card - and so many nurses just go by that, they don't use their MAR, don't give all or sometimes any of their OTCs, do not catch new orders, give meds that have been DC'd or dosages changed, the list goes on.

You will get faster with time, and with better organization - I don't know any two nurses that do things exactly the same, they all find what works the best for them. I do not like to take shortcuts or do things that I would not do if the state surveyors were monitoring my medpass, that way when they are there, or when I am orienting a new nurse, I don't have to change what I normally do.

There is an easy way to set up the Miralax ahead of time - say there are 8 residents that get it with each breakfast. Take a plastic med cup for each of them, labeling it with their name, their room number, and the med (Miralax 17 gm). Don't pour the Miralax directly into the med cup, but place a new empty cup inside of each labeled cup and put the Miralax in there. That way they are ready to go, labeled with the pt name and the med.

Do you have an easy way to track who you have already given meds to? Some nurses highlight on their report sheet once morning meds are given, then once noon meds are done, etc. This works for me at some facilities, but at others I have found that it is easier to take a plastic med cup for each resident, writing their name and room number on a cup. I place them in alphabetical order and then place an empty plastic med cup inside. I can fill the cup with their meds, pull out the unlabeled cup and take it to the resident, and stack the labeled med cups upside down. That way I know that I still have to give meds to anyone that has a labeled cup still sitting on the top of the cart. You may not need this with the E-mar system that you have.

Just do it right, always always always compare your med to the MAR, and do your best. Accuracy is the most important thing.

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Although I'm not new to LTC and med passes there are good quick days and bad slow days, it all depends on what is happening on the unit. Don't compare yourself to others, everyone has their own "system" and as long as you are not violating any regulations, I say go with what works for you.

A couple useful tips:

If you work with med punch cards, arrange each persons in the order they appear on the MAR, makes it quicker.

If you use a preprinted census sheet, put the BP, blood sugar and SPO2 readings in preprinted blanks, that way you never forget to record info and makes it easier for charting.

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As many have said - the nurses that get done extremely fast aren't doing their job and it is so easy to tell once you follow them. Another thing I have noticed - many facilities write the time the med is due on the card - and so many nurses just go by that, they don't use their MAR, don't give all or sometimes any of their OTCs, do not catch new orders, give meds that have been DC'd or dosages changed, the list goeos on.

Not necessarily true.

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Wow I have nothing to complain about. I normally have 18 residents and when we are short I have about 33 and I think that's awful. There are no IVs, Gtubes, or any other speciality care. There is one bad wound dressing that needs to be done daily and it takes me about 2-2 and a half hours for the night med pass. It all depends on what CNAs I have too. If I don't have good ones I end up answering a lot of call lights, taking people to the bathroom, and hearing about how water didn't get passed. All in all every day is different. It also changes by if I have a lot of orders to do, if I need to call the on call doctor etc.

If you really want my opinion I think 35 people is a lot to take care of but that might be average for where you are IDK. At least they told you that up front at my place of work they would tell you that you have about 20 and then you realize that is if we are full staffed, surprise you now have 30+!

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