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!
Specializes in Gerontology, Med surg, Home Health.
It is NOT good practice to wait until the end of your med pass to sign out narcotics. It's an invitation to be off on count and in my buildings, you would receive progressive discipline for continuing this.
Round 2: How to save another SIX hours a day on a med pass in a LTC place:
*During narcotic count- how many of those drugs have been expired for...years? Are the patients even still alive? How long have you been counting meds, day after day, for patients that are long gone, every day? Keep a dynamic list of meds that need DC'd, and get them out of the cart. Inform the pharmacist. Be consistent, and insistent- your DON may hesitate, since it is a LOT of time and regulatory paperwork to clear out a junked up med cart. And if meds turn out to be missing after the fact? Hmm. You do not want to go there. Get rid of them, ASAP.
*How many PRN meds are being used so often as to be used daily? Get them changed to routine to prevent the exra documention required of PRN meds. Especially for pain, blood pressure and glucose- how many times a shift are MD calls made for those issues?
If you are energetic, and have the will to survive? LTC CAN be an option.
Had to resurrect this thread because "Are the patients even still alive?" Made me chuckle.
Specializes in Telemetry, Step-Down, Med-Surg, LTC, PACU.
I have read every post in this thread and found the tips to be incredibly helpful as a new RN in a LTC facility working the hall that "no one wants to work" due to the needs of the patients and workload and either half of another hall or all of it (I've found out from meeting and speaking to fellow co-workers.)
I also work 11p-7a with several G-tubes and a few IVs. I've noticed a lot of Nurses tend to move the Med Cart with them as they go room to room but my 6am Med Pass is so hectic and certain people wake up early and are used to getting their meds at this time but then I also have a random IV med to be hanged around the same time, and the list goes on... I'm having trouble finding my niche. I created my own brain sheet that seems to help a lot with keeping up with who needs Vitals, BS checks, and times meds are to be given but that 6am pass is just wild. Any other tips for a heavy med pass in the morning when several patients are getting up and may be hitting that call light?
I am a new CMT and My facility puts be on different divisions where needed! One of the floors has 46 residents and I am the only one passing the medications which includes otc meds, bubble pack meds, drops, inhalers, breathing treatments, giving out shakes etc... can I get some advice about how to become faster? I'm just now learning but I am feeling pressure from my boss about not having my morning meds not being passed out in the time frame allowed which puts me late! Any suggestions would be greatly appreciated!
Specializes in Post Acute, Med/Surg, ED, Nurse Manager.
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- When you pop a narc flip the card backwards & return it to its spot. When it's time to review the count, just go to the narcs that are flipped backwards. I never sign as I pop narcs. Slows me down. I pop and flip. When I've finished everything? I open the cart, search for flipped narc cards & refer to my notes to record the times of admin.
This is seriously BAD BAD BAD advice. Sign as you go. Messing up a Narc is serious. Pop and flip, maybe help you track what you did if you miss something. But IF I count with people and they are making up times as they go I count EVERYTHING very very carefully. Plus, you should count everything every time. Something goes missing or unaccounted for once it is your cart your liable. You are suddlenly missing two oxycodone, by signing the narc book after count it on you. MAybe the nurse ahead of you forgot to flip when she popped and you didn't count it. Oh well.
Specializes in Mental Health, Gerontology, Palliative.
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.
If I know that Mrs A and Mrs B and Mrs C in ajoining rooms all have 20mls liquid paracetamol at the same time then I'll pour out three med cups of 20mls liquid paracetamol.
I will still check each one against my EMAR before giving it as well as going through the five rights with each patient.
I get the angst against predispensing and if a nurse is pre preparing medications for all 30 patients on their wing then yes its a med error waiting to happen.
OP, its about finding the way that works for you at the same time ensuring that you remain safe in your practice. . On morning shift I have several patients who have controlled drugs which I will give with the night nurse. I then start the meds on the smaller wing, going back to the larger wing to give meds to several patients who only take their meds with breakfast and then head back to the smaller wing to finish off there before starting the meds in the bigger wing.
CapeCodMermaid, RN
6,092 Posts
It is NOT good practice to wait until the end of your med pass to sign out narcotics. It's an invitation to be off on count and in my buildings, you would receive progressive discipline for continuing this.