1st med pass did not go so well...

truern · May 28, 2009

See if you can get a copy of the MAR your facility uses or recreate something on your computer....get some of your OTC meds that come in blister packs and put them in baskets or whatever, put a bracelet on a teddy bear and then practice, practice, practice. Sounds silly, but I promise it works :)

Pepsi_Girl · May 29, 2009

Please don't feel to horrible and beat yourself. I can relate, I too messed up on one of my 1st med. passes. In my program 2 mess-ups and your out of the program. I felt horrible. My pt. was non-verbal, I had done everything right including checking his arm band but I didn't ask are you "so and so". Got nailed right there. My instructor was cool and let me have it outside of the rm. We both knew the second it happened, there was that look between intructor and student. Anyway what I can tell you is that you will especially careful from now on, I can almost say without a doubt you will probably never make that same mistake again.

9livesRN, BSN, RN · May 29, 2009

Hello there, I created this neat little note that I carry with me, based on the questions that were made to me before med admin. so i can be up to what it is expected!

1-which meds?

2-what about them?

3-what do they do?

4-what to watch for?

5-needs reassessment?

6-at what time?

7-should you check anything before you give?

8-how do you give it ? oral? sq, im, iv, topic? (if it is an injection she wants to know how do you do it, which 9-siringe? needle? angle? technique?)

10-oral? with food? milk? juice? would you crush this if you needed to???

11- tube feed? how do you flush it?

12- have you gotten base line vitals? aipical pulse for 1 full minute?

then she goes with you to the med room, and you log on the computer, imput what you want

then:

1- check the med with the EMAR when you get it

2- check the med again before you go to the room

3- check it the 3rd time, when you are scanning the patient, just before you give it

if insulin, have 2 RN nurses check it with you, and document the check

then at the room:

1 - can you confirm your date of birth to me?

2 - check wrist band for name and DOB

3 - look at your hand pc to see if it matches!

4 - I will be giving such and such to you today.

5 - this drug is for bla bla bla

6 - do you have any questions about this drug?

7 - observe the patient swallowing the med if oral

8 - document it! (also if refusal document why? inform the risks of not taking it, and do pt teaching explaining why it is important, and document it)

9 - reassess if needed ex. opioids and so on...

hope it helped!

9livesRN, BSN, RN · May 29, 2009

ah, we never use:

are you "john doe" to confirm the right patient because it could be some one else, there just saying yeah, or uh huh, and you can screw it up,

nor just crossing the mar to the band, because it could be the wrong band and the wrong mar (paper mars.)

Sharingan · May 29, 2009

Sorry to hear that.

For us, we would first look at the MAR (to just get an idea about what meds will be given), then we'd go do vital signs/head-to-toe assessment. Then, we'd look up lab values and then prepare meds. We always have drug book with us all the time to look up meds that we're not familiar with. Plus, the instructor quizzes us about meds also.

picurn10 · May 29, 2009

we're not allowed to say "are you Mr. so so so?" either because a confused pt just might say yes! In fact that very thing happened to me last week. I wasn't doing meds, but I was getting ready to do vitals and I asked are you so so so? and introduced myself, then I checked the bracelet and lo and behold, pt was NOT mr. so so so! Needless to say I felt like a dummy.

Try not to beat yourself up over it. I recently dropped all the pts meds all over him! Wow, I felt like a moron. Then I had to go down to the pharmacy with the pills that hit the floor to get new ones. Luckily my instructor wasn't upset about it, and most of the pills fell on his gown so we were able to just drop them back in the cup.

shrimpchips, LPN · May 29, 2009

Ahhh please do not beat yourself up over that! As with everything related to nursing, it takes time and practice to get things right. Use your patient identifiers when doing med passes, and use at least two. Acceptable patient identifiers according to JCAHO include:

the individual's name (ask them to give you their full name, don't ask "are you so-and-so?" because as others have said, a confused pt could say that they are so-and-so when really they are not)
the assigned identification number of the patient
telephone number
date of birth
social security number
address
photograph
other person - specific identifiers

Some facilities might have barcode scanners to help identify patients.

I always ask them for their full name & date of birth and compare with the information on their armband or the MAR.

Also always remember the 5 rights to medication administration:

Right patient
Right drug
Right dose
Right route
Right time

And when you are pulling up meds from the med cart or med room or whatever, always check, double check, re-check and check again with the MAR making sure you have the right patient, drug, dose, route & time.

When giving oral meds I always observe them take it. I ask them to open their mouth so I can see that they have swallowed it. And as helpingothersinllife said, DOCUMENT!!! And don't forget to sign off on the MAR - if there is no indication that the drug was given on the MAR, then the drug has not been given - even if it was! This can be dangerous!