State audited med pass, nursing home LPN.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Mar 1, 2017

Hi everyone. For the past 2 years, I've been the "Night Shift Nurse" at my job. As of last week I was selected by DON to become a Day Nurse. I am looking forward to this as I am very tired of feeling exhausted and sleep deprived. I am however nervous about certain aspects of a day shift, and probly most important nervous about passing medications in front of state surveyors. I have been on night shift so long I really have forgotten all that they can cite.
If anyone could help me out, I have a few questions about certain procedures, and would appreciate Aby answers from nursing home nurses who have done this with surveyors.
1. Is it acceptable to measure liquid medications in a 30cc measuring cup or must it be measured in a syringe ? If the amount to be measured is clearly marked on the med cup, use the cup. Any overage or odd amount (3cc for example) must be drawn up in a syringe.
2. Protocol for eye gtts? You must know which eye drop can be instilled first, and you must wait at least 5 minutes between drops. Lower lids.
3. Protocol for accu checks and sanitizing the glucometer? Use your facility protocol (should include cleaning between patients/residents). When removing gloves in a patients room, is it okay to touch lancet with bare hands until walking it to sharps container? No, it is not ok. The entire process requires gloved hands. Can used glucose test strips be thrown in regular waste/sharps? Yes. Again, facility protocol may vary.
4. Protocol for inhalers/multiple inhalers ? Know which one can be administered first, which one requires rinsing afterwards, generally 10-15 minutes between inhalers.
5. G tube/J tube protocols? Check for residual by aspirating stomach contents. Do not mix liquid medications, flush with 30cc water prior to administering meds, 5-10cc water between each med, and 30cc water after med administration is complete. These directions should come from the physician and included on the medication, enteral feeding, or treatment administration record.
If anyone would happen to have a structured list based on what surveyors look for/ dos and donts it would be greatly appreciated ! Thank you in advance ?[/quote
My responses are in bold type above. This is just a guideline for your comparison. Your state may or may not have different guidelines and you facility must have specific policies to guide each of these questions that you asked. The above is based on my experience during my nursing LPN years, and as a former state surveyor. Again, check the policies and procedures at your facility since they should have been incorporated based on your state's regulation.

downsouthlaff, LPN · Mar 1, 2017

Hi everyone. For the past 2 years, I've been the "Night Shift Nurse" at my job. As of last week I was selected by DON to become a Day Nurse. I am looking forward to this as I am very tired of feeling exhausted and sleep deprived. I am however nervous about certain aspects of a day shift, and probly most important nervous about passing medications in front of state surveyors. I have been on night shift so long I really have forgotten all that they can cite.
If anyone could help me out, I have a few questions about certain procedures, and would appreciate Aby answers from nursing home nurses who have done this with surveyors.
1. Is it acceptable to measure liquid medications in a 30cc measuring cup or must it be measured in a syringe ? If the amount to be measured is clearly marked on the med cup, use the cup. Any overage or odd amount (3cc for example) must be drawn up in a syringe.
2. Protocol for eye gtts? You must know which eye drop can be instilled first, and you must wait at least 5 minutes between drops. Lower lids.
3. Protocol for accu checks and sanitizing the glucometer? Use your facility protocol (should include cleaning between patients/residents). When removing gloves in a patients room, is it okay to touch lancet with bare hands until walking it to sharps container? No, it is not ok. The entire process requires gloved hands. Can used glucose test strips be thrown in regular waste/sharps? Yes. Again, facility protocol may vary.
4. Protocol for inhalers/multiple inhalers ? Know which one can be administered first, which one requires rinsing afterwards, generally 10-15 minutes between inhalers.
5. G tube/J tube protocols? Check for residual by aspirating stomach contents. Do not mix liquid medications, flush with 30cc water prior to administering meds, 5-10cc water between each med, and 30cc water after med administration is complete. These directions should come from the physician and included on the medication, enteral feeding, or treatment administration record.
If anyone would happen to have a structured list based on what surveyors look for/ dos and donts it would be greatly appreciated ! Thank you in advance ?[/quote
My responses are in bold type above. This is just a guideline for your comparison. Your state may or may not have different guidelines and you facility must have specific policies to guide each of these questions that you asked. The above is based on my experience during my nursing LPN years, and as a former state surveyor. Again, check the policies and procedures at your facility since they should have been incorporated based on your state's regulation.
BSN be done, thank you for your response , one question regarding accu checks! If you bring the lancet into the residents room, glove, check the CBG, and then complete the procedure, if your sharps container is in the med cart in the hallway, how would you carry the lancet into the hallway with gloves on when there can be no gloves in the hallway?would it be possible to drop the lancet into a plastic cup and then transfer it to the sharps from the cup ? Thanks again !

quiltynurse56, LPN, LVN · Mar 1, 2017

For eye drops you also need to follow hand washing and gloving.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Mar 1, 2017

BSN be done, thank you for your response , one question regarding accu checks! If you bring the lancet into the residents room, glove, check the CBG, and then complete the procedure, if your sharps container is in the med cart in the hallway, how would you carry the lancet into the hallway with gloves on when there can be no gloves in the hallway?would it be possible to drop the lancet into a plastic cup and then transfer it to the sharps from the cup ? Thanks again !
Your med cart should be right at the door. That way, once you make it back to the resident's door, you're only less than an arm's length from the sharp's container. State surveyors are not that particular. You just don't need to be walking down the hall to the nearest sharps container with gloves on. Personally, I would not say anything about placing the lancet in a med cup for transport to the container if you were going directly to the med cart. But, a cup is not an approved container, and some surveyors are extremely rigid when it comes to the rules and regs. Discuss this with your DON because you want to cover yourself. Your DON should know what is acceptable practice when it comes to nursing duties.
It is not uncommon for an employee to be terminated after a failed inspection, as a means for a Plan of Correction. It's not fair, but nursing homes do tend to get rid of the responsible party in lieu of retraining. We have nothing to do with who's terminated and for what reason. And they do sometimes terminate the wrong individual. Ask your manager what is expected or specifically, where you can expect to locate the policy on this. You can also request this information from whomever does your inservices and trainings.

amoLucia · Mar 8, 2017

A little late, but your Facility's Pharmacy Service may have left all kinds of handouts or other information with your Staff Development. See if you can get copies.

There have also been numerous postings here about surveys and med pass. Just check them out. Lots of good suggestions from staff doing the med passes.