State is coming, random medication questions

LuvScience · Jun 6, 2012

Your facility should have specific policies to cover these questions. At my facility our policy allows us to crush and give medications together. There is no reason to use gloves while preparing medication unless you are actually going to touch the medication e.g. opening a capsule. If you drop a pill onto a clean barrier on top of your med cart there shouldn't be a problem with using it. However, if this happened to me and a state surveyor was observing I would waste it and get another rather than try to convince the surveyor that my cart is clean. I had some questions like this when I first started but the policy book answered most of my questions and the pharmacy rep was able to clarify the rest.

Nascar nurse, ASN, RN · Jun 6, 2012

1. For oral medications you can crush them all at once. Make sure you have an order to crush. Make sure each medication is allowed to be crushed - remember those extended release, potassium, etc can't be crushed at all. PEG medications should be crushed and administered seperately with a water flush between each med (there should be orders for this water flush between meds)

2. If the pill falls on the cart I would just destroy the medication per facility policy....don't just plop it in the sharps container. Remember to follow policy. We got cited for this one year so it really sticks in my mind.

3. No need to wear gloves during entire med prep...the surveys may think you are clueless and then really start picking apart everything you do. Gloves for insulin injections, eye drops, blood sugars, PEG tube meds

4. Never let 'em see you sweat! Act confident so they will believe you know what you are doing.

Good luck

CapeCodMermaid, RN · Jun 6, 2012

We have an order for gtube meds that says "may crush meds, mix, and administer together". This is the only facility I've worked in that had this order.I am in agreement with the others. If a pill falls on the cart, don't use it. One of the surveyors we had was "shocked" that the nurse manager picked a pen off the floor...a pen!!You only need gloves for injections, eye meds, but wrap a tissue around the end of your finger that touches the resident's skin near their eye.Remember all your rights of med administration and you'll be fine. Keep posted.

buytheshoes11, MSN, RN · Jun 7, 2012

I know in our facility, for PEG meds you must crush each one (if the med is crushable, of course) and mix it with water with a water flush in between each medication. No "cocktails" are allowed per state rules. If a med falls onto any type of surface, protected or not, it must be thrown away. If a medication is being given PO, then I wouldn't wear gloves.

Nascar nurse, ASN, RN · Jun 7, 2012

Oh, just to add...make sure you read and understand your facility policy on cleaning the glucometer between uses. My state surveyors are ruthless on this. We have 2 machines per cart. After each use, each machine is wrapped in a sanitizer wipe and left to sit (still wrapped up) for 2 minutes. This is what our surveyors demand to see and if not done they cite as an immediate jeopardy.

RNGriffin · Jun 7, 2012

I have experienced State visits more times than I will care to remember. I sympathize with your anxiety and hysteria. But, you must calm yourself to prevent from making a tedious mistake.

Medications have no need to be crushed separately as long as you have used the 3 point check system( it used to be 5 in NY).

Discard of any medications that have fallen onto your cart, regardless of barrier. Unless you are cleaning your cart after every time you administer medication, this is the rule to follow. State inspectors typically won't care how much you explain the sterilization of your cart!

Gloves are not a necessity in the administration of medications.

Carry on with your duties, only stopping to chat if asked questions in sequence. I typically walk and talk.

ellemiche, BSN, RN · Jun 7, 2012

I don't have any comment on this topic but rather, i do appreciate these things I just have read. I really learned things from reading articles such this...Thanks for posting questions, thoughts, opinions and ideas...I can apply this in the near future.

litbitblack, ASN, RN · Jun 16, 2012

I would definately try to get the difficult ones out of the way prior to them arriving if at all possible. Heck sometimes I would only have 3-5 more to do.

loveanurse777 · Jul 2, 2012

Ive been through two state surveys. The first one I was clueless. 4 months into my first job. Terrified but luckily they did not try to follow me. They did nitpick one of my patients though on edema and weight gain. They questioned p&p of measuring edema, weight, diet, and I&O.

Second survey I knew my patients very well. I planned my game plan very well at home lol. Listing all the patients that had inhalers, eye drops, injections, tube feeders, difficult patients that may cause problems...and I got them all out of the way first. Saving my easy alert patients with simple meds (but keeping in mind that they need to follow a certain amount of meds so don't pick people that have like one or two meds because they will be around forever). Anyways, my game plan worked. It helped me get through my med pass quickly. Actually, they tried to follow me but I had like 2 or 3 patients left and they were receiving therapy in the gym...which they won't allow me to give meds there...so sorry try again next time! I did get followed for ONE blood sugar check. Luckily they had a glucose level of 110...no insulin needed lol. Don't forget hand washing and your facility p&p on using hand sanitizer.