I am an RN in a LTC facility. I love the residents, and I love my co-workers. The only problem is, I hate what I do! When I say that, I mean that my entire shift revolves around two large med passes and I totally dread them. I think about it on the way to work and I anticipate it until it is a reasonable time to get started on it, then once I start it, I highlight everyone's name that I have passed meds to so that I can feel like I am making a dent in it. I realize that a lot of this is probably personality type or just plain being in the wrong kind of work, but what can I do to get over this feeling that the med pass controls my life and looms before me like a big, brick wall that must be climbed every time I work? Some of you may think I'm nuts, but those of you who "get it" know what I'm talking about. Is it just that I need to adjust to LTC nursing and that the med pass really is just about all I am going to do as long as I am in this kind of nursing? My experience is in med/surg hospital nursing and hospice nursing but when I went back to work after being a SAHM for six years, my hospital experience wasn't recent enough for the jobs that I applied for and, while I did get a job in hospice and totally loved it, I couldn't get enough hours to pay the bills. I did interview last week to go back to the hospice now that they have a full-time opening, and a local hospital actually called me for an interview as well to be part of the contingent float staff, so I have options. It's just that I hate to give up on this job after only four months in a way, but it's just that DARNED med pass!
The facility I work in has two groups, each evenly divided, numberwise. However, in one group, the majority can swallow pills whole and has few diabetic checks and neb treatments--the other has many accuchecks + insulins, and most need crushed in pudding, holding drinks, twice per shift neb treatments, and constant alarms for getting up (many dementia pts).
I have no problems finishing everything with time for charting on the easier one. But, oh that other one I dread! All I get done is med passes by starting 0645 and finish both by 1415, allowing myself just one 10 min break. I've never had less than 34 pts yet.
Oh, and wouldn't it be nice if the activities people would ask if you need the pt before they get whisked away for a couple of hours? Especially if you're just a couple of doors down?
The facility I work in has two groups, each evenly divided, numberwise. However, in one group, the majority can swallow pills whole and has few diabetic checks and neb treatments--the other has many accuchecks + insulins, and most need crushed in pudding, holding drinks, twice per shift neb treatments, and constant alarms for getting up (many dementia pts).
I have no problems finishing everything with time for charting on the easier one. But, oh that other one I dread! All I get done is med passes by starting 0645 and finish both by 1415, allowing myself just one 10 min break. I've never had less than 34 pts yet.
Oh, and wouldn't it be nice if the activities people would ask if you need the pt before they get whisked away for a couple of hours? Especially if you're just a couple of doors down?
I love my patients, though!:redpinkhe
If I have their meds poured, and activities or PT takes them without letting me know, I will go find them and give it to them. I need to do my job too.
If the resident is being seen by the Doctor or is in the bathroom. Then I will wait.
I no longer work in LTC, but I know EXACTLY where you're coming from with the med pass. Organization is key in getting it done. I had my cart stocked and pockets stocked with everything I could possibly need while out on the floor. I also had Diabetic supplies on the cart, along with a little basket that had the insulins. This avoids trips back to med room which eat in to your time. Try to work the same hall. This is especially important if you're new and management should try to accomodate this. Also Make a worksheet for yourself. This is one page front and back with everything you need to know for that shift. Search on here and you'll find several examples. After the shift is over take it home and use it to prepare the next days sheet. You'll have all your treatments written down, as well as who get accuchecks,vs,ect.. This is a roadmap for the next shift. Also get one of those four color pens and right in different colors to signal different things. Red means important. Have a list of all residents and the way they get their meds, whole or crushed. Know the residents who you have to get to first as well as those who can wait without harm. Diabetics fall into first category. Prioritize. Sometimes You just can't get mr. X his colace before he goes down to dining room. It won't hurt if he gets it an hour later. You have to do this with treatments also. If you can't get all of them, get the most important ones. A fresh surgical dressing change would be an example. Try not to skip the same ones two days in a row. Carry a black sharpe marker. If you have somebody's pills poured and can't find them, write their name on the cup and keep in top drawer of the medcart. When you see them, make sure you give them. Mark the names of residents across the bottles of liquid meds. When you open the bottom drawer, you'll be able to quickly find the bottle for that resident. If you have the blister cards full of pills, mark your shift on the top of the cards. For example, I would write 3-11 on all the cards I use that shift. This way you don't have to look through all the cards. Another way is to keep all the cards in each residents section separated by shift. Extra cards should be turned around, so you're not looking through them. See if there's a pattern to the way things are done on the hall. There almost always is. For example if all the residents going to the dining room line up at a certain spot. If you park your cart there, they'll come to you. All of these will help you get through the med pass quicker. This is important in case something unexpected comes up. Which almost always will. Every shift you work, if you get just a little quicker, things will get that much easier. You may even be able to go on break once in a while;).
I don't trust the people who "fly throught the med pass and still have time to sit." I worked 7 months at a LTAC facility in Detroit and seen with my own eyes a RN who DISCARDED meds from the patients med box in the pyxis room instead of passing them, when I mentioned something she literally said, "these people don't need all this." Disgusting....
I have a problem with getting meds passed on time as well. I always seem to run behind. At one place I worked I was required to call the physician if meds were late. Which ones were late and the patients. I couldn't stand it anymore. I have gone into travel nursing for the first time, and still a problem! All those medications to pass and found that I had no time to do treatments. Because I didn't speed up I was let go. I was there for a week. I need help!!! I like my profession I just do not see how nurses get done on time to even have a break. You get interrupted often. I had a couple of people on tab alarms as they liked to get up out of their chair and would fall. They were put at the very end of the hall and at times the aides were to busy to answer the alarm so I would have to stop what I was doing and tend to them. Here we go further behind in my meds. Anyone that can help???
I would say that 75% of the pills passed during any given med pass are vitamins & supplements. Maybe asking providers for labs to verify true vitamin deficiencies and discontinuing the ones not backed up by labs? Polypharmacy is a huge problem for older people. When I was pushing a cart, I would often think to myself that all those pills were unnecessary and simply a way of the facility to add to the monthly invoice. Getting rid of unnecessary OTCs not only cuts the physical number of pills having to be dished out. it benefits your residents by reducing polypharm'ing them. Hope this helps & !good luck
qestout, ASN, RN
57 Posts
The facility I work in has two groups, each evenly divided, numberwise. However, in one group, the majority can swallow pills whole and has few diabetic checks and neb treatments--the other has many accuchecks + insulins, and most need crushed in pudding, holding drinks, twice per shift neb treatments, and constant alarms for getting up (many dementia pts).
I have no problems finishing everything with time for charting on the easier one. But, oh that other one I dread! All I get done is med passes by starting 0645 and finish both by 1415, allowing myself just one 10 min break. I've never had less than 34 pts yet.
Oh, and wouldn't it be nice if the activities people would ask if you need the pt before they get whisked away for a couple of hours? Especially if you're just a couple of doors down?
I love my patients, though!:redpinkhe