Time management help?

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Specializes in Professional Development Specialist.

I work in what should be LTC, but for some reason my wing is sub acute mixed with LTC. I have 11-15 pts on this cart, with 2-3 being LTC. I've been there about 6 weeks as a new grad nurse and am still having a heck of a time managing it all. :( I've been trying to pin down where my day is going wrong and I think part of it might be that some of my pts take FOREVER to take their pills. I had an orientee one day last week and she took the pills in to one of them. In the time she was gone I was able to pass meds to 3 other patients! Med pass to these 3 particular pts takes 10-20 mins each, with me standing in their room encouraging them. All are AO3. I have tried leaving the pills with them and coming back in a few minutes, only to find they haven't taken a single pill.

I have pts with trachs and g tubes, some on dialysis that I am responsible for setting up (another 20 minute time chunk of my 8 hr day) plus hospice pts with med passes every 2 hrs, and some needing close monitoring on the edge of heart failure or sepsis on any given day. 45 minutes out of my morning med pass devoted to 3 pts leaves me running all day.

Any suggestions for these pts? Do I start with them, end with them? I've tried giving their meds in their room, then in the dining room, but the result is always the same. I'm a little suprised to have this problem with 2 of them, since they were in my shoes once as nurses.

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Specializes in Cardiology.

Wow, that sounds frustrating to say the very least... I'm still a student, so I don't have too much experience to offer, but I can tell you that during my med/surg internship I had a patient who was giving me similar problems and it was affecting the care that my other 5 patients were receiving. I was told that the best way to handle it would be to save the slowest for last, or to only give the most important meds first and then go back to give the others if/when I had time.

Also, a side note: I was told to never put the pills in the room and leave because you can't legally document that the pills were taken if you didn't see the patient take them- they could actually just be down the toilet, or in a pillowcase, or whatever other creative place people can come up with to hide a pill.. ;)

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Specializes in LTC.

What is their reason behind not taking the meds right away? Are they asking questions about the meds? Just chit chatting? Are they busy doing something and don't want to be interrupted? Are they having difficulty swallowing the meds that are being given?

IMHO from what you posted it sounds like A: they are lonely and use this time to talk to someone or B: it is a way to control something when they may not be able to in other areas for example like what they eat, when to go to bed etc. While they have the meds and you in the room they have control over you because you can't leave until the meds are gone . ( Where I work we cannot leave meds in the room.)

You could try asking them when would be a better time to come back and give the meds to them, or do them as the last ones so you don't have the pressure of the rest of the med pass on you. Monitor how they are taking the meds, would it be easier if the larger ones were halved? Crushed? Put in pudding or applesauce? Swallow eval needed? Also ask the other nurses who have worked with these residents how they get them to take their meds and if they have the same problem that you have. Ask them for tips and suggestions on how to handle these residents. Good Luck

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Specializes in neuro/ortho med surge 4.

I worked LTC for 5 months and I had a few patients like this. I would generally leave them for last. I would sometimes crush the pills and put them in applesauce. Do these people have dementia or alzheimers? It is a shame when you cannot give your patients/residents the extra bit of time for the TLC they may need. That is my biggest complaint as a nurse. Too much charting and too little people time.

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Specializes in Professional Development Specialist.

They are all alert and oriented. It is mainly a control issue I'm guessing, along with being lonely. All three complain about the amount of pills, and take each individually with a lot of moaning and groaning and complaining in between each one. I've also tried taking a few at a time over the course of the am but that takes just as much if not more time and they complain each time I come in "MORE PILLS? I thought you gave me mine already!?" Maybe we should make them all roommates. :lol: Crushing isn't an option, I suggested it already but since they are alert and oriented they don't want them that way.

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Is it possible the Dr could review these meds and perhaps DC some of them? It sounds like they don't take pills well because they don't want to take pills. Are they saying "I don't like taking this pill because I don't like what it does to me."? Can they take their pills themselves or do you have to spoon feed each pill?

I had a lady say to me "hurry up I need my breathing treatment" and when I got in to her she started asking me all kinds of questions, so I said to her "you talk an awful lot for someone who is SOB" She stopped talking and took her breathing treatment. Sometimes you just have to confront them with what they are doing.

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Specializes in Professional Development Specialist.

They each take their pills themselves. Most of the pills are vitamins (why are the vitamins always the biggest?!) Maybe I will talk to the Drs next time they are in the building. I wish I had extra time later in the day to give a little TLC for each one, but it's just not going to happen.

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Since most charting seems to be same old same old, every single day, maybe take some charting into the room with you? That way you can chart (on patients that are pretty easy to chart on, so you don't need to be paying 100% attention) and be in the room "chatting" while they take their pills. If it takes 10 minutes, you might not get 10 minutes of charting done, but if you can 5 minutes of charting done, it at least makes up for some of the time. :)

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Seriously, put the pills whole in applesauce and say, "Good morning! Here you go!" When they ask why they're in applesauce, "Well, I know you dislike taking so many pills. This is easier. They go down more easily." Huge smile.

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Sounds like they just want your company. You must be a nice nurse. Tell them that you have something you have to attend to, and when they get started, go to the next person, and once they are both taking their pills say I'll be back if you need any help. And put their pills in applesauce. Or you might hear them saying" oh I dropped a pill on the floor!" Applesauce is like glue for the Pills!!!!

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Oh, Jen, use the pill halver to cut the MVI with minerals and the calcium in half.

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Specializes in Home Care.

Be nice but firm with them. Let them know that you need them to take their pills asap and that you'll have time to chit chat once you get everyone's meds completed.

You'd be surprised at what a smile, redirection and encouragement can do to speed up the slow pokes.

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