Tips for med pass followed by state

[anonymous09]

State is coming soon to the LTC facility that I work at and I am just wondering what are some tips for doing med pass in front of a surveyor. I am a new nurse only have been in orientation for 4 days so I'm hoping that they won't want me working while state is there being that I am new and will most likely forget something but just in case I do work when state is there I'm just looking for advice from others who have gone through this or are going to go through this.

[baygrl11]

First of all, "study" and know the proper way to dispense medications, remind yourself to do identification checks, necessary vitals prior to medication administration, etc. I kept this sheet on my cart in the weeks before state came, and "studied" daily.

When state shows up, I did the difficult patients first--GT's, people with eye drops, etc. As soon as I received report and counted narcotics I was on the floor and started right away with rounds, etc...get as many things out of the way so you can focus on med pass and not making any mistakes. . I saved the "easy" patients for last--the ones that were very compliant and took medications orally.

Remember to wash your hands before and after contact with patients. Do the ID checks. Check the medications against MAR, the route of administration, all the "checks" for med pass. Ask your resident if they are in pain.

If you have to practice with a coworker! Role play!

Hope this helps a little, I'm sure there's a lot I missed but that's what I can think of for now :)

[Sam J.]

Wash your hands. If gloves are required wash your hands before and after. If going into a room, knock first and ask permission to enter. Close the door, and pull the curtain. Be sure your cart is stocked. Be sure all the orders in the MAR are legit, on all fronts. Be sure no meds are expired or are unlabeled, and stored correctly. Read your pharmacy manual and your P/P manual to be sure you know the correct way of doing things, versus the way things may actually be done- the surveyor will be asking questions. Don't volunteer information. Ask the patient if you can give them their meds, explain everything to the patient, before you do it, even if they are comatose, and ask or assess to see if pain meds, etc. may be needed. Try to make sure your patients are clean (a dirty mouth/dentures, etc. are 'biggies'), dressed, have ID bands or whatnot, and toileted in advance. A patient's basic needs take precedence over your med pass- if they are wet or dirty or want to go to the bathroom, take care of that first and come back later if you need to. Knock. Ask before you enter. Wash your hands. Close the door. Pull the curtain. Ask permission for everything and explain everything. Then wash your hands, AGAIN. Lots of this stuff is overlooked on a daily basis, and when that happens it can take a lot of doing to get back to the right habits.

[anonymous09]

Wash your hands. If gloves are required wash your hands before and after. If going into a room knock first and ask permission to enter. Close the door, and pull the curtain. Be sure your cart is stocked. Be sure all the orders in the MAR are legit, on all fronts. Be sure no meds are expired or are unlabeled, and stored correctly. Read your pharmacy manual and your P/P manual to be sure you know the correct way of doing things, versus the way things may actually be done- the surveyor will be asking questions. Don't volunteer information. Ask the patient if you can give them their meds, explain everything to the patient, before you do it, even if they are comatose, and ask or assess to see if pain meds, etc. may be needed. Try to make sure your patients are clean (a dirty mouth/dentures, etc. are 'biggies'), dressed, have ID bands or whatnot, and toileted in advance. A patient's basic needs take precedence over your med pass- if they are wet or dirty or want to go to the bathroom, take care of that first and come back later if you need to. Knock. Ask before you enter. Wash your hands. Close the door. Pull the curtain. Ask permission for everything and explain everything. Then wash your hands, AGAIN. Lots of this stuff is overlooked on a daily basis, and when that happens it can take a lot of doing to get back to the right habits.[/quote']

Thanks for the advice!!:)

[anonymous09]

First of all "study" and know the proper way to dispense medications, remind yourself to do identification checks, necessary vitals prior to medication administration, etc. I kept this sheet on my cart in the weeks before state came, and "studied" daily. When state shows up, I did the difficult patients first--GT's, people with eye drops, etc. As soon as I received report and counted narcotics I was on the floor and started right away with rounds, etc...get as many things out of the way so you can focus on med pass and not making any mistakes. . I saved the "easy" patients for last--the ones that were very compliant and took medications orally. Remember to wash your hands before and after contact with patients. Do the ID checks. Check the medications against MAR, the route of administration, all the "checks" for med pass. Ask your resident if they are in pain. If you have to practice with a coworker! Role play! Hope this helps a little, I'm sure there's a lot I missed but that's what I can think of for now :)[/quote']

Thanks:)

[Sam J.]

Thanks for the advice!!:)

You're welcome, as long as you remember to wash your hands!

[amoLucia]

Something the day nurses told me in my LTC - have your med cart SUPER WELL STOCKED.

Apple sauce and milk/puddings chilled as nec.

Your glucometer/fingerstick procedure needs to be spot-on.

Just remember your good technique from school and BREATHE.

Good luck.

[Momtomykiddos]

Gloves for blood draws, eye drops, and injections. We don't always do all of the above on a daily basis, but when state is there, do it! Also privacy is a big one. Many residents won't care about doing their medications, finger sticks, or insulin in the hallway--state does care. Verify the resident before you give meds. State doesn't care that you may have worked with this person forever--ask their name before administering meds. Apical pulses for dig. Clean your stethoscope and glucometer after each resident.

[Sam J.]

Something the day nurses told me in my LTC - have your med cart SUPER WELL STOCKED.

Apple sauce and milk/puddings chilled as nec.

-Make sure it's all date stamped. And be sure your water/juice pitchers don't have crud in or on them.

And don't crush meds that aren't ordered or appropriate to be crushed.

And on this idea, don't give meds with supplements that need an evaluation or an order (such as a 'health shake'), just because someone 'likes it', or 'we always do that'...that phrase is something surveyors LOVE to hear!

Another issue- what to do if someone refuses a med, or if a parameter is exceeded, and you need to hold a med, or report an refusal- do you do that right away, wait till med pass is over? What is the procedure for the MAR, for notification, for re-attempts to give the med? This situation can get sticky.

You can do it. Really, it all sounds more intense that it normally is. Unless you don't knock, or close the door, or wash your hands~

[amoLucia]

Another weird thing - don't substitute liquid for solid, like Colace liquid because the pt swallows poorly. Hold it and GET AN ORDER. Don't take it upon yourself to sub.

Another thing - when directions said 'give with food', we were supposed to give with graham crackers. Applesauce WAS NOT considered as food. Maybe that was just our surveyors' quirk.

[kbender]

What about pulling all the patients meds and putting them in the same cup for the patient to take? also I work on a psych unit so most of mine will refuse. And if it's a patent with crush meds, do we still mix it in Pudding. I have been a nurse like 4 months and really nervous.

[Lioness333]

I know that there are surveyors on this site, reading and contributing, and I just wanted to say that I think they are very far removed from reality.