Tube feeders and the state inspectors

leslie :-D · Nov 10, 2004

:) Has anyone ever done a med pass with a state inspector watching you? At the LTC I work at the nurses crush all the pills together and mix it with water. The nurses then take the liquid meds and mix them all together and then give them to the resident via the G-tube. How exactly does one give tube feeder meds when the state is watching you? Do you take each pill and each liquid med seperately and put it into the tube? What exactly does the state want to see you do when you give meds via G-tubes? Thanks :)

they do NOT want to see anything mixed together.

give each med (crushed or liquid) separately followed by 30cc water.

and before instilling any meds, they want to see you check for residual.

but the main points being are to give separately with flushes inbetween.

and depending on your p&p, the fdg might have to be turned off 1/2 hr before giving dilantin.

leslie

longtermcarern · Nov 10, 2004

follow the P&P for your facility exactly. in our facility, we flush between each med with 10cc, off for 1 hour before and after dilantin etc. every facility has their own policy and that is what the surveyors are looking for.

txspadequeenRN, BSN, RN · Nov 10, 2004

I have and it is not a pretty sight. This was many years ago and I cannot remember all the small details. First you need to make sure you have crush orders on all thoses pills. And if I remember correct they wanted to give each liquid then flush behind it ..Now come on, the liquid all goes the same place and how can I keep accurate count of my liquid flush if I do that. I beleive the pills could be together mixed with water but the liquids needed to be seperate. He watched me check for placement and residual. Then questioned me on the orders. I was lucky and my tube got stopped up during admin and I had to do a little plunging to unstick it. Then I let it drain to gravity. He got down to eye level to measure the water I was giving for the flush...Heaven forbid you give your resident a little extra water... Make sure you put the HOB up as well... Come to find out he was not a nurse, but a Pharmacist. He then followed me on the remainder of my pass,irritating and pissing me off the entire way . He was constantly asking me questions. "How much medpass do you have in that cup and whats the order." or "You cant chart that you gave all the med when they left 1 cc of MOM in the cup". I finally said "Im going to the bathroom and when I get done Im going to chart". What a A-hole , he eventually found someone else to terrorize. :uhoh3:

:) Has anyone ever done a med pass with a state inspector watching you? At the LTC I work at the nurses crush all the pills together and mix it with water. The nurses then take the liquid meds and mix them all together and then give them to the resident via the G-tube. How exactly does one give tube feeder meds when the state is watching you? Do you take each pill and each liquid med seperately and put it into the tube? What exactly does the state want to see you do when you give meds via G-tubes? Thanks :)

CapeCodMermaid, RN · Nov 10, 2004

For years no matter where I've worked, if we have a patient with a Gtube and he/she has QD meds, we give the meds at 6am.... no surveyors around to watch and the resident is already in bed. If you can't do that, try to get as many of the meds in liquid form and make sure you know your facility's P&P. It doesn't hurt to have a copy of it with the MAR to refer to.

anndoodle · Nov 10, 2004

When I worked LTC, I went on a med pass with state and had ALL tube feeders. I got out the meds, crushed the ones that were pills - made sure I had the order to crush unless contraindicated - mixed the crushed pills with about 25cc water. I then prepared any liquid meds individually in their own plastic med cups. Checked placement of feeding tube per ascultation/aspiration and yes, check residual. Flushed with 100 cc water, then pulled up the crushed pills in water and slow pushed them, separately. Then pulled up any liquids one at a time and pushed them, too. Followed up with the 100 cc water flush (some residents had specific orders for the amount of flush...make sure you use the right amount, they'll watch to verify!)

Thing is, some liquids you don't want to necessarily give with other meds, such as liquid dilantin. I know, they all end up in the same place, no matter how they get there, but that's the way I was taught. The surveyor was impressed, and left me after my first pass to go follow the next nurse.

Blackcat99 · Nov 11, 2004

:chuckle Thanks all for your great information and "real life" experiences. I have never done a med pass with a state inspector and I pray I never have to. I can only imagine how stressful it would be to have a state inspector around when giving meds. Good grief! The state actually checks to see if you are giving the exact amount of water for the tube feeders!!! Unbelievable!