WAKE UP!!!!

LadyFree28, BSN, LPN, RN · Aug 30, 2014

I don't memorize, I exercise the 5 rights...things can change in the 24-hr business that we are in.

Long Term Care Columnist / Guide · Aug 30, 2014

Orders can change every day, sometimes more than once in a given 24-hour time period. Any nurse who "memorizes" her/his patients' medications and gives them by rote is reckless and foolish.

garciadiego · Aug 31, 2014

I'm not talking about memorizing meds and not looking at the MAR, I'm asking if routine lends itself to mistakes.

Long Term Care Columnist / Guide · Aug 31, 2014

That was the point, I believe. Going by "routine" and not the MAR causes errors, mostly of omission but also wrong doses and the continuation of meds that have been D/C'd.

Nola009 · Aug 31, 2014

Yes. Happens a lot where I work.Many of the other nurses have em memorized (that's until something changes), grab em with bare hands, and give em. I do not do this and I don't even want to get into that bad habit. Not saying I'm 100%perfect, but I hate the way LTC nursing is. It is reminiscent of factory work and cashier work in a way.

I don't think having a routine leads to mistakes, but not looking at the mar does (if something changes).

benegesserit · Aug 31, 2014

I think sometimes routine, combined with being in a hurry (and who isn't in a hurry with ~25 patients to medicate within a 2 hour window?), can lead to seeing what you expect to see.

You've cared for Mr. Smith for the past 3 years. He receives 500mg of metformin every morning. The dosage is increased to 1000mg. The old med card remains in use, and no one marks the dosage change on it. The fact that there's been an order change is highlighted in the eMAR for 3 days, but those were the 3 days you were off-shift. Easy to miss if you're in a rush.

ktwlpn, LPN · Aug 31, 2014

>Do any of you LTC nurses who pass the same meds to the same patients day after day, and you probably think you have memorized which patient gets what med, inclines a nurse to med error? :nailbiting: >

I never assumed I knew those meds from pass to pass. I could probably tell you who gets Lasix,plavix,aspirin,exelon patch, etc but I always used the MAR.I know plenty of nurses who did not and they did make errors and tried to cover themselves as long as they could until they were finally shown the door. NOT a good practice.

garciadiego · Aug 31, 2014

Thanks Nola, for your REAL world assessment, flight controlers ,studies say, make more mistakes during a routine day vs days with variety and the unexpected.

Dewman · Sep 1, 2014

In a previous job in LTC, I was the sole 2nd-shift nurse on my hall of 35 residents, some of whom received a veritable pharmacy's worth of routine meds. The eMAR forced you to accomplish that within a 2-hour window. If you didn't, you could expect to have your personal orifice reamed out by your super or the DON. They would usually say things like "All the other nurses get it done."

Well guess what, Ms. DON? "All your other nurses" who get it done, MEMORIZE the MAR, pre-setup each resident's meds, and other things I won't go into here.

IOW, they are FORCED to take "short-cuts" that violate good nursing practice - not to mention putting their license at risk - because THAT is the ONLY way to give 35 people meds in 2 hours. In my not-so-humble opinion.

I hated doing that. I left.

garciadiego · Sep 1, 2014

In a previous job in LTC, I was the sole 2nd-shift nurse on my hall of 35 residents, some of whom received a veritable pharmacy's worth of routine meds. The eMAR forced you to accomplish that within a 2-hour window. If you didn't, you could expect to have your personal orifice reamed out by your super or the DON. They would usually say things like "All the other nurses get it done."
Well guess what, Ms. DON? "All your other nurses" who get it done, MEMORIZE the MAR, pre-setup each resident's meds, and other things I won't go into here.
IOW, they are FORCED to take "short-cuts" that violate good nursing practice - not to mention putting their license at risk - because THAT is the ONLY way to give 35 people meds in 2 hours. In my not-so-humble opinion.
I hated doing that. I left.

Thank you Dewman, it's a wonderful world!

LadyFree28, BSN, LPN, RN · Sep 1, 2014

I'm not talking about memorizing meds and not looking at the MAR, I'm asking if routine lends itself to mistakes.

You stated "memorize"...

Having a "routine" is essential for nursing practice.

I have a "routine" in any setting; in LTC, I use a "brain sheet" differently than I would in another setting, but I have a VS list, accu check list, ADL/Medicare charting list, Q 15 and 30 min checks, etc. I do a quick "eyeball" on pts before starting; especially the pts who can't make it to the dining room; get BPs first, and then start meds; if I have a trach pt and hospice pts, they are given meds first, then pts on checks are given meds; and pts who are ambulatory that have came back from breakfast are given meds. I'm usually done by 11 am give or take issues and falls with documentation for frequent check pts, ADL notes/Medicare notes, etc; treatments are done by 12; lunch at one, few afternoon meds done by 2:15, and I'm usually out the door by 3:25.

My "routine" is in the spirit of anticipation; I'm always assessing, engaging and observing my pts; they are all different, however I still able to address their needs and be able to give their meds, if they refuse meds, I document, usually they take a few that they want, even though they are crushed; they still have a right to self-determination; those who have altered mental status Some take the meds, some don't and documentation and care planning is in place; I cluster care for the most part, and am able to do so; I am mindful of the time-meaning appointments and dialysis, and other surprises and will make sure immediate and concerns needs are met; most need take time, but they are able to be placed in the proper channels successfully :yes: