WAKE UP!!!!

Nola009 · Sep 2, 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.

Good for you that you left. Bet the "other nurses" took some really bad short cuts, and even skipped giving meds. It's a shame managers aren't more supportive of their staff in giving GOOD nursing care!

garciadiego · Sep 3, 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.

You nailed it!

garciadiego · Sep 3, 2014

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

You definetly have it together.

kbrn2002, ADN, RN · Sep 3, 2014

Actually I've found the opposite to be true. I know my residents well enough that if something looks "off" when I am checking the meds against the EMAR I notice right away. By not just assuming that the pills in the blister pack are correct I have found on more than one occasion a wrong dose, or just plain wrong med was packaged. I noticed because the pills looked different so I used the pill identifier function of our online drug book to double check before I gave them. I have also found that it was indeed the correct med and for whatever reason it came from a different manufacturer.

On the other hand, if you are talking about nurses that give meds from memory because they "know' them...please don't do that!