What if I can't get meds out on time during survey?

Lev, MSN, RN, NP · Dec 29, 2014

From what advice I have seen given to LTC nurses on this site is that you don't need to check BP before giving BP meds in LTC, unless there are parameters to hold meds if it's below a certain value. The residents are living at home and when patients are at home from the hospital or elsewhere, they don't check their BP generaly. In a perfect world you would check the BP before giving BP meds. The only meds that needs checking would be those that affect HR, such as digoxin, and I would want to check for high doses of metoprolol (not ER tabs) as well. The G-tubes should go quick because you just need to crush, mix, and inject. Why don't you try crushing meds for the other patients too, if they are ok with it? I know how long some elderly patients can take to swallow 15 pills. The only meds that can't be crushed are enteric coated tablets and extended release (XR or ER) tablets. Non-extended release capsules can be opened. 47 patients is a lot, even for LTC.

The surveyors won't care much about how many meds you have left and how little time you have left to pass them. When the surveyors come and if they want to follow you, you take your time, verify your patient's name and the order, offer them meds one at a time and tell them what they're for, and yes, check BP before giving BP meds, and then make sure to document correctly. I worked on a sub-acute rehab floor (considered LTC) for a short time, and the surveyors came and followed my AM med pass. And yes I was thrown off for the rest of the day and some of my meds were late.

caliotter3 · Dec 29, 2014

I would go through my med pass as best I can and leave it at that. Hopefully, they will not choose you for the "alongside". If they see that you are lagging, just answer their questions with the truth. Your employer can't expect you to lie to the surveyors. At one facility where I once worked, there was a nurse who had been there forever. She was known as the "med pass queen". She did it with flair. The nurses would find out when the surveyors would be checking the med pass ahead of time and this nurse would "magically" end up scheduled to work at that time. This information was even known by the surveyors, they remarked about it. If your facility truly was concerned about the med pass, they would develop their own "med pass queen" and stop the worry.

Long Term Care Columnist / Guide · Dec 30, 2014

I was a surveyor for a few months earlier this year. Surveyors are supposed to observe more than one med pass by more than one nurse, and on different shifts; so don't think you're the only one who might get "picked on". They may ask you questions during your pass, and if they do it while you're pulling your meds be sure to ask them to wait a moment while you're doing so. They expect this. There is less concern over late meds than you'd think; they're more interested in whether you do it accurately. They also know you're nervous and it's OK to tell them that.

They are also aware that if med passes routinely run over the accepted time frame, it's usually a facility issue e.g. understaffing. That's something the big bosses will have to deal with. Your nurse to resident ratio on day shift is ridiculous even by LTC standards. There's no way that you can pass meds to such a large group in a 2-hour time frame, so whatever you do, DON'T beat yourself up for being unable to do it. And don't hold yourself up to a standard that doesn't exist, because you have to know the Med Pass Queen is cutting a lot of corners.

Libby1987 · Dec 30, 2014

47 patients? That's not logistically possible let alone humanly possible. I'm sorry, not at all helpful. I'd like to see the surveyors recognize and cite them for absurd assignments.

wheeliesurfer · Dec 31, 2014

Also, many SNFs and LTCs will have an "educated guess" of when the survey is likely to happen and they might alter their staffing ratios accordingly in the weeks leading up to survey. By doing this it makes the staff time per patient increase and influences their scoring. I was in a LTC facility for a while as a rehab patient and personally watched this happen. Suddenly call lights were answered faster, patient areas were cleaner, meds came closer to the time they were due, etc. just my observation and .02. I have never worked in this area personally.

firstinfamily, RN · Dec 31, 2014

LTC med passes can be brutal just because it takes so long to give so many medications in a safe manner, and that is what surveyors are looking for. Most LTC facilities have an hour leave-way on either side of the medication time. We never checked B/P every day with every blood pressure medication. Each floor had 2 days during the week when blood pressures were checked. Unless the patient was receiving multiple B/P meds(they were checked daily). Also I found sometimes giving the larger pills in applesauce helped the pts swallow them better, sometimes I would give the smaller pills in applesauce just to make things go easier. I have never had that many G-tubes on one floor, that is a little unrealistic!!

Gooselady, BSN, RN · Dec 31, 2014

Yes, in front of the surveyor your priorities are the Five Rights, patient safety, verifying orders, hand hygeine and following facility policies.

Timing of meds? Like was already said, they know what life is like in LTC.

People take HTN meds at home by the billions without a BP check, even the oral hyperglycemics (eek).

First surveys scare everyone. I've been the nurse manager in two consecutive JCAHO surveys, even flew to Chicago for a four day 'preparation'. It was good to see the 'insides' of JCAHO. The surveys are definitely important. But how ya do what ya do during a survey ought to be no different on any other day. Except for the door stops . . .

firstinfamily, RN · Dec 31, 2014

Gooselady hit the "goose egg on the head", sorry couldn't resist!! You should be doing every day what you should do with any survey. Your habits are what are going to give you away to a surveyor and if you are doing things the way they should be done according to your facility, then there is nothing to worry about. If you have poor work habits and always looking for short-cuts that is going to catch up with you. Surveys should not be so blown out of proportion, do what should be done everyday, not just when surveyors are in the house!!

litbitblack, ASN, RN · Dec 31, 2014

Why is everyone saying "People at home take blood pressure medications all the time without checking their blood pressure so its ok?" No its not ok. They are in a nursing facility for a reason. They pay (or someone does) an obsurd amount of money for nursing care and that's what they should get. 47 residents on a med pass is ridiculous but you have to work with what you have so do the best you can. Get all of your VS prior to starting your med pass so that cuts down on stopping and doing it at that time. The residents that take longer to swallow or take one pill at a time can be saved for last ect. There are ways to work around it. I would just be truthful with the surveyors if you are watched and make sure you follow the proper procedure for each pass.

tyvin, BSN, RN · Jan 3, 2015

Where ever I've worked, they always hired more staff when survey showed up...

jnnfrbry · Jan 5, 2015

Thank you for your response, it really helps a lot!