When asked "what meds are you giving me?"

[Kitty Hawk, ADN, RN]

Since my last post here, I've come up with a good plan and have gotten better w/my med pass staying organized.

I look at the MAR before going in and making sure the cards I have are matching the MAR instructions (give on alt days etc...) so I'm not punching anything out yet. Once that's verified I punch them out. Trouble is some of the folks are on many as you know, so sometimes I'm asked...what am I getting again? And so I'll feel stupid if I can't remember from the cart to the room! Sometimes I can look at it and say that's a lopressor, that's a flomax but quite a few I need to go back to the cart and check. Is this just something that gets better with time?

Also, if a resident wants to know how the drugs may be interacting in her system...what's the best way to research this? I get the side effects of some on their own, but when it comes to the varioius ones interacting with another where do I look to piece this together?

Thanks

[Katie5]

Carry a med or drug book if you can. Just something simple but portable. And if you have to, tell your patients, you'd be sure to look it up for them. Look it up and let them know- it builds trust when you do what you say you would.

[kathy313]

I just loved when they did that to me...lol! It does get easier, you'll be able to do it by heart soon, just make sure you're checking for anything new though. I always told the residents if I didn't remember that I had to check, nothing wrong with that. Same goes for interactions...you can check the MAR, some severe or strict guidelines are printed there, also check drug books, computer...use the resources you have there. More often than not, they will appreciate the fact that you took time to answer their questions or look something up. I used to take care of a very on the spot 98 y.o., she quizzed me on everything, she often had more info than me!

One lady asked me the same thing every evening, she got several meds at bedtime, I told her they were pills I found on the floor, she really just wanted to make sure she was getting her pain pill. She was cute.

[tewdles, RN]

I think that it is hard to provide a patient consultation about their meds while you are trying to complete a med pass....you have a time frame and other patients, etc...you have to stay focused if you want to get done on time without errors. Having said that, perhaps you could arrange to come back to those people with questions and provide a more indepth review of their meds with them after the med pass?

[Abishag]

Every med I've ever given has been in a package with the name on it and we used an electronic scanner or computer mar in the room. However, if you're still on paper, my suggestion is just bringing the wrappers (even if you've already put it in a pill cup) into the room. Whether the patient asks or not, I always say, "Here are you meds, I'm giving you ---, ----, and ----." That way if they want to refuse a drug (which they are allowed to do) they can do it then before they've already gotten it. I mean when you are handing them a poop pill and you tell them "this is gonna make you poop" and then they say, "Oh well I have diahhrea now." That is good info to know and you toss it or put it back (if unopened...i always open in the room for moments like these).

HTH!

[ktwlpn, LPN]

Some residents will do this if they are not familiar with you and since many have short and long term memory problems it continues for years. Others may just want some attention or control. I will sometimes tell them "This is the same stuff I gave you yesterday" Or "It's the same stuff you've been getting for months" and then offer to go back after the med pass and go over the meds-but every time I have done so they "forgot" These LTC med passes can be horrors

[dannyc12]

You can always use the approach implemented at a nursing home I used to work at:

"JUST TAKE THEM!"

Actually, you cannot do that.

[hopefulnurse84]

This is actually a great opportunity to help you! With time you will see and learn major side effects. I recommed you ask your institution for single dose packages, what if someone doesn't want their med? you just throw it away, then who gets charged. also, if you go over your meds with the patient, you can help prevent errors and learn a little. Nursing is a forever learning experience, just when you think you know, soon you will realize how much you don't know. :)

[EDRN-2010]

This is a general curious to know question not geared at you because i am sure you are just doing what you were told to do but...you don't open the pills in front of the patient?

I have always had to open the pills in front of the patient and put them into the little cup and say "this is your lopressor" etc. I would get the pills from the med room/omni/whatever and open them in front of the patient. IV meds that are not in single use syringes - we prepare elsewhere but are required to label the syringe with the name of the med, dose, our initials and date.

I am just surprised because I thought this was something everyone was required to do for patient safety.

Is there a way you could do something like this? I think it would make it easier for you and would probably make the patients feel better for you to tell them what they are getting.

[BunnyRN]

I would look up meds before going into the room, see if VS need to be taken, look up any unfamiliar medication. Just briefly, and side effects, drug interactions. Once in the patients room with the MAR, i'll tell them what I am going to be administering. Then with my scanner, scan their PATIENT ID, read list of meds to be given.

If patient is getting a newly ordered med, I give them a print out to educate them. You will have patients still quizzing about the meds that they take at home, but if you come up not knowing something. Just tell them that you will look it up.

It's ok, not to remember every single interactions, drug actions, but patients are happy when their nurses are aware of to why they are administering meds.

[kanzi monkey]

At my institution, many of the patients are ordered similar (or identical) med lists. During the morning med pass I am giving 8-20 meds to each of my 4 patients (I'm saying this because I am in acute care--I imagine things are quite different in LTC, especially the number of patients). What I do is put all the "standard" meds (colace, vitamins, etc) in one cup, and the more specific disease oriented meds in another. I learned to remember what these meds are by thinking about why the patient is taking them--that way I'm automatically thinking about what it's doing, and what I need to assess to determine how it's working (ie, BP, U/O, HR, blood sugar, pain, etc). My conversation with the pt is then: "I'm giving you this med for your (fill in the blank) and this for your (fill in the blank). In this other cup is your (scripted list of memorized vitamins), and your colace" (I always have a little chat about the bowel regimen meds). It's a great opportunity to ask when the pt last had a BM, if they're having any trouble urinating (for pt's getting meds for BPH) or going a lot (with diuretics), if they've had any pains in their chest, dizziness or feeling that their heart is racing (pt's with afib, HTN, orthostasis, etc), how's their appetite, is their sugar normally this high at home, etc, etc. When all goes well, my med passes turn into very helpful subjective assessments. I also find out when meds are missing or ordered incorrectly when I have this conversation.

If I'm unfamiliar with a med, I look it up, check the class and MOA. If it fits a disease listed in the patient's history, I give it the same way as above. If it doesn't, I ask the patient what it is. If they don't know, I check their paml. If it's not there, I either run it by another nurse, or send a quick page to the doc "pt Y is ordered for (med)--pt not familiar with, not on paml. Pls advise, thanks"

These techniques have helped me tremendously with safe medication administration AND they help me get to know my patients and anticipate potential problems.

[SuesquatchRN, BSN, RN]

I do fine with, "This one is your heart pill, this one keeps you pooping, this one is to keep you from being too sad...."