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?
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.
I'm getting the impression that you don't work long-term care? A morning med pass in LTC is a whole different beast than a med pass in a hospital. Meds don't come in little individual packages in LTC, they come in cards with appx. 30 pills to a card with one label on top and you punch the pills from the card into the cup at the med cart. Meds aren't obtained from a pyxsys or something, they're kept in the med cart that gets pushed from room to room with a old-fashioned 3 ring binder paper MAR sitting on top.
If someone attempted to bring the cards into the room for each patient (plus all the bottles for stock meds) it would turn into a nightmare and the med pass would never get done. Imagine balancing a stack of cards about twenty deep, easily a foot high, some much more (I have patients that take up a whole row in the med cart by themselves) plopping this huge, toppling stack onto a bedside table and going over them one by one with each of 30+ patients, many of whom get easily get 15-20 pills each morning. Simply impossible.
To the OP, a lot of residents do this when they see a new face. Usually I find many don't actually want to know exactly what they're getting (this is your lopressor, hydralazine, lasix, plavix, baby ASA, colace, flomax, diovan, calcium, multivit, claritin, vic. c, iron, folic acid, aldactone, xanax, celexa, fish oil, coq10, acidopholous, etc. etc.) and are happy with simpler explanations (this is your heart medicine and your vitamins, etc. etc.)
I agree with the person who said you simply don't have time to do a full med consult with each patient every day. Most have been getting the same meds for years. In most of these facilities it's polypharmacy to the max. Maybe if the MD had to actually explain to each patient what they are on, why they take it, and if these 25 meds could interact with each other they would consider DCing some stuff on these elderly LTC patients.
As with all of you, I pass hundreds of meds in a med pass so it is not easy to remember all of them. It takes time and there is nothing wrong with admitting that you will have to check it out for them. Always remember to go back later and explain it to them so as not to lose your credibility. Most of the residents/patients just want to make sure you are willing to be of assistance to them. I like the post that suggested not opening the package until you get to the room and therefore know exactly what you are giving no matter how many you have.
I'm a new student so I have no experience in passing meds, but the drug book we have is AMAZING! it talks about everything so I thought I'd throw the name out there in case you were interested in looking for a book. It is Davis Drug Guide. The isbn # for it is 0803619111.
It's gotten a lot easier for me (I've been working at a SNF for 7 months), and it's also taught me a lot of meds along the way. Once you start dealing with the same meds over and over, you'll be able to tell what a lot of them are just by looking at the actual pill. I never hesitate to say I'll look up something if I've forgotten or don't know a medication.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I'm a new student so I have no experience in passing meds, but the drug book we have is AMAZING! it talks about everything so I thought I'd throw the name out there in case you were interested in looking for a book. It is Davis Drug Guide. The isbn # for it is 0803619111.
This is available for your PDA or smart phone also...this is my preferred reference in the field as well.
At my LTC most sched meds are in single dose paks, Narcs are on the 30 day supply cards. So I suppose we could take the meds to the room and pop them in front of the Resident, but would make the pass alot longer I would think. However, with that in mind, If we did take the meds in the room and tell the resident that this is your ........... for your ......... , and this is your ....... for your ........ Couldn't that be a HIPPA violation, being that the roommate could hear you, or esp. if the roommate had visitors at the time?
I usually tell them that these are your evening medications, and that usually satisfies them, I think mostly they are just wanting some sort of interaction and chit chat in the few minutes that we are able to devote our time to just them.
The charge personnel where I work mainly only gives narcs, the CMT's pass the others...but when I have passed meds on occasion, I always think about that person and their diagnoses. Then over time, I match the pill up to what their diagnoses are and can say, "here, this is for your high blood pressure" etc. Of course, we don't pass that many pills when a charge does pass it is usually on station 3 with a total of 20 residents; I always pass directly by the MAR so I'm looking at it right before taking the pills into the resident's room. On our MAR's, the diagnosis is listed right next to the med...it really helps!!!
When I get asked, it ends up being a rapport-building opportunity. My immediate memory is not the greatest, so I'll say something like, "You're getting a stool softener, your blood thinner, one for high cholesterol, and...something else...hang on, I'll double check. I'd forget my arms if they weren't stapled on tight!" The resident usually laughs, and I go check the MAR, then come back and say, "Okay, it's Lopressor for high blood pressure. Sorry about the wait," then the usual 'can I help with anything else while I'm here blah blah'.
sometimes in LTC a resident is trying to "cover up" there confusion when asking this. If I say "these are your breakfast meds" they can be happy as pie. they then know what time it is!! I have from 7am til 9am to give meds to 39 residents- do blood sugars first, and of course- eye drops, nasal spray, neb tx and vital signs. the most meds one resident gets is 32 pills in the am. the least is 7. so I dont have time to pop them in front of each resident. It would not be humanly possible to do this and to get done within mandated state guideline.
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
Not possible,I think, when passing meds to 20-30 patients.
NotFlo
353 Posts