≥92% of participants will know correct and efficacious medication pass process.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥92% of participants will know correct and efficacious medication pass process.
After completing this course, the participants will be able to:
Long-term nursing is not an easy field, but it comes with many rewards as well as challenges. Long-term care nurses care for patients in need of extended care, including geriatric, wound care, chronic diseases, and disabilities. Nurses must be dedicated to patient care because the same patients are seen day in and day out. Although most residents are elderly, many are younger.
A long-term care nurse must have a passion for working with special residents in a long- term care facility. The work can be difficult at times but can be so rewarding. Let's explore the duties of a long-term care nurse.
Long-term care nurses focus on providing care to patients in need of extended care. This care may entail routine care, wound care, dementia, including Alzheimer's disease, cancer, and aftercare following surgery or strokes. The main focus is assessing and monitoring the residents' functional status and maintaining or restoring physical health. Due to physiological changes, particularly in hepatic metabolism and renal elimination, dosing in the elderly population can be challenging. The elderly may experience an increase in side effects or toxicity more easily. Awareness of side effects in the elderly is particularly important as most elderly patients are on more than one drug. Great care should be taken when combining drugs.
Routine care involves nursing assessments, medication administration, wound care, and collaboration with the team including physicians, families, pharmacy, and therapy. Also included would be daily care with Activities of Daily Living (A.D.L.s) as needed and proper documentation.
Responsibilities may include:
These responsibilities sound overwhelming, especially for a new nurse, but it does become easier with time and experience. A solid orientation is of the utmost importance and the nurse must feel comfortable asking questions.
The medication pass takes up the most hours of the day and evening shifts. The medication pass is the most intimidating task to new nurses. They will need assistance when first starting off. Having the responsibility of giving 30 patients their medications can be frightening and overwhelming for new nurses and even for seasoned nurses.
Medication errors are serious and can cause resident harm or even death. It is human nature to want to simplify things when there is much to be done. In an attempt to do this, sometimes shortcuts are made. However, this is not good practice. ESPECIALLY when it comes to medications. Do not take shortcuts. More specifically, do NOT, under any circumstances, try to pre-pour medications to save time. Pre-pouring medications are against regulations. In addition, it increases the risk of making mistakes.
First and foremost, nurses must remember the 10 Rights of Medication Pass:
Right Patient Education:
Right to Refuse:
Jane, a new graduate, was doing her first med pass alone after one week of training on the cart. She was passing the morning meds, the heaviest med pass of her day, when one of her residents began to get upset. After trying to calm her down, to no avail, Jane went to her cart to look at the M.A.R. to see what med she could give her. She found the order for Lorazepam 1 mg to be given I.M. every 12 hours and verified it had not been given for almost 36 hours. After Jane retrieved the Lorazepam from the refrigerator, she drew up the entire 2 ml of the drug, thinking that the concentration was 1 mg/2 ml. The actual concentration was 1 mg equals 1 ml. She gave the resident the injection and the resident finally calmed down and fell asleep. At the end of the shift, during report and narcotic counting, the ongoing nurse asked Jane where the other half of the Lorazepam was as she did not see that it was wasted. When Jane realized what happened, she went to the shift supervisor to report the error. The resident was monitored throughout the night. There were no adverse reactions and the resident slept well. Jane learned a valuable lesson and will always remember her first med error.
Before beginning a med pass, take a look at the MAR. NEVER go by memory. Check documentation for patient allergies. Do not bring the cart into the dining room. Do not perform blood sugar checks or administer medications in the common areas of the facility. This can be considered a breach of resident confidentiality.
If another nurse asks you to give a medication she has already poured, you should decline. Only administer medications you have prepared yourself. You may not be sure the medication is correct and it may not be the correct patient. Do not borrow medications from another resident's drug drawer. If a drug is missing, use the Emergency Drug Kit and follow the specific procedure for your facility.
Look for expiration dates on all medications, including over-the-counter drugs. Most insulins expire after 28 days after opening the vial. Metered-dose inhalers (MDIs) expire one month after opening.
Some of the abbreviations we use for medication passes are not utilized anymore, as they can cause confusion and increase the risk of medication errors. Per The Joint Commission (T.J.C.) (2020), here is the most recent list of abbreviations to avoid:
|Do Not Use||Potential Problem||Use Instead|
|U, u (unit)||Mistaken for "0" (zero), the number "4" (four) or "cc"||Write "unit"|
|I.U. (International Unit)||Mistaken for IV (intravenous) or the number 10 (ten)||Write "International Unit"|
Q.D., Q.D., q.d., qd (daily)
Q.O.D., Q.O.D., q.o.d, qod(every other day)
Mistaken for each other
Period after the Q mistaken for "I" and the "O" mistaken for "I"
Write "every other day."
Trailing zero (X.0 mg)*
Lack of leading zero (.X mg)
|Decimal point is missed|
Write X mg
Write 0.X mg
MSO4 and MgSO4
Can mean morphine sulfate or magnesium sulfate
Confused for one another
Write "morphine sulfate"
Write "magnesium sulfate"
The rules regarding not using these abbreviations applies to all orders and medication-related documentation that is handwritten (including free-text computer entry) or on pre-printed forms.
*Exception: A "trailing zero" may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report the size of lesions, or catheter/tube sizes. It may not be used in medication orders or other medication-related documentation (T.J.C., 2020). Because there are many medication errors involving Morphine Sulfate, it is very important to never use the abbreviation!
Many patients require high-risk/high-alert medications. High-risk medications are drugs that bear an increased risk of causing significant patient injury when they are used incorrectly. If is up to you to identify high-alert medications based on your facility's approved list. Examples of high-alert medications are anticoagulants, antidiabetic agents, sedatives, and chemotherapeutic drugs. It is especially important to monitor medication dosing carefully, particularly if dosing adjustments are necessary because of narrow therapeutic windows. Also, make sure to obtain and review any laboratory values required for dosing adjustments, collaborate with the practitioner if values are out of the therapeutic range, and watch for adverse effects.
The nurse is expected to know the action of each medication, so a medication reference book must be kept on each cart. Be sure to look up all medications you are not familiar with!
High-alert medications can be dangerous to your residents. Familiarize yourself with your facility's list of high-risk medications, check and recheck physician's orders, ask for help when you are unsure if an order is correct or if the resident is showing signs/symptoms of an adverse reaction.
Before we continue with the med pass, let's review residents' rights regarding medications:
Keeping these rights in mind while passing medications helps the residents keep their dignity.
When preparing oral doses, be sure to follow facility guidelines as well as CMS and pharmacy guidelines:
Always use a tissue, put on gloves, and ask the resident to look up. Do not touch the eye with the dropper. Count the drops being administered. Have the resident close their eyes to help wash the medication drop over the entire eye. Wait at least five minutes before administering another drop.
Always use gloves when administering ear drops. Have the resident lie down with the affected ear up, pull up and back on the ear lobe, and instill drops without touching the dropper to the skin, ear lobe, etc.
Every new nurse will think that it will not be them to have a medication error, but they will. Especially with the time constraints for med pass in long-term care. Remember the phrase "to err is human." Slowing down, ensuring the correct medication is being given, and remembering the ten rights of medication pass can help reduce medication errors.
"A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional." (National Coordinating Council for Medication Error Reporting and Prevention [NCCMERP], 2021).
Antipsychotics, antidepressants, sedatives/hypnotics, and anticoagulants are the most common drugs for errors. The most common errors are giving medications at the right time, the right dose, and the right route. Sound familiar? Remember the ten rights of medication administration!
The right documentation during and after a med pass is of the utmost importance. Remember, if it is not documented, it is not done! Always document the meds given AFTER they have been given. If you document before and the resident refuses or spits out the medication, you will have more steps to do in order to complete your paperwork properly.
Remember to use the Nursing Process (nursing 101): Assessment, Diagnosis, Planning, Implementation, and Evaluation. The assessment includes vital signs, lung sounds, abdominal sounds, and adverse reactions to medications. Your documentation is your proof of care provided to each resident.
The nurse has two hours to complete the medication pass. Ask the floor staff to go to the supervisor with questions as med nurses should not be interrupted during the pass. Check the MAR for the times medications are due. After each patient, enter the drugs given. If you have a missed dose, wait until the end of the pass to get the med. If a PRN is given, mark the time, dose, reason, and then go back after 1 hour to recheck the effectiveness. For pain medications, don't forget to document the pain level before it is given and then after 1 hour. The nurse must be sure to fill in every space. Remember: If it is not charted, it is not done!
Judy, a new Registered Nurse (RN) on the unit, has been previously "instructed" by the other nurses to pre-pour medications to stay within the time-limit boundaries of 1 hour before and 1 hour after for timely medication administration. She felt pressured to follow the other nurses' routines, afraid she would not get more help if needed if she did not. Unfortunately, soon after Judy finished pre-pouring the medications, Betty walked in. She took her cart into the med room, emptied all the filled cups into her pockets, and dumped them in an appropriate receptacle. This action slowed her time down, and now she has to start med pass over again. When she asked the unit manager why the nurses were allowed to pre-pour medications, the manager answered, "that is actually not allowed." Judy learned a valuable lesson that day: Do NOT pre-pour meds! If Betty had not found all those prefilled med cups, they would have been fined, and the nurse may have been fired. Pre-pouring medications is dangerous and the biggest reason for medication error.
Long-term care nursing is a rewarding and challenging career. A Long-term care nurse must have a passion for working with special residents in long-term care. The nurse wears many hats and the days are hectic. When the medication pass is thrown into the mix, the new nurse may become frantic and worried about getting the pass done in a timely fashion. This does sound overwhelming, especially for a new nurse, but it does become easier with time and experience. A solid orientation is of the utmost importance and the nurse must feel comfortable asking questions. Following the rules and regulations of the facility helps the new nurse with all the duties and responsibilities of the day, including an error-free medication pass.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.