Q: We were recently cited for a nurse giving medications outside of the scheduled time. How can we reduce interruptions and stress to improve the med pass?

A: We hear this concern often from nurse leaders and medication nurses! Expecting one nurse to do vitals, meds, eye drops and handle interruptions is nearly impossible, especially with more than 30 residents. Because of multiple diagnoses, one resident can be on 18 different medications.

If you have more than one nurse on duty, have one handle care needs and other  interruptions, while the other passes meds. Train the staff which nurse to seek out while the med nurse is passing meds. Consider a medication aide, who may assist the nurse after being trained and passing any state- required tests.

Meet with your pharmacy and therapeutics committee. Are there medication times that can be changed? Can you schedule the 6 a.m. or 7 a.m. medication to be given from 6 a.m. to 10 a.m.? Expand dinner medications from 5 p.m. to 9 p.m.?

Are there any medications that you can combine or discontinue? As William Vaughan RN, BSN, has said, if you have a medication that requires you to sit your resident at a 90-degree angle for 30 minutes before giving the drug, then following the administration with 8 ounces of water, and you know your resident will be combative at 6 a.m., and will not tolerate sitting at a 90-degree angle for 30 minutes or drink a full 8 ounces of water, then talk to the pharmacist and medical director about discontinuing it. 

Keeping a medication scheduled, knowing you are unable to administer it correctly, is  setting your nurses and facility up for failure. 

Having a flexibly timed med pass, combining and discontinuing unneeded medication and limiting the med nurses’ interruptions will help you gain a better hold on your med pass times — and hopefully eliminate any future deficiencies.