I am responsible for the medication pass and worried about doing it with surveyors watching. Can you give me a few tips?

First, I recommend that you pass medications with a routine every day. Be consistent. Start the pass at the same time and administer medications to residents or rooms in the same order. This will help keep you organized. 

Surveyors will look for omissions, unauthorized medications, wrong doses, etc. They also will look for failure to confirm placement of a feeding tube, which must occur before any medication or flush is administered. Failure to do this is a medication administration error. Follow manufacturer’s specifications or accepted professional standards for administration, too. Failure to shake well could become a cited error.

Crushing or combining medications that should not be crushed also is a problem. Have your pharmacy assist you with a list of these drugs. Flushing the feeding tube between each medication is also a required standard of practice, but a nurse is not required to flush between each medication if the physician order specifies a different schedule because the resident has a fluid restriction. 

The physician’s order must state the amount of water to be used for flushing between crushed medications and administration of medications. Many citations are being given for this item.

Wash your hands and lock the cart!  Also, do not leave the MAR open so that others can read it when they walk by the med cart. This could be seen as a HIPAA violation. Ask your pharmacy consultant for advice too, as they are excellent resources!

Act as though inspectors are there every day. Get your routine, and stick with it! If you pass meds correctly when you do not have visitors, it will be much easier when you do.

Please send your resident care-related questions to Sherrie Dornberger at ltcnews@mcknights.com.