Sometimes I think the only way to tell there's a holiday at my facility is to see what the aides are wearing. Long red caps with white puffballs on the end? Must be christmas. Plastic top-hats that say "happy new year"? Must be new year's.

Another hint that there's a holiday going on is the massive amount of LOAs (leaves of absence). I thought this would make the day go easier, but in reality it takes away some of my options for meds and treatments, and I find myself stretching some of the "rules" that got beaten into me in nursing school. Specifically I'm talking about pre-pouring medications.

My medication cart has five drawers, a locked narcotics box, and all of the medications for about 17 people; some of whom take 20-30 medications daily. House stock medications (colace, aspirin, miralax, vitamins, etc), lidoderm patches, glucometer equipment, pretty much everything I need. The only thing I have to walk to our medication room (which is about 100 feet away from the farthest point on my side) is refrigerated medications (liquid vancomycin, for example).

During holidays, many of the residents go out with family. Some go to restaurants, some go to the home of a family member, some visit their spouses or friends on the independent living side of our facility. More than once I've found myself standing in front of a room with no one in it, holding a soufflé cup full of pills (and maybe a filled syringe or two) for an absent resident. Rather than waste the expensive and possibly controlled medications, I'd lock them up, soufflé cup and all, maybe with initials etched into the side with a pen.

Now, if I were orienting or training junior faculty, I would discourage this practice, just as I was discouraged from doing it back in school (it -is- slightly different having an automated medication dispenser around, however). Too many things could go wrong. Were there 9 pills in that cup or 11? There's a pill that looks like it fell outside the cup. Is it zolpidem or metoprolol? Or maybe just an aspirin? Better make sure to lock that cart up every time you step away!

Despite the fact that I think it's a bad idea and I've been trained to think it's a bad idea, I still do it occasionally. Always within reason. Never more than one or two cups, separated in different drawers, with initials written on them. Any cups containing narcs go in the narc box, tucked in the back, locked under a separate key. It's a sad fact of our situation, perhaps, that rules have to be bent once in a while in order to get everything done and still leave 30 minutes late instead of 75.

Some of the more experienced nurses do this also, and they all sing the same chorus when asked. "Do what you're comfortable with". Take risks if you must, but be prepared for the consequences. One particularly competent nurse pre-pours only the house-stock medications like stool softeners and vitamins, so she doesn't have to keep reaching for the large bottles every time. Makes sense I suppose.


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