Would You Like Some Eggs and Toast with Your Pills?

You don’t have to pass so many medications at breakfast…

As I discussed in my blog last week, recent research has pointed out what many of us know from professional experience: assisted living med aides pass a lot of medications during a typical shift.

In case you missed my last blog, I referred to a recent joint study by Oregon Health Sciences University, Rutgers Center for State Health Policy, University of Washington Bothell, and Northern Illinois University, which found that the most common medication error in the assisted living facilities they observed was giving medications at the wrong time.  In the study, wrong time accounted for a whopping 71.3% of the medication errors observed.

Although very few of the errors witnessed during the study posed a serious potential for harm, it none-the-less raises the question about what we can do to minimize this relatively simple error.  What can we do to ensure medications are given to residents on time in our assisted living facilities?

Well, of course, the first thing you have to look at as an assisted living executive director, nurse, or administrator is whether you have enough staff on-hand to handle the number of residents and medications you are managing.  But what I want to focus on in this article is a somewhat simpler and perhaps less expensive solution: adjusting the administration time of medications to more evenly distribute the workload.

We’ve all seen it; a doctor orders a medication for once a day (QD), and what do most of us do?  We schedule for the 8:00 am, a.k.a. “breakfast,” dosing time.  Twice day (BID) orders?  Well, of course, they are likely going to be scheduled for 8:00 am (breakfast) and 5:00 pm (dinner).  And three times a day (TID) will probably end up being given at 8:00 am (breakfast), 12:00 noon (lunch), and 5:00 pm (dinner).

This common approach to medication administration scheduling leads to a very heavy burden on the med aide(s) responsible for managing the breakfast dosing period, which lends itself to numerous errors including wrong time, as well as an overly clinical environment during breakfast, as med aides scurry about the dining room in an attempt to pass all of the medications before residents head off to various morning activities.

The obvious question becomes, “Why do we have to give so many medications at 8:00 am?” 

In some cases this may be medically necessary, but in most cases it is unnecessarily self-imposed by the assisted living provider and/or the pharmacy that is preparing the medication administraton record (MAR).  Why can’t some of the medications be given at 7:00 am for early risers and 9:30 am for residents that enjoy sleeping in?  The answer most often is: they can. 

So here are a few simple steps you can follow to more evenly distribute your medication administration schedule:

1. ALWAYS check with the physician first
In some cases, albeit rare, the physician will order that a medication be given at a specific time of day, such as “give at bedtime (HS).”  Most often, however, a physician simply orders QD, BID, TID, etc.

2.  Ask your pharmacist

If the physician has simply ordered QD, BID, etc, the pharmacist can offer important advice for the specific time of day to schedule the medication.  For example, some medications are best taken in the morning, some are best taken on an empty stomach, etc.  Let your pharmacist know that you are trying to more evenly distribute medication administration times throughout the day, and he/she will be able to offer plenty of practical suggestions.

3. Involve your med aides

Be sure to talk to your med aides before making any major changes in the administration schedule.  It may be that your med aides have developed a routine of calling in refills to the pharmacy everyday at 10 am, and if you change the schedule that requires them to administer medications at that time, they need to be prepared. 

Additionally, your med aides probably know your residents’ schedules better than you do and can suggest the best schedule for each resident.  The more you can individualize the plan for each resident, the better.

4. Adjust your medication administration records (MARs)

Ultimately it is the MAR that acts as the medication administration “day planner” for your med aides.  They constantly refer back to it to ensure that they have given each resident their medications at the correct time of day, so be sure you adjust your MARs accordingly. If you are lucky enough to receive MARs preprinted from your pharmacy, you will need to work closely with them to ensure they are correctly prepared each month.

Rescheduling all of your residents’ medication administration times is not something you want to do overnight, but consider these suggestions and discuss them with your staff and your residents’ physicians and pharmacies to see if it can make life a little easier for your med aides, and a little better for your residents.

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