Re-thinking the medication pass in long-term care
I can vividly remember the day I learned how to pass medications from a very large rolling medication cart. It was much different from the way I had been taught to pre-pour medications in a med-room. We used those little med cards that matched the orders on the kardex, filled medication cups, placed the cup and cards on trays and hoped that they didn't get knocked over! The facility I was working in at the time had a wonderful DNS and staff development nurse who stood by our side as we re-learned how our med pass systems of bringing all those pills to our residents. Nowadays those large medication carts are considered "artifacts" of a nursing home, they are those tools we just expect to see and now we all know how to use. They are reminders of a medical based model.
The philosophy of symbolic interactionism teaches us that there are items in a nursing care facility that are symbols of being sick, handicapped, institutionalized or even symbols of dying, the medication cart being one of largest of these symbols. Mechanical lifts, blood pressure cuffs, medical professionals, uniforms, schedules, meal trays, wheel chairs, nurses' station and utility rooms are all reminders of being sick, they are images of a hospital. As we all move towards a culture and atmosphere that reflects a change in culture, these are all practices we should consider to change.
I was fortunate to get to visit the Green Houses of Tupelo Mississippi with my Leadership AAHSA fellow class. While there I was so impressed by how in these small homes they had locked medication cabinets in each person's room. This helped the environment feel more like the home it should feel like. The nurse there would pour and provide the pills in the privacy of the person's room.
I am looking to hear from you, do you have any ideas as to how to re-think the medication cart systems in long term care. What are you doing to creatively make the delivery of pills more person centered? What alternatives are working for you or didn't work?