A Different Run; Or How Not to Do A Medication Pass

Yesterday I came to work with the goal of becoming more organized on my run, and was beginning to settle in for the day when one of the nursing assistants looked at the schedule and said, "you're on South today, Arlene." I looked at the schedule, which had many entries crossed out, in disbelief. That horrible sinking feeling when you know that you are going to be far out of your comfortable and familiar routine. New "on the floor", I can barely do my own med run in an organized manner. Because of a severe staffing shortage of nurses, I and another nurse from the long-term care side had been moved to the more active Medicare side of the building, where neither of us had ever practiced. Although we recognized that our assignments were the best solutions to a difficult problem, we felt as if we had been hijacked. I was assigned to a very active and challenging run, and the other nurse not only had an unfamiliar run, but had to split a run with another nurse, taking 30 instead of 20 patients, mostly "tube feeders" and very time-consuming.

We met with the Director of Nursing to clarify our assignments, and I helped the other nurse accept our difficult situation. Later it turned out that, like staff who work double shifts, a meal tray was provided for us, in recognition for accepting a difficult assignment. This was welcome, as I knew there was no way we would have time for a lunch break.

As it turned out, I had three tube feedings to start at a specific time, one person with one IV antibiotic to run and another person who had two IV's during the shift, as well as seven people who needed their blood sugars checked before dinner and at bedtime.

Despite an excellent report from the outgoing nurse, the day immediately went to chaos trying to relieve "Lucinda" of her horrible pain from back abcesses. One of her as-needed medications, oxycodone, had been allowed to run out, and she was screaming that she needed relief NOW. I phoned the pharmacy and learned that, since this was not a new prescription, they would not allow taking it from the emergency "E-Kit." Fortunately there is a team of two doctors who take turns every week visiting the facility every day, so the doctor wrote a prescription for Dilaudid. More time on the phone with the pharmacy, obtaining permission to pull the Dilaudid. Unfortunately, only one med cart set of keys had the key to the narcotics E-Kit, and none of the nurses assigned to those carts knew which set of keys had the narcotics key, or what it looked like. I went from one to another nurse, borrowing their keys and trying them in the locked cupboard. Finally I phoned the Director of Nursing, who was still in the building, who found the appropriate key and obtained the Dilaudid for me. It was well after 4 PM and I hadn't done any of the seven before-dinner blood sugar tests on that hall, or delivered more than a few medications.

For the next seven hours I had three interruptions for every patient I visited. I discovered that multiple family members come in the back door every evening at different times, setting off the alarm. Lucinda's bariatric bed broke and the maintenance man came in, who ended up waiting for someone else to come in who could help him repair the bed; the repairman had to come down from Lynnwood to Puyallup on a Friday evening, completing his regular route as he came. Lucinda was transferred from her bed to a "shower bed" constructed of giant-bore PVC pipe, to a regular bed; then ultimately back to her own bed after it was repaired. None of this could have been comfortable.

Later in the evening, personnel from a mortuary came in the back door, with business on another hall, setting off the alarm every time they entered or left. I kept receiving phone calls about residents I knew nothing about. The entire shift was total chaos. When the night nurse came in, I enlisted her help to finish up the medication pass [fortunately I only had about two people left to see.] As a crowning touch to the evening, the night nurse placed the cart keys in the top drawer, and one of us locked the keys inside the cart. Fortunately, on another set of keys there was a key to the business office suite. By some miracle, the DNS' office was unlocked, which had a spare key to the cart.

It was a horrible feeling to scrape by, just barely getting the medications delivered and blood sugars and insulins done, feeling so frustrated and incompetent. I have to say that everyone was alive at the end of the shift, and I did not make medication errors, and the evening came to an end eventually. I would not want to repeat it.

There is a reason they call it a medication "run."

Epilogue: When I turned on my phone after I came home, I learned that while I was at work, my mother had died.