Medication line can be daunting for nurses new to the correctional setting. The American Nurses Association Scope and Standards of Professional Practice describe medication administration as a defining feature of correctional nursing and make the point that while the methods of nursing in this setting may differ, the standards of practice remain the same (2013). The correctional nurse may administer medication to a line of 200 or more inmates who gather two, three or four times a day. In addition, the nurse may run med line from a medication cart stationed near the dining hall or by the rec yard or to roll the cart from housing unit to housing unit. Clearly this is not like how medication administration is done in most other clinics, emergency rooms, hospitals or nursing homes. Here are some tips from a previous post by Lorry to make running med line go more smoothly:
- Make sure the medication cart or area is stocked with the things you are likely to need including:
- Patient medications
- Medication administration records (MARS)
- Pen, highlighter and notepad
- Current drug reference book
- Pill crusher and packets if needed
- Pill cups
- Water and drinking cups
- Waste receptacle
- Keys needed to access the medication room, cart, and narcotics container
2. Take these steps before med line:
- Scan the MARS for any new medication orders, any new patients, that each MAR indicates whether the patient has allergies and if so, what the allergy is.
- Check to see that any new medications are available (in the cart or medication room) and if not where it is in the process of getting dispensed and delivered.
- If there are any medications, you are unfamiliar with check the drug reference.
- Make any calculations you need to administer the correct dose.
- Clean the surfaces of the cart and make sure that the water receptacle is washed and ready for use.
- Perform hand hygiene.
3. Follow the steps each time at med line:
- Following the same steps is called habituation and helps you not forget a step, if distracted. When you are consistent in practicing this way it is also easier to manage inmate behavior.
- Use two forms of identification to ensure it is the right patient. Do not rely on your visual memory of what the patient looks like.
- Locate the MAR corresponding to the patient’s name and identification.
- Scan the MAR for medications due.
- Locate the medication and check the medication name, dose, time and route against the MAR.
- Put the medication in a cup.
- Repeat for each medication that is due.
- State the name of each medication to the patient as you prepare to put it into the cup. If it is a new medication confirm that the patient knows its purpose, major side effects or precautions.
- Recheck the MAR and medications in the cup.
- Ask the patient if they have any questions about the medications.
- Watch the patient take the medication, watch for palming and check the patient’s oral cavity for cheeking. Beware of any distractions at this point; diversion is likely.
- Have the patient put the medicine cup into the waste before leaving the medication cart or window.
When med lines are too long: Sometimes nurses are pressured to abandon the rights of medication administration (right patient, right medication, right dose etc.) in the interest of speed because there are too many inmates to medicate in the time available. Here are some options to manage this problem without abandoning your accuracy and jeopardizing the patient’s safety.
- Create a separate time and line for certain medications, like insulin, or those that have tight dosing schedules or certain groups of patients like those just starting a new medication, those on mental health medications etc.
- Suggest establishing a self-administration program if one does not exist.
- Deliver KOP medication in another line.
- Spread patients who are on once daily dosing out among several med lines rather than all in one.
- Collaborate with providers to reduce the volume of prescriptions and dosing. Can a medication be provided once a day rather than twice? Are there prescriptions that could be eliminated, treated with over the counter preparations, or delivered in long lasting form?
- Suggest using the commissary or some way to provide over the counter medications other than med line.
What tips would you give to new nurses about passing medication in the correctional setting? What solutions have you found for the problem of long med lines? Please share your tips and solutions with other correctional nurses by replying in the comments field of this post.
References not hyperlinked in the blog post:
American Nurses Association. (2013). Correctional nursing scope and standards of practice. Silver Spring, MD: American Nurses Association.
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