The Med Pass That Took Four Hours

My pass used to start at 8 a.m. and end at noon. Not because I had that many medications. Because I spent two and a half hours looking for things that should have been where I was already standing.

I’m a med tech. Sixty-two beds, assisted living and memory care. I’ve been doing this six years. Before this I was a delivery driver. I took the job because the hours were regular and I liked being around older people. I did not take the job because I enjoyed detective work.

A med pass is not hard because giving pills is hard. A med pass is hard because everything around the pills is broken.

Here is what a four-hour pass looks like. I start with the binder. The MAR is printed the night before, which means anything that changed after 5 p.m. is not in it. I walk into room 12. Mrs. Patterson is not there. She went to the hospital yesterday at 3. Nobody removed her from the MAR, because the night shift didn’t know, because the handoff was a sticky note on the med cart that fell off.

I walk into room 14. Mr. Deluca’s new Lisinopril order is in the chart, but the chart is in the nursing station, and the MAR was printed before the order was entered, so I give the old dose and hope somebody catches it later. They usually do. Sometimes they don’t.

I walk into room 18. Mrs. Okonkwo has a PRN for pain. I need a documented rationale before I can give it. The rationale is in a three-ring binder at the desk, two halls away. I go get it. I come back. She’s in the bathroom. I wait. I give it. I write the time wrong on the paper, cross it out, write it again. That crossed-out entry will be flagged at the next state survey as a documentation error, which it technically is, which is hilarious, because the error exists because I was trying to be accurate.

What the other two and a half hours were

By 9:30 a.m. I have given maybe twelve medications. The pharmacy delivery is supposed to come at 10. At 10:15 I call. They say it left at 9:45. I wait. At 10:45 I call again. It’s in the building, in the administrator’s office, because somebody signed for it and put it there. I walk over. I sort it. Half the labels don’t match the names on my MAR, because the pharmacy uses legal names and my MAR uses preferred names, and on a Monday morning I do not have the mental bandwidth to remember that Dorothy is legally Theodora.

At 11:15 a family member stops me in the hall. She wants to know why her father’s cholesterol medication was discontinued. I don’t know. I look in the binder. It says per physician order, which is not an answer. I say I’ll find out. I never do, because by the time I finish the pass, the doctor’s office is closed for lunch, and by the time they’re back, I’m on a different hall covering someone else’s callout.

At 11:45 I’m in room 22. Mr. Henderson refuses his medication. This is normal. He refuses three mornings a week. I have to offer twice, document the refusal, notify the nurse, and come back later. The documentation alone takes four minutes. I do this for four residents a day. That’s sixteen minutes. That doesn’t sound like much. Multiply it by five days. Then multiply it by the number of med techs in this building. Then tell me that’s not where your labor budget went.

“I used to eat lunch at 2 p.m. Now I eat lunch at 11. That’s not the point. The point is I used to hate my job by lunch. Now I don’t.”

The Tuesday it changed

They told us the new eMAR would go live on a Tuesday. I had been through three software rollouts in six years. I was not optimistic. I showed up at 7:45, signed in, and opened the cart.

The screen had a list. Not a binder. A list, with faces next to names. Mrs. Patterson was grayed out, with a note that said Hospital transfer · 5/17 · 3:12 p.m.She was already gone from my pass. I didn’t have to discover it. I didn’t have to cross her out. She was just gone.

Mr. Deluca’s Lisinopril showed the new dose. The order had been entered at 6:47 a.m. by the night nurse, and it was already there. I didn’t have to go to the chart. I didn’t have to wonder if I was giving the wrong thing.

Mrs. Okonkwo’s PRN had the rationale pre-populated. Not a binder. Not a hunt.Prior documented rationale: lower back pain · given 5/16 at 8:45 a.m. · effective.I tapped it. I gave it. I documented in twelve seconds. She was still in the room. I didn’t have to wait.

The pharmacy delivery

At 9:30 a notification appeared: Pharmacy delivery checked in · building entrance · 9:28 a.m. It listed what was in it. It matched the names on my screen to the names on the labels. Dorothy and Theodora were the same person. The system knew that. I didn’t have to.

I finished the pass at 9:35. I stood in the hallway and didn’t know what to do with myself. Six years of finishing at noon, and now I was done before the first coffee got cold. I went to the break room. I sat down. I ate a sandwich. I cannot explain how foreign that felt.

What came back

The family member stopped me again. She asked about the cholesterol medication. This time I pulled up the screen. I showed her the discontinuation note from the physician, dated, signed, with the reason right there. She read it. She nodded. She said thank you. I didn’t have to make up an answer. I didn’t have to disappear.

Mr. Henderson refused his medication. I tapped offer declined · first offer, and the system queued the second offer for 9:45. I moved on. I came back at 9:45. He accepted. The whole interaction took ninety seconds. The documentation was automatic. Nothing was crossed out. Nothing would be flagged.

What I want to say is not that technology fixed everything. That would be dishonest. What I want to say is that the things that made this job feel impossible were not the pills. They were the friction. They were the looking. They were the not-knowing whether what you were doing was right, because the right information was in seven different places and you only had two hands.

The pass is still the pass. The residents are still the residents. But I am present for them now. Before, I was present for the binder.

— Marcus, Medication Technician · Assisted Living · As told to SeniorCRE^®