The source of the problem has not been that the nurses do not know the relevant aspects of clinical medicine nor that they do not know the pertinent procedures. Rather, it is simply that they have not been exposed to long-term care and its unique regulations and requirements. Further, they are not accustomed to the level of scrutiny consultant pharmacists give to mundane tasks such as charting of doses given and preparation of doses for administration. Several in-service programs have now been provided for hospital nurses who have been hired in subacute care units in our facilities. The basic information we provide covers medication pass procedures, rights of nursing home residents, drug interactions and other clinical details, and pharmacy ordering procedures.
Activities surrounding the medication pass are a key focus of our concerns.
While ostensibly similar to acute-care units, our subacute units are different with respect to oral liquids that must be measured, crushing of medications for administration through nasogastric tubes, or patients unable to swallow. Oral liquids are more likely to be available in premeasured unit dose containers in hospitals than in nursing homes. Residents' rights issues also creep into the medication administration discussion. In the subacute care unit, patients are more often confined to bed, but they remain free to ambulate in the facility. Hospital nurses are not accustomed to patients moving freely away from their rooms.