1. Agency for Persons with Disabilities State Curriculum January 2009
Medication Administration and Assistance with Self-Administration of Medication Florida Administrative Rule 65G-7
Agency for Persons with Disabilities State Curriculum
January 2009

2. Florida Administrative Rule 65G-7
Medication Administration Rule
Allows unlicensed staff who are working with clients of the Agency for Persons with Disabilities to
Administer medication or
Supervise the self administration of medication
Gives specific training/validation guidelines
Discusses the do’s and don’t of the Medication Assistant Provider (MAP)
Explains the documentation process
Florida Administrative Rule 65G-7

3. Direct Authority Florida Statutes 393.506 Section (5)
“ The agency shall establish by rule standards and procedures that a direct service provider must follow when supervising the self-administration of medication by a client and when administering medication to a client”
This statute is what gives the APD the authority to write and enforce the Medication Administration Rule.
Direct Authority

4. Outcome of Training Course
Will understand both training and validation requirements
Will demonstrate ability to complete and maintain all required forms
Will understand how to document and communicate determination of need
Will state the six rights of medication administration
Will understand the difference between fully capable of self administration, supervision of self administration and administration of medication
Will understand the importance of information on symptoms of adverse reactions and side effects of prescribed or over the counter medications, and how to locate it
Will understand health care practitioner orders, prescriptions and prescription labels
Will understand how to complete a Medication Administration Record (MAR)
Will be able to discuss safe handling of medications and sanitary conditions
Will understand the allowed routes of medication administration
Will have knowledge of proper preparation and positioning of the client
Will have knowledge of medication errors, disposal of medication and safe storage
Will understand steps that need to be taken when medication is taken off-site
Outcome of Training Course

5. When can I give medications?
After attending a minimum 4 hour class and passing the exam with 80% or above
Once you have completed this course and pass the course exam, you will be issued a certificate of successful completion
After on-site Validation with 100% competency by a RN, ARNP, or MD (APD form 65G7-04)
You will receive a Validation Certificate, with each route you are validated for signed off on the back.
Once you receive a client assignment you will need to make sure the next 2 items are in place:
Authorization for Medication Administration signed by client’s MD, PA, or ARNP (APD form 65G7-01)
Informed Consent for Medication Administration form, signed by client or their legal representative (APD form 65G7-02)
This class is longer than 4 hours!
When can I give medications?

6. On-site validation by route
Must be done on-site, with real client
Must be done by a RN, ARNP, or MD
Must validate with 100% competency
Each Route of medication administration must be individually validated (signed on back of form)
Revalidation must occur yearly
Employer, if any, must also keep a copy available for review
DO ACTIVITY ONE IS SMALL GROUPS, THEN DISCUSS AS A CLASS.
Emphasize that the MAP keeps their original copy of the validation certificate and the certificate from this class… NOT the employer. The employer gets a copy for their files.
On-site validation by route

7. What are “routes?” Approved
The ways that medications can be delivered to the body
MAP’s can administer medication for only approved routes of delivery.
MAP’s can only administer medication via a route that they have been validated for
Approved
Routes of
Delivery:
Oral
Topical
Transdermal
Ophthalmic
Otic
Rectal
Inhaled
Enteral
What are “routes?”

8. Client/guardian Informed Consent
(APD form 65G7-02)
Signed by client or client’s authorized representative
May be filled out with the agency (ie: abc group home) or individual MAP’s name in the provider space
Kept in client record readily accessible for review
Client/guardian Informed Consent

9. Authorization for Medication Administration 65G-7.01
The Authorization Form
Three levels of “ABILITY”
Must be completed by an MD, PA, or ARNP for clients annually or with any changes to health status or ability
Keep with clients record, easily accessible for review
Fully capable of self administering own medication without supervision
Requires supervision while administering own medication
Requires medication administration
Authorization for Medication Administration 65G-7.01

10. “Fully capable of Self Administration” What does this mean?
These clients may take their own medications by themselves, without supervision
A MAR is not kept (document only what you do)
The client may need a little help with reminding, reordering or getting medication from the pharmacy
Not required to lock up medication in own home
Storage:
May use pill minder
Keep in locked container if client lives in GH or multi- person SL
Under certain circumstances medication may need to be centrally stored
Medication threatens health, welfare or safety of the client or others
Client does not keep medication in locked place
Physical arrangements or habits of other clients makes it unsafe
Client or their authorized representative asks for the medication to be centrally stored
“Fully capable of Self Administration” What does this mean?

11. Supervision of self administration
Will need properly trained and validated MAP complete this task
Tasks will not be the same for every client
MAP may complete the following duties
Prompt and observe client taking medication
Confirm the client is taking dosage as prescribed
Assist clients when there is something they can’t do
Document on MAR
Medication must be centrally stored
Supervision of self administration

12. Supervision of Self Administration
Supervision of Self Administration of medication includes instructions or any other assistance necessary to ensure the correct self administration of medication.
Client may be able to take oral medications – but cannot give themselves eye drops, or insert a rectal suppository
Client may be able to identify the medications needed, and the route…but may be unable to remove the medication from the container, or put the medication in their mouth without help
Client may be able to self administer a topical medication in an easy to reach area, but need the MAP to apply it on a less easy to reach area
MAP must assist with every scheduled medication delivery
MAP documents on MAR that they observed the client appropriately received the scheduled medication
Supervision of Self Administration

13. Administration of Medication
Clients are not yet able to safely give their own medications
MAP must prepare and give medications
MAP must document immediately on a Medication Administration Record (MAR)
Medication must be centrally stored
Administration of Medication

14. Training and encouragement for clients to become independent is central to the views of this agency.
Your input can be very helpful to health care practitioners when deciding on the client’s capabilities.
Reviews must be done annually and/or upon health status change
DO ACTIVITY TWO IN SMALL GROUPS – EACH GROUP GETS ONE QUESTION. HAVE EACH GROUP PRESENT THEIR QUESTION.
Goal is Independence

15. Does Administrative Rule 65G-7 Apply to EVERYONE?
NO, it does not.

16. Health care practitioners whose licenses include medication administration-LPN’s RN’,s, etc.
A client’s family members or friends who provide assistance with medication with out compensation
Providers employed by or under contract to: Intermediate Care Facilities for the developmentally disabled, home health agencies, hospices, health care service pools, or assisted living facilities.
Clients who are authorized to self administer their medications without supervision.
Who is exempt?

17. Six Rights of Medication Administration

18. What rights do clients have?
Safely give medication by practicing the Six Rights of Medication Administration
Right Client
Right Medication
Right Dosage
Right Time
Right Route
Right Documentation
What rights do clients have?

19. Prescription is ordered for your client
What happens next?

20. Tracking and Documentation
Health care practitioner writes the prescription
MAP makes copy of the prescription for the client record and takes original to pharmacy
Current copies in the MAR for reference
Archive discontinued prescription orders
Write prescription order on the client MAR
When medication is picked up or delivered from pharmacy
Compare label with copy of prescription and with MAR
All information must match
Medication should be started in a reasonable time frame (within 24 hours)
Medication is given as prescribed
Document on MAR
Tracking and Documentation

21. Who can write a medication order?
Medical Physician or Psychiatrist (MD)
Osteopathic Physician (DO)
Advanced Registered Nurse Practitioner (ARNP)
Physician Assistant (PA)
Dentist (DDS or DMD)
Optometrist (OD)
Podiatrist (DPM)
Who can write a medication order?

22. Pharmacist duties Dispenses Labels Packages
Only pharmacist can change a label
Only pharmacist can write on a label
Only pharmacist can transfer from one container to another
Pharmacist duties

23. What is on a prescription label?
Example (PRN)
Name
Strength
Route
Amount
Time
Reason for use
Condition to notify MD
Maximum number of doses
Tylenol
325mg
By mouth
2 tablets (650mg)
Every 4 hours
Fever> 101F
Fever> 102F
3 days
What is on a prescription label?

24. Manufactures Labels for OTC medications
Will contain
Name of medication
Strength of medication
Purpose of medication
Amount of medication included in container
Directions for use
Active and inert ingredients
Possible side effects
Warning- possible drug interactions, maximum dosage
Storage conditions
Name and address of the manufacturer
Expiration Date
Lot number
Manufactures Labels for OTC medications

25. What you need to know! All medication must be properly labeled
Sample Medication:
Must be accompanied by a prescription
Maintained in original container
Labeled by dispensing healthcare practitioner
Clients name
Practitioners name
Directions for administering the medications
The MAP must initial the label and add the date the medication was opened
What you need to know!

26. You can not change a prescription label.
The physician may
Change the dose or time of medication
All changes must be in writing on a prescription and taken to the pharmacy to dispense the appropriate medication with the appropriate label
Write “as directed” on the prescription
You will need to get more specific directions in writing before medication can be given
Try to give you verbal order
You must ask the physician to fax the order since all orders must be in writing.
You can not change a prescription label.

27. Healthcare Practitioner must provide written directions that include:
Then name of the medication
The prescription number, if applicable
The prescription dosage
Specific directions for use, including medical reason for the medication, the time intervals for administration, the maximum number of doses, the maximum number of days that the medication should be administered and conditions under which the health care practitioner should be notified
PRN medication

28. Controlled Medications
Medication that is regulated under the jurisdiction of the Controlled Substance Act of 1970
Abuse is the highest with schedule I drugs
Five groups (scheduled I thru V)
Example:
Schedule II:
Ritalin, Codeine, Demerol, Duragesic patch, Percocet
Schedule IV:
Phenobarbital, Valium, Ativan
Controlled Medications

29. Documentation of Controlled Drugs
When do I document?
Pharmacy provided form stamped with “C”
On the MAR immediately after administration
Control Medication Count Sheet (APD form 65G7.07)
To verify count accuracy
Must be signed by two providers
Your responsibility to count and document as directed by rule
Must report any medication discrepancies to supervisor
Documentation of Controlled Drugs

30. How to store controlled drugs
Stored separately from other prescriptions or OTC drugs
Double Locked
A locked container
A locked enclosure
How to store controlled drugs

31. Forms of Packaging Labeled Bottles Bubble packs or bingo cards
Color coding on packaging for different time periods (only developed by the Pharmacy)
Unit dose dispensing systems
Show different forms of packaging you have brought with you
Forms of Packaging

32. Abbreviations po by mouth a.c. before meals p.c. after meals
prn as needed
QD every day
QOD every other day
Tab tablet
Q3h every 3 hours
QID or qid four times per day
sig label
TID or tid three times per day
U units
a.c. before meals
ad lib as directed
BID twice a day
cap capsule
d/c or D/C discontinue
gtt drop
H.S. or h.s hour of sleep
mg milligram
ml milliliter
od right eye
os left eye
ou both eyes
Abbreviations

33. Abbreviations - continued
When writing on a MAR it is best NOT to use the abbreviations. While many health care practitioners use them, abbreviations have been identified as the main cause of many medication errors.
VERY CONFUSING
QD, QID, QOD (look similar)
PO, pc, pr, prn (look similar)
CAN YOU SEE WHY IT IS BEST NOT TO USE ABBREVIATIONS?
Abbreviations - continued

34. Procedures for Routes of Medication Administration
How to give medications
You may demonstrate/practice each route as they are covered, or at the end of this section. There is a class activity to be done at that time, as well.

35. Medication Administration for Oral Route
Wash your hands.
Gather equipment – medication spoon or syringe, medicine cup, pill cutters or crushers, paper towels, glass of water or other liquid with which to take or follow medication.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR and check expiration dates.
Make sure you follow any special instructions, for instance “take on empty stomach,” “take with food,” “check pulse and hold for pulse less than 60,” “do not give if client is having diarrhea.”
Medication Administration for Oral Route

36. Oral Medication Place a dot on the MAR.
Pop or pour the medication into a medication cup – remember to pour a pill from the container into the lid, then into the medication cup. If you pour too many into the lid, you can pour them back into the bottle and try again. Do not touch with fingers.
For liquid medications, shake bottle before pouring (as directed by label), make sure that the cup is on a level surface for accurate measuring, pour away from the label. Wipe the lid and neck of the bottle with a dampened paper towel before returning to storage. Read the amount of medication at the bottom of the curve of the liquid in the medication cup at eye level.
Crush medications if directed to do so, and mix with applesauce, pudding, or ordered substance.
Compare the label on the medication to the directions on the MAR again.
Oral Medication

37. Oral Medications - continued
Return the medication to the storage area and lock.
Hand the medication cup to the client, followed by glass of liquid with which to swallow the pills. Verify that the client swallows the medication. Give pills first, liquids last. If giving a medication for cough, it should be given last to coat the throat.
Again check the label against the MAR. Sign the MAR and blister pack, if used.
Wash your hands.
Document on the MAR. Controlled substances requires additional documentation on the Controlled Drug Count Form (see attached)
Check on client and assist to comfortable position, if needed.
Check client for response to medication, especially if PRN medication.
Oral Medications - continued

38. Buccal or Sublingual Wash your hands.
Gather equipment-medication cup, gloves, glass of water or other liquid with which to take or follow medication.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR and check expiration date.
Make sure you follow any special instructions, for instance “take on empty stomach.” “take with food,” “check pulse and hold for pulse less than 60,” “do not give if client is having diarrhea.”
Place a dot on the MAR.
Pop or pour the medication into a medication cup-remember to pour a pill from the container into the lid, then into the medication cup. If you pour too many into the lid, you can pour them back into the bottle and try again. Do not touch with fingers.
Compare the label on the medication to the directions on the MAR again.
Buccal or Sublingual

39. Buccal or Sublingual - continued
Return the medication to the storage area and lock.
Hand the medication cup to the client and instruct them to place the medication under their tongue if sublingual, or between cheek and gum if buccal. If the client is unable to do this, carefully place the medication in the appropriate spot yourself.
Instruct the client not to drink liquids until the medication has dissolved and been absorbed.
Tell the client not to swallow the pill, and to let it dissolve Again check the label against the MAR. Initial the MAR and blister pack, if used.
Wash your hands.
Document on the MAR. Controlled substances require additional documentation on the Controlled Drug Count Form (see attached).
Check on client and assist to comfortable position, if needed.
Check client for response to medication, especially if PRN medication. (if PRN medication document response on back of MAR)
Buccal or Sublingual - continued

40. Inhaled (such as albuterol)
Wash hands.
Gather equipment – spacers, glass of water, tissue,
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR.
Place a dot on the MAR.
Remove the cap from the inhaler and ensure that mouthpiece is clean; shake if indicated.
Ask the client to exhale and then place the mouthpiece, tilted slightly upward, into his/her mouth. Instruct the client to close lips around mouthpiece.
Use a spacer attached to the mouthpiece as instructed if the client is unable to close lips around mouthpiece.
Ask the client to inhale slowly as you push the cylinder of the medication down against the mouthpiece one time.
Inhaled (such as albuterol)

41. Ask the client to hold his/her breath for several seconds.
Remove the mouthpiece from the client’s mouth.
Ask the client to exhale slowly through pursed lips.
If a second puff is required, wait at least one minute between each puff, and then repeat above instructions.
Ask the client to rinse out his/her mouth.
Rinse the mouthpiece with warm water, dry with a paper towel, and recap.
Wash hands.
Store medication in proper locked area.
Document on the MAR.
Have the client use any inhalers first and then take oral medications.
Inhaled - continued

42. Dry powder inhalers (such as Advair)
Follow the steps above for inhalers through step 6.
Pull back the dose lever until it clicks into place. Do not tilt the inhaler, and ask the client not to breath into the inhaler.
Ask the client to exhale.
Place the mouthpiece into the client’s mouth, and instruct the client to close his/her lips around it.
Instruct the client to inhale forcefully and deeply.
Continue with steps for inhalers, above.
Document on the MAR.
Have the client use any inhalers first and then
take oral medications.
Dry powder inhalers (such as Advair)

43. Nose spray Gather paper towels or tissues and gloves
Wash hands
Gather paper towels or tissues and gloves
Verify the first five Rights of Medication Administration
Unlock the medication storage area – remove one client’s
medication at a time
Select the needed medications, making sure to compare the label
to the order or prescription to the MAR
Place a dot on the MAR
Put on gloves
Ask the client to blow his/her nose gently to clear the nasal
passages
Ask the client to tilt his/her head backwards, making sure the neck
is supported
Elevate the nostrils slightly by pressing the thumb against the tip
of the nose
Nose spray

44. Hold the spray just above the client’s nostril, without touching it.
Use spray as directed by the prescription or order
Ask the client to inhale slowly and deeply through the nose, hold breath for several seconds and then exhale slowly.
Client may blot nose with tissue, but ask client not to blow nose for several minutes following instillation
Rinse the tip of the spray bottle with hot water or wipe with an alcohol pad and dry with tissue before recapping
Remove gloves and dispose of properly
Place medication back in locked storage area
Wash hands
Document on the MAR
Nose spray - continued

45. Follow the directions for nasal sprays above, making sure to use the correct number of drops.
Do not touch the nostrils with the dropper.
Document on the MAR.
Nose drops

46. Transdermal – self adhesive patches
Wash hands.
Gather equipment – gloves, washcloth and towel.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR.
Place a dot on the MAR.
Provide for privacy for client.
Wear gloves; check client for latex allergies if using latex gloves.
Remove old patch and dispose of appropriately.
Transdermal – self adhesive patches

47. Transdermal patches - continued
Make sure site for new patch is clean and dry. If needed, clean area with soap and warm water and then pat area dry. Do not apply over a bony prominence such as the collarbone or shoulder blade. Do not apply the patch over a pacemaker site. Apply in a hairless area. Apply the patch to a different site with each new patch application. Avoid areas of increased warmth (such as the back if bed-ridden) which would promote faster absorption. Do not apply to areas with redness, rash, or broken skin. Report these areas to your supervisor.
Open the package and remove the patch.
Date and initial the patch.
Remove the backing from the patch.
Apply the patch to the chosen spot, pressing firmly around the edges to adhere.
Apply, and cover patch, if applicable, making sure it is dated and initialed.
Remove gloves and dispose of properly
Place medication back in locked storage area.
Wash hands.
Document on the MAR.
Transdermal patches - continued

48. Topical (ointments, lotions, creams, sprays)
Wash hands.
Gather equipment – gloves, applicators, wash cloth and towel, water.
Verify first five Rights of Medication Administration, making sure you understand where on the client’s body the medication is to be applied.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR.
Place a dot on the MAR.
Provide for privacy for client.
Wear gloves: check client for latex allergies if using latex gloves.
Make sure site for medication is clean and dry. If not, cleanse gently with soap and warm water and pat dry, unless the prescription directions say otherwise. Previous medications are usually removed before applying additional medication, except for lotions which are used for soothing the skin).
Topical (ointments, lotions, creams, sprays)

49. Squeeze a small amount of medication (if a cream, ointment, or lotion) onto the applicator. Always shake lotions to activate ingredients. If applying to a large surface area, warm lotions/creams in hands before use so the client does not chill. Keep powder away from the nose and mouth to keep the client from inhaling it. If applied to the face, apply while the client exhales. If applying nitroglycerin ointment, measure in centimeters or inches on special provided paper or applicator. Do not apply to areas with redness, rash, or broken skin unless you are treating that area (rash).
Apply gently to correct site.
If a spray, hold the can about 6” away from site and spray.
Discard applicator.
Gently lay dressing over site, if applicable, and secure. MAP may only apply simple dressings which are intended to cover and protect, such as Band-Aids, Telfa or gauze pads.
Discard gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on the MAR.
Topical - continued

50. Eye medications (ointments and drops)
Wash hands.
Gather equipment – gloves, cotton balls or gauze, tissues, wash cloth, towel, warm water, simple dressing, if ordered.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR. Check number of drops and eye (right, left, both).
Place a dot on the MAR.
Wear gloves: check client for latex allergies if using latex gloves.
Assist the client to a comfortable position either sitting or lying down with head tilted back. May turn the head slightly toward the affected side to prevent medication or tears from flowing toward the opposite eye. If using both drops and ointment, administer the drops first and wait 5 minutes before applying the ointment.
Eye medications (ointments and drops)

51. Eye medications - continued
Give client a tissue to remove solution/tears that may spill from eye during the procedure.
Clean eye area if discharge or crusting is present. Use cotton balls moistened with warm water (unless ordered otherwise). Use each cotton ball for only one stroke, starting at the inner eye corner and working outward away from the nose. If using wash cloth instead of cotton balls, rotate to new area of wash cloth with each stroke.
After removing the lid to the medication, place on a clean tissue, on its side.
Gently pull down on the lower eyelid.
Ask the client to look upward.
Approach the eye from the side and drop medication into the center of the lower lid. Do not touch the eye with the dropper, or drop medication directly onto the surface of the eye.
Eye medications - continued

52. Eye medications - continued
If using ointment, gently apply the prescribed length of ointment in a thin line along inner edge of the lower lid moving from the inner corner to the outer corner. Do not touch the eye with the end of the tube. If the client blinks, closes eye, or if drops/ointment lands on the outer lid margin, repeat the procedure
Release the lower lid after the eye drops or ointment is administered.
If drops, ask the client to close eyes slowly, but not to squeeze or rub them. Apply gentle pressure over inner corner of eye to prevent eye drops from flowing into tear duct. If ointments, ask the client to close eye and rub lid gently in circular motion, if rubbing is not contraindicated.
Client may open eyes after 30 seconds and gently wipe off excess medication or tears with a tissue.
If multiple medications are needed for the same eye, you must wait at least 5 minutes between medications.
Remove gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on MAR.
Eye medications - continued

53. Ear (Otic) Medications
Wash hands
Gather equipment – gloves, tissues, clean wash cloth, warm water
Verify the first five Rights of Medication Administration
Unlock the medication storage area and remove one client’s
medication at a time
Select the needed medications, making sure to compare the label
to the order or prescription to the MAR
Place a dot on the MAR
Put on gloves
Assist the client to a comfortable position either sitting with the
head tilted to the side or lying down so that the ear needing drops is up
Warm the medication to body temperature (hold in your hand or
place in a cup of warm water for a few minutes) to minimize
discomfort to the client
Place drops in the ear according to the prescription, letting the
drops fall on the side of the ear canal and not directly on the
eardrum. Take care not to touch the ear with the dropper
Ear (Otic) Medications

54. Ear Medications - continued
Release the ear and have the client hold the head position for at least 2-5 minutes
Allow the client to wipe ear with a tissue
Instill drops in the other ear, if prescribed, using the same procedure
MAP may insert or remove cotton portion (wick) into or from outer part of canal if ordered
Remove gloves and dispose of properly
Place medication back in locked storage area
Wash hands
Document on MAR
Ear Medications - continued

55. Rectal Suppositories Wash hands.
Gather equipment – gloves, tissues, water soluble lubricant (K-Y jelly)
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR.
Place a dot on the MAR.
Return the medication to the storage area and lock.
Explain to the client what you are about to do, and provide for privacy.
Rectal Suppositories

56. Rectal suppositories - continued
Place the client in a side lying position, preferably on the left, with the right leg bent at the knee and drawn up towards the stomach. Keep client covered as much as possible. Place waterproof pad or other absorbent material beneath client’s hips and buttocks.
Remove wrapper and lubricate the suppository rounded end or remove cap and lubricate tip (if applicable) and finger tips with a water soluble gel (K-Y jelly).
Separate the buttocks and then have client relax by breathing slow, deep breaths through the mouth while the suppository is gently inserted through the anus about 4 inches for adults and 2 inches for children and infants. Do not attempt to push the suppository through stool. Instead try to place it along the side of the rectal space.
Rectal suppositories - continued

57. Rectal suppositories - continued
Hold the buttocks together, or press lightly against the anus with a tissue until the urge to push the suppository out has passed. Ask client to remain on side or flat for at least 5 minutes.
Remove gloves and disposes of properly.
Assist client to rearrange clothing, etc. Be sure that client understands that he/she is to retain the suppository, usually for minutes after insertion. Have some way (bell) for client to alert staff of urgency if the suppository was a laxative or stool softener.
Wash hands
Document on MAR.
Observe and record effects of suppository in comments section of MAR
Rectal suppositories - continued

58. Enemas (such as Fleet’s)
Follow steps 1-9 for suppositories
Remove cap and gently insert lubricated enema tip slowly into rectum until the entire tip is in the rectum (3-4 inches). If the tip is not lubricated use a water soluble gel (such as K-Y) to lubricate. It is best to guide along the rectal wall, and not try to push it through any stool that may be present.
Gently squeeze the enema bottle slowly (to prevent cramping) to expel the contents into the rectum and colon.
Enemas (such as Fleet’s)

59. If the client begins to cramp, stop squeezing until the cramp eases and then resume squeezing slowly. Encourage the client to hold the enema for as long as possible until the urge to have a bowel movement occurs (at least 2-5 minutes).
Assist the client to the toilet, bedside commode, or bedpan, if necessary. Attend to any cleaning of the client that is needed.
Remove gloves and dispose of properly
Wash hands
Document on MAR. Also document results of enema per your company policy and in the comments section of the MAR.
Enemas - continued

60. For clients receiving continuous feeding through their tube, make sure to turn the feeding off at least 30 minutes before giving medication. Get a written order for when to pause pump and for when to resume feeding.
It is extremely important that you understand how to use the type of tube a particular client has. If at any time you are asked to give medication through a tube or device with which you are unfamiliar, you must ask for help. You may need to be validated by a RN or MD if the device is unfamiliar to you. Check with your supervisor.
Remember
These are general instructions for giving medications through a feeding tube. Check with the prescribing health care practitioner about specific instructions for the client you are assisting.
Enteral (G tube)

61. Enteral medications - continued
Wash hands
Gather equipment – gloves, extension tubing, cup, warm water, pill crusher, 30-60cc oral, enteral, or catheter tipped syringe.
Verify the first five Rights of Medication Administration.
Unlock the medication storage area and remove one clients medication at a time.
Select the needed medications, making sure to compare the label to the order or prescription to the MAR
Prepare the medications as appropriate for administration through the tube – remember that you need an order to crush, dissolve, or dilute any medications. Mix each crushed medication with 10-30cc warm water to dissolve. Remember that each medication must be mixed and administered separately from others.
Enteral medications - continued

62. Enteral medications - continued
Place a dot on the MAR.
Position the client appropriately. If in bed, the head of the bed must be elevated at least 45 degrees in the position that is specific to that individual. Explain to the client what your are going to do.
Put on gloves.
Connect the extension tubing, if necessary.
Flush the tube with at least 30cc of warm water, or the amount ordered by the health care practitioner. Do not force a flush if the tube is not flowing easily. Contact your supervisor.
Enteral medications - continued

63. Enteral medications - continued
Pour the medication into the syringe, and allow to flow slowly by gravity.
Flush with at least 5cc water via gravity after each medication.
Repeat the above two steps with each medication until all medications are given. It is a good idea to give liquid medicines first, medicines that need to be dissolved second, and thick medications last.
Once all medications are administered, flush the tube with at least 30cc warm water via gravity, or the amount ordered by the health care practitioner.
Enteral medications - continued

64. Importance of positioning
For Medication Administration

65. Positioning for Medication Administration
PO – by mouth
Ophthalmic – eye
Otic – ear
Topical medications
Sitting upright
Sitting upright with head tilted back and supported – OR lying on back with head tilted back over a pillow
Lying on the opposite side medication is given. May turn to the other side after 5 minutes if medication ordered for both ears
No specific positioning is needed. If possible, keep the client off of the body part being treated for a few minutes.
Positioning for Medication Administration

66. Positioning - continued
Transdermal Patches
Nasal drops and sprays
Inhalers
Rectal
Enteral – G-Tube
No specific positioning
Sitting with the head tilted back and supported OR lying in bed with the head tilted back
Sitting upright in chair or in bed with head of bed at a 45 degree angle
Side lying – preferably on left side with right knee bent with knee pulled up towards stomach
Lying in bed with head of bed at a 45 degree angle or higher OR sitting upright in a chair
DO ACTIVITY 3. PLACE SCENARIOS PROVIDED ON INDEX CARDS OR SLIPS OF PAPER. PAIR UP STUDENTS AND ROLE PLAY IN FRONT OF CLASS, WITH ONE PERSON ACTING AS THE MAP AND THE OTHER AS THE CLIENT. HAVE THEM FILL OUT MOCK MARS TO THE BEST OF THEIR ABILITY, AND HAVE LABELED MEDICATION CONTAINERS AND SUPPLIES AVAILABLE FOR USE.
Positioning - continued

67. Documentation on a MAR
Prescription, OTC, PRN

68. What is a MAR? Medication Administration Record Legal Document
Document after medication has been swallowed, applied, inhaled, inserted, etc.
Cannot change any entries (even errors)
Clarifications made in note section on back
MAP initials and signature for identification
Hand out MAR here
What is a MAR?

69. What form do I have to use?
Pharmacy generated MAR
APD approved form (65G7.00)
Facility generated with required information
Client’s name
Allergies to food or medication or other substances
Name of each medication the client takes
Strength
Date ordered
Date changed or discontinued
Prescribed dosage –for instance 10mg or 10mg tab, give two tabs
Time
Route
Instructions for crushing, mixing or diluting (if applicable)
Dates each medication to be given
What form do I have to use?

70. Check to make sure the HCP order, the printed section on the MAR and the label all read the same (no abbreviations)
Initial the MAR immediately after successful administration (be sure your full signature is also in the space provided)
To ensure safety: here are some tips
a updated picture of the client should be in the MAR (best practice –not required)
develop system to check the prescription label with the MAR at the beginning of the month or with medication changes (to ensure accuracy)
at each administration check prescription label with MAR documentation and client name (place dot in box if all match)
put initials in box once medication has successfully been administered (use the code system in rule for medication not administered as prescribed)
MAR? What is my role?

71. Missed medication! What do I do?
How to Document
Determine the reason
Place your initials in the space provided on front of MAR and circle initials
On the back of the MAR explain reason for missed medication (using the code and explanation when necessary)
Code established by Rule
Home visit
ADT/School/Work
ER/Hospitalization
Refused/Chose not to
Medication not available
Held per MD order/NPO
Other
# 5, 6, and 7 must be accompanied with an explanation on the back of the MAR
Make sure you notify the designated person for your facility
Missed medication! What do I do?

72. YOU MUST! Identify the right client One client at a time
Give medication at the correct time
Only medication properly ordered, labeled, dispensed
Be sure medications are filled on time
Make sure medication has been swallowed
Understand how to operate equipment (if applicable)
Check for all special instructions
Report all problems
Be sure to document
Educate
Be kind and friendly and assist as needed
Observe
At least for 20 min
The person who prepares the medication must administer the medication to the right client. To identify the correct client you may call the client by name, ask the client to tell you his/her name (if possible), use a photo ID, if present in MAR, or ask another staff member to identify client
You may give the medication up to one hour before or after the designated time and always make sure the client swallows the medication before documenting it as given. If you are having problems, for any reason, notify your supervisor per agency policy. Also notify your supervisor if medication is not refilled timely. The goal is to educate the client and to encourage independence. Be sure to listen to your client. For the clients who need more support you must observe for adverse reaction or side effects. Twenty minuets is recommended but please be aware that time frame of reaction may vary per client. Always check for doctor ordered special instructions that are critical to the medication that is being administered.
YOU MUST!

73. Is there anything I cannot do?
Prepare syringes for injections
Vaginal or tracheotomy medications
Mix or pour medication administered through a positive pressure breathing machine
Irrigation or debridement of skin
Medications that require judgment
Medications prepared by others
Medication that has to be cut (may break a scored tablet, if necessary)
MAPs may not administer or supervise the administration of an injection, vaginal medication or any medication that would be administered through a tracheotomy tube. MAP’s may assist or supervise clients with medication through a positive pressure breathing machine if the MAP is properly trained on the equipment by a certified equipment technician, respiratory therapist, or registered nurse. Remember a certificate of training must be issued and kept in client file. The MAP may not do any dressing changes. The MAP may reinforce dressings to keep body fluids from contaminating clothing, etc. (such as band aids, telfa pads or gauze dressings) MAPs may not change or apply dressings to decubitus ulcer (bedsores) or surgical wounds that require packing, or irrigation. In doubt- ASK a SUPERVISOR.
Always ensure ALL SIX RIGHTS HAVE BEEN MET!
Is there anything I cannot do?

74. Use either the APD approved form, pharmacy generated MAR or facility generated form
Documentation required
Client’s name and allergies
Name of prescribing HCP
Date medication ordered
Name, dose, route, directions for use and when HCP needs to be notified
Date, time and MAP initials each time used (do not forget the MAP signature at bottom of page)
DO ACTIVITY FOUR HERE. MAKE SURE ALL PARTICIPANTS HAVE A BLANK MAR. PRACTICE TRANSCRIBING THE SCENARIOS ONTO THE MARS.
Points for discussion include: Does the prescription or order give enough information? Which MAR should be used? Are missed medications properly documented?
How do I document PRN’s?

75. Where are documents kept?
MAR
All current
Prescriptions
Controlled medication form
Authorization form Medication Administration
Current Informed Consent
Current Drug Information Sheet
Remember to Archive all old information
Depending on where the client lives, there may be a MAR book for the entire facility with all clients included (usually seen in group Homes), or each client may have a separate record that includes the MAR (usually in supported living or family home). Wherever the current MAR is, the information about side effects, adverse reactions, and drug interactions for each medication should be kept in the back of that clients MAR, or in a separate book that is READILY available for consultation. Copies of prescriptions or orders for current medications are kept in the same area of the book or record. It is good to have copies of any lab report or consultations related to these medication also with the MAR.
Where are documents kept?

76. Common Medications and Their Side Effects
The next slides are examples of classes of drugs and the most common medications in each. Refer to your handouts for more complete lists.

77. Cardiovascular System Medications
Vasodilators……Nitroglycerin, Isosorbide
Diuretics……Lasix, HCTZ, Aldactone… many others
Antihypertensives…Lopressor, Calan, Captopril…many!
Antiarrhythmics…Digoxin, Lanoxin, Quinora, many more
Anticoagulants…Warfarin, Coumadin, Plavix, others
Most side effects come from over dosage. Report headache, nervousness, “pounding pulse,” weakness, flushing of skin, or fainting immediately!
Monitor the use of aspirin with anti-coagulants – both thin the blood, used together, may cause bleeding.
Cardiovascular System Medications

78. Respiratory system medications
Antitussives… cough suppressants like Codeine, Dimetapp-DM, and many others.
Expectorants… break up thick mucus. Examples are Robitussin, Mucinex, many others.
Decongestants…reduce swelling, dry up mucous membrane. Examples are Neo-Synephrine, Sudafed, Afrin, others. May come as nasal sprays, or oral medications.
Bronchodilators… relax and expand the bronchioles. Usually an inhaler such as albuterol, Advair, theophylline
Respiratory system medications

79. Medications for the skin
Common ones you are familiar with – Calamine lotion, neosporin, triple antibiotic ointment or lotion, zinc oxide, moisturizers, anti- fungals, hydrocortisone creams, alcohol, betadine. Do you know what each of these is for?
Less common… Parasiticides such as Kwell, or Nix. These kill parasites like scabies or lice.
Skin medications may be sold over-the-counter – but if they are medicated they require a doctor’s order to use.
Medications for the skin

80. Urinary system medications
Antibiotics – urinary tract, bladder, and kidney infections. Cipro, Bactrim, Septra, Macrobid are examples
Analgesics – relieve pain from UTI. Pyridium is one. These drugs may stain the urine bright ORANGE. Make sure clients or caregivers know this so they are not alarmed.
Benign prostatic hyperplasia drugs – increase urinary flow when an enlarged prostate is present…Flomax, Proscar, Uroxatral are some.
Diuretics – increase urine flow for persons with kidney disorders… Lasix (furosemide), Dyazide (triamterine), HCTZ
Urinary system medications

81. Gastrointestinal System medications
Most chronic gastrointestinal (stomach or digestive system) problems require physical care and oversight by a medical professional, as well as medication.
Antacids – relieve gastric and ulcer pain… Milk of Magnesia, Maalox, Gelusil, Mylanta are some of these
Acid Blockers – Block the production of acid by the stomach… examples include Zantac, Prilosec, Axid
Antiflatulents – relieve gassiness and bloating… Phazyne, Di-Gel, Mylanta, Gas-X and others
Emetics – cause vomiting in case of poisoning… Ipecac
Anticholenergics/antispasmodics – treat ulcers and irritable bowel syndrome… Levsin, Bentyl (dicyclomine)
It is important to take GI medications as ordered. Often, the orders will tell you to give these medications “30 minutes before eating” or “on an empty stomach.” Many of them will not work as intended if the directions are not followed.
Gastrointestinal System medications

82. More Gastrointestinal medications
Anti-inflammatory drugs – treat colitis… Medrol and Prednisone
Gastrointestinal stimulant – speeds transit time of food through the bowel, relieves nausea, promotes gastric emptying… Reglan (metoclopramide) Persons on this drug should be observed for jerky movements of the limbs or face (tardive dyskinesia) regularly. If noted inform the person’s doctor immediately.
More Gastrointestinal medications

83. More gastrointestinal medications
Medications for Constipation – MANY!!!
Stimulants… Castor oil, Senokot, Dulcolax, Ex-lax
Saline… Milk of Magnesia, Epsom Salts, Saline Enemas
Bulk formers… Metamucil, others
Emollients and Lubricants (stool softeners)… Colace (docusate), Peri-Colace, Senokot-S, mineral oil enemas
The best laxative of all: plenty of fluids – especially water!
Take care that persons taking bulk forming medications like Metamucil drink plenty of fluids. Bulk formers can make constipation worse if enough fluids are not supplied.
More gastrointestinal medications

84. Endocrine system Medications
Antidiabetic agents – oral – used to control blood sugar levels… Glucotrol (glipizide), Glucophage (metaformin), Micronase Diabeta (glyburide), others
Antidiabetic agents – injectable – used to control blood sugar levels… Humalog, Novolin, Humulin, others
Hormonal drugs – for thyroid, pituitary, and/or adrenal glands, pancreas, ovaries and testes… Synthroid, Pitressin (vasopressin), ACTH (corticotropin), estrogen, Androderm, birth control pills and patches
Ensure that residents take these medications at their regularly scheduled times. DO NOT MISS DOSAGES. If the resident stops taking this medication, notify the health care provider
Please remember that MAPs are not permitted to assist with injectable medications. If a client is authorized to self administer without supervision, a MAP may remind them that it is time for them to take their medications, and may bring the medications to the client – but they may not fill syringes, inject medications, or supervise a client who is using injectables.
Ensure that residents take these medications at their regularly scheduled times. DO NOT MISS DOSAGES. If the resident stops taking this medication, notify the health care provider.
Please remember that MAPs are not permitted to assist with injectable medications. If a client is authorized to self administer without supervision, the MAP may remind them that it is time for the medication, and may bring the client the medication – but a MAP may not fill a syringe, inject medications, or supervise a client who is using injectables.
It is ok for a MAP to perform a blood glucose check (fingerstick) – as long as the fingerstick is NOT associated with the administration of insulin.
Endocrine system Medications

85. There are many of these… Dilantin (phenytoin), Depakote, Tegretol (carbamazepine), Klonopin (clonazepam), Neurontin (gabapentin), and others
It is VERY important that these medications are taken as ordered, and that doses are not missed! Many clients will be taking more than one medication of this type.
Watch for: slurred speech, dizziness, insomnia, twitching, headache, increased eye movement, confusion
Seizure Medications

86. ANTI-DEPRESSANTS PSYCHIATRIC MEDICATIONS BRAND NAME GENERIC NAME
Elavil
Amitriptyline
Norpramin
Desipramine
Tofranil
Imipramine
Pamelor
Nortriptyline
Sinequan
Doxepin
Ludiomil
Maprotiline
Paxil
Paroxetine
Prozac
Fluoxetine
Wellbutrin
Bupropion
Zoloft
Sertraline
Desyrel
Trazodone
PSYCHIATRIC MEDICATIONS are given to decrease the symptoms of mental disorder. Each medication helps a certain set of symptoms.
ANTI-DEPRESSANTS are used to decrease symptoms of depression such as troubled concentration, loss of enjoyment, changes in sleeping and eating patterns, or thoughts of wishing to die.
ANTI-DEPRESSANTS

87. ANTI-ANXIETY PSYCHIATRIC MEDICATIONS BRAND NAME GENERIC NAME Ativan
Lorazepam
Klonopin
Clonazepam
Librium
Chlordiazpoxide
Serax
Oxazepam
Tranxene
Clorazepate
Valium
Diazepam
Xanax
Alprazolam
Buspar
Buspirone
Medications are given to decrease symptoms of anxiety such as panic, intense fears, repetitious thoughts, stomachaches, fast breathing and heartbeat, and tremors. THESE MEDICATIONS ARE OFTEN HABIT FORMING.
ANTI-ANXIETY

88. ANTI-PSYCHOTIC MEDICATIONS
BRAND NAME
GENERIC NAME
Mellaril
Thioridazine
Stelazine
Trifluoperazine
Thorazine
Chlorpromazine
Trilafon
Perphenazine
Navane
Thiothixene
Loxitane
Loxapine
Moban
Molindone
Clozaril
Lozapine
Risperdal
Risperidone
Haldol
Haloperidol
Prolixin
Fluphenazine
Zyprexa
Olanzapine
Seroquel
Quetiapine
are given to decrease symptoms of psychosis such as hallucinations, delusions, or disorganized thinking.
Some side effects that are associated with anti-psychotic medications are dangerous. Tardive dyskinesia is often seen in persons taking anti-psychotic medications. Untreated the symptoms that are characteristic of this side effect can become permanent. These include involuntary movements such as facial tics; facial grimacing, eye blocking, lip smacking, tongue thrusting, foot tapping, shuffling gait, head nodding, and moving ones head to the back or to the side. If you notice any of these symptoms, notify the health care provider as soon as possible. One of the most serious side effects is a life threatening problem called neuroleptic malignant syndrome (NMS) which is a medical emergency. You would suspect NMS if the client has a high fever, stiff muscles, sweating, fast or irregular heartbeat, change in blood pressure, and confusion.
ANTI-PSYCHOTIC MEDICATIONS

89. PSYCHIATRIC MEDICATIONS
BRAND NAME
GENERIC NAME
Lithium
Lithobid, Lithium
Eskalith
Tegretol
Carbamazepine
Depakote
Depakene, Valproic Acid
MOOD STABILIZING MEDICATIONS are used to treat the symptoms of mania such as not sleeping for several nights, frantic highs, and drastic lows.
Lithium Toxicity occurs when the body has too much lithium and is a potentially life-threatening side effect. It can also occur due to dehydration. Dehydration results from diarrhea, too much alcohol, a bad sunburn, vomiting or anything that causes the person to lose a lot of body fluids.
Some or all of the following symptoms would be present if a person is suffering from lithium toxicity: slurred speech, mental confusion, vomiting, diarrhea, severe muscle tremors, severe drowsiness, poor coordination, and coma. If a resident is showing these signs contact the health care provider immediately or call 911.
MOOD STABILIZING MEDICATIONS

90. UNDERSTANDING SIDE EFFECTS OF MEDICATION
A side effect is the body’s reaction to a medication, which is different from that which was intended by the health care provider. There are some general side effects that you should be aware of. Some mild side effects can be taken care of by simple techniques. More severe side effects should be reported to the consumer’s healthcare provider immediately (these are commonly called ‘adverse reactions’). Your facility should have clear procedures for responding to changes in a client’s condition. These procedures should describe the type of changes which should be documented in the client’s records, when changes should be reported to the supervisor, nurse, or health care provider, and who should call the health care provider. Before administering a medication, find out what your facility’s procedure is. Remember, you are responsible for safely administering the needed medications and for noticing side effects and responding to them in a timely manner.
UNDERSTANDING SIDE EFFECTS OF MEDICATION

91. COMMON MILD TO MODERATE SIDE EFFECTS
SYMPTOM
Eyes sensitive to light
Dry lips or mouth
Occasional upset stomach
ACTION TO TAKE
Wear sunglasses, hat, avoid prolonged sun exposure
Increase fluid intake, rinse mouth with water, offer ice chips or sugarless gum
Drink small amounts of water, eat dry saltines or toast. Do NOT take over- the-counter medications without an order from the health care provider
Call the health care provider if no relief is obtained by following these suggestions.
COMMON MILD TO MODERATE SIDE EFFECTS

92. COMMON MILD TO MODERATE SIDE EFFECTS - CONTINUED
SYMPTOM
Occasional constipation
Occasional dizziness
Tiredness
ACTION TO TAKE
Increase water intake, physical exercise, eat leafy green vegetables and bran cereal, drink lemon juice in warm water
Get up slowly from a sitting or lying down position
Take a brief rest period during the day
COMMON MILD TO MODERATE SIDE EFFECTS - CONTINUED

93. COMMON MILD TO MODERATE SIDE EFFECTS - CONTINUED
SYMPTOM
Dryness of skin
Mild restlessness, muscle stiffness, or feeling “slowed down”
Weight gain
Dark or discolored urine
ACTION TO TAKE
Mild shampoo and soap, hand and body lotion after bathing, seasonal protective clothing
Exercise, short walks, stretching, relax to music
Increase exercise, reduce overeating, watch diet
Increase fluid intake
COMMON MILD TO MODERATE SIDE EFFECTS - CONTINUED

94. Medication Errors

95. Medication Errors Definition
The National Coordinating Council for Medication Error Reporting and Prevention (2005)
“any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures and systems, including prescribing orders; communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use”
Medication Errors

96. What could cause a medication error?
Preparing meds in poor lighting
Pouring meds for more than one client at a time
Pre-pouring medications
DISTRACTIONS!!!
Talking to others
Talking on your cell phone, or texting
Watching TV or listening to the radio
Attending to other tasks while preparing medications
What could cause a medication error?

97. Medication Error (Form 65G7.05)
A medication error is the following action
Wrong medication
Wrong dose
Wrong route
Wrong reason
Wrong client
Wrong time
Not documenting immediately or accurately
Not filling or refilling current medication on time
Giving improperly labeled medication
Failing to conduct accurate medication for controlled medications
Medication errors could be classified as high risk events and low risk events. All errors are to be taken seriously. All errors need to be documented, reviewed and analyzed. All efforts to recognize and prevent medication errors should be built into the providers system to ensure health and safety.
Medication Error (Form 65G7.05)

98. What do I do Next? An error could cause serious harm
Observe (call 911 if applicable)
Notify your supervisor (according to agency policy)
Notify the HCP
Fill out the medication error report
To facility administrator/supervisor
To APD MCM within 24 hours of discovery
Keep error report in client file if in SL or FH
If the medication error was the wrong medication or a wrong dosage, you must watch the client closely for at least 20 minuets or longer. You must immediately report any observed changes in the clients condition. It is best to report the prescribing HCP or call 911 to request emergency service if the client exhibits respiratory difficulty or other life-threatening symptoms. Be sure to document what happened, who you notified and the outcome of the event. If the MAP notices a discrepancy in the accounting of controlled substances they must report by 5PM of the next business day following the discovery of the error to the APD office. You will also need to notify your supervisor.
What do I do Next?

99. Medication Refusal Not a medication error
Clients have a right to refuse some or all of their medication.
What should you do?
Educate and encourage them to take there medication
Notify supervisor and WSC
Notify the HCP
Document in the client record
If the client is incompetent or a minor
Notify the Guardian and WSC immediately
Document in client record
Medication Refusal Not a medication error

100. All medication locked in a cabinet/cart at normal temperature
Controlled Drugs –Double Locked
Kept in original container
Kept separate from other clients medication
Each route of medication separated by physical barriers from other routes
Refrigerated when necessary (locked)
Keys must be stored in safe area which is inaccessible to clients
To ensure the health and safety of the clients you must maintain these strict rules for storage in a facility. If you leave the facility with the keys you must return them immediately. An extra key could be maintained by the supervisor per written policy of the facility.
Medication Storage

101. Medication Destruction Record APD Form 65G7-06
What medication needs to be destroyed?
Discontinued
Expired
Two way to dispose
Return to pharmacy in a sealed container or bubble pack
Consult with your pharmacy as to safe destruction practice. You will need two people to destroy, witness and document on form
Medications that are contaminated or refused may be destroyed at the facility using procedure #2. Do not forget to document on back of MAR the reason medication was destroyed.
Medication Destruction Record APD Form 65G7-06

102. Enough medication must be provided for all doses needed while away
Must be sent in original containers
Only client who is authorized to self administer medications without supervision may use a “pill minder”
Meds must be counted when provided, and when returned, using the “Off-Site Medication Form” 65G7-08
MAP must provide the name and contact person, AND the name and telephone number of the client’s HCP
When a client is away from a licensed residential facility or supported living home and will need medication assistance by some one other than MAP
Medication may not be transferred to weekly pill minders. This would be consider a dispensing act which can only be done by a pharmacist. If the client is fully capable of self administration, then he/she could put their own medications in pill minder. A family member or legal guardian could also assist with the filling of a pill minder. Once the client and his her medication is returned to the facility and you discover discrepancies such as medications that may not have been given, you would notify your supervisor. This is not considered to be a medication error, however all family errors should be documented in the client record. If a pattern of errors is noted, the health care practitioner must be contacted, as well as, your APD Area Medical Case manager for consultation and assistance.
Off-Site Medication

103. DO ACTIVITY 5 AS A CLASS. DISCUSS THE SCENARIO AND PICK OUT AREAS OF CONCERN.
Questions?