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Medication Administration Program Administering Medication the Right Way.

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Presentation on theme: "Medication Administration Program Administering Medication the Right Way."— Presentation transcript:

1 Medication Administration Program Administering Medication the Right Way

2 Successful Completion 100% Attendance Pre-Test

3 Three Components 1. Computer Based Test-75 min. 50 questions (40/50 is passing) Must pass CBT to be eligible to take skills Skills 2. Transcription-15 min. 3. Med Administration-10 min. Apply knowledge of 5 Rights while verbally demonstrating 3 checks D&S Diversified Technologies

4 Medication Certification Meds may be administered to adults only in DDS/DMH funded, operated or licensed programs Good for 2 years

5 Fictional Characters Melissa Chip Freddy

6 Community Resources

7 MAPConsultant MAP Consultant Registered Nurse Pharmacist Licensed Practitioner

8 Learning Strategies Objectives Terms to Study Apply What You've Learned Exercises

9 Required for Medication Administration Health Care Provider (HCP) Order Pharmacy Label Medication (med) Sheet

10 Medication Book Includes: HCP orders HCP visit form (if it includes an order) Med sheets Medication Information sheets

11 Countable Substances Book Three sections: Index Count sheets Shift count sheets

12 Basics of Medication Administration

13 Safe Medication Administration Standardization

14 Knowing the People You Support Helps to recognize changes Helps when reporting Helps when documenting

15 Respecting Rights To be treated with respect and dignity To be free from too much medication To know what meds they are taking To know about risks and benefits To refuse medication

16 Principles Mindfulness Maximizing Capabilities Communication

17 Safe Medication Administration Cycle of Responsibility

18 Record Information Communicate with Pharmacist Support Visits to HCP Report changes Observe Store Medication Administer Medication Document the Med Administration

19 Daily Routine Come to work ready to: Talk with other staff Greet person Ask how person is doing Pay attention to behavior

20 How to Prevent and Control Infection

21 Prevent and Control Infection Hand washing  When  How

22 Prevent and Control Infection Wearing Gloves  When  How

23 The Cycle of Responsibility General Guidelines Medication Administration

24 The Five Rights Right Person Right Medication Right Dose Right Time Right Route

25 The Right Person If not certain get help Ask other staff Check picture

26 The Right Medication If brand name written on prescription, pharmacist will usually substitute generic If unsure, ask pharmacist

27 The Right Medication If familiar with med but notice a change in color, size, shape, markings, etc. Ask the Pharmacist

28 The Right Dose HCP orders dose Usually written in “mg”

29 The Right Time Particular time of day Number of times per day Time between doses

30 The Right Time Most meds can be given safely one hour before and up to one hour after time on med sheet If unsure, ask pharmacist

31 The Right Route The form of med determines the route: tabs, caps, liquids (usually oral) ointment to skin (topical)

32 General Guidelines Three cross checks of the Five Rights before administration

33 How to Administer Medications The Process

34 Medication Administration Process Prepare Administer Complete

35 Prepare Determine the meds to give Know the reason ordered Clean area Wash hands Gather supplies needed Identify individual Unlock storage area Open count book, if needed

36 Administer Cross check one Cross check two Prepare med Cross check three Give med

37 Complete Observe for effects Look again Document Lock Wash hands

38 Med Pass Instructions Chip Brown 8pm med Sept. 3, yr

39 Med Pass Instructions Chip Brown 8am meds Sept. 4, yr

40 Support Plan for use of PRN Medication for Anxiety Specific behaviors that show us Chip is anxious: 1. Pacing in a circle for more than 4 minutes. 2. Head slapping for longer than 30 seconds or more than 5 times in 4 minutes. A. Staff will attempt to engage Chip in one on one conversation re: current feelings and difficulty. B. Staff will attempt to direct and involve Chip in a familiar activity such as laundry, meal preparation, etc. If unsuccessful with A or B staff may suggest/offer Chip: Ativan 0.5mg once daily as needed by mouth. Must give at least 4 hours apart from regularly scheduled Ativan doses. (Refer to HCP order) If anxiety continues after the additional dose, notify HCP.

41 Med Pass Instructions Chip Brown PRN med for anxiety Sept. 4, yr 3pm

42 Document Med Administration Place initials in box that directly corresponds to time and date given Initials and signature at bottom of med sheet (if first time giving) PRN medication time/initials in same box and write a progress note

43 Oral Medication Oral Medication HCP order required to crush and mix a med with food or liquid

44 Oral Medication MUST have HCP order to: empty contents of a capsule

45 Oral Medication May give half tabs ONLY if halved by the pharmacy

46 Liquid Med Administration Oral Med Cup: Place on flat surface at eye level Use thumbnail to mark correct measurement Shake bottle of med well, if needed Pour slowly

47 Liquid Med Administration Oral dosing syringe

48 Liquid Med Administration  Dropper

49 Other Routes of Medication Administration Other Routes of Medication Administration Never administer a med by any route unless you have received training in that route

50 General Cautionary Guidelines Administering meds if: Unable to read HCP order Missing any piece of info Unable to read label Label is missing Med was prepared by another staff

51 General Cautionary Guidelines Administering Meds If: You have any doubts about the five rights If person has a serious change If person has difficulty swallowing If person refuses If med seems to be tampered with

52 Medication Refusals

53 Dealing With Refusals  Offer 3 times  wait minutes in-between  Contact HCP for recommendation  Notify Supervisor  Document

54 Documenting a Refusal Circle initials Medication progress note  Refusal description  Who was notified HCP Supervisor

55 Medications What You Need to Know

56 Medication Used to treat health problems Taken to eliminate or lessen symptoms Improves quality of life

57 Medication Chemicals that enter the body and change one or more of the ways the body works

58 Categories of Medications Prescription Over the Counter (OTC) Brand name Generic name Countable substances Holistic/Herbal Compounds

59 Prescription Medications Written by HCP Uses a small prescription notepad May not photocopy to use in place of a HCP order

60 OTC Medications Must have HCP order Administered, documented and stored just as prescription meds Label requirement options Medication occurrence (mistake) if not given as ordered by HCP

61 Brand Name Medications Made by a specific pharmaceutical company

62 Generic Medications Basically same as brand name meds Made by different companies Usually less expensive

63 Countable Substances Specific Requirements for: 1. Storing 2. Packaging 3. Tracking 4. Counting

64 Holistic/Herbal Compounds Very popular HCP order required Administered, documented and stored just as prescription meds

65 Other Substances Alcohol Nicotine Caffeine

66 Medication Sensitivity How a person responds to a med depends on: age weight health

67 Effects of Medication Three outcomes: Desired or Therapeutic Effect No Apparent Desired Effect Unwanted Effects

68 Desired Effect Examples: Tylenol helps a headache Dilantin helps reduce seizures

69 No Apparent Desired Effect Examples: Could be because it may take time before full effect of med can occur Even after enough time passes for med to work, it does not

70 Unwanted Effects Meds can cause effects that are not intended or wanted. Also known as side effects. Examples: Allergic reaction Anaphylactic reaction Paradoxical effect Toxicity

71 Medication Interactions Mixing of Meds in the Body Mixing of Meds in the Body May increase or decrease the effect of another med

72 Medication Interactions The more meds taken at one time increases the possibility The more meds taken at one time increases the possibility Changes observed could be caused by a med interaction

73 Resources for Obtaining Information about Meds Prescribing HCP Pharmacist Package Inserts Reputable Online sources Medication Reference books

74 The Cycle of Responsibility

75 Basic Responsibilities Observe Observe Report Report Document Document

76 Observation Objective Information (Factual)

77 Observation Subjective Information

78 Reporting Immediate reporting Certain time reporting Routine reporting

79 Reporting If unsure… REPORT

80 Forms for Documenting Info Observed/Reported

81 Reporting Information to the Right People

82 Med Pass Instructions Melissa Sullivan 8pm meds Sept. 3, yr

83 Med Pass Instructions Melissa Sullivan 8am meds Sept. 4, yr

84 The Management of Med Administration

85 Transcription Certified staff copy info from HCP order and pharmacy label on to med sheet Certified staff copy info from HCP order and pharmacy label on to med sheet

86 Documentation Complete Accurate Clear Ink only Include date and time Sign your name

87 Correcting Documentation Draw a single line through mistake Write the word “error” and initial No scribbling, “marking over”, erasing or using “white out”

88 Medication Sheet

89 Abbreviations Is safer not to use abbreviations

90 Abbreviations DC (discontinue) mg (milligram) Cont (continue) tab (tablet) cap (capsule) mL (milliliter) tsp (teaspoon)

91 Frequency HOUR 8am 4pm HOUR 8am 4pm 8pm HOUR 8am 12pm 4pm 8pm Number of times per day to be givenNumber of times per day to be given Specific hour chosenSpecific hour chosen Examples:

92 Discontinuing an Order 1. Mark COMPLETELY through all boxes next to where med was scheduled to have been given 2. Mark a diagonal line through left section of med sheet, write D/C and date 3. Mark a diagonal line through grid on med sheet, write D/C and date

93 Step 1

94 D/ D/ D/C 12/5/yr KM Step 2

95 D/ D/ D/C 12/5/yr KM KM Step 3

96 Transcription Workbook

97

98 Dose Found in HCP order, usually in “mg” The dose is: ___ mg Health Care Provider Order Chip Brown No Known Allergies Zantac 150mg twice a day by mouth Signature: Dr. Jones Date: 6/11/yr

99 Strength and Amount Rx# 135ABC Pharmacy Main Street Any Town, MA Chip Brown6/11/yr Ranitidine HCL 75mg I.C. ZantacQty: 120 Take two tablets by mouth twice a day Dr. Jones Lot#323-5ED: 6/11/yrRefills: 3 The strength per tablet is: ___ mg The amount of tabs to give: ___ tabs Found on pharmacy label

100 PRACTICE SKILLS-TRANSCRIPTION INSTRUCTIONS You have taken Chip Brown to the doctor and have received medication from the pharmacy. Pretend that the date is June 11, year. It is 1 pm. Use the health care provider’s order, pharmacy label and generic equivalents to discontinue the order and transcribe the new order on to the Medication Sheet. Please Note: Do not place your initials in the medication box. You are not administering a medication at this time. This is transcription only.

101 STAFFSTAFF DOCTORDOCTOR Name: Chip BrownDate: 6/11/yr Health Care Provider: Dr. JonesAllergies: no known allergies Reason for Visit: Chip states he has a burning feeling in his throat during the day. Current Medications: Pantoprozole 40mg by mouth every evening Staff Signature: John Smith, Program Manager Date: 6/11/yr Health Care Provider Findings: Medication/Treatment Orders: D/C Pantoprozole Zantac 150mg twice a day by mouth (dose) (frequency) (route) Instructions: Follow-up visit:Lab work or Tests: Signature: Dr. Jones Date: 6/11/yr HEALTH CARE PROVIDER ORDER

102

103 Pharmacy Label Rx#135 ABC Pharmacy Main Street Any Town, MA /11/yr Chip Brown Ranitidine HCL 75mg (strength) I.C. Zantac Qty. 120 Take two tablets by mouth twice a day (amount) Dr. Jones Lot# ED: 6/11/yr Refills: 3 Generic Equivalents Brand NameGeneric Equivalent ZantacRanitidine HCL LoramLoramine LoxaprillLoxaprilline TylenolAcetaminophen AmoxilAmoxicillin EESErythromycin DepakoteDivalproex HaldolHaloperidol TegretolCarbamazepine Pen VKPenicillin

104 MEDICATION INFORMATION SHEET: SAMPLE ONLY Zantac is a stomach acid reducing medication used to treat and prevent ulcers, to treat GERD (gastro esophageal reflux disorder) and excessive acid secretion conditions. How to take: Take orally, with or after meals. If you are taking antacids, separate the dose of Zantac and the antacid by 30 minutes. What to do if you miss a dose: Take the dose as soon as you remember except if it is close to the time for the next dose. Never double the dose. Side effects: Nausea, diarrhea, headache until the body adjusts. Call HCP if you have unusual bleeding or bruising, chest pain, rash, weakness, trouble sleeping, mental changes or any other change. Interactions: Tell your HCP about all the medications you are taking, especially triazolam, itraconazole or Ketocanozole. Special precautions: Tell your HCP about any medical problems you have especially heartburn with lightheadedness, sweating or dizziness. -8- Overdose reaction: Symptoms of overdose may include dizziness, fatigue, weakness, tremors, and an increase in heart rate or trouble breathing. If an overdose is suspected, call your local poison control center or emergency room. US residents can call the national poison control hotline at

105 Medication Administration Sheet

106 DC 6/11/yr JS DC 6/11/yr JS

107 Medication Administration Sheet DC 6/11/yr JS DC 6/11/yr JS

108 “Post” HCP Order Completed for new orders after transcribing Agency may choose certain ink color Written on order sheet Write:  “posted”  signature  date  time

109 Name: Chip BrownDate: 6/11/yr Health Care Provider: Dr. JonesAllergies: no known allergies Reason for Visit: Chip states he has a burning feeling in his throat during the day. Current Medications: Pantoprozole 40mg by mouth every evening Staff Signature: John Smith, Program Manager Date: 6/11/yr Health Care Provider Findings: Medication/Treatment Orders: D/C Pantoprozole Zantac 150mg twice a day by mouth Instructions: Follow-up visit:Lab work or Tests: Signature: Dr. Jones Date: 6/11/yr HEALTH CARE PROVIDER ORDER Posted John Smith 6/11/yr 1pm

110 PRACTICE SKILLS-TRANSCRIPTION INSTRUCTIONS You have taken Chip Brown to the doctor and have received medication from the pharmacy. Pretend that the date is June 20, year. It is 1 pm. Use the health care provider’s order, pharmacy label and generic equivalents to discontinue the order and transcribe the new order on to the Medication Sheet. Please Note: Do not place your initials in the medication box. You are not administering a medication at this time. This is transcription only.

111 Name: Chip BrownDate: 6/20yr Health Care Provider: Dr. JonesAllergies: no known allergies Reason for Visit: complaint of pressure on forehead, mild fever, dizziness, increase in head slapping behavior Current Medications: Synthroid 0.125mg by mouth once a day in the morning Staff Signature: Paula Jones, Program Manager Date: 6/20/yr Health Care Provider Findings: sinus infection, elevated blood pressure Medication/Treatment Orders: D/C Synthroid Armour Thyroid 30mg by mouth once a day in the morning on an empty stomach Inderal 20mg by mouth once a day in the morning Amoxil 500mg by mouth three times a day for 10 days Instructions: Follow-up visit: 2 weeksLab work or Tests: Signature: Dr. Susan Smith Date: 6/20/yr HEALTH CARE PROVIDER ORDER dose

112 Rx#139 ABC Pharmacy Main Street Any Town, MA /20/yr Chip Brown Armour Thyroid 30mg Qty. 30 Take one tablet daily in the morning on an empty stomach by mouth Dr. Smith Lot# 659 ED: 6/20/yr Refills: 3 Rx# ABC Pharmacy Main Street Any Town, MA /20/yr Chip Brown Propanolol 10mg I.C. Inderal Qty. 60 Take two tablets daily in the morning by mouth Dr. Smith Lot# ED: 6/20/yr Refills: 3 Rx# ABC Pharmacy Main Street Any Town, MA /20/yr Chip Brown Amoxicillin 500mg I.C. Amoxil Qty. 30 Take 1 tablet three times a day for ten days by mouth Dr. Smith Lot# ED: 6/20/yr Refills: 0 strength

113 Answer

114 Answer

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117 Answer

118 Answer

119 Answer

120 Transcription of HCP Orders Strength (supplied by pharmacy) Amount (#tabs, caps, teaspoons,etc.) Dose (mg doctor wants person to receive each time med given) Strength X Amount = Dose

121 New Orders If the medication has not changed but the dose, frequency, or route (or symptoms if PRN) is changed, it is considered a NEW order D/C old order Transcribe new order

122 “Post” HCP Order Completed for new orders after transcribing Agency chooses ink color Written on order sheet Write:  “posted”  sign your name  date  time

123 “Verify” HCP Order Second certified staff double-checks Agency chooses ink color Write:  “Verified”  sign your name  date  time OK to give meds if not verified yet

124 Telephone Orders Check your agency policy Remind HCP to call pharmacy Must be signed by HCP within 72 hrs.

125 Fax Orders Legal Signed by HCP Preferred

126 Liquid Med Review HCP: 100mg Label: 50mg per 4mL 4 mL 3 mL 2 mL 1 mL = 50mg

127 Liquid Med Exercises Dose StrengthAmount mg75mg/10mL ____ mg50mg/6mL ____ mg50mg/2mL ____ mg75mg/4mL ____ mg100mg/5mL ____ mg50mg/3mL ____ mg25mg/2mL ____

128 The Cycle of Responsibility Continues

129 Visiting the Health Care Provider Advocacy Respect and dignity Ask questions

130 Information for the HCP Reason for visit Allergies Current medications HCP order form Insurance information

131 Encourage Participation Redirect HCP’s questions to the person Encourage person to give own description first. Then explain any additional symptoms and changes

132 Obtaining Medication A Health Care Provider (HCP) writes a prescription In a community program a HCP order (also written by the HCP) is required to administer medication

133 Information From the HCP Prescription HCP order Diagnosis What to expect from new med

134 Getting Prescriptions Filled

135 Communicating with the Pharmacist Prescription can be given to person to bring to pharmacy HCP can send directly by fax or electronically HCP can call prescription into pharmacy Staff can bring prescription to pharmacy to be filled

136 Rx# Rose Garden Pharmacy Main Street Any Town, MA Freddy Connors 1/1/yr Amoxicillin 250mg IC: Amoxil 250mg Qty.-20 Take one tablet twice a day for ten days by mouth. Drink lots of water when taking. Dr. T. Smith Lot# Exp. Date: 1/1/yr Refills: 0 Pharmacy Label

137 Obtaining Medication A Pharmacist fills the prescription Certified staff receive a labeled container of meds from the pharmacist

138 Ensure Pharmacy Provided Right Medication Compare HCP order with label If familiar with med, open and look at If not, look up or ask

139 Med Pass Instructions Vi Lee 8pm med Sept. 3, yr

140 Med Pass Instructions Vi Lee 8am med Sept. 4, yr

141 Med Pass Instructions Vi Lee 4pm med Sept. 4, yr

142 Countable Substances Countable prescription medications require extra: counting tracking documenting special packaging double-locked storage

143 Countable Substances  Higher incidence of abuse Count requirement:  Each time staff changes, 2 certified staff count together Documentation requiring 2 signatures: 1. When beginning a new count sheet page 2. Adding a refill onto count sheet 3. Page transfer (bottom of old page/top of new) 4. Refusal 5. Disposal

144 Sample Index Page

145 Sample Count Sheet Page 11

146 Sample Shift Count Sheet

147 Non Suspicious Count Discrepancy Count is off Can be easily resolved by checking addition, subtraction Report Document in count book

148 Count Discrepancy Count is off Suspicion of tampering, theft, unauthorized use of drugs Report to DPH

149 Medication Storage

150 Storage of Medications Locked/double locked Labeled storage containers per person Separate oral meds from other routes Must remain in original packaging Rules for refrigerated medications Restricted access (medication keys)

151 Medication Disposal Two certified staff, one must be a supervisor Proper disposal of medication Document Do NOT return medications to the pharmacy

152 DPH Disposal Form

153 Leave of Absence (LOA)  Meds must be prepared by the pharmacy if the: 1. LOA is planned/scheduled 2. Person will be away from their residence for more than 72 hours

154 Leave of Absence (LOA) If pharmacy cannot Certified staff may only package meds for an unplanned absence of less than 72 hours

155 Day Program Medication Staff at the home responsible to: Photocopy HCP order for day program Provide a pharmacy labeled container of meds Remember to contact and fax HCP order if med is DC’d

156 Medication Errors One of the five rights went wrong

157 Medication Occurrence (Error) Wrong Individual Wrong Medication Wrong Dose Wrong Time (includes omission) Wrong Route

158 Medication Errors An opportunity to improve procedures that put people at risk Focus on the cause rather than who made the mistake

159 Medication Error Reporting Self reporting system

160 Medication Errors Safety of the person is the primary concern

161 What To Do Check to see if individual is okay

162 What To Do Know Emergency Procedures

163 What To Do IMMEDIATELY contact MAP Consultant Follow recommendation and document

164 Medical Intervention Lab work, medical tests, physician visit, clinic visit, emergency room visit, hospitalization or other medical care provided

165 HOTLINE Medication Occurrence If medical intervention, illness, injury or death follows an occurrence fax MOR to DPH within 24 hours

166 What To Do Notify your supervisor

167 HOTLINE For Hotlines ONLY, this DPH form is required in addition to HCSIS data entry.

168 Medication Occurrence Report (MOR) Form/Data Entry


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