Medication Administration Program

Medication Administration Program
Administering Medication the Right Way Icebreaker Introductions Housekeeping: Bathrooms, Smoking Area, scheduled break Class rules to include cell phones silent Training materials MAP is overseen by DPH Carried out jointly by DDS/DMH

Successful Completion
100% Attendance Pre-Test Tips for success: ask questions, participate in activities On your own: review training material; know info in Massachusetts “call out” boxes; practice skills Practice on your own: Sample Computer Based Test (CBT) 10 questions Mock Transcription Test #777 Last day of Certification Training: Pretest (two components) 1. Transcription 15 min. 2. Written 35 min. 30 questions (24/30 is passing) Must pass pretest to be eligible to test with D&S

D&S Diversified Technologies
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 You will receive an ID and PIN from me with test scheduling instructions. You can use the same info to reschedule once at no charge, look up your test results and change your address, phone number, etc. CBT test results available in hours-monitor for passing results then schedule to take skills

Medication Certification
Meds may be administered to adults only in DDS/DMH funded, operated or licensed programs Good for 2 years When you pass the D&S notification explains how to print your MAP Certification letter from the website Proof of current med certification must be in every program where you give meds at all times Review pages a, b, c on own for FAQ’s specific to med certification

Fictional Characters Melissa Chip Freddy
Divide into 3 groups, read info on Melissa, Chip and Freddy and describe to others. Roman numeral xi

Community Resources

MAP Consultant Registered Nurse Pharmacist Licensed Practitioner
*roman numeral xiii Can answer questions about medication procedures or questions specific to meds. Will provide recommendations if too much, too little or if a med is not given at all. Find out who your MAP consultant(s) are and where phone numbers are located where you work. Each program is required to have 24/7 access to a MAP consultant.

Learning Strategies Objectives Terms to Study
Apply What You've Learned Exercises *pg. 1 Objectives-key ideas *pg. 2 and 3 Terms-help to understand what the words used mean RAISE hand if have taken a prescription med -why did you need it? -how did you get it …sick, called HCP, went to doctor, med prescribed, pharmacy **Where else can you get meds? Grocery store, drug store, mail order **Where do you get info about meds? TV, radio, magazines **What would be different about giving meds in a program rather than to yourself or a family member?

Required for Medication Administration
Health Care Provider (HCP) Order Pharmacy Label Medication (med) Sheet These will be used when giving meds HCP-anyone who can prescribe a med

Medication Book Includes: HCP orders
HCP visit form (if it includes an order) Med sheets Medication Information sheets Go through… HCP orders must be renewed at least yearly. (Many times renewed in conjunction with yearly physical.) For training purposes, the year of these documents is not specified. (yr.) PRN meds -order must give specific reason for you to give -renewed yearly Remember to mention “special instructions” …see behavior support plan Reason med is ordered (in general) is listed on med sheet Acceptable Codes at bottom next to signature key

Countable Substances Book
Three sections: Index Count sheets Shift count sheets Go through mock books… Do a single person count and document

Basics of Medication Administration
To give meds safely, we will review critical info you need to know.

Safe Medication Administration
Standardization (Page 3-4) To give meds safely you must follow the same steps when administering meds. It’s also important to remember you are working in someone’s home. Let’s do: EXERCISE page 4 Now tell me about how you’ve learned about the people where you work.

Knowing the People You Support
Helps to recognize changes Helps when reporting Helps when documenting (Page 5) Getting familiar with a person’s daily habits, routines is important because a big part of your job is looking for changes in their physical condition or behavior. You also have a responsibility to treat the people you work for just as you or a family member would want to be treated. We all have basic rights…tell me rights people have specific to med administration. EXERCISE pg. 6

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

Principles Mindfulness Maximizing Capabilities Communication (Page 7)
Mindfulness means a few things: pay attention think about what you are doing minimize distractions be observant report observations VOLUNTEER to read key points pg. 7 Maximizing capabilities: -helping a person to function as independently as possible Communication *other than talking give me examples of how we communicate…facial expressions, listening, written notes, body language EXERCISE p. 10

Safe Medication Administration
Cycle of Responsibility Giving meds safely is part of a larger process called the cycle of responsibility.

Cycle of Responsibility
Observe Document the Med Administration Report changes Administer Medication Support Visits to HCP Page 11 Cycle begins with you because who is most likely to see change in a person’s physical condition or behavior? You What do you do with that info? Report facts, NOT a hunch or guess of what you think Why report? Any change could signal a problem and reporting can help prevent problems that could be harmful or even fatal. The change may require a HCP visit. The quality of health care received depends on your observations and reporting. Pharmacist, provide info to other staff verbal and written in a clinical progress note and possibly staff communication log, transcribe, Store, Administer, Document med administration, Continue to observe p. 13 EXERCISE-assign each table 2 parts of cycle So…how do you make this cycle part of your daily routine? Store Medication Communicate with Pharmacist Record Information

Daily Routine Come to work ready to: Talk with other staff
Greet person Ask how person is doing Pay attention to behavior p. 16 EXERCISE If you look at page 18, this is a chart of the knowledge and skills you need to give meds safely p. 17 VOLUNTEER-read key points

How to Prevent and Control Infection
Page 49

Prevent and Control Infection
Hand washing When How Page 51 What is the purpose of hand washing? How long should you rub your hands together? seconds Give examples other than before and after giving meds of when you should wash your hands. Mention may use antiseptic hand cleanser. If have not yet attended a hand washing in-service read page In addition to before and after administering meds, tell when you should wash your hands. How long should you rub together with soap and water? (At least seconds.) If you have not had an inservice on handwashing yet…review pgs

Prevent and Control Infection
Wearing Gloves When How Page 53 In addition to hand washing you may need to wear gloves. If have not yet attended an in-service on taking off gloves read page 53.

The Cycle of Responsibility
Who has heard of the 5 rights? You will be cross checking the rights as you compare them between the HCP order, label and med sheet to ensure the info agrees General Guidelines Medication Administration

The Five Rights Right Person Right Medication Right Dose Right Time
Right Route READ highlighted info p. 64 Page 65-70 Divide into groups each taking a “right”, read, talk about what it means and report back to group.

The Right Person If not certain get help Ask other staff Check picture
Page 65

The Right Medication If brand name written on prescription, pharmacist will usually substitute generic If unsure, ask pharmacist Page 65

The Right Medication If familiar with med but notice a change in color, size, shape, markings, etc. Ask the Pharmacist Page 66 EXERCISE p. 66

The Right Dose HCP orders dose Usually written in “mg” Page 66-67
EXERCISE p. 67

The Right Time Particular time of day Number of times per day
Time between doses Page 67

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 Page 67-69

The Right Route The form of med determines the route:
tabs, caps, liquids (usually oral) ointment to skin (topical) Page 69-70

General Guidelines Three cross checks of the Five Rights before
administration (Page 71, 72, 73) Three cross checks of the 5 rights between HCP order, label and med sheet. You will be reading the written info on these to ensure it all agrees with each other. Checks are absolutely necessary because there is always a possibility a change was ordered since the last time you worked.

How to Administer Medications
The Process (Page 76)

Medication Administration Process
Prepare Administer Complete Objects Draw shapes, label grid Have students follow along Demonstration while student reads from drawing (grid)

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 (Page 77)

Administer Cross check one Cross check two Prepare med
Cross check three Give med (Page 79)

Complete Observe for effects Look again Document Lock Wash hands
(Page 81)

Med Pass Instructions Chip Brown 8pm med Sept. 3, yr
Review additional documentation with a countable med. Count book Use index Spell out number used “0ne” Stress to use the pretend info Review how to remove meds from a blister pack. Demo then practice together. Good way to learn: Read step out loud as you practice, then have your partner do the same for you (then pair off and do next practice).

Med Pass Instructions Chip Brown 8am meds Sept. 4, yr
Pair off and practice

Support Plan for use of PRN Medication for Anxiety
Specific behaviors that show us Chip is anxious: Pacing in a circle for more than 4 minutes. Head slapping for longer than 30 seconds or more than 5 times in 4 minutes. Staff will attempt to engage Chip in one on one conversation re: current feelings and difficulty. 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. Review

Med Pass Instructions Chip Brown PRN med for anxiety Sept. 4, yr 3pm
Pair off and practice. AFTER PRACTICING… EXERCISES pg. 61 and 74 (if not enough time …do beginning of Day 2 Review homework assignment End of Day 1

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 Beginning of Day 2 Review questions on business cards Practiced yesterday…any questions?

Oral Medication HCP order required to crush and mix a med with food or liquid Who has seen other certified staff crush meds and mix in applesauce, pudding, yogurt, etc. or put a whole tablet in applesauce before giving? You should be able to see an order to do so on a person’s HCP orders and it must specify, may crush and mix in applesauce or may put whole tab in applesauce to give. May change the form of a med only with a doctor’s order

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

Oral Medication May give half tabs ONLY if halved by the pharmacy
Not allowed to break, cut, etc.

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 Page 85-86 Demonstrate pouring a liquid med. Ask what would you do if pour too much. Household teaspoons hold from 2 to 10 milliliters of liquid. But a measuring teaspoon holds 5 milliliters of liquid. So if you measure your liquid medications with a regular teaspoon, chances are you either giving too much or too little medicine. (

Oral dosing syringe Page 86 Pass around examples

Dropper Page 86, 87 Another common marked measuring device for liquid meds. Pass around examples

Other Routes of Medication Administration
Never administer a med by any route unless you have received training in that route Focus on oral meds, info on other routes is found in Section 4, Reference Information. Page 76 has a list of other routes including: Meds via g/j tube and use of an epi-pen are separate person specific trainings by licensed staff. Check with your supervisor to see if anyone in your program has HCP order for epi-pen and if not sure if anyone receives meds through g/j tube DMH staff may not administer suppositories or enemas

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 (Page 74) Never use another person’s med

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 (Page 75) ASK for VOLUNTEER pg. pg. 101 EXERCISES p. 101 and 102

Medication Refusals Page 95 “call out” box Definition
-refuses or spits right back out -spits out later -intentional vomiting within a ½ hr. after taking meds Suggestions if occurs: Ask person why they do not want to take Tell the person you will call HCP HCP may adjust meds Definition of Refusals in MA in box on page 95

Dealing With Refusals Offer 3 times Contact HCP for recommendation
wait minutes in-between Contact HCP for recommendation Notify Supervisor Document pg. 95 Ask how to document a refusal.

Medication progress note
Documenting a Refusal Circle initials Medication progress note Refusal description Who was notified HCP Supervisor EXERCISE p. 96

Medications What You Need to Know (Page 21)

Medication Used to treat health problems
Taken to eliminate or lessen symptoms Improves quality of life What’s your definition of a med

Medication Chemicals that enter the body and change one or more of the ways the body works (Page 23) Meds can affect different parts of the body at the same time so…it’s important to observe for both desired and side effects. Example – Motrin All meds have the potential to cause side effects so must watch for.

Categories of Medications
Prescription Over the Counter (OTC) Brand name Generic name Countable substances Holistic/Herbal Compounds Page 24 6 Groups Assign Decide key points, spokesperson to present

Prescription Medications
Written by HCP Uses a small prescription notepad May not photocopy to use in place of a HCP order P. 24

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 pg Can buy without a prescription but must have HCP order in a program setting to give.

Brand Name Medications
Made by a specific pharmaceutical company Page 25 Only way to receive brand name from pharmacist is for HCP to write no substitution at bottom of prescription form.

Generic Medications Basically same as brand name meds
Made by different companies Usually less expensive Page 25

Countable Substances Specific Requirements for: Storing Packaging
Tracking Counting Page 25 Will go into detail later Depending on the company you work for the packaging will vary. Blister packs are most common. There is also Opti-Pak and OPUS packaging

Holistic/Herbal Compounds
Very popular HCP order required Administered, documented and stored just as prescription meds Page 25

Other Substances Alcohol Nicotine Caffeine Page 25
Why is it important for the HCP to know if a person uses alcohol, smokes, drinks coffee/tea/soda? These can interact with OTC and prescription meds as well as herbal compounds. Look at Chip’s Ativan med info sheet for interaction Meds can fit in to more than one category-give me an example… EXERCISE p. 26 If we had ignored his behavior, this problem may have gotten worse and a more serious interaction could have developed.

Medication Sensitivity
How a person responds to a med depends on: age weight health (Pg. 26) Drug sensitivity-how a med will affect, help or bother a person. Have you or a family member ever had an unexpected reaction to a med? Any medication a person is taking may cause physical and behavioral changes. Important to observe for 3 possible outcomes of taking meds-report, document if you see a change in a person.

Effects of Medication Three outcomes: Desired or Therapeutic Effect
No Apparent Desired Effect Unwanted Effects *Page 27 Divide into 3 groups Assign

Desired Effect Tylenol helps a headache Dilantin helps reduce seizures
Examples: Tylenol helps a headache Dilantin helps reduce seizures Page 27 Desired/Therapeutic Med is working Must know a meds desired effect, indication or reason for use.

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 Page 27 No Apparent Desired Effect-hasn’t worked yet or did not work If after 24 hours person is no better, still experiencing fever, etc., no effect- HCP must be notified since med is not working as intended and person is still experiencing the problem.

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 Page 28, 29 Unwanted effects may show up as physical or behavioral changes. Side/Adverse effect-not desired (rash, nausea, vomiting, diarrhea-temporary, usually go away) Blurred vision, dry mouth, confusion, anxiety, drowsiness may be harder to recognize. Allergic reaction-high sensitivity Anaphylactic reaction (severe allergic reaction) is potentially life threatening and requires immediate medical help. Paradoxical-opposite. Toxicity-body stores up more med than it can handle. EXERCISE p. 29 and 30 Do people where you work receive more than 1 med? If so, there is always the potential for med interactions.

Medication Interactions
Mixing of Meds in the Body May increase or decrease the effect of another med ASK FOR VOLUNTEER to read the 4 important points Page 31

Medication Interactions
The more meds taken at one time increases the possibility Changes observed could be caused by a med interaction Why is it important for a HCP to be aware of all meds a person is taking? Can prescribe a new med that has a lower chance of interacting with current meds Where can you find out about interactions? You need to know where to look or who to ask if you have questions regarding medications in general…give me examples

Resources for Obtaining Information about Meds
Prescribing HCP Pharmacist Package Inserts Reputable Online sources Medication Reference books Page 33 Pass around The Pill Book Find out where the drug reference book in your program is kept. EXERCISE p. 32 ASK VOLUNTEER to read p.33 first paragraph EXERCISE p. 35 and 36 ASK VOLUNTEER to read summary p.34

The Cycle of Responsibility
Page 37

Basic Responsibilities
Observe Report Document Role play Follow up on what you have reported to learn what was done.

Observation Objective Information (Factual) Page 39
Paying attention to the people you support and recognizing a change has occurred. Objective-what you can see, hear, feel, smell AND things that can be measured, i.e., temp., BP

Observation Subjective Information
Subjective-what/how a person tells you they feel EXERCISES p. 40 and 42

Reporting Immediate reporting Certain time reporting Routine reporting
Page 43 Detailed verbal reporting helps staff make decisions and helps the HCP to determine the best treatment and meds. Reporting is both verbal and written. Immediate Reporting-communicating with others instantly when there is a change in a person, whether emergency or not. Certain time reporting-communicating at a specific time. Routine Reporting-communication with others at shift change.

Reporting If unsure… REPORT Why report if you are unsure???
Any change in physical condition or general behavior could be important.

Forms for Documenting Info Observed/Reported
Page 46 What kinds of data tracking forms besides med sheets and HCP orders have you seen or do you use? (seizure activity, bowel movements, behavior)

Reporting Information to the Right People
READ SUMMARY Page 47 EXERCISES p. 48 Being aware of who to report to is an important part of your responsibilities. (Could be directly to the HCP, supervisor, MAP consultant.) Find out from your supervisor-do you directly contact doctor if need info about a person’s health etc. Depending on the situation and the provider you work for the answer may be different. However, if a ? regarding meds and how to give…always contact MAP consultant first and directly. Practice giving meds-get out whatever you choose to use for reference. (Different partners.)

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

Med Pass Instructions Melissa Sullivan 8am meds Sept. 4, yr Practice
End of Day 2 Provide practice med book, count book and corresponding copies of blister packs to use for practice outside of training Handout DBQ Exercise and review how to answer questions using corresponding documents.

The Management of Med Administration
Begin Day 3 Business cards with questions Answer questions/comments regarding DBQ exercise

Transcription Certified staff copy info from HCP order and pharmacy label on to med sheet Page 132 Part of skills test with D&S. Have 15 minutes using a HCP order to D/C one med and transcribe another. Transcription packets as group. Transcription workbook. Does everyone understand a prescription and a HCP order are two different forms? Who writes both? What do you do with the prescription? The HCP order?

Documentation Complete Accurate Clear Ink only Include date and time
Sign your name Page 46 Remember med sheets, HCP orders, etc. are legal documents. Ask if know how to correct a documentation error.

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

Medication Sheet Documenting accurately on a med sheet is key to safe med administration. Page 132 SPECIAL INSTRUCTIONS -pass around pharmacy label stickers Med sheets are used to document vital signs

Abbreviations Is safer not to use abbreviations
It is common to still see on a HCP order and script. Should be a reference list in med area In the transcription workbook copy the information exactly as written Will be using a few abbreviations.

Abbreviations DC (discontinue) mg (milligram) Cont (continue)
tab (tablet) cap (capsule) mL (milliliter) tsp (teaspoon) Will be using these when transcribing

Frequency Number of times per day to be given Specific hour chosen
Examples: HOUR 8am 4pm HOUR 8am 4pm 8pm HOUR 8am 12pm 4pm 8pm Page 68 (frequency when written on a med sheet is the same as time) Samples of how to choose med times. Consider: Persons daily schedule, agency policy Do not choose “off” times 12 am same as midnight 12 am is usually considered the first dose of the day. 12 pm same as noon The q6h and q8h transcriptions are considered more difficult and are not covered in the basic training-for reference only A.m. times go in top boxes P.m. times go in bottom boxes General rule - times chosen must be at least 4 hrs. apart

Discontinuing an Order
Mark COMPLETELY through all boxes next to where med was scheduled to have been given Mark a diagonal line through left section of med sheet, write D/C and date Mark a diagonal line through grid on med sheet, write D/C and date Turn to p. 141 as your reference for example to dc’ing a med order Once the program receives a written order from the HCP indicating the med is to D/C’d there are 3 parts to the D/C process

Step 1 Mark completely through all the empty spaces next to where the med was scheduled to be given.

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

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

Transcription Workbook
Close up training manual and get the Transcription Workbook.

Health Care Provider Order
Dose Found in HCP order, usually in “mg” Health Care Provider Order Chip Brown No Known Allergies Zantac 150mg twice a day by mouth Signature: Dr. Jones Date: 6/11/yr If transcribing this HCP order, would copy 150mg next to the word “dose” on the med sheet The dose is: ___ mg

Strength and Amount Found on pharmacy label
Rx# 135 ABC Pharmacy 20 Main Street Any Town, MA 09111 Chip Brown 6/11/yr Ranitidine HCL 75mg I.C. Zantac Qty: 120 Take two tablets by mouth twice a day Dr. Jones Lot# ED: 6/11/yr Refills: 3 If transcribing, would copy “75mg” next to the word strength on the med sheet If transcribing, would copy “2 tabs” next to the word amount on the med sheet The strength per tablet is: ___ mg The amount of tabs to give: ___ tabs

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.

HEALTH CARE PROVIDER ORDER
Name: Chip Brown Date: 6/11/yr Health Care Provider: Dr. Jones Allergies: 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 S T A F D O C T R

Tear out page 6

Pharmacy Label Generic Equivalents Brand Name Generic Equivalent
Rx# ABC Pharmacy 20 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 Name Generic Equivalent Zantac Ranitidine HCL Loram Loramine Loxaprill Loxaprilline Tylenol Acetaminophen Amoxil Amoxicillin EES Erythromycin Depakote Divalproex Haldol Haloperidol Tegretol Carbamazepine Pen VK Penicillin

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. 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 You will see a mini version in your packet when testing with D&S but will do nothing with it. D&S “mimics” the way a HCP should go in that if you’ve received a new HCP order and filled the prescription at the pharmacy you will also have been provided with a medication information sheet. -8-

Medication Administration Sheet
Turn back to your HCP order on page 5 and have the med sheet next to it. Now let’s DC the current med.

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

“Post” HCP Order Completed for new orders after transcribing
Agency may choose certain ink color Written on order sheet Write:  “posted”  signature  date  time After transcribing the new med, the HCP order is “posted”. Your signature means you are the certified staff who took care of the new HCP order. (Remember not all new orders are for medications. You may be asked to monitor someone’s weight or how much they drink, etc.)

John Smith, Program Manager
HEALTH CARE PROVIDER ORDER Name: Chip Brown Date: 6/11/yr Health Care Provider: Dr. Jones Allergies: 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 Turn back to the HCP order on page 5. Place a check mark next to each order. Then under the HCP signature write the word “posted”,your signature, the date and time. Posted John Smith 6/11/yr 1pm

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. Tear out the med sheet on page 12

HEALTH CARE PROVIDER ORDER
Name: Chip Brown Date: 6/20yr Health Care Provider: Dr. Jones Allergies: 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 weeks Lab work or Tests: Signature: Dr. Susan Smith Date: 6/20/yr How many new meds are there? What is the dose of Armour Thyroid? Circle it. The dose of Inderal? Circle it. The dose of Amoxil? Circle it. Write the word dose (once) so you remember these are the doses of each new med. dose

Rx# ABC Pharmacy 20 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# ED: 6/20/yr Refills: 3 Rx# ABC Pharmacy 20 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 strength What is the strength in mgs per tablet of Armour Thyroid supplied by the pharmacy? Circle it. The Inderal? Circle it. The Amoxil? Circle it. Then write the word strength once out to the side of the labels. Rx# ABC Pharmacy 20 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

Answer For the next exercise tear out the med sheet on page 21.

Answer

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 Additional math required if half tab or liquid med

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 (Page 133) This we have practiced…if any part of a HCP order changes-start over.

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

“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 Page 132, 133 Ask who posted/what time was verified

Telephone Orders Check your agency policy Remind HCP to call pharmacy
Must be signed by HCP within 72 hrs. Page 124 Sample form p. 125 Check with agency to see if allowed to take a T.O. Ask supervisor where T.O. form is kept. Read back to the HCP what you have written Ask if do not know how to spell a word How do you get the new med?

Fax Orders Legal Signed by HCP Preferred Page 124-125
Review liquid exercises Practice giving meds Assign homework

Liquid Med Review HCP: 100mg Label: 50mg per 4mL = 50mg 4 mL 3 mL 2 mL
How many “mL’s” total are you going to give? If you were transcribing this information on to the med sheet, what are you going to copy next to Dose, strength, amount? = 50mg

Liquid Med Exercises Dose Strength Amount 150mg 75mg/10mL ____
Answers: 1. 20mL 2. 12mL 3. 4mL 4. 8mL 5. 10mL 6. 9mL 8mL

The Cycle of Responsibility Continues
Show DVD-Making the Connection

Visiting the Health Care Provider
Advocacy Respect and dignity Ask questions Page 114 Ask if anyone has assisted with a appointment. Training Manual p.117

Information for the HCP
Reason for visit Allergies Current medications HCP order form Insurance information Page 114, 115 What has changed since the last visit

Encourage Participation
Redirect HCP’s questions to the person Encourage person to give own description first. Then explain any additional symptoms and changes Page 117 DDS Health review checklist pg. 196, 197 DDS Annual health screening recommendations pg. 198 DDS Health Record

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 Page 57

Information From the HCP
Prescription HCP order Diagnosis What to expect from new med Page 119

Getting Prescriptions Filled
Page 121

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 Page 59 Take out Vi Lee’s Kazinem blister pack/ask questions

Pharmacy Label Rx# Rose Garden Pharmacy Main Street Any Town, MA Freddy Connors /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 Page 60, 61 What does IC mean? ASK: name of pharmacy name of HCP how many refills What is a refill What # to give pharmacist if refill is needed? What if zero refills and current HCP order? Find out who is responsible for re-ordering meds instructions expiration date Difference between exp. Date and stop date written on med sheet? strength amount quantity in bottle name of med prescription # why would be prescribed? name of individual In one day, what is total # of capsules he would take

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

Ensure Pharmacy Provided Right Medication
Compare HCP order with label If familiar with med, open and look at If not, look up or ask Page 122 Look in drug reference book, package insert, online Ask pharmacist What if it doesn’t look right? VOLUNTEER to READ p. 126-summary End of Day 3 Handout, review and re-emphasize Sample CBT for homework, sample transcription D&S Candidate handbook-key points (how number of questions asked correspond with table of contents in AMRW, etc.)

Med Pass Instructions Vi Lee 8pm med Sept. 3, yr Beginning of Day 4
Show med pass DVD Different pairs and practice.

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

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

Countable Substances Countable prescription medications require extra: counting tracking documenting special packaging double-locked storage Page 143 Subtracted from count book after taken out of package Of the meds we have been practicing with, which are countable? How do you know if a med is countable?

Countable Substances Higher incidence of abuse
Count requirement: Each time staff changes, 2 certified staff count together Documentation requiring 2 signatures: When beginning a new count sheet page Adding a refill onto count sheet Page transfer (bottom of old page/top of new) Refusal Disposal Page 143 Countable Substance Book : bound, numbered pages, Index - always updated as meds are given Pass around count book

Sample Index Page Every count book has an index page at the beginning of the book that identifies the pages that are currently in use Staff must update the index when transferring a medication to another page in the book

Sample Count Sheet Page 11 Each prescription is entered onto a separate numbered page in the count book These pages tell us the current number of pills remaining (amount left) on each prescription Look at the first yr entry – what happened there? When a count sheet page is full, the prescription gets transferred to a new page At the bottom of the ”full” page (page 10) Karen and Lisa’s signature would be there also Look at 12/20/yr 11:00 am entry – what happened there? Meds had been re-ordered and the refill blister package is added to the existing supply

Sample Shift Count Sheet
Countable meds must be counted every time the shift/staff changes Ideally with a staff coming on and another staff who is leaving If that is not possible, count with another MAP Certified staff working on the same shift as you What if count is wrong?

Non Suspicious Count Discrepancy
Count is off Can be easily resolved by checking addition, subtraction Report Document in count book Page 146

Count Discrepancy Count is off
Suspicion of tampering, theft, unauthorized use of drugs Report to DPH Page 146 Call supervisor DPH Drug Incident Report form pg. 204

Medication Storage Next 3 topics 3 Groups: Med storage p. 147-148
Med disposal p LOA p. 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) P “Props” for internal/external storage DPH regs to ensure safety In a cool, dry place away from excessive heat, light and moisture Mention med info sheet lists storage requirements

Medication Disposal Two certified staff, one must be a supervisor
Proper disposal of medication Document Do NOT return medications to the pharmacy P Why would meds require disposal?

DPH Disposal Form Disposal form pg. 193
Documentation of any prescription med disposal is required on a DPH disposal form If the prescription med is countable there must be a corresponding progress note in the count book indicating the med was disposed of. OTCs do not require documentation of disposal per DPH but check with employer PRACTICE med disposal Scenario-Melissa needs Percocet due to back discomfort during transfers, when you prepare it falls on floor.

Leave of Absence (LOA) Meds must be prepared by the pharmacy if the:
LOA is planned/scheduled Person will be away from their residence for more than 72 hours Page Day program meds and routine family visits are examples LOA form page 209 Ask supervisor where kept

Leave of Absence (LOA) If pharmacy cannot
Certified staff may only package meds for an unplanned absence of less than 72 hours Page 150 How is a LOA med documented on med sheet, count book? LOA form with double signatures needed. Meds returned from an LOA may not be used and must be destroyed.

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 Find out communication system between the two programs

Medication Errors One of the five rights went wrong Page 151

Medication Occurrence (Error)
Wrong Individual Wrong Medication Wrong Dose Wrong Time (includes omission) Wrong Route Page 151 Need to look back at HCP order to figure out which right went wrong EXERCISE p. 153

Medication Errors An opportunity to improve procedures that put people at risk Focus on the cause rather than who made the mistake Supervisor can set up procedures to minimize the chance that another staff will make the same error.

Medication Error Reporting
Self reporting system

Medication Errors Safety of the person is the primary concern

What To Do Check to see if individual is okay

What To Do Know Emergency Procedures
Most Med occurrences are not emergencies but know your agencies emergency procedures. Call 911, if needed.

What To Do IMMEDIATELY contact MAP Consultant
Follow recommendation and document

Medical Intervention Lab work, medical tests, physician visit, clinic visit, emergency room visit, hospitalization or other medical care provided The MAP Consultant may recommend a medical intervention and if does is considered more serious and is called a “hotline”.

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

What To Do Notify your supervisor
Contact supervisor after MAP consultant

HOTLINE For Hotlines ONLY, this DPH form is required in addition to HCSIS data entry. “HOTLINE” See DPH form on pg. 194 for hotlines only (DDS) DMH this form is used for all med occurrence reporting

Medication Occurrence Report (MOR) Form/Data Entry
HCSIS paper process (page ) then data entry (DDS) EXERCISE p. 154 MOR cards from call box quiz p.152 Review questions Evaluation Pretest

Medication Administration Program

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Medication Administration Program

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