Presentation on theme: "Medication Administration Program"— Presentation transcript:
1Medication Administration Program Administering Medication the Right WayIcebreakerIntroductionsHousekeeping:Bathrooms, Smoking Area, scheduled breakClass rules to include cell phones silentTraining materialsMAP is overseen by DPHCarried out jointly by DDS/DMH
2Successful Completion 100% AttendancePre-TestTips for success: ask questions, participate in activitiesOn your own: review training material; know info in Massachusetts “call out” boxes; practice skillsPractice on your own:Sample Computer Based Test (CBT) 10 questionsMock Transcription Test #777Last 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
3D&S Diversified Technologies Three Components1. Computer Based Test-75 min.50 questions (40/50 is passing)Must pass CBT to be eligible to take skillsSkills2. Transcription-15 min.3. Med Administration-10 min.Apply knowledge of 5 Rights while verbally demonstrating 3 checksYou 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
4Medication Certification Meds may be administered to adults only in DDS/DMH funded, operated or licensed programsGood for 2 yearsWhen you pass the D&S notification explains how to print your MAP Certification letter from the websiteProof of current med certification must be in every program where you give meds at all timesReview pages a, b, c on own for FAQ’s specific to med certification
5Fictional Characters Melissa Chip Freddy Divide into 3 groups, read info on Melissa, Chip and Freddy and describe to others.Roman numeral xi
7MAP Consultant Registered Nurse Pharmacist Licensed Practitioner *roman numeral xiiiCan 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.
8Learning Strategies Objectives Terms to Study Apply What You've LearnedExercises*pg. 1Objectives-key ideas*pg. 2 and 3Terms-help to understand what the words used meanRAISE 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?
9Required for Medication Administration Health Care Provider (HCP) OrderPharmacy LabelMedication (med) SheetThese will be used when giving medsHCP-anyone who can prescribe a med
10Medication Book Includes: HCP orders HCP visit form (if it includes an order)Med sheetsMedication Information sheetsGo 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 yearlyRemember to mention “special instructions” …see behavior support planReason med is ordered (in general) is listed on med sheetAcceptable Codes at bottom next to signature key
11Countable Substances Book Three sections:IndexCount sheetsShift count sheetsGo through mock books…Do a single person count and document
12Basics of Medication Administration To give meds safely, we will review critical info you need to know.
13Safe 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 4Now tell me about how you’ve learned about the people where you work.
14Knowing the People You Support Helps to recognize changesHelps when reportingHelps 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
15Respecting Rights To be treated with respect and dignity To be free from too much medicationTo know what meds they are takingTo know about risks and benefitsTo refuse medication
16Principles Mindfulness Maximizing Capabilities Communication (Page 7) Mindfulness means a few things:pay attentionthink about what you are doingminimize distractionsbe observantreport observationsVOLUNTEER to read key points pg. 7Maximizing capabilities:-helping a person to function as independently as possibleCommunication*other than talking give me examples of how we communicate…facial expressions, listening, written notes, body languageEXERCISE p. 10
17Safe Medication Administration Cycle of ResponsibilityGiving meds safely is part of a larger process called the cycle of responsibility.
18Cycle of Responsibility ObserveDocument the Med AdministrationReport changesAdminister MedicationSupport Visits to HCPPage 11Cycle begins with you because who is most likely to see change in a person’s physical condition or behavior? YouWhat do you do with that info? Report facts, NOT a hunch or guess of what you thinkWhy 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 observep. 13 EXERCISE-assign each table 2 parts of cycleSo…how do you make this cycle part of your daily routine?Store MedicationCommunicate with PharmacistRecord Information
19Daily Routine Come to work ready to: Talk with other staff Greet personAsk how person is doingPay attention to behaviorp. 16 EXERCISEIf you look at page 18, this is a chart of the knowledge and skills you need to give meds safelyp. 17 VOLUNTEER-read key points
21Prevent and Control Infection Hand washingWhenHowPage 51What is the purpose of hand washing?How long should you rub your hands together? secondsGive 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 pageIn 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
22Prevent and Control Infection Wearing GlovesWhenHowPage 53In 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.
23The 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 agreesGeneral Guidelines Medication Administration
24The Five Rights Right Person Right Medication Right Dose Right Time Right RouteREAD highlighted info p. 64Page 65-70Divide into groups each taking a “right”, read, talk about what it means and report back to group.
25The Right Person If not certain get help Ask other staff Check picture Page 65
26The Right MedicationIf brand name written on prescription, pharmacist will usually substitute genericIf unsure, ask pharmacistPage 65
27The Right MedicationIf familiar with med but notice a change in color, size, shape, markings, etc.Ask the PharmacistPage 66EXERCISE p. 66
28The Right Dose HCP orders dose Usually written in “mg” Page 66-67 EXERCISE p. 67
29The Right Time Particular time of day Number of times per day Time between dosesPage 67
30The Right TimeMost meds can be given safely one hour before and up to one hour after time on med sheetIf unsure, ask pharmacistPage 67-69
31The Right Route The form of med determines the route: tabs, caps, liquids (usually oral)ointment to skin (topical)Page 69-70
32General 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.
33How to Administer Medications The Process(Page 76)
34Medication Administration Process PrepareAdministerCompleteObjectsDraw shapes, label gridHave students follow alongDemonstration while student reads from drawing (grid)
35Prepare Determine the meds to give Know the reason ordered Clean area Wash handsGather supplies neededIdentify individualUnlock storage areaOpen count book, if needed(Page 77)
36Administer Cross check one Cross check two Prepare med Cross check threeGive med(Page 79)
37Complete Observe for effects Look again Document Lock Wash hands (Page 81)
38Med Pass Instructions Chip Brown 8pm med Sept. 3, yr Review additional documentation with a countable med.Count bookUse indexSpell out number used “0ne”Stress to use the pretend infoReview 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).
39Med Pass Instructions Chip Brown 8am meds Sept. 4, yr Pair off and practice
40Support 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
41Med 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 2Review homework assignmentEnd of Day 1
42Document Med Administration Place initials in box that directly corresponds to time and date givenInitials and signature at bottom of med sheet (if first time giving)PRN medication time/initials in same box and write a progress noteBeginning of Day 2Review questions on business cardsPracticed yesterday…any questions?
43Oral MedicationHCP order required to crush and mix a med with food or liquidWho 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
44Oral MedicationMUST have HCP order to:empty contents of a capsule
45Oral Medication May give half tabs ONLY if halved by the pharmacy Not allowed to break, cut, etc.
46Liquid Med Administration Oral Med Cup:Place on flat surface at eye levelUse thumbnail to mark correct measurementShake bottle of med well, if neededPour slowlyPage 85-86Demonstrate 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. (www.healthlink.mcw.edu)
47Liquid Med Administration Oral dosing syringePage 86Pass around examples
48Liquid Med Administration DropperPage 86, 87Another common marked measuring device for liquid meds.Pass around examples
49Other Routes of Medication Administration Never administer a med by any route unless you have received training in that routeFocus 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 tubeDMH staff may not administer suppositories or enemas
50General Cautionary Guidelines Administering meds if:Unable to read HCP orderMissing any piece of infoUnable to read labelLabel is missingMed was prepared by another staff(Page 74)Never use another person’s med
51General Cautionary Guidelines Administering Meds If:You have any doubts about the five rightsIf person has a serious changeIf person has difficulty swallowingIf person refusesIf med seems to be tampered with(Page 75)ASK for VOLUNTEER pg. pg. 101EXERCISES p. 101 and 102
52Medication Refusals Page 95 “call out” box Definition -refuses or spits right back out-spits out later-intentional vomiting within a ½ hr. after taking medsSuggestions if occurs:Ask person why they do not want to takeTell the person you will call HCPHCP may adjust medsDefinition of Refusals in MA in box on page 95
53Dealing With Refusals Offer 3 times Contact HCP for recommendation wait minutes in-betweenContact HCP for recommendationNotify SupervisorDocumentpg. 95Ask how to document a refusal.
54Medication progress note Documenting a RefusalCircle initialsMedication progress noteRefusal descriptionWho was notifiedHCPSupervisorEXERCISE p. 96
56Medication Used to treat health problems Taken to eliminate or lessen symptomsImproves quality of lifeWhat’s your definition of a med
57MedicationChemicals 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 – MotrinAll meds have the potential to cause side effects so must watch for.
58Categories of Medications PrescriptionOver the Counter (OTC)Brand nameGeneric nameCountable substancesHolistic/Herbal CompoundsPage 246 GroupsAssignDecide key points, spokesperson to present
59Prescription Medications Written by HCPUses a small prescription notepadMay not photocopy to use in place of a HCP orderP. 24
60OTC Medications Must have HCP order Administered, documented and stored just as prescription medsLabel requirement optionsMedication occurrence (mistake) if not given as ordered by HCPpgCan buy without a prescription but must have HCP order in a program setting to give.
61Brand Name Medications Made by a specific pharmaceutical companyPage 25Only way to receive brand name from pharmacist is for HCP to write no substitution at bottom of prescription form.
62Generic Medications Basically same as brand name meds Made by different companiesUsually less expensivePage 25
63Countable Substances Specific Requirements for: Storing Packaging TrackingCountingPage 25Will go into detail laterDepending on the company you work for the packaging will vary. Blister packs are most common.There is also Opti-Pak and OPUS packaging
64Holistic/Herbal Compounds Very popularHCP order requiredAdministered, documented and stored just as prescription medsPage 25
65Other 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 interactionMeds can fit in to more than one category-give me an example…EXERCISE p. 26If we had ignored his behavior, this problem may have gotten worse and a more serious interaction could have developed.
66Medication Sensitivity How a person responds to a med depends on:ageweighthealth(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.
67Effects of Medication Three outcomes: Desired or Therapeutic Effect No Apparent Desired EffectUnwanted Effects*Page 27Divide into 3 groupsAssign
68Desired Effect Tylenol helps a headache Dilantin helps reduce seizures Examples:Tylenol helps a headacheDilantin helps reduce seizuresPage 27Desired/TherapeuticMed is workingMust know a meds desired effect, indication or reason for use.
69No Apparent Desired Effect Examples:Could be because it may take time before full effect of med can occurEven after enough time passes for med to work, it does notPage 27No Apparent Desired Effect-hasn’t worked yet or did not workIf 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.
70Unwanted EffectsMeds can cause effects that are not intended or wanted. Also known as side effects.Examples:Allergic reactionAnaphylactic reactionParadoxical effectToxicityPage 28, 29Unwanted 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 sensitivityAnaphylactic 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 30Do people where you work receive more than 1 med?If so, there is always the potential for med interactions.
71Medication Interactions Mixing of Meds in the BodyMay increase or decrease the effect of another medASK FOR VOLUNTEER to read the 4 important points Page 31
72Medication Interactions The more meds taken at one time increases the possibilityChanges observed could be caused by a med interactionWhy 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 medsWhere 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
73Resources for Obtaining Information about Meds Prescribing HCPPharmacistPackage InsertsReputable Online sourcesMedication Reference booksPage 33Pass around The Pill BookFind out where the drug reference book in your program is kept.EXERCISE p. 32ASK VOLUNTEER to read p.33 first paragraphEXERCISE p. 35 and 36ASK VOLUNTEER to read summary p.34
75Basic Responsibilities ObserveReportDocumentRole playFollow up on what you have reported to learn what was done.
76Observation 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
77Observation Subjective Information Subjective-what/how a person tells you they feelEXERCISES p. 40 and 42
78Reporting Immediate reporting Certain time reporting Routine reporting Page 43Detailed 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.
79Reporting If unsure… REPORT Why report if you are unsure??? Any change in physical condition or general behavior could be important.
80Forms for Documenting Info Observed/Reported Page 46What kinds of data tracking forms besides med sheets and HCP orders have you seen or do you use? (seizure activity, bowel movements, behavior)
81Reporting Information to the Right People READ SUMMARY Page 47EXERCISES p. 48Being 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.)
83Med Pass Instructions Melissa Sullivan 8am meds Sept. 4, yr Practice End of Day 2Provide practice med book, count book and corresponding copies of blister packs to use for practice outside of trainingHandout DBQ Exercise and review how to answer questions using corresponding documents.
84The Management of Med Administration Begin Day 3Business cards with questionsAnswer questions/comments regarding DBQ exercise
85TranscriptionCertified staff copy info from HCP order and pharmacy label on to med sheetPage 132Part 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?
86Documentation Complete Accurate Clear Ink only Include date and time Sign your namePage 46Remember med sheets, HCP orders, etc. are legal documents.Ask if know how to correct a documentation error.
87Correcting Documentation Draw a single line through mistakeWrite the word “error” and initialNo scribbling, “marking over”, erasing or using “white out”
88Medication SheetDocumenting accurately on a med sheet is key to safe med administration.Page 132SPECIAL INSTRUCTIONS -pass around pharmacy label stickersMed sheets are used to document vital signs
89Abbreviations 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 areaIn the transcription workbook copy the information exactly as writtenWill be using a few abbreviations.
90Abbreviations DC (discontinue) mg (milligram) Cont (continue) tab (tablet)cap (capsule)mL (milliliter)tsp (teaspoon)Will be using these when transcribing
91Frequency Number of times per day to be given Specific hour chosen Examples:HOUR8am4pmHOUR8am4pm8pmHOUR8am12pm4pm8pmPage 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 policyDo not choose “off” times12 am same as midnight12 am is usually considered the first dose of the day.12 pm same as noonThe q6h and q8h transcriptions are considered more difficult and are not covered in the basic training-for reference onlyA.m. times go in top boxesP.m. times go in bottom boxesGeneral rule - times chosen must be at least 4 hrs. apart
92Discontinuing an Order Mark COMPLETELY through all boxes next to where med was scheduled to have been givenMark a diagonal line through left section of med sheet, write D/C and dateMark a diagonal line through grid on med sheet, write D/C and dateTurn to p. 141 as your reference for example to dc’ing a med orderOnce 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
93Step 1Mark completely through all the empty spaces next to where the med was scheduled to be given.
98Health Care Provider Order DoseFound in HCP order, usually in “mg”Health Care Provider OrderChip Brown No Known AllergiesZantac 150mg twice a day by mouthSignature: Dr. Jones Date: 6/11/yrIf transcribing this HCP order, would copy 150mg next to the word “dose” on the med sheetThe dose is: ___ mg
99Strength and Amount Found on pharmacy label Rx# 135 ABC Pharmacy20 Main StreetAny Town, MA 09111Chip Brown 6/11/yrRanitidine HCL 75mgI.C. Zantac Qty: 120Take two tablets by mouth twice a day Dr. JonesLot# ED: 6/11/yr Refills: 3If transcribing, would copy “75mg” next to the word strength on the med sheetIf transcribing, would copy “2 tabs” next to the word amount on the med sheetThe strength per tablet is: ___ mgThe amount of tabs to give: ___ tabs
100PRACTICE SKILLS-TRANSCRIPTION INSTRUCTIONSYou 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.
101HEALTH CARE PROVIDER ORDER Name: Chip BrownDate: 6/11/yrHealth Care Provider: Dr. JonesAllergies: no known allergiesReason for Visit: Chip states he has a burning feeling in his throat during the day.Current Medications:Pantoprozole 40mg by mouth every eveningStaff Signature:John Smith, Program ManagerDate: 6/11/yrHealth Care Provider Findings:Medication/Treatment Orders:D/C PantoprozoleZantac 150mg twice a day by mouth(dose) (frequency) (route)Instructions:Follow-up visit:Lab work or Tests:Signature: Dr. JonesSTAFDOCTR
103Pharmacy Label Generic Equivalents Brand Name Generic Equivalent Rx# ABC Pharmacy20 Main StreetAny Town, MA /11/yrChip BrownRanitidine HCL 75mg (strength)I.C. Zantac Qty. 120Take two tablets by mouth twice a day(amount) Dr. JonesLot# ED: 6/11/yr Refills: 3Generic EquivalentsBrand NameGeneric EquivalentZantacRanitidine HCLLoramLoramineLoxaprillLoxaprillineTylenolAcetaminophenAmoxilAmoxicillinEESErythromycinDepakoteDivalproexHaldolHaloperidolTegretolCarbamazepinePen VKPenicillin
104MEDICATION 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 atYou 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-
105Medication 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.
108“Post” HCP Order Completed for new orders after transcribing Agency may choose certain ink colorWritten on order sheetWrite: “posted” signature date timeAfter 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.)
109John Smith, Program Manager HEALTH CARE PROVIDER ORDERName: Chip BrownDate: 6/11/yrHealth Care Provider: Dr. JonesAllergies: no known allergiesReason for Visit: Chip states he has a burning feeling in his throat during the day.Current Medications:Pantoprozole 40mg by mouth every eveningStaff Signature:John Smith, Program ManagerDate: 6/11/yrHealth Care Provider Findings:Medication/Treatment Orders:D/C PantoprozoleZantac 150mg twice a day by mouthInstructions:Follow-up visit:Lab work or Tests:Signature: Dr. JonesTurn 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
110PRACTICE SKILLS-TRANSCRIPTION INSTRUCTIONSYou 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
111HEALTH CARE PROVIDER ORDER Name: Chip BrownDate: 6/20yrHealth Care Provider: Dr. JonesAllergies: no known allergiesReason for Visit: complaint of pressure on forehead, mild fever, dizziness, increase in head slapping behaviorCurrent Medications:Synthroid 0.125mg by mouth once a day in the morningStaff Signature:Paula Jones, Program ManagerDate: 6/20/yrHealth Care Provider Findings: sinus infection, elevated blood pressureMedication/Treatment Orders:D/C SynthroidArmour Thyroid 30mg by mouth once a day in the morning on an empty stomachInderal 20mg by mouth once a day in the morningAmoxil 500mg by mouth three times a day for 10 daysInstructions:Follow-up visit: 2 weeksLab work or Tests:Signature: Dr. Susan SmithDate: 6/20/yrHow 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
112Rx# ABC Pharmacy20 Main StreetAny Town, MA /20/yrChip BrownArmour Thyroid 30mgQty. 30Take one tablet daily in the morning on an empty stomachby mouth Dr. SmithLot# ED: 6/20/yr Refills: 3Rx# ABC Pharmacy20 Main StreetAny Town, MA /20/yrChip BrownPropanolol 10mgI.C. Inderal Qty. 60Take two tablets daily in the morning by mouthDr. SmithLot# ED: 6/20/yr Refills: 3strengthWhat 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 Pharmacy20 Main StreetAny Town, MA /20/yrChip BrownAmoxicillin 500mgI.C. Amoxil Qty. 30Take 1 tablet three times a day for ten days by mouthDr. SmithLot# ED: 6/20/yr Refills: 0
113AnswerFor the next exercise tear out the med sheet on page 21.
114AnswerFor the next exercise tear out the med sheet on page 27.
115AnswerFor the next exercise tear out the med sheet on page 33.
116AnswerFor the next exercise tear out the med sheet on page 39.
117AnswerFor the next exercise tear out the med sheet on page 45.
118AnswerFor the next exercise tear out the med sheet on page 51.
120Transcription 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 = DoseAdditional math required if half tab or liquid med
121New OrdersIf the medication has not changed but the dose, frequency, or route (or symptoms if PRN) is changed, it is considered a NEW orderD/C old orderTranscribe new order(Page 133)This we have practiced…if any part of a HCP order changes-start over.
122“Post” HCP Order Completed for new orders after transcribing Agency chooses ink colorWritten on order sheetWrite: “posted” sign your name date timePage
123“Verify” HCP Order Second certified staff double-checks Agency chooses ink colorWrite: “Verified” sign your name date timeOK to give meds if not verified yetPage 132, 133Ask who posted/what time was verified
124Telephone Orders Check your agency policy Remind HCP to call pharmacy Must be signed by HCP within 72 hrs.Page 124Sample form p. 125Check 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 writtenAsk if do not know how to spell a wordHow do you get the new med?
125Fax Orders Legal Signed by HCP Preferred Page 124-125 Review liquid exercisesPractice giving medsAssign homework
126Liquid 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 toDose, strength, amount?= 50mg
128The Cycle of Responsibility Continues Show DVD-Making the Connection
129Visiting the Health Care Provider AdvocacyRespect and dignityAsk questionsPage 114Ask if anyone has assisted with a appointment.Training Manual p.117
130Information for the HCP Reason for visitAllergiesCurrent medicationsHCP order formInsurance informationPage 114, 115What has changed since the last visit
131Encourage Participation Redirect HCP’s questions to the personEncourage person to give own description first. Then explain any additional symptoms and changesPage 117DDS Health review checklist pg. 196, 197DDS Annual health screening recommendations pg. 198DDS Health Record
132Obtaining MedicationA Health Care Provider (HCP) writes a prescriptionIn a community program a HCP order (also written by the HCP) is required to administer medicationPage 57
133Information From the HCP PrescriptionHCP orderDiagnosisWhat to expect from new medPage 119
135Communicating with the Pharmacist Prescription can be given to person to bring to pharmacyHCP can send directly by fax or electronicallyHCP can call prescription into pharmacyStaff can bring prescription to pharmacy to be filledPage 59Take out Vi Lee’s Kazinem blister pack/ask questions
136Pharmacy LabelRx# 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: 0Page 60, 61What does IC mean?ASK: name of pharmacyname of HCPhow many refillsWhat is a refillWhat # to give pharmacist if refill is needed?What if zero refills and current HCP order?Find out who is responsible for re-ordering medsinstructionsexpiration dateDifference between exp. Date and stop date written on med sheet?strengthamountquantity in bottlename of medprescription #why would be prescribed?name of individualIn one day, what is total # of capsules he would take
137Obtaining Medication A Pharmacist fills the prescription Certified staff receive a labeled container of meds from the pharmacist
138Ensure Pharmacy Provided Right Medication Compare HCP order with labelIf familiar with med, open and look atIf not, look up or askPage 122Look in drug reference book, package insert, onlineAsk pharmacistWhat if it doesn’t look right?VOLUNTEER to READ p. 126-summaryEnd of Day 3Handout, review and re-emphasize Sample CBT for homework, sample transcriptionD&S Candidate handbook-key points (how number of questions asked correspond with table of contents in AMRW, etc.)
139Med Pass Instructions Vi Lee 8pm med Sept. 3, yr Beginning of Day 4 Show med pass DVDDifferent pairs and practice.
142Countable SubstancesCountable prescription medications require extra: countingtrackingdocumentingspecial packagingdouble-locked storagePage 143Subtracted from count book after taken out of packageOf the meds we have been practicing with, which are countable?How do you know if a med is countable?
143Countable Substances Higher incidence of abuse Count requirement:Each time staff changes, 2 certified staff count togetherDocumentation requiring 2 signatures:When beginning a new count sheet pageAdding a refill onto count sheetPage transfer (bottom of old page/top of new)RefusalDisposalPage 143Countable Substance Book : bound, numbered pages, Index - always updated as meds are givenPass around count book
144Sample Index PageEvery count book has an index page at the beginning of the book that identifies the pages that are currently in useStaff must update the index when transferring a medication to another page in the book
145Sample Count SheetPage 11Each prescription is entered onto a separate numbered page in the count bookThese pages tell us the current number of pills remaining (amount left) on each prescriptionLook at the first yr entry – what happened there? When a count sheet page is full, the prescription gets transferred to a new pageAt the bottom of the ”full” page (page 10) Karen and Lisa’s signature would be there alsoLook 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
146Sample Shift Count Sheet Countable meds must be counted every time the shift/staff changesIdeally with a staff coming on and another staff who is leavingIf that is not possible, count with another MAP Certified staff working on the same shift as youWhat if count is wrong?
147Non Suspicious Count Discrepancy Count is offCan be easily resolved by checking addition, subtractionReportDocument in count bookPage 146
148Count Discrepancy Count is off Suspicion of tampering, theft, unauthorized use of drugsReport to DPHPage 146Call supervisorDPH Drug Incident Report form pg. 204
149Medication Storage Next 3 topics 3 Groups: Med storage p. 147-148 Med disposal pLOA p. 150
150Storage of Medications Locked/double lockedLabeled storage containers per personSeparate oral meds from other routesMust remain in original packagingRules for refrigerated medicationsRestricted access (medication keys)P“Props” for internal/external storageDPH regs to ensure safetyIn a cool, dry place away from excessive heat, light and moistureMention med info sheet lists storage requirements
151Medication Disposal Two certified staff, one must be a supervisor Proper disposal of medicationDocumentDo NOT return medications to the pharmacyPWhy would meds require disposal?
152DPH Disposal Form Disposal form pg. 193 Documentation of any prescription med disposal is required on a DPH disposal formIf 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 employerPRACTICE med disposalScenario-Melissa needs Percocet due to back discomfort during transfers, when you prepare it falls on floor.
153Leave of Absence (LOA) Meds must be prepared by the pharmacy if the: LOA is planned/scheduledPerson will be away from their residence for more than 72 hoursPageDay program meds and routine family visits are examplesLOA form page 209Ask supervisor where kept
154Leave of Absence (LOA) If pharmacy cannot Certified staff may only package meds for an unplanned absence of less than 72 hoursPage 150How 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.
155Day Program Medication Staff at the home responsible to:Photocopy HCP order for day programProvide a pharmacy labeled container of medsRemember to contact and fax HCP order if med is DC’dFind out communication system between the two programs
156Medication ErrorsOne of the five rights went wrongPage 151
157Medication Occurrence (Error) Wrong IndividualWrong MedicationWrong DoseWrong Time (includes omission)Wrong RoutePage 151Need to look back at HCP order to figure out which right went wrongEXERCISE p. 153
158Medication ErrorsAn opportunity to improve procedures that put people at riskFocus on the cause rather than who made the mistakeSupervisor can set up procedures to minimize the chance that another staff will make the same error.
159Medication Error Reporting Self reporting system
160Medication ErrorsSafety of the person is the primary concern
162What To Do Know Emergency Procedures Most Med occurrences are not emergencies but know your agencies emergency procedures.Call 911, if needed.
163What To Do IMMEDIATELY contact MAP Consultant Follow recommendation and document
164Medical InterventionLab work, medical tests, physician visit, clinic visit, emergency room visit, hospitalization or other medical care providedThe MAP Consultant may recommend a medical intervention and if does is considered more serious and is called a “hotline”.
165HOTLINE Medication Occurrence If medical intervention, illness, injury or death follows an occurrence fax MOR to DPH within 24 hours
166What To Do Notify your supervisor Contact supervisor after MAP consultant
167HOTLINEFor 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
168Medication Occurrence Report (MOR) Form/Data Entry HCSIS paper process (page ) then data entry (DDS)EXERCISE p. 154MOR cards from call box quiz p.152Review questionsEvaluationPretest