1. Medications, Effects, & the Importance of Observation CMT Training #1 The Center for Life Enrichment Resource: MTTP Student Manual

2. 4 Reasons to Use Medications 1.To cure an illness/disease 2.To prevent an illness/disease 3.To reduce/relieve symptoms related to an illness/disease 4.To manage an illness/disease

3. Staff Responsibilities in Administering Medications As a CMT, you will be responsible for ensuring that individuals take their medications safely Administering medications safely requires following the Medication Administration Process/Cycle: 1.Observing the individual for changes in physical condition and/or changes in behavior 2.Reporting these observations to the RN CM/DN and supervisor in an appropriate time frame 3.Assisting the individual in a visit to the HCP and communicating and obtaining all necessary information (May apply to CMTs providing ISS/CSLA support) 4.Communicating with the pharmacist and obtaining the prescribed medication (i.e. new orders/refills) (May apply to CMTs providing ISS/CSLA support) 5.Storing the medication safely 6.Administering medications correctly 7.Ensuring medications are taken 8.Recording information promptly, correctly and on correct forms

4. Identifying Effects of Medication As a CMT, you spend more time with the individuals in your care than anyone else. Because of this, you are the most important advocate responsible for communicating the preferences and needs of those individuals You are the best person to notice when changes occur in the individual’s physical condition or in their usual ways of behaving Some changes may be sudden and drastic, while others are more subtle

5. Identifying Effects of Medication Continued… When medication therapy is used, there are three (3) main effects of medication: 1.Desired effect: the medication is doing what it is meant to do. It is your responsibility to observe for and record the desired effect of medication therapy 2.Unwanted/side effects: even though the medication may be working (desired effect), it may produce unintended symptoms. Unwanted/side effects can range from being harmless to being potentially fatal. It is your responsibility to always observe for, report and document any unwanted/side effects an individual experiences related to medication therapy 3.No apparent effect: a medication is not producing the desired effect with no observable benefits or side effects. When a medication is noted to have no apparent effect, the RN CM/DN and prescribing HCP must be informed. The dose or medication may need to be adjusted by the HCP

6. Factors Affecting the Individual’s Response to Medication Age: children and aging individuals require smaller doses of medication and react differently to certain drugs Weight: body weight may delay or speed up medication Gender: hormone levels may affect the body’s utilization of specific medications General Physical Condition: the presence of a chronic or acute illness may also alter the body’s response to medication

7. Objective Signs Objective signs are observable/measurable information that you can document about another person The changes you see in an individual’s appearance, behavior, and bodily functions are objective signs They can be seen, heard, felt, smelled, or measured For example, you may: ▫See or hear a person crying or moaning ▫Feel an individual’s skin as warm or cold ▫See that the individual has vomited ▫See that an individual has a change in bowel habits ▫Hear an individual slurring his speech ▫Measure an individual’s temperature or weight ▫See that an individual’s eating habits have changed

8. Subjective Symptoms The changes that you cannot see, but that are experienced and/or reported by the individual are subjective symptoms An individual may verbally tell you of changes he/she perceives or may use nonverbal behavior to express these changes For example, the individual may complain of: ▫Pain ▫Itching ▫Dizziness ▫Feeling upset or worried ▫Weakness ▫Loss of appetite ▫Nausea

9. Objective Signs & Subjective Symptoms When an individual reports a symptom to you, you should not only report the symptom but also look for other signs. ▫For example, if an individual reports that he is dizzy (symptom), a sign would be if he held onto furniture to help steady himself There are times when you might have to observe an individual’s nonverbal behavior and report these behaviors to assist in detecting symptoms ▫For example, what might these signs indicate?  Holding one’s head  Pointing toward part of the body  Limping  Restlessness  Pacing

10. Changes in Physical Condition To observe correctly you must notice any and all changes that occur in the individual’s physical condition To accurately detect changes, you must be familiar with the individual’s daily patterns, baseline behaviors, and health status To detect changes, be alert to: ▫A change in body weight ▫Urinary patterns change (e.g. frequency or incontinence) ▫Constipation, diarrhea, or other change in bowel habits ▫Loss of appetite ▫Change in walking/gait or balance ▫Change in ability to perform activities of daily living (ADLs) e.g. put on coat, wash hands, etc. ▫Change in eating pattern ▫Change in cognition (process of knowing/thinking) and/or memory ▫Change in temperature, pulse, respiratory (breathing) rate, and/or blood pressure

11. Changes in Behavior In identifying changes in an individual’s behavior, it is necessary to first learn what is usual or baseline for that individual Compare his or her present behaviors to the usual behaviors that the individual has shown in the past For individuals with dementia or behavioral problems, it becomes especially important to know what their “usual” behavior pattern was like before receiving any medications to target behavior Behavioral changes may present as: ▫Emotional changes (e.g. mood, withdrawn, anger, etc.) ▫Change in sleep patterns ▫Change in level of activity ▫Changes in ability to communicate ▫Changes in socialization with others ▫Change in level of consciousness (e.g. lethargy, hyperactivity, drowsiness, etc.) ▫Increased irritability ▫Increased pacing ▫Increased or decreased resistance to care ▫Change in level of cooperativeness ▫Mental changes (e.g. memory, ability to concentrate, etc.)

12. Your Role is Very Important! While only the HCP can order medication, your reported observations and descriptions of physical and behavioral changes contribute to the information that the HCP uses in planning treatment Because you are the person in closest contact with the individual experiencing physical and behavioral changes, it is your responsibility to observe, describe and report signs and symptoms to the RN CM/DN right away!

13. Contact Info Pat Breitmaier, RN CM/DN, TCLE  301-373-8100 *821 (office)  301-904-0676 (cell)  301-884-3283 (home) Ann Kline, Quality Assurance Director, TCLE  301-373-8100 *830 (office) Know your immediate supervisor’s contact info! Have access to emergency contact numbers for the individuals in your care!

14. Be Well Informed! It is important that you read the Individual Plan (IP) and health record of each individual in your care Pay close attention to the recommendations from all health care professionals, including the RN CM/DN You are responsible for reviewing and implementing the individual’s Nursing Care Plan (NCP) You are responsible for asking questions if you don’t understand

15. Any Questions?