Medication Administration Training Zumbro House, Inc.

Training Requirements Before administering medications you must: Be at least 18 years of age Complete an approved Medication Administration class Complete and pass a written exam Complete and pass an on-site observed skill demonstration

Client Rights Each of our clients has the right to: Expect that the medications they receive are exactly what has been prescribed by their doctor. Expect that anyone who administers medications is qualified to do so. Expect everyone who administers medications to know and respect the client rights. Refuse medications or treatments. Be informed of any consequences that may occur as a result of refusing medication.

Staff Responsibilities As unlicensed, non-medical, personnel, your responsibilities include: Successfully completing this medication administration course before giving any medication. Following the medication order exactly as written. Informing your supervisor if you are unsure of the correct procedure for a medication administration task you have been asked to perform. Ensure that Zumbro House policies are followed. Following any government regulations, including those regarding privacy and client rights. Remember: You are responsible for your actions!

“Rights” of Administration You MUST check for all 7 Rights each time you administer any medication to any person. Right Person Right Date Right Time Right Medication Right Dose Right Route The 6 Rights above are checked BEFORE you administer the medication. Check 3 times: When removing the medication from the cabinet Just before dispensing the medication After dispensing the medication, before returning it to the cabinet The 7th Right is observe AFTER you administer the medication Right Documentation

Medication Errors If you make a mistake in administering medications, or if you find that someone else has made a mistake, take the following steps: Call the nurse immediately. Explain the error and follow any instructions. Document the error in the client’s Health Progress Notes. Document the error on the medication sheet (circle the box). Complete a Medication/Treatment Discrepancy form. Medication errors will result in specific consequences as outlined in to Medication Administration Agreement. Failure to follow proper procedures in response to a medication error may result in additional penalties. If a medication or treatment is not initialed on the medication sheet, it is your responsibility to contact the staff person who worked that shift and ask if the medication was given or the treatment was done.

Standing orders Each person must have a Standing Order list approved and signed by his physician. The physician may individualize the list as necessary. No over-the-counter (OTC) medications may be used unless they are authorized by the client’s physician. When administering a Standing Orders medication administer it: For exactly the reason(s) stated on the order In exactly the way the order states No substitutions or alterations are allowed After administering a Standing Order medication, document: The medication name The dosage given The time administered The reason used What effect the medication caused Once the Standing Orders form has been signed, it is considered doctor’s orders. No form of OTC medication may be given without written, signed orders from the doctor.

Medication Information Never administer a medication unless you are familiar with its use. There are many sources of information concerning medication available to you. You can read the informational leaflets, which are typically kept in the client’s book near the med sheets. You can call the nurse with any urgent questions or concerns. You can call the pharmacy. A pharmacist or nurse should be available by phone to answer any questions you may have. You can call the person who prescribed the medication (i.e. doctor, dentist, nurse practitioner, etc.) for clarification, questions, or concerns. If necessary, you can call Poison Control to get information about medications. When you begin your employment, and whenever a client is given a new prescription, it is your responsibility to review information about the drug before administering it.

Documentation Medication Sheets: Documentation on the med sheet is done after the medication has been administered. Initial the box indicating the medication, date, and time for any medication you have administered. Once a month, you must initial and sign the last page of the med sheets. If a client refuses a medication, write “R” in the box and then circle it. Document on the last page of the med sheet that the client refused the medication. If you have packaged medications for a client to take on a vacation or therapeutic leave, draw a horizontal line through the box on the med sheet. Write “L” in the top half of the box and your initials in the bottom half. If a medication was held (i.e. due to illness or medical tests) write “H” in the box and then circle it. Document on the last page of the med sheet that the medication was held and the reason.

Health Progress Notes Use the Health Progress Notes to document any of the following: Illness or injury Any complaints of illness or injury Use of PRN medications Refusal of medications Medication administration errors Medical appointments Any other issues or concerns related to the client’s health. Remember to use only objective facts in Health Progress Notes For example, an appropriate entry might say that the client “was coughing and sneezing, complained of a headache, and had a temperature of 101.3”. It would not be acceptable to say that the client had a cold or that the client seemed sick.

Receipt of Medications Destruction of Medications Receiving and Destroying Medications Receipt of Medications Destruction of Medications All medications to be destroyed should not be flushed. The medication should be dissolved in water in a disposable container, such as a plastic water bottle. Once the medication is dissolved, add in used coffee grounds or cat litter to ensure that the dissolved medication cannot be consumed. The container should be thrown in the trash. Two staff members must be involved in any medication destruction. Destruction of medication must be documented on a Medication Destruction form. Both staff members must sign the form. When medications are received from the pharmacy, they must be documented on a Medication Receipt form. All medications must be properly stored. Any new Drug Information leaflets (for new medications, not just additional copies) that come with the medications are to be added to the client’s book.

Release Of Medications Medications that are to be administered by someone other than Zumbro House staff must be “released” to another responsible person. Individually package each dose in an envelope. Write on the envelope: The name of the medication(s) The dose of the medication(s) The time the medication is to be given Any other instructions Two copies of a Release of Medication form are to be filled out. One copy is to be signed and placed in the client’s file, the other is to be sent with the medications. In order to document medications prepared for a therapeutic leave, draw a horizontal line through the box on the med sheet. Write “L” in the top half of the box and your initials in the bottom half.

Special Situations Vomiting: If a client is vomiting, or has been vomiting recently, withhold any oral medications (with nurse approval). Check the client’s standing orders to see if any medications or procedures have been prescribed for vomiting. Document in the client’s Health Progress Notes. Difficulty Swallowing: If a client has difficulty swallowing medications, the medication may be prescribed in a liquid form. If the medication is not available in a liquid, it may be acceptable to crush the tablet or break open the capsule and mix the powdered medicati0n with applesauce to be given to the client. Some medications must not be crushed. These include enteric coated and time-released medications. If you are uncertain about crushing a medication, contact the pharmacy or the doctor who prescribed the medication.

Special Situations, Cont. Refusal of Medications: If a client refuses a medication, it may be acceptable to hold the medication for a short time and attempt to administer the medication again later (within 30 minutes) If the client still refuses the medication the drug must be destroyed. Both the client’s refusal of the medication and the staff’s destruction of it must be properly documented. Document on the back of the med sheet and in the Health Progress Notes that the client refused the medication. Document destruction of the medication on a Medication Destruction form.

Psychotropic Medications Psychotropic medications are prescribed to alter mood or behavior. They require the informed consent of the client’s legal guardian. They also require regular monitoring of side effects. Informed Consent: No psychotropic medication may be given without the consent of the client’s legal guardian. The guardian must be given information about the proposed medication, the potential risks and benefits of the medication, and the reason the medication is being proposed. This information must be shared both orally and in writing. The guardian must sign an Informed Consent form stating that they have been informed about the medication and are giving consent for the client to receive the medication.

Psychotropic Medications, Cont. Psychotropic Medication Monitoring: Psychotropic medication use must be reviewed by the agency and by the client’s physician on a regular basis. Clients receiving psychotropic medication must be assessed regularly for side effects. MOSES and DISCUS are two of the scales used to monitor side effects of psychotropic medications. These assessments must be performed by personnel who have been specifically trained to do so. PRN Psychotropic Medications: Occasionally, psychotropic medications are prescribed on a PRN, or as needed, basis. Before a PRN psychotropic implication can be administered, the client must meet specified behavioral criteria. These criteria should be listed in the client’s book. The nurse must also be notified. After administering a PRN psychotropic, document in what way the client met the criteria and document that the nurse was notified.