Pharmacology Information, Rules, and Laws For Medications Prepared by Scooter Brown, RN, Director of Nursing (For use by Mental Health clinic staff as Annual Refresher training.) New

Class Objectives Understand: Classifications of Medications Purpose/Intended Effects of Medications Common Side Effects of Medications TIMA Program Medication Rules & Laws

What is Our Role With Medications? Help the Consumer Be Independent Help Keep the Consumer Safe Follow Federal and State Laws

Who Makes the Rules? Federal Drug Enforcement Agency (DEA) Texas Legislature per Texas Administrative Code Texas Board of Pharmacy Texas Medical Board Texas Board of Nurse Examiners Texas Department of Public Safety (DPS) Other

Is prescribing medication a guessing game? Medical research and studies determine a best course of treatment for doctors to follow for most major medical conditions. These are referred to as “standards of care” or “best practices” or “evidence based treatment”.

Texas Implementation of Medication Algorithms “Best Treatment” TIMA Texas Implementation of Medication Algorithms

3. Patient/Consumer Education Four Parts to TIMA 1. Algorithm 2. Training to Staff 3. Patient/Consumer Education 4. Record Keeping

1. Algorithm An algorithm is a tool for solving problems by going through a series of steps. A medication algorithm recommends to the doctor which medication is best to use in a particular situation and what steps to follow if the first treatment does not work at all or does not work completely.

TIMA Materials Algorithms

2. Training Doctors are trained so they can use the algorithms in the most effective way. The goal is to get as much improvement in symptoms as possible. This may mean trying different medications.

3. Patient & Family Education Information can increase the consumer’s understanding about illness and treatment so consumers can be a true partner in treatment

4. Record Keeping Assisting the consumer to keep a journal of medications, symptoms, side effects, etc., can help the doctor visit be more productive. Appropriate documentation of consumer’s statements, appearance, and actions verifies the consumer’s status as well as the staff member’s actions. Accurate documentation insures funding and compliance.

TIMA is for consumers with a diagnosis of: Depression Bipolar Disorder Schizophrenia

Teaching Consumers About Their Medications Expected Action of the Medication Be realistic Help the consumer track their progress TIMA Education Booklet is an excellent source for this

Teaching Consumers About Their Medications Reason for medications Teach the consumer about their diagnosis and condition Please use approved sources, such as TIMA and approved handouts or approved websites*

Teaching Consumers About Their Medications Possible Side Effects to the Medication May be temporary Help the consumer track the frequency and severity TIMA Education Booklet is an excellent source for this

Why are prescription medications different? Many medications require a prescription because they are too dangerous without a doctor’s supervision. Most prescriptions fall into this “dangerous drug” category. Other prescription medications have potential to become habit forming or may interfere with breathing. These are called “controlled substances” and are monitored even more strictly.

What categories of prescription medications do we use? Antidepressants Several Categories Mood Stabilizers Anti-Manic/Anti-Convulsants Antipsychotics/Neuroleptics Typical & Atypical First Generation/Second Generation or New Generation Other Anti-Anxiety (Anxiolytic)/Anti-EPS/Anti-Parkinsonism/Stimulant Sedative/Hypnotic

Teaching Consumers About Their Medications How to Take Medication As directed by the doctor. (Staff should check the latest doctor’s order. The directions may have changed since the Rx was filled) With a full glass of water and with food unless instructed by doctor, nurse, or pharmacist to take without food. If dose missed*, don’t double up. Don’t run out of meds.* *Call the nurse or doctor.

Teaching Consumers About Their Medications “Five Rights” of Medication Right Person (Correct Consumer Name on the Med Bottle) Right Medication (Correct Name of Medication on the Med Bottle) Right Dose (Correct Amount or Size of Pill) Right Time (Correct Time of Day) Right Route (Correct Way)

For Best Results Encourage Consumers To: Keep Clinic Appointments Take Medications As Prescribed Report Symptoms or Side Effects

What are the rules for consumer’s medications? There must be a doctor’s order (prescription) for the medication. The medication container must be labeled by a pharmacist or doctor/practitioner. Only a doctor, pharmacist, or consumer may place the medications in the prescription bottle. A nurse may fill a consumer’s “pill minder”, “pill planner”, or similar container specifically designed for medication storage (or an RN may specifically delegate this function in accordance with the Nurse Practice Act guidelines.) Only the person on the prescription may use the medication or be in possession of the medication unless acting as a documented agent of a facility or practitioner. Only a nurse, doctor, or other practitioner may call in medication doses or instructions to a pharmacy.

Medication Procedures Medication Handling Guidelines for Staff

Definitions Dispense: to prepare, package, compound, or label a dangerous drug. ONLY A DOCTOR OR PHARMACIST Administer: removal of a medication from a previously dispensed, properly labeled container. ONLY A LICENSED HEALTH PROFESSIONAL UNLESS SPECIFICALLY AUTHORIZED IN ACCORDANCE WITH THE RN DELEGATION RULES OF THE TEXAS RN NURSE PRACTICE ACT Prescribe: to authorize a “dangerous drug” or controlled substance to be dispensed. ONLY A LICENSED PRACTITIONER.

Transporting Medications Always verify and sign for the medications you accept to transport for any reason, and require the receiving person to do the same.

Transporting Medications Never leave medications in a vehicle -theft risk -heat or cold can damage or alter medications

Assisting Consumers With Their Pill Containers A licensed nurse may fill the pill containers in instances where the consumer is unable to do this. In special circumstances an RN may delegate a specific unlicensed person to do this as long as all the criteria for delegation is met.

Criteria for RN Delegation to Unlicensed Assistive Staff Consumer is in an independent living environment. Consumer or guardian is willing to participate in consumer’s care. Consumer has a stable predictable condition (chronic not recuperative). Process An RN must make an assessment of the consumer to determine if delegation of the nursing task is appropriate. An RN must verify the competency of the unlicensed staff to perform the nursing task. RN should be available for consultation and questions.

If Filling Medication Pill Containers is Delegated to You It must be documented with RN signature and staff signature and consumer or guardian. Universal precautions must be observed (gloves and no touching pills). Use it as a teaching activity. Information about how to call the nurse or clinic prior to taking a medication if there are questions. Incorporate TIMA materials.

Items on the Prescription Bottle Verify The Following: Consumer Name Medication Name Medication Dose Medication Time Medication Route These are also the “Five Rights”

Poison Control 1-800-222-1222

Documentation Needs to be legible. Should indicate purpose of appointment, what was addressed, and consumer’s understanding of information, as well as action consumer is to take. If consumer reports problem, symptom, concern, question, etc., always document what action will be taken and by whom. If consumer indicates suicidal or homicidal thoughts, address those as appropriate: “Are you saying you feel like hurting yourself or someone else?...How do you think you might do that?...Do you think you might act on those feelings?” Notify the doctor, nurse, LPHA, or Clinic Director if yes to above and document that notification or follow up to comments.

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