RCFE ADMINISTRATOR 20 CEU Approved Vendor # #

RCFE ADMINISTRATOR 20 CEU Approved Vendor # #2000558
RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

RCFE Care Consultants ABOUT US: WE ARE CONSULTANTS ASSISTING BOARD AND CARE PROVIDERS IN THE CENTRAL AND TRI-VALLEY AREAS. OUR MARKET IS SMALL TO MEDIUM-SIZED RESIDENTIAL CARE FACILITIES FOR ELDERLY (RCFE) WITH 49 BEDS OR LESS. WE HAVE A NETWORK OF CONSULTANTS TO HELP WITH ELDERCARE RESOURCES FOR CARE PROVIDERS IN HOME CARE, HOME HEALTH, HOSPICE, TRANSPORTATION, REAL ESTATE, CARE PLACEMENTS, STAFFING AND PHARMACY SERVICES. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

About us: WE OFFER THE FOLLOWING SERVICES: EDUCATION COMPLIANCE
CONSULTING FOCUS ON MEDICATION MANAGEMENT & PERSONAL CARE IN-SERVICES NETWORKING COMMUNITY ALLIANCE & RESOURCES FOR ELDERCARE RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

CONTACT INFORMATION: MAILING ADDRESS: 1852 W. 11TH STREET 213 TRACY CA TRAINING LOCATION: 22 W. 10TH STREET 205 TRACY CA PHONE: FAX: WEBSITE: Facebook: Networking: RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Welcome to RCFE CEU 20! Day One: Friday, 4:30-8:30 PM
Postural Support-Restricted Health Condition- Hospice (4.0 CEU) Day Two: 8:00 AM-4:30 PM Medication Management (8.0 CEU) Day Three: Managing Alzheimer’s and Related Dementias (8.0 CEU) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Things you need to know:
5 minute break every hour 30 minute lunch break for an 8 hour day No lunch break will be given if the training is 4 hours of less Please complete the sign-in sheet to verify your full name for your certificates Exam will be given today if you are only signed- up for one class RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

THINGS YOU NEED TO KNOW:
You will be given a set of questions at the end of each training session and must pass a minimum score of 70% to get your certificates It is your responsibility to keep your certificates! Replacement certificates will be made available at an additional charge Fill out CEU Survey form at the end of the class -RCFE Care Consultants, LLC RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

WELCOME ADMINISTRATORS!
IF YOU WERE NOT HERE ON DAY ONE, PLEASE INTRODUCE YOURSELF: NAME: FACILITY/COMMUNITY: YEARS OF EXPERIENCE AS AN ADMINISTRATOR RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Day TWO Medication Management

RCFE MEDICATION TRAINING For administrators (8.0 ceu)
Developed by: RCFE Care Consultants, LLC Education. Compliance. Consulting. 1852 West 11th Street, 213 Tracy, CA 95377 (209) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication management ceu
OVERVIEW OF ASSISTED LIVING COMMUNITY ASSISTED LIVING DOCUMENTARY HISTORY OF ASSISTED LIVING DIFFERENT TYPES OF ASSISTED LIVING RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT CEU:
Assisted Living Documentary Video (9 minutes) Life & Death in Assisted Living (53 minutes) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

History of Assisted Living
Motivated by distaste of nursing home care, a shift occurred in senior housing beginning in 1979 to The shift initiated the service capacity and consumer-centered care model. In 1986 to 1993, the providers, consumers, and government became interested and created four distinguishable kinds of assisted living communities. They included hybrid (reworking the old style), hospitality (resort like setting), housing (55+), and health care (continuum care model) appeared. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

History of Assisted Living
Then in 1994 to 2000 Wall Street brought financial investors, and quality of care became the ideal model. Today, due to older adults living longer, eruption of chronic illnesses, and the exploding boomer market, assisted living is reorganizing and examining its standards and how it provides care. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Current Status AND THE NEED FOR MORE REGULATIONS
Assisted living expanded largely through the private or out-of-pocket pay market. Although as of July 2013, close to forty-five states provide some public funding under Medicaid waivers. Because assisted living was initially a private pay community, regulatory oversight lagged behind development. Now with the large numbers of citizens served and growing public payment, the interest in quality standards and oversight is mounting. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

CALIFORNIA’S ASSISTED LIVING WAIVERS (ALW)
BACKGROUND: MARCH Medi-Cal began paying for assisted living care for qualified aged and disabled residents of Los Angeles, Sacramento and San Joaquin counties under the Assisted Living Waiver (ALW). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

GOAL: To enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to a community setting in a Residential Care Facility for the Elderly (RCFE) or public subsidized housing. The program was converted into a five-year federal waiver program as of March 1, Pending final approval, the waiver program will be renewed through February 28, 2019. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCOPE OF PROGRAM: The ALW is currently operating in the counties of Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara and Sonoma. However, some of the counties in which the ALW program is operating do not currently have any RCFEs participating in the program. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCOPE OF PROGRAM: Participants in the ALW have access to the following services Assisted Living Services: The following is a list of some of the services that must be provided to ALW participants. These services may be provided in an RCFE, or by a licensed Home Health Agency to residents in public housing. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

LIST OF SERVICES: Assisting in developing and updating an individualized care plan for each resident • Personal care and assistance with activities of daily living • Laundry • Housekeeping RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

• Providing intermittent skilled nursing care • Meals and snacks • Maintenance of the facility RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

•Providing assistance with self-administration of medications • Providing or coordinating transportation • Providing recreational activities • Providing social services RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Residents Who Cannot be Safely Maintained in the Community Some potential participants may require more care than can be safely provided through the ALW. The following conditions automatically render an individual ineligible for the project: (a) Active communicable tuberculosis; (b) Bi-Pap dependency without the ability to self- administer at all times [BiPap defined as Bi-level Positive Airways Pressure] RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

(c) Chemotherapy; (d) Coma; (e) Continuous IV/TPN therapy (TPN, or Total Parental Nutrition, is an intravenous form of complete nutritional sustenance) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

(f) Nasogastric tubes; (g) Wound Vac therapy (a system that uses controlled negative pressure, vacuum therapy, to help promote wound healing); (h) Restraints except as permitted by the licensing agency; (i) Stage 3 or 4 pressure ulcers; and (j) Ventilator dependency. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Care Coordination: These services include identifying, organizing, coordinating and monitoring services needed by participants. Nursing Facility Transition Care Coordination: These services help transition participants from a nursing home to the community RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Eligibility: Participants require a nursing facility level of care since ALW is designed to serve people who would otherwise need nursing home care Contracted Care Coordination Agencies use a standardized assessment tool to determine the clients need for nursing home level of care Must be age 21 and older. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

California’s assisted living waivers (alw)
Care Planning: Participating RCFEs must develop a care plan to implement the service plan for each resident. A licensed, Medi-Cal certified home health agency will implement care plans for participants who live at public housing sites. In this setting, the services provided are called Assisted Care. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Payment Rates: Participants pay for their room and board Medi-Cal pays for their care and services. In 2017, for participants with monthly SSI income of $1,158.37, the room and board rate is $1, For participants with income of $1, or greater, the room and board rate is $1, RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Payment Rates: Medi-Cal pays the RCFEs and home health agencies for five levels of care and services, with daily rates ranging from $52 per day for tier 1 to $200 per day for tier 5. RCFEs and home health agencies cannot negotiate the services to be delivered or the payment rate. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

For Assisted Living Services in either a Residential Care Facility or Publicly Subsidized Housing Setting Tier 1 $52.00 per participant per day Tier 2 $62.00 per participant per day Tier 3 $71.00 per participant per day Tier 4 $82.00 per participant per day Tier 5 $ per participant per day RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Choosing a Facility Participants select the facility or provider of their choice. Care coordination agencies will inform participants about available facilities and providers. RCFEs are allowed to reject a participant. However, once a facility admits someone, it must provide necessary services and adapt services as the person’s needs change. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

California’s assisted living waiver (alw)
To Apply or For More Information: Assisted Living Waiver Department of Health Care Services Long-Term Care Division Capitol Avenue, MS PO Box Sacramento, CA Phone: Source: Updated: 1/3/17 RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Introduction to Assisted Living
National: Communities: over 31,000 (4+beds) Licensed beds: over 971,900 Average resident age: 86.9 Average resident income: $27, 260 RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

INTRODUCTION TO ASSISTED LIVING
California: Communities: 7,475 Licensed beds: 146,420 Average resident age: 86.9 Average resident income: $27,260 Source: National Survey of Residential Care Providers, CDC 2010 (National) Community Care Licensing, 2013 (California) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Communities by Size RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Recent AL Study Results: Medication Use
77.5% of residents needed assistance with medications Residents were taking an average of: 10 routine medications 3 PRN medications 13 total medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Regulatory Board CDSS has more than 4,000 employees in 54 offices throughout the state and is responsible for: Providing services that foster self-sufficiency and dignity Providing social services to the elderly, blind, disabled and other children and adults Licensing and regulating foster homes, group homes, residential care facilities, day care facilities, child care facilities and preschools Evaluating eligibility of applicants for disability-related benefits for certain federal and state programs, including Supplemental Security Income, Social Security Disability and Medi-Cal RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Community Care Licensing Division
Issues licenses for residential facilities which provide 24-hour non-medical care for children, adults and the elderly Health & Safety Code Title 22 Regulations CCL Policy RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Community care licensing division
HEALTH AND SAFETY CODE ONE OF THE 29 CODES IN CALIFORNIA LAW COVERS THE SUBJECT AREAS OF HEALTH AND SAFETY IN SOCIAL SERVICES (NON- MEDICAL) AND HEALTH SERVICES (MEDICAL) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

COMMUNITY CARE LICENSING DIVISION
TITLE 22 REGULATIONS: CONTROLS THE ACTIONS OF ALL FACILITIES LICENSED BY COMMUNITY CARE LICENSING DIVISION RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

COMMUNITY CARE LICENSING DIVISION
EVALUATOR MANUAL (CCL POLICY) ONE REFERENCE SOURCE THAT ENSURES STATEWIDE CONSISTENCY IN ADMINISTRATION OF LICENSING PROGRAM, ENFORCEMENT OF LAWS, POLICIES AND PROCEDURES. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT CEU
MEDICATION MANAGEMENT IN ASSISTED LIVING ASSISTANCE VERSUS ADMINISTRATION LICENSEE’S ROLE DIRECT CARE STAFF’S ROLE RESIDENT AND RESPONSIBLE PARTIES ROLE SUPPORT SERVICES RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medications are an important component of care for many of our seniors, especially the ones in assisted living communities. With proper patient teaching and caregiver training, medications become effective treatments for short-term (acute) or long-term (chronic) health conditions, which in turn leads to a longer and better quality of life. Proper pain management can allow a person to participate more with daily activities, and a person on blood pressure medications can manage their condition better. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Management by State In a state-by-state analysis of 2007 regulations related to medication management in AL, researchers calculated the following statistics (unpublished research): RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

• Fourteen states require nurse administration of medications in AL. • Thirty-two states allow direct care staff to administer medications to AL residents. • Four states have special conditions: Kentucky and New York require AL residents to self-administer their medications, and Louisiana and Minnesota require AL residents to contract with an outside source for medication administration if they cannot self-administer RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

ASSISTANCE VERSUS ADMINISTRATION What is the difference between “Medication Administration” and the task of “Assisting with Medication”, or providing “Assistance” to a resident who takes their medication independently? RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Administration: Is to be done by an appropriately skilled professional, such as a licensed doctor or a licensed nurse. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Assistance with Self-Administration: Is delegated to a direct care staff that has been trained by a qualified trainer on medication management based on Title 22 Regulations and California Health & Safety Code RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Knowing the 6 rights of medication assistance are the basis for safe handling and assisting of self-administration of medication to residents. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DIRECT CARE STAFF’S ROLE IN MEDICATION MANAGEMENT Each employee of the facility who assists residents with the self-administration of medications must meet: Initial training Testing Annual training RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

These requirements specified in Health and Safety Code section Training is designed to ensure staff understands the following: RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Role, responsibilities & limitations of staff who assist residents with self-administration, including tasks limited to licensed medical professionals. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Terminologies specific to medication assistance Different types of medication orders: Prescription, OTC, controlled and other medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Basic rules & precautions of medication assistance Medication forms & routes for medications taken by residents RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Procedures for providing assistance with self-administration of medications in/out of facility & info on medication documentation system used in the facility Guidelines for proper storage, security & documentation of centrally stored medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Working with pharmacy: ordering, refills & receipts Dementia & psychotropic drugs: Side effects, adverse reactions, errors, adverse effects/increased risk of death RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

LICENSEE’S ROLE IN MEDICATION MANAGEMENT BASED ON PLAN OF OPERATION TITLE 22 CCR Licensee designates staff to handle medication Follow the written policies and procedures provided in the facility’s Department-approved plan of operation for the functions of these designated staff. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Train all staff responsible for medications as described in the facility’s Department approved plan of operation. Verify and document staff training and competence in these areas. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICE: Review the plan of operation on a regular basis. Revise policies and procedures as needed and submit to Department for approval. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

ROLE OF A DIRECT CARE STAFF: Coordinate quality care by expert communication/observation Assist the resident to consume the medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Assure the available medications coincide with the physicians order Store medications safely Order and refill medications in a timely manner RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Log medication in the LIC 622 when received Destroy medication in accordance with state and facility procedures RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Document all communication with providers, family, and the resident Continual observation of each resident for potential adverse reactions to medications and/or signs/symptoms RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

ROLE OF THE RESIDENT IN MEDICATION MANAGEMENT RESIDENTS AS THEIR OWN ADVOCATE MUST FAMILIARIZE THEMSELVES WITH THE SIX RIGHTS AS WELL PATIENT TEACHING IS THE KEY TO BETTER MEDICATION MANAGEMENT. ENCOURAGE THE RESIDENTS TO ASK ANY MEDICATION-RELATED QUESTIONS THEY HAVE DURING DOCTOR’S APPOINTMENTS REPORT ANY ADVERSE EFFECTS OR CHANGES TO DIRECT CARE STAFF TO ALERT PRIMARY CARE PHYSICIAN. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

ROLE OF RESPONSIBLE PARTY IN MEDICATION MANAGEMENT THERE WILL BE TIMES WHEN A FAMILY MEMBER WILL BE AN ADVOCATE FOR THE RESIDENT IN YOUR COMMUNITY, ESTABLISHING A GOOD RELATIONSHIP WITH THEM IS A GREAT WAY FOR THEM TO BE AN ACTIVE PART OF THE RESIDENT’S DAILY LIFE. FAMILY TEACHING-ENCOURAGE THEM TO ASK THE PRIMARY CARE PHYSICIAN QUESTIONS RELATED TO RESIDENT’S MEDICATION MANAGEMENT DURING DOCTOR’S VISITS. EDUCATE THEM ON THE MEDICATION POLICY AND PROCEDURE OF YOUR COMMUNITY AND TITLE 22 REGULATIONS. THIS WILL SAVE YOU TIME RECEIVING MEDICATIONS THAT FALL OUTSIDE THE LICENSING GUIDELINES. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SUPPORT SERVICES IN MEDICATION MANAGEMENT AS A LICENSEE/ADMINISTRATOR OF A RESIDENTIAL CARE FACILITY FOR ELDERLY, YOU ARE NEVER ALONE IN PROVIDING YOUR RESIDENT THE BEST CARE THAT YOU COULD POSSIBLY PROVIDE. FOR BETTER MEDICATION MANAGEMENT, THESE ARE THE SUPPORT SERVICES THAT YOU SHOULD COMMUNICATE WITH ON A REGULAR BASIS. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

RESIDENT FAMILY OR RESPONSIBLE PARTY CARE STAFF PRIMARY CARE PHYSICIAN PHARMACY LICENSING DIVISION RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Classification and Identification CLASSIFICATION OF COMMONLY USED MEDICATIONS Anticonvulsants Antibiotics Pain Medications Topical Ointments or Creams Psychotropic Medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Anticonvulsants and Elderly: medications used to treat epilepsy (seizures) seizure disorders increase in incidence and prevalence after the age of 60 years 32 percent of the seizures were caused by strokes, 14 percent by brain tumors and 25 percent had no identifiable cause. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Anticonvulsants and Elderly (continuation) Medications used to treat seizures: Valproic acid Tegretol Neurontin Gabitril RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Anticonvulsants and Elderly (continuation) SIDE EFFECTS: Dizziness, sedation, nausea, vomiting, confusion, blurred vision, fluid retention, weight gain, headache, vomiting are some of the common side effects of anticonvulsant medications. REPORT ANY OF THESE SIDE EFFECTS TO THE DOCTOR IMMEDIATELY! RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Antibiotics and Elderly: medications used to treat infections. Infectious diseases account for one third of all deaths in people 65 years and older. A change in mental status or decline in function may be the only presenting problem in an older patient with an infection RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Antibiotics and Elderly: Types of Infection: Pneumonia (lung infection) Urinary Tract Infection (bladder infection) Skin infection (bed sores, pressures) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Antibiotics and Elderly: Medications to Treat Infection: Levaquin Penicillin Doxycycline Tamiflu Ampicillin Bactrim RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Antibiotics and Elderly: Side Effects: vomiting, severe watery diarrhea, abdominal cramps, allergic reaction (shortness of breath, hives, swelling of lips, face, or tongue, fainting), rash vaginal itching or discharge, white patches on the tongue (oral thrush) REPORT ANY OF THESE SIDE EFFECTS TO THE DOCTOR IMMEDIATELY! RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Pain Medication and Elderly: used to manage acute/chronic pain such as, headache, back pain, bone pain, joint pain, hip pain or any type of pain related to aging. medications are available over-the-counter or prescription type. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Pain Medication and Elderly: Medications Used to Manage Pain: Non-steroidal anti-inflammatory drugs- (NSAIDS) example: Ibuprofen, Advil, Aleve Acetaminophen- example: Tylenol Narcotics (controlled)- example: Vicodin, Norco RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Pain Medication and Elderly SIDE EFFECTS: nausea, rash, liver damage, constipation, heartburn, stomach upset, kidney damage, vomiting. REPORT ANY OF THESE SIDE EFFECTS TO THE DOCTOR IMMEDIATELY! RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

TOPICAL MEDICATIONS: Topical medications are used as: a skin barrier protection, moisturizer or to treat any skin problem or infection. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

TOPICAL MEDICATIONS: Different Types Lotions produces local effect Creams produces local effect Ointments produces local effect Patches produces systemic effect RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SIDE EFFECTS: Rash Small Skin Blister Numbness and Tingling Redness of Skin Skin Inflammation Skin Irritation REPORT ANY OF THESE SIDE EFFECTS TO THE DOCTOR IMMEDIATELY! RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Psychotropic Medication and Elderly: commonly administered to elderly clients to: manage behavior manage psychiatric symptoms. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Psychotropic Medications and Elderly: Different Types of Psychotropic Medication Stimulants-example: Adderall Antidepressants-example: Zoloft Antipsychotics-example: Haldol Mood stabilizers-example: Depakote Antianxiety agents-example: Ativan RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Psychotropic Medications and Elderly: SIDE EFFECTS: periods of great excitement, euphoria, delusions, overactivity, psychosis, hallucinations, suicidal ideation, heart attack, stroke, sudden death REPORT ANY OF THESE SIDE EFFECTS TO THE DOCTOR IMMEDIATELY! RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

REFERENCES: ANTICONVULSANTS: American Family Physician, ANTIBIOTICS: American Family Physician, PAIN MEDICATION: American Family Physician, WEB MD, TOPICAL OINTMENTS: PSYCHOTROPIC MEDICATIONS: RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

II. Identification of Commonly Used Medications As a licensee/administrator of a non- medical care community, you have to make sure that you follow-up with each resident’s doctor’s visit and laboratory appointment. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

For any type of clarification or identification of medication used by your residents, it is best to utilize any or all of these to ensure proper medication management and safety of your residents: 1. Use a reference guide 2. Consult with a pharmacist 3. Communicate with the doctor RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

End of morning class: Sign-in again for the afternoon class
30 minute lunch break Sign-in again for the afternoon class Enjoy your lunch RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

TITLE 22 REGULATIONS: MEDICATION MANAGEMENT FOR RCFE ADMINISTRATORS RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

General Requirements: RCFE licensees must ensure the following with regard to medication assistance: Licensees are required to assist residents with self-administration of medications as needed, as specified in Title 22 section 87465(a)(5). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

General Requirements: Assistance with self-administration of medications is limited to those medications usually prescribed for self-administration which have been authorized by the resident’s physician and medications prescribed during an illness determined by the physician to be temporary and minor, as specified in Title 22 section (a)(6)(A) and (B). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

General Requirements: Assistance with self-administration of medications can also include when a resident needs assistance due to tremor, failing eyesight and similar conditions, as specified in Title 22 section (a)(6)(C). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

General Requirements: Assistance with self-administration of medications does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident’s knowledge and consent, or otherwise infringing upon a resident’s right to refuse to take a medication, as specified in Title 22 section (a)(6)(D). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Incidental Medical and Dental Care Services (22 CCR 87465) Scenarios, Regulations and Best Practices RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident arrives with medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Ensure a physician authorization is provided for each prescription and nonprescription PRN medication that facility staff will provide assistance to the resident. Maintain a log of centrally stored medications for each resident. The LIC 622 is available for this purpose. Retain on file a copy of the prescriptions for centrally stored medications in the resident’s file. Keep centrally stored medications in a safe and locked place that is not accessible to others. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Communicate the list of medications to the doctor Inspect each label to ensure the medication is prescribed for the resident and the medication has not expired. Conduct a count of pills received. This will assist with documenting when refills are to be ordered Review the amount of refills remaining on the prescription and ensure that the medication is refilled if needed. If no refills are available, contact the physician for further instructions. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Ensure medication which is not centrally stored is kept in a safe and locked place by the resident. Discuss medications with the resident and the responsible party/authorized representative Have physician routinely review and approve a list of all medications taken by the resident and verify dispensing instructions RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Make sure the primary care physician is aware of medications prescribed to a resident by any specialists. Review the medications and the dispensing instructions with staff. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications required to be centrally stored RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Centrally store any medication that the resident is unable to manage on his/her own, as documented by their physician. The administrator or Department can decide to centrally store medication because of the potential dangers related to the medication itself or if determined to be a safety hazard to others. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Keep centrally stored medications in a locked place that is not accessible to others. Maintain centrally stored medications in accordance with label instructions (e.g. refrigerate, room temperature, out of direct sunlight, etc.) o Refrigerated medication needs to be locked in a receptacle, drawer, or container RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT CEU:
DESCRIPTION OF REGULATIONS: Do not alter prescription labels Record all medications centrally stored in the facility. The Centrally Stored Medication and Destruction Record (LIC 622) is available for this purpose and identifies what information must be recorded for all centrally stored medications. o If the facility chooses to utilize a form other than the LIC 622, ensure all required information is included on the form. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Maintain a record of centrally stored medications for each resident for at least one (1) year. Maintain medication destruction records for at least three (3) years RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY AND PROCEDURE) Every non-prescription medication centrally stored in the facility should be logged similar to prescribed medications. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident is allowed to maintain and administer their own medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS Residents may store and administer their own medication with written approval from the physician on file if licensee procedures allow for this. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Per Title 22, section 87466, changes observed in the resident’s physical, mental, emotional, and/or social functioning shall be documented and brought to the attention of the resident’s physician (obtain an updated physicians report if needed) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Per Title 22, section 87463, update the resident’s appraisal when significant changes to their physical, medical, mental, and/or social condition occur. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Residents allowed to store and self- administer their own medications should keep the medication locked to prevent access by other residents. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: A resident is accidentally given a double dose or misses a dose of medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: If the resident appears to be in distress or complains of symptoms, call and seek immediate medical attention. Per Title 22, section 87211, document what happened, who was contacted, how the situation was handled and report to the CCLD Regional Office. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Check the medication label for instructions when excess medication is ingested or if a dose is missed. Call the appropriate medical professional, advice nurse or poison control center and follow their directives. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: A dosage is changed between refills RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Changes to an existing prescription require the physician’s signed and dated order which is maintained in the resident’s record. Prescription labels cannot be altered by facility staff. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Per Title 22, section 87466, changes observed in the resident’s physical, mental, emotional, and/or social functioning shall be documented and brought to the attention of the resident’s physician (obtain an updated physician’s report if needed) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Discuss the dosage change with resident and responsible person/authorized representative Have a facility procedure (e.g. card file/index card, notebook, flagging system, and/or electronic data management system) to alert staff of changes and ensure they understand the change. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medication is refilled RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: As with all prescriptions, inspect container(s) to ensure all information on the label is correct. For centrally stored medications, ensure the refilled medication is recorded. The LIC 622 is available for this purpose. For centrally stored medications, ensure the refilled medication is locked. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Discuss any changes in medications with the resident and responsible person/authorized representative Communicate with the physician, pharmacist, or the responsible person to discuss procedures for payment of medications, identify who will be ordering and picking up the medications and the like. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT (CEU)
BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Make sure refills are ordered promptly (e.g. order 10 days prior to running out). Note any changes in instructions and/or medication (e.g. change in dosage, change to generic brand, etc.) and review with staff and resident. Have a facility procedure (e.g. card file/index card, notebook, flagging system, and/or electronic data) Never let medications run out unless directed to by the physician in writing. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medication is permanently discontinued RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Obtain written documentation of the discontinuation of medication from the physician. Destroy the medications in compliance with local, state, and federal laws. The LIC 622 is available for this purpose. Record the destruction of the prescription medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Telephone the resident’s physician to confirm the discontinuation of medication. Document the phone call in the resident’s record, including the date, time and name of the person at physician’s office Have a facility procedure (e.g. card file/index card, notebook, flagging system, and/or electronic data) to alert staff of the changes Discuss the discontinuation with the resident and the resident’s responsible person/authorized representative RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications are placed on hold (physician has instructed the resident to stop taking the medication for a limited amount of time) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Obtain a written documentation from the physician to hold the medication. As with all prescriptions, any change to an existing prescription requires the physician’s signed and dated order which is maintained in the resident’s record RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Discuss the changes with resident and responsible person/authorized representative Without altering the label, mark or identify medication containers with hold orders (e.g. removable colored stickers) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Have a facility procedure to alert staff of the changes Medications temporarily discontinued by the physician may be stored by the facility Contact the physician prior to the expiration of the medication on hold or the date the resident is scheduled to resume taking the medication for further instructions. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medication reaches its expiration date RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Expired medication shall be returned to the issuing pharmacy or destroyed in the facility. Record the destruction of the prescription medication. The LIC 622 is available for this purpose. Maintain medication destruction records for at least three (3) years. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Check prescriptions and over-the-counter medications containers regularly for expiration dates. Pay close attention to medications taken “as needed” (PRN) since they are not in the regular medication rotation. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident refused medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: A resident cannot be forced to take any medication. Document refusal of medication in the resident’s medication record and notify the prescribing physician RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Discuss with the resident the reason for refusing the medication. Through this discussion, you may find there are adverse side effects or that the medication is not effectively treating the resident’s symptoms, etc. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications need to be crushed or altered RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: A resident cannot be forced to take any medication. Assistance with self-administered medications does not include hiding or camouflaging medications in other substances without the resident’s knowledge or consent A medication can be crushed with a written physician order. As with all medications, the physician order must specify the name and dosage of the medication to be crushed. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) The following written documentation should be in the resident’s file if the medication is to be crushed or altered: Verification of consultation with a pharmacist or physician that the medication can be safely crushed, identification of foods and liquids which can be mixed with the medications, and instructions for crushing or mixing medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) A form consenting to crushing the medication signed by the resident. If the resident has a conservator or someone with authority over his/her medical decisions, the consent form must be signed by the conservator, power of attorney for health care, or person with such legal authority. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Measuring oral medications for self-administration RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Direct care staff with medication training shall assist residents with self-administered medications as needed. o Assistance can include measuring liquid medication into calibrated cups, droppers, oral syringes without needles and dosing spoons for the resident to self-administer orally. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications may be “set up” or "poured" under the following circumstances: RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Direct care staff with medication training shall assist residents with self-administered medications as needed. Medication training must be in compliance with Health and Safety Code section RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medications must be stored in their original containers and not transferred between containers. Per Title 22, section 87303, ensure the area where staff is handling medications is clean, safe and sanitary. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Pour medications from the bottle directly into the individual resident's cup/utensil to avoid touching or contaminating the medication. Implement a process to ensure medication is given to the correct resident. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Implement procedures for situations such as medication spillage, contamination, assisting with liquid medication, interactions of medications, etc. Medications should not be set up more than 24 hours in advance. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications are transferred for outings, etc. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: If medications are being given directly to the resident for self-administration away from the facility premises, check the Physician's Report (LIC 602A) to ensure they are given only to residents whose doctors have indicated they may control their own medications. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES :COMMUNITY POLICY & PROCEDURE The process for having the person entrusted with the medications account for them upon leaving and returning should be outlined in the facility’s plan of operation. When a resident leaves the facility for a short period of time during which only one dosage period of medication is needed, the licensee may give the medications to a responsible person/authorized representative in an envelope (or similar container) labeled with the facility's name and address, resident's name, name of medication(s) and instructions for administering the dose. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY & POLICY PROCEDURE If a resident will be gone for more than one dosage period, the license may do any one of the following: o A small envelope may be used for each individual dose. The facility can use multiple envelopes. Each envelope must contain the resident’s name, medication name and dose instructions. Do not use an empty used prescription container RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY POLICY & PROCEDURE Give the full prescription container to the resident or responsible person/authorized representative. o Have the pharmacy either fill a separate prescription or separate the existing prescription into two bottles. o Have the resident's family obtain a separate supply of the medication for use when the resident visits the family RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident transfers, dies, or leaves medication behind RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Prescription medications left behind when either a resident transfers or dies must be returned to the issuing pharmacy, otherwise disposed of or destroyed in the facility. A licensed RCFE with 16 or more residents may donate unexpired centrally stored medications to a voluntary drug repository and distribution program with an approved waiver, as specified in Health and Safety Code section (a)(10). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Destroy the medications in compliance with local, state, and federal laws. Record the destruction of the prescription medication. Maintain medication destruction records for at least three (3) years. Note: Medication can be destroyed by a healthcare waste management company with an approved waiver. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) All efforts should be made to send the resident’s prescriptions and over-the-counter medications with the resident when transferring the resident. Document when the medication is transferred with the resident. Obtain the signature of the person accepting the medications (e.g. responsible person/authorized representative or staff at the new facility). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) For donated medication, include in the resident’s file: o Name of the resident o The prescription number and the name of the pharmacy RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY POLICY & PROCEDURE o The drug name, strength, and quantity donated o The date of donation o Name of distribution entity to which medication was donated o Identifier or reference number, if any. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medications sent for commercial destruction RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Per Title 22, section 87209, the licensee may use alternative techniques, which could include contracting with a commercial medication destruction company or other alternatives such as a county operated “drop off program” provided: RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Such alternatives shall be carried out with provisions for safe and adequate service. o A written request for a waiver or exception is submitted in advance to CCLD by the licensee. o Prior written approval from CCLD is obtained. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Destroying medications in the facility RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Medication must be destroyed by the adult who is not a resident, unless a waiver has been approved to dispose in some other manner. o Medication that is a controlled substance must be disposed of in compliance with Drug Enforcement Administration requirements, per the California Medical Waste Management Act as specified in Health and Safety Code section (i)(1). RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Every prescription medication which is destroyed in the facility must be recorded and logged. The LIC 622 is available for this purpose and identifies what information must be recorded for all destroyed prescription medication. A record of centrally stored prescription medications disposed of in the facility must be maintained for at least three (3) years in an RCFE. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY POLICY & PROCEDURE According to the Federal Drug Administration (FDA), if no disposal instructions are given on the prescription drug labeling and no take-back program is available in the area, the drugs can be destroyed by following these steps: o Remove the medication from the original container, dissolve the medication in water and mix the water with an undesirable substance, such as used coffee grounds, dirt or kitty litter (this makes the drug less appealing to children and pets, and unrecognizable to people who may intentionally go through the trash seeking out drugs). o Place the mixture in a sealable bag, empty can or other container into the outside trash receptacle to prevent the drug from leaking or breaking out into the facility’s garbage can. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Medication from another country RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Assistance with self-administration of medications is limited to those medications usually prescribed for self-administration which have been authorized by the resident’s physician RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) According to the Federal Drug Administration (FDA), there is a lot of concern about the safety risks associated with the importation of prescription drugs from foreign countries. If you have a resident using medication from another country, you can ensure it meets all legal requirements by consulting with resident’s primary care physician and/or pharmacist. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

PRN MEDICATIONS: PRN Medications (Medications Delivered "As Needed") “PRN” is the Latin abbreviation for “pro re nata,” which means “as the occasion arises” or “when necessary.” RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

PRN MEDICATIONS: PRN medications can be either prescription medication or over-the-counter (nonprescription) medication, as prescribed or ordered by the resident’s physician. Facilities assisting residents with the self-administration of PRN medication encounter a different challenge with ensuring the continued health and safety of residents, because proper judgment is required to determine “when needed.” RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident can determine and clearly communicate need for prescription and/or nonprescription PRN medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Verify on the LIC 602A or other signed document from the physician that the resident is able to administer his/her own PRN medication. Obtain the physician’s signed, dated, written order for the medication on a prescription blank or the physician’s business stationery and maintain it in the resident's file. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

o Physician e-orders including physician e- signatures are also allowed if all required information is included and the electronic order is printed and placed in the resident’s file. As with all medications, ensure the physician's order and the PRN medication label identify the specific symptoms which indicate the need for use of the medication, exact dosage, minimum hours between doses, and maximum doses to be given in a 24-hour period. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: (COMMUNITY POLICY & PROCEDURE) Create a form for the resident’s physician to complete which identifies the resident’s capacity to determine and communicate their need for PRN medications, as well as their capacity to communicate his/her symptoms clearly. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident cannot determine need, but can communicate his/her symptoms clearly RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Verify on the LIC 602A or other signed document from the physician that the resident is not able to determine his/her need for a nonprescription PRN medication but can communicate his/her symptom RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Obtain the resident's physician’s signed, dated, written order on a prescription blank or the physician’s business stationery which is maintained in the resident's file. o Physician e-orders including physician e- signatures are also allowed if all require information is included and the electronic order is printed and placed in the resident’s file. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Ensure the written order identifies the name of the resident, the name of the PRN medication, instructions regarding when the medication should be discontinued, and an indication when the physician should be contacted for re-evaluation. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: As with all medications, ensure the physician's order and the PRN medication label identify the specific symptoms indicating the need for use of the medication, exact dosage, minimum hours between doses, and maximum doses to be given in a 24-hour period. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Once ordered by the physician, the medication is given according to the physician's directions. Maintain a record of each dose in the resident's record, including the date, time, dosage taken, and the resident's response. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY POLICY & PROCEDURE Create a form for the resident’s physician to fill out that identifies the resident’s capacity to determine and communicate his/her need for PRN medications. The form should clearly indicate if the resident RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident cannot determine need for a prescription or nonprescription PRN medication, and cannot communicate his/her symptoms RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Verify on the LIC 602A or other signed document from the physician that the resident is not able to determine his/her need for a nonprescription PRN medication, and cannot communicate his/her symptoms clearly RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Obtain the physician’s signed, dated, written order on a prescription blank or the physician’s business stationery which is maintained in the resident's file. o Physician e-orders including physician e- signatures are also allowed if all required information is included and the electronic order is printed an placed in the resident’s file. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Ensure the physician's order and the PRN medication label identify the specific symptoms, indicating the need for use of the medication, exact dosage, minimum hours between doses, and maximum doses to be given in a 24-hour period RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF GUIDELINES: Contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist in the self-administration for each dose. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Document the date and time of each contact with the physician and the physician's directions and maintain this documentation in the resident's file. Maintain a record of each dose in the resident's records, including the date, time, dosage taken, and the resident's response RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: For residents who need assistance with on-going pain management (or other symptoms) or may have diminished capacity, the responsible person/authorized representative may want to discuss with the resident’s physician a need to change the PRN medication order to a routinely scheduled medication. Create a form for the resident’s physician to fill out that identifies the resident’s capacity to determine and communicate their need for PRN medications RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Over-the-Counter/Nonprescription Medications Despite the relative ease of access, over-the- counter (OTC) nonprescription medications (e.g. aspirin, cold medications, vitamins, herbal remedies, etc.) can also be dangerous. Licensees have a responsibility to protect the health and safety of residents, even with the self- administration of OTC medication. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident takes an over the counter medication(s) that is centrally stored RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Ensure the resident’s physician provides written authorization for each OTC medication for which facility staff will provide self-administration assistance RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: RCFEs are allowed to use a centrally stored facility stock (or house supply) of OTC medications. All regulatory requirements regarding the use of OTC medications must be followed, including licensee verification of approval by the resident’s physician to use the OTC medication before giving the resident a dose from the house supply. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Once an over the counter medication has been prescribed by a physician and has a prescription label affixed to it, the OTC becomes a prescription medication and should be treated accordingly. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Keep centrally stored medications in locked place that is not accessible to others. OTC medication given on a PRN basis must meet all PRN requirements RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICE (COMMUNITY POLICY & PROCEDURE) Every OTC medication centrally stored in the facility should be logged similar to prescribed medications. The Centrally Stored Medication and Destruction Record (LIC 622) is available for this purpose. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) The resident's name should be on the over-the- counter medication container when: o It is purchased for the resident's sole use; o It is purchased by the resident's family; or o The resident's personal funds were used to purchase the medication. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident takes an over the counter medication(s) that he/she can store and administer RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF GUIDELINES: Residents with written approval from the physician on file (LIC 602A can be used for this purpose) may store and administer their own OTC medication, if licensee procedures allow for this. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF GUIDELINES: Per Title 22, section 87466, changes observed in the resident’s physical, mental, emotional, and/or social functioning shall be documented and brought to the attention of the resident’s physician (obtain an updated physician’s report if needed) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES (COMMUNITY POLICY & PROCEDURE) Residents allowed to keep their own medications should keep the medication locked to prevent access by other residents RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Ear or Eye Drops and Nasal Sprays Although medications are to be self-administered by residents in RCFE’s, regulations allow facilities to provide assistance to residents due to tremor, failing eyesight and similar conditions. CCLD policies do not require facilities to obtain an exception for staff to assist in the administration of eye, ear or nose drops under specific circumstances. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

SCENARIO: Resident is not able to self-administer his/her own eye, ear or nose drops due to tremors, failing eyesight or other similar conditions. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Direct care staff with medication training shall assist residents with self-administered medications as needed. o Prior to providing ongoing resident assistance with the drops, facility staff may consider the use of assistive devices, such as an eye cup, which would enable the resident to self-administer the drops RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Verify on the LIC 602A or other signed document from the physician that the resident is able to administer his/her own medication (including eye, ear and nose drops) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Obtain documentation from the resident’s physician outlining the procedures for care when using eye, ear and nose drops o The documentation from the physician regarding the resident’s condition and care must be kept in the resident’s file. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Medication training must be in compliance with Health and Safety Code section et seq. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

DESCRIPTION OF REGULATIONS: Trained staff must complete the required training on resident-specific procedures prior to providing the service. As with all training, documentation of completed training must be kept in the individual’s employee file. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BEST PRACTICES: COMMUNITY POLICY & PROCEDURE If the care to be provided is not routine, contact the resident’s physician to determine if a skilled medical professional should be providing the assistance. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Summary of the Title 22 (87465): Incidental Medical and Dental Care Services
Assistance with self-administered medications limited to: Medications prescribed by physician Assistance required because of tremor, failing eyesight and similar conditions RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Summary of the Title 22 (87465): Incidental Medical and Dental Care Services, cont…
Assistance with self-administered medications does NOT include Forcing a resident to take a medication Hiding or masking medications without resident’s knowledge and consent Any other act that might infringe upon a resident’s right to refuse a medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MAY DO With appropriate training and documentation, unlicensed direct care staff may: Assist with the self-administration of oral medication (i.e. pills, capsules, gel caps, etc.) Assist with self-administration of liquid medications May assist with self-administration of inhalers Assist with ear, nose, and eye drops (if trained by a licensed medical professional) Assist with topical medications and transdermal patches RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MAY NOT DO Unlicensed direct care staff may never:
Draw up or give injections Insert suppositories or enemas Place a medication in a resident’s mouth Force any resident to take a medication Cannot apply topical medications to a post-surgical wound RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

BLOOD PRESSURE AND PULSE
Unlicensed professionals may take vital sign readings as long as the readings are not used to determine need for medication. But, if blood pressure and pulse readings are taken to determine the need for medications, only the following persons may take these readings: Resident Physician or registered nurse Licensed vocational nurse under the direction of a registered nurse or physician Psychiatric technician under some circumstances RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Terms and Abbreviations
The medical field uses abbreviations everyday. A good understanding of terminology is critical in assisting your residents with medications Terms and abbreviations can change from medical facilities Use terminology that you are familiar with and approved by your facility Always ask when unsure of a term or abbreviation RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Assistance Terminology
Centrally Stored: upon move-in of the resident, medications are documented and taken from them and then lock in a central location in your community. Prescription: a medication order prescribed by a physician, also known as an “Rx.” PRN= as needed medication (prescribed or over-the- counter) OTC=over-the-counter RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Assistance Terminology
Common Medical Terminology DC or D/C=discontinue or discharge DNR=do not resuscitate FX=Fracture H&P=history & physical examination H/O=history of HA=headache HTN=hypertension RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Common Medical Terminology
IM=intramuscular JT=joint LBP=lower back pain N/V=nausea or vomiting Na=sodium NPO=nothing by mouth P=pulse R/O=rule out T=temperature RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Common Medical Abbreviations
qd=everyday PO=by mouth q2h=every 2 hours PRN=as needed tid=3 times a day ac=before meals STAT=immediately pc=after meals D/C=discontinue qod=every other day tab=tablet bid=twice a day cap=capsule RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Controlled Medications
Schedule I contains drugs with very high abuse potential with no medical use Schedule II contains drugs with accepted medical use but with very high abuse potential Schedule III contains drugs with less abuse potential Scheduled IV contains drugs with somewhat less abuse potential than Schedule III Schedule V contains drugs with little potential for abuse RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Sample Medication Sample medication can be used if:
- Ordered by a physician - Contains basic prescription information (drug, dosage, direction, physicians name, expiration date) No experimental drugs should be available in the facility RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Prescription Medication
Controlled Substances (Scheduled drugs) are drugs that are monitored by the DEA Are addictive and categorized by their abuse potential Check with your facility to inquire whether extra documentation is required, according to the schedule of drug. No specific RCFE requirement Pharmacy may designate a “c” in the prescription number to note controlled substances Schedule II drugs are require a hand written prescription each dispensing. All scheduled drugs are required on a special tamper-proof form, or telephoned by the physician’s office RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Self-Administration of Medication
(30 minutes) Resource: California Department of Social Services RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Assistance 101
Follow the 6 Rights Prepare medication for one resident at a time Always triple check. Check the medication label with your documentation at least 3 times Check that all medication supplies are available Wash your hands before/after assisting with self-administration Wear gloves as indicated Avoid unnecessary interruptions during medication assistance If unsure of a medication order, always clarify with the doctor or a pharmacist Do not give expired medication Verify drug allergies RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Administration Documents
Forms Purpose Centrally Stored Medications Used to log in and log out medications Medication Administration Record Used to document when medications were taken by client, medication errors, side effects, and/or any comments or concerns regarding medications. PRN Authorization Used when the consumer needs specific medication on an as needed basis, i.e. Tylenol, Pepto Bismo, Mylanta, etc. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Common Routes of Medications in RCFE
Assist with the following: Oral/Sublingual Inhalation Topical Transdermal RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT PROCESS
Physician Order Pharmacy Dispenses Medication Medication Received Medication Administration Documentation Ongoing Communication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION MANAGEMENT
Given that assisted living residents take an average of 10 prescription medications, let’s do the some math to see how many medications may get passed to residents every month. It is not unusual for the person responsible for passing medications in a larger Community to pass medications to 35 residents. 35 residents X 10 medications each=350 a day 350 meds per day X 30 days per month=10,500 medications passed each month! To prevent errors and maximize safety, it is very important to make sure a system is in place, monitored, and followed. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Order Changes
Ask physician to provide written documentation of desired changes including discontinuing, new meds and change of doses. Provide documentation to pharmacy ASAP In a multi-dose system the pharmacy will exchange “blister tray” with medication changes RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Order Changes cont…
Do not alter prescription label. A direction change label can be attached to container until a new supply is obtained Rewrite MAR with new order Discuss medication change with resident and responsible party At times, the pharmacy will be contacted directly by physician RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Resident Refusal of Medication
A resident has a right to refuse to take a medication Document refusal with proper time and date Physician must be contacted. If multiple doses are refused, seek order for specific parameter when to contact physician Consider asking physician to discontinue, if resident consistently refuses medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Resident Refusal of Medication
Contact responsible party Inquire why a resident is refusing medications Address barriers to acceptance, prior to discontinuing medication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

RESIDENT REFUSAL OF MEDICATIONS
The following is a list of common reasons for refusal with interventions/responses to consider. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

REASON FOR REFUSAL INTERVENTION
Pills are difficult to swallow. Request a liquid if available. See guidelines for crushing medications. The side effects are too disruptive or severe. Consult MD for a different medication or different dosing schedule. Manipulative behaviors, this may be the resident’s way of gaining power. Allow greater resident control in other areas The resident is agitated or confused. Re-attempt several minutes later, do not draw attention to the issue. Remove environmental distractions, such as noise or other residents. The resident was not informed of changes to his/her medication regimen. (e.g., “Why am I getting a blue pill instead of my two white ones?” Discuss medication changes with your resident in advance. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

The Med Room should have:
Pharmacy address and phone numbers Reference material Med Storage tools (cabinet, rack, cart) Poison Control #’s/ Physician #’s Accessible fax machine Internet access (if possible) Refrigerator Temperature control Appointment tool / telephone Policies and procedures Pharmacy order sheets RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Storage The facility has the responsibility to properly store and maintain security of all medications centrally stored All meds should be locked up Adhere to labeling requirements on medication container (i.e.. Refrigerate) Refrigerated meds should be separated from perishable products and clearly marked Avoid co-mingling of external and internal meds and ear and eye drops RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Orders YOU TOUCH IT, YOU OWN IT
Where are they placed when received? Where are they permanently stored? RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION ORDERS Types of Orders Physicians give many different types of orders Regarding a resident’s medications. They may include: Routine Order are given (i.e., the same time every day). Routine orders are carried out until the physician cancels it by another order or until a prescribed number of days elapse. PRN Order are not given on a set schedule; they are given “as needed.” In addition to the components of a physician order above, a PRN order will include maximum dose in a 24 hour period and symptoms which would warrant the use of medications. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION ORDERS (cont.)
Single (one-time) A “one-time order” is for Order medication that is given only once at a specified time. STAT Order A “STAT” order is to be implemented immediately, for example an antibiotic. MEDICATION ORDERS (cont.) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

MEDICATION ORDERS (cont.)
Hold Order Sometimes a physician will want to hold a medication for a period of time. An example of this may be a resident who is scheduled to have surgery. The physician (or surgeon) may want to “hold” certain medications for the day(s) leading up to the surgery. Discontinue Order Sometimes called a “D/C” order, this is an order from the physician to stop a medication. Upon receiving the order, the medication is stopped and destroyed or returned to the pharmacy per protocol. RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

HOSPICE ONLY for residents on hospice, a relative or
friend NOT receiving monetary or any other form of compensation for their services, and who is trained by the hospice agency may Administer medications to his/her relative or friend if the following is done: It is specified in the hospice care plan The hospice agency provides a statement for the licensee’s records that the relative or friend has been trained There is a plan in place to ensure that the resident can receive the needed medication by a licensed health professional if the relative or friend fails to arrive at the appointed time. Licensees must maintain documentation on procedures and on the training provided by the hospice agency RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Preventing Medication Errors

Types of Errors RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

The Six Rights Right Resident Right drug Right dosage Right time
Right route Right documentation RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Common Medication Errors
Pharmacy Errors System errors Staff errors RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Pharmacy or System Errors
Ambiguous labels Lack of generic and trade name Poor Delivery Multiple pharmacies Limited Policies and Procedures Packaging Miscommunication with physicians RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Obstacles Multiple new generic meds
Risperdal – Risperidone Depakote – Divalproex Norvasc – Amlodipine Coreg – Carvedilol Zoloft – Sertraline Zocor – Simvastatin Seroquel – Quetiapine Multiple Manufactures – various sizes, shapes RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Medication Obstacles Different insurances – different meds
Intrusion of Part D insurances on psych meds Different and changing formularies Decreasing reimbursement – decreasing services? RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Staff Errors Generally occur when med tech is:
In a hurry/ not paying attention Inexperienced Providing medication for more than one resident Preparing medications without proper lighting Preparing medication in a cluttered area RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Prevention of Medication Errors
Read label 3 times during dose preparation Write legibly and keep MAR’s updated Ask for clarification if order is hard to read If workload is unusually heavy, speak with the supervisor Correctly identify resident before assisting Monitor residents for adverse reactions and changes of condition Slow down as rushing may cause errors Prepare meds in a quiet well lit area RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Prevention of Medication Errors
Avoid using unnecessary symbols on medication orders Include indication for each medication. Example, “for severe pain” Familiarize yourself with new medications by referring to a PDR or contact the pharmacist Maintain only authorized medications Have written policies Adopt “no blame, no shame” policy Implement annual in-services on medication error prevention RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

If a Medication Error Occurs:
Don’t panic; don’t attempt to cover up Don’t give the medication at the wrong time if you missed a dose Contact your supervisor immediately Contact the physician Carefully document the error, physician’s instructions, condition of the resident, and your actions Complete an incident report RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Working Effectively with Pharmacy
Order medications in a timely organized fashion Provide accurate billing and responsible party info Know how to reach the pharmacy at all times Keep physician and lab appointments Check medications when delivered Set/meet pharmacy delivery schedule Be prepared when speaking to health care professionals Advise pharmacy of licensing and QA issues Always keep good lines of communication RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Ordering Refills Use forms provided by pharmacy to order/ track refills Order at least 7 days in advance. Many refills will require contacting the physician for approval Don’t order more than 10 days ahead of the next refill date since payment may be denied Use 1 pharmacy whenever possible If family is supplying medication, note when contacted and when medications are expected RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Activity: Read the Pharmacy Label
Fill in the blank (Next page) RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Watch a webinar: Alzheimer’s facts 2016
TOPIC: 2016 Facts and Figures Hours: 1:30:00 Credit/Source: Alzheimer’s Association RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Watch a webinar: why diagnosis matters
Hours: 44:15 Credit/Source: Alzheimer’s Association RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

Watch a webinar: https://youtu.be/0_VgE330Xaw TOPIC: MEDICATIONS
(HOURS: 45:59) TOPIC: HOW DO YOU KNOW WHEN ALZHEIMER’S MEDICATIONS SHOULD BE STOPPED? (HOURS: 2:21) CREDIT/SOURCE: Alzheimer's Association RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

THANK YOU!!! IT’S TIME TO TAKE YOUR EXAM! PASS THE EXAM (MINIMUM SCORE OF 70%) GET YOUR CERTIFICATE OF COMPLETION GET YOUR CERTIFICATE OF CEU RCFE CARE CONSULTANTS, LLC EDUCATION. COMPLIANCE. CONSULTING.

RCFE ADMINISTRATOR 20 CEU Approved Vendor # #

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RCFE ADMINISTRATOR 20 CEU Approved Vendor # #

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