1. Medication Transcription, Verifying Medication Orders & Administration By: Evelyn W. Stone RN.,BSN.,M.Ed. www.qprofessionalmentalhealthservice.com

2. Types of Drug Orders Written Verbal PRN Discontinued STAT

3. Written Order Prescriber may write order on order form. Prescriber may call order in to pharmacy. order Carefully check medication label to be sure it agrees with the order you have received. FAXED orders are legal and acceptable.

4. Verbal Order May be received in person or on the phone (only by nurses or pharmacists). The person receiving it must prepare a written copy of the order for the prescriber’s signature.

5. PRN Order Medication/treatment may be used “as needed” Include what the medication is. Include what the treatment is. The problem being treated. Frequency of administration.

6. Discontinue Order Medication/treatment is to be stopped Discontinued medications should be immediately removed D/Cd meds can be - 1.returned to the pharmacy 2.flushed down a drain Document name of med, amount, method and date of disposal on med disposal form

7. STAT Orders Do it now Get the med and give to client Document in designated section on the MAR Report to oncoming nurse of the STAT order and that it was carried out

8. STAT (Continued) Use highlighter and yellow out the section of the MAR where you initialed or signed that the stat med was given. Document in the progress notes that the medication was given.

9. Physician Orders All orders, whether written or verbal, must include: Client name Medication to be given Strength of medication Dose to be given Frequency to be given Route Length of time to be given

10. Medical Alerts/Allergies Physician must be made aware of… 1.Allergies 2.Conditions 3.All other meds client is taking which might contraindicate a specific medication. ***Be prepared to give complete, correct information about a client’s diagnoses, allergies, and all current meds to physician.

11. Factors that Influence Medication Dosage Age Weight Time Rate Excreted Route Drug Combinations/Interactions Condition of the client

12. Age Pediatric and the Elderly excrete meds at different rates

13. Weight Some medication dosages are calculated by the physician & based on body weight.

14. Time The time is specified if it is to be given once a day. If unsure of the time in which the med is to be given, call the pharmacist. Call the Administrator, Director or Qualified Professional

15. Route How medications are taken and absorbed by the body may affect the dosage.

16. Drug Combinations/Interactions Two drugs given together may react differently than the same drugs given separately.

17. Condition of the Client Behavior Seizures Diabetes Vital Signs (history of high BP, fast irregular heart rate) Acceptance of food, fluids Mobility Others

18. Basic Rules for Administering Medications Be sure medications are being taken as prescribed. Be alert to changes in client’s behavior, and physical well- being. Report changes to the Administrator & Nurse. Correct transcription of orders Knowledge of drugs being given Special administration instructions Knowledge of client’s physical condition Knowledge of client’s emotional status Climate conducive to concentration Communication of information to others Resources for medication information

19. Correct Transcription of Orders Read every word on the script. Fax the script to the pharmacy. When the medication is received from the pharmacy, check to make sure that it is the correct medication. Write each word on the MAR that is on the medication label. Recheck your transcription word for word to make sure that it was transcribed correctly.

20. Knowledge of Drugs Being Given Name of Medication and dosage Why it was ordered What benefit should be expected Side-effects to be expected Special monitoring needed: a.Vital signs b.Stool records c. seizure records Special administration instructions: 1. crushed or chewed 2. given in food 3. need to be given on empty stomach 4. given with any liquid

21. Knowledge of Client’s physical condition Medical alert – Seizures, Diabetes, HIV etc. Physical limitations – Spinabifeda, amputee etc.

22. Knowledge of client’s emotional status Disoriented Hostile Mute, withdrawn Refusing medications Assaultive behavior

23. Climate Conducive to Concentration Temperature 68-82 degrees Not too hot Not too cold

24. Communication of Information to Others Drug Information Learn the information that comes with the drug. Call the Pharmacist and request medication leaflets that are suitable for lay public. Client information – Special alerts to staff. Staff to give client education each time the meds are given to help the client recognize his meds and what they are for.

25. Resources for Medication Information Pharmacist Physician/Dentist RN Consultant/RN Qualified Professional Drug Information Sheet Drug Handbook

26. Common Dosage Forms Solids Topical Tablet Capsule Liquids Gases

27. Solids Suppository- small, solid, cone shaped, glycerin base, melt at body temperature, administered by rectum or vagina. Refrigerate as directed Topical- applied directly to skin, lotion (external use), paste (mixture of powders and ointments), ointment, cream (suspension of oil and water), powder (finely ground drugs), shampoo (medication in soap), patches (slowly release meds.), Aerosol sprays (suspended in gas, e.g. Desenex spray, Cruex spray). Used for local effect

28. Solids (cont.) Tablet- powdered drug compressed into small, hard disc Capsule- powdered, liquid, or oil drug form 1. hard or soft 2. dissolves quickly in the mouth

29. Liquids Solution- one or more drugs dissolved in water. Suspension- preparation of a finely divided, undissolved drug in a liquid. Syrup- aqueous solution of sugar. Elixir- drug mixed in an alcohol solution, sweetened.

30. Gases Inhalant- Medication carried into the respiratory tract through air, oxygen, or steam

31. Common Routes of Administering Medications Medications are designed for one or two specific routes of administration. Physicians order the route of administration when ordering the medication. Oral Insertion Instillation Topical Inhalation Parenteral

32. Oral 1.By mouth 2.Buccal – between the cheek and gum 3.Sublingual – under the tongue

33. Insertion “Putting in” vaginally or rectally

34. Instillation Putting a drug in liquid or ointment form into ears, eyes or nose

35. Topical External application of meds to the skin, nails or hair

36. Inhalation Inhaling a drug into the respiratory tract.

37. Parenteral By injection ** Injections are given by a licensed person. A habilitation tech may be trained by a licensed person to give insulin injection.

38. Correct Preparation and Administration General Medication administration procedures Oral Medications Liquid Medications Inserting Medications Instilling Medications Topical Medications Inhalants Nebulizers

39. General Med Administration Procedures: Wash hands Verify the order on the MAR by checking it against the doctor’s order. Do the “Three Checks” a. when selecting from the storage area b. before pouring the med c. after pouring and prior to returning med to storage area

40. (continued) Confirm the client’s identity. Give the med by the route as ordered. Document on MAR “IMMEDIATELY” after they are given to each client before going to the next client. Never sign off meds prior to giving it. ** Complete this process for each client prior to going to the next client.

41. Administering Oral Meds Pour the correct number of pills/capsules into the medication lid, then into the med cup. Explain to client what meds you are giving and the purpose at client’s level of understanding. Give with water or other fluid. Stay with client until all meds are swallowed. Sublingual meds are placed under the tongue.

42. Liquid Medications Liquid meds must be measured in a calibrated medication cup. Place the med cup on a level surface at eye level Hold the med container so that the medication flows from the side opposite the label so it doesn’t run down the container and stain or obscure the label. Check the med cup again to make sure you have poured the correct amount. For small amounts less than 5cc, use a calibrated syringe to measure the medication. Give the med with the appropriate liquid. Always do the “3” checks before giving the med.

43. Eye Drops Explain purpose and procedure Have client assume back-lying position Put on gloves Instruct client to look up toward ceiling Hold dropper 1” above eye, install drops into pocket of the outer 1/3 of the eye Instruct client to close eye gently and wipe excess away Remove and discard gloves Gather and dispose of equipment Wash hands

44. Eye Ointments Follow steps for eye drops Discard first bead of ointment Squeeze small amount of ointment into the lower eyelid from the side near the nose to the outer eye

45. Ear Drops Draw proper amount of med into dropper Explain purpose of the med Put on gloves Straighten ear canal – adult pull up & back/child pull down & back Hold the tip of the ear dropper just over the ear canal. Client should remain on side for 5-10 minutes Remove gloves & wash hands

46. Nose Drops Explain purpose of med Put on gloves Have client lie on back with head slightly hyper-extended Draw up med into dropper Push up the tip of the client’s nose slightly Hold dropper just above the nostril and direct its tip toward the midline of the nose so the drops flow toward the back of the nasal cavity. Instill the number of drops Have client remain in lying position for 5 minutes and breathe through the mouth Remove the gloves Wash your hands

47. Topical Explain purpose of med Put on gloves Open container and place cap or lid upside down to prevent contamination Use a tongue blade, gauze or cotton applicator to apply Cover the end of the tongue blade, gauze or applicator with med Apply medication to affected area Remove the gloves Wash your hands

48. Aerosol Sprays Explain purpose of medication Shake the container if indicated Hold the container 6-12 inches from the affected area Spray evenly

49. Inhalants Explain the purpose of procedure Shake the inhaler Have client exhale completely then place the mouth piece in mouth, close lips around it. Have client inhale slowly & deeply Repeat the procedure as necessary to give as prescribed Client may gargle to remove medication from the mouth Clean mouth piece Return to storage place

50. Narcotics – Schedule II Drugs Controlled substances Secured under “DOUBLE LOCK” system Sign out each dose each time a dose is given on the medication sign out sheet that came with the medication from the pharmacy Always confirm the correct count of all narcotics when oncoming and off going.

51. Safety Rules Right Client Right Drug Right Dose Right Time Right route Right Documentation

52. (Continued) No medication should ever be given without a doctor’s order Encourage client to take meds as prescribed Keep an MAR on each client For Each medication, your MAR should include drug name, the amount to be given & how often the drug should be taken

53. (Continued) Medication should always be administered within 1 hour of the time it is prescribed If a client refuse medication, try & find out why You can not force a client to take medication Write “R” in the block of the date it supposed to be given & circle it Write on the back of the MAR in the designated area about the refusal

54. (Continued) Document in the progress note the refusal and the reason Inform the Administrator Notify the physician Notify the team

55. Conclusion 1.Remember to do the “three” checks 2.Remember If there are more than “three” pills recheck the order before administering 3.Remember “6” checks 4.Remember Client education must be done each time medication is given

56. Other Services Medication Administration Seizure Management Behavior Management Client Abuse Incidents Ten Traits of a Professional Boundaries

57. Other Services Mental Illness Bloodborne Pathogens Autism Developmental Disabilities Develop Procedure & Policy Manual

58. To Contact Instructor: www.ewsastaffingnetwork.com www.qprofessionalmentalhealtservice.com 1008-F Big Oak Court Knightdale, NC 27545 (919) 266-7050