Medication Administration

1. Medication Administration Early Intervention – Greatest Success Strengthening Character – Spiritual Hope and Focus New Experiences – Unlocked Potential and Success Worth with Youth & Families – Healthier Relationships

2. Medication Administration Objectives • When/where to obtain medication training • Storage of medications • Documentation requirements • Process to obtain/administer psychotropic medication

3. Medication Orders • Prescribed medication should be followed exactly as the doctor prescribed it. Any medication without a label should be properly disposed of. • Over-the-counter medication should be followed exactly as written on the bottle. Any medication without a label should be properly disposed of. • Medication should be disposed of at your local disposal site. • Before leaving the doctor’s office, ensure that you know: Drug type, administration procedures, adverse reactions, and documentation procedure (if required by physician).

4. Accepting Medications at Admission • Foster parents must never administer medications lacking pharmacy labels. • Review all medications prior to the transporter/caseworker leaving. • Ensure all medications are accounted for and that there is an adequate supply provided. If there is not, make sure a plan is created immediately on how this will be accomplished.

5. Storage of Medication • Medication must be stored in a locked location and inaccessible to all children in the home. • Medication requiring refrigeration must be stored in a locked bag in the refrigerator. • A variance needs to be completed by the licensing worker if a particular medication must be kept unlocked.

6. Medication Administration During Respite Care • Prepare medications well in advance of respite care. • Foster children’s medications should be packed in plastic Ziploc bags with the following information enclosed with the medication: • Child’s name • Date to take medication – Time to take medication • List: Quantity-Name of Medication - # of mg • Any special instructions • If a foster child returns to the foster home with medications that have not been given, or if a child comes to you with a short supply, notify the child’s caseworker.

7. Examples: John Smith 9/30/2016 8am 1-Claritin 5mg 1-Vitamin D 400mg Take with a full glass of water John Smith 9/30/2016 6pm 1-Claritin 5mg

8. Medication Administration Log • Use one log sheet per child. This includes: • Children who are placed in your home • Children who come to your home on respite care • Children who are placed in your home on a borrowed bed • Complete the log sheet to its fullest. • Document EVERYTHING!!!! • If it is not documented or initialed-it was not given. • If medications are packed for a respite visit, write R on the log sheet instead of initialing. • If a child refuses to take their medication, note the refusal on the log sheet and note the reason the medication was not given.

9. Purpose of Log Sheets • Log sheets tell everyone: • Medication dosage • Administration times for medications • Who administered the medications • Why medications were not administered (refusals) • Any actions/effects noted from the medication • Adverse side effects • This is also important proof for when a complaint is received regarding the child (not) receiving his/her medication.

10. Log Sheet Rules • Make sure the sheet is legible. • Provide complete and accurate documentation. • Keep log sheet up-to-date • Make sure your substitute caregiver knows how to administer medications and how to log it on the sheet. DO NOT DO IT FOR THEM!! • Never use white-out on a log sheet. • The log sheet should be changed monthly. At your monthly foster home visit you can give the log sheet to the foster care worker who will place it in the child’s file. Your licensing worker may also collect the log sheet during your annual/renewal.

11. Other Documentation with Log Sheet • Document the child’s reactions to the medication • Child’s comments and /or concerns regarding the medication. • Your own observations and comments regarding the effect of the medication. • Feedback regarding the medication’s effects on the child from birth parents, therapists, daycare providers, teachers, etc. • All feedback (oral and written) from the prescribing clinician.

12. 5 Rights of Medication Administration • Right Child • Right Medication • Right Dosage • Right Route • Right Time

13. Practicing the 5 Rights of Medication Administration • Right Child • Make sure the right medication is being administered to the right child. • Right Medication • Make sure the name on the prescription bottle matches the child’s name. • Right Dosage • Compare the dosage on the prescription bottle to the doctor’s orders (25mg, 10ml, 1 pill, 2 tablets, etc.). • Right Route • Make sure the route (oral, topical, etc.) is correct. • Right Time • Make sure the time is accurate on a daily basis.

14. Medication Labels • Make sure the prescription bottles match the labels of the medication • Child’s name • Medication name • Medication dosage • Medication direction • It is important to make sure the documentation on the prescription bottle matches the doctor’s orders.

15. Medication Administration: Step by Step • Wash hands • Remove medication from locked area only for the child you are preparing for at the time. • Pills should be taken with 8 ounces of water • Check medications for special instructions such as “take with food”, take after a meal”, etc. • IF NEEDED: Once the medication has been given, check the inside of the child’s mouth: cheek, gum lines, under the tongue, etc. to check for any medications not swallowed.

16. DO NOT’S of Medication Administration • Do not borrow or share medications between children. • Do not turn your back on a foster child when they are taking their medications • Do not let the foster child turn his/her back on you when they are taking their medication. • Do not take your eyes off the foster child at any time during medication administration.

17. Important Notes • Dosage Times: Medications should be given at the same time every day…but may be given up to ONE hour before or ONE hour after the designated time • Give the medications with a sufficient amount of fluid-at least 8 ounces • Helps prevent “cheeking” and improves absorption by the body. • Always encourage a child to take his/her medication, but do not attempt to force the child. If the medication is refused by a child, document the refusal on the log sheet. • Medications cannot be discontinued unless ordered by the doctor to do so.

18. Important Notes • Any adverse side effects must be documented and reported to both the foster care worker and the child’s physician that prescribed the medication. • Antibiotics must be given as directed. • Medications that are available over-the-counter do not require documented consent by the caseworker or the birth parents.

19. Psychotropic Medication

20. What Is Psychotropic Medication? Affects or alters thought processes, mood, sleep, or behavior. A medication classification depends upon its stated or intended effect. Psychotropic medications include, but are not limited to: • Anti-psychotics for treatment of psychosis or other mental and emotional conditions. • Antidepressants for treatment of depression. • Anxiolytics or anti-anxiety and anti-panic agents for treatment and prevention of anxiety.

21. What is Psychotropic Medication? Continued… • Mood stabilizers and anticonvulsant medications for treatment of bi-polar disorder (manic-depressive), excessive mood swings, aggressive behavior, impulse control disorders, and severe mood symptoms in schizoaffective disorders and schizophrenia. • Stimulants and non-stimulants for treatment of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). • Alpha agonists for treatment of attention deficit hyperactivity disorder (ADHD), insomnia and sleep problems relating to post traumatic stress disorder (PTSD).

22. How NOT To Use Psychotropic Medications • Use of a psychotropic medication as a behavior management tool without regard to any therapeutic goal is strictly prohibited! • Never use as a method of discipline or punishment. • Not to be used in lieu of or as substitution for identified psychosocial or behavioral interventions and supports that are required to meet a child’s mental health need.

23. Who Prescribes Psychotropic Medication? • Only a certified and licensed physician can prescribe psychotropic medication to children in foster care. • If the prescribing clinician is not a child psychiatrist, referral to or consultation with a child psychiatrist should occur if the child’s clinical status has not improved after 6 months of mediation use. • A general psychiatrist can prescribe medication if a child psychiatrist is unavailable.

24. What Has To Happen Prior To Prescribing? • The child must have a current physical examination on record • If indicated, baseline laboratory work is needed • The child must have a mental health assessment with a current DSM-base psychiatric diagnosis of the mental health disorder. • The prescribing clinician must explain the purpose and effects of the medication in a manner consistent with the individual’s ability to understand (child, and/or parent/legal guardian, if applicable).

25. Documentation Needed • DHS-1643, Informed Consent OR • Approval alternative consent form

26. It’s important to note that Psychotropic Medication CANNOT be administered until a DHS1643 Informed Consent has been signed by the appropriate person authorized to grant consent. If a child is prescribed psychotropic medication, and the approved authority to authorize the medication was not at the doctor’s appointment or was not available by phone to speak with the doctor during the appointment then you MUST wait to administer the medication until consent is granted. In order to expedite this process as much as possible please let your case worker know of all medical appointments where the child’s medication is being reviewed.

27. When does consent need to be granted? • When a child enters foster care and is already taking psychotropic medication. (Documentation of informed consent must be completed within 45 days of entry into foster care) • Prescribing new psychotropic medications • Increasing dosing beyond the approved dosing range on the most recent valid consent. • Annually, to renew consents for ongoing psychotropic medications • At the next regularly scheduled appointment following a legal status change or when a youth turns 18.

28. FOSTER PARENTS AND RELATIVE CAREGIVERS MAY NOTSIGN CONSENT FOR PSYCHOTROPIC MEDICATIONS.

29. Legal Status Authority to Consent Time Frame Temporary Court Wards A parent or legal guardian. Within seven business days of treatment recommendation. After a diligent effort has been made for parental signature with no response, the caseworker must seek an order for treatment by petitioning the court on the eighth business day. MCI/State Wards The supervising agency.* Within seven business days of treatment recommendation. Permanent Court Wards (regardless of placement setting) The court must provide Seek an order by petitioning the a written order. court within three business days of treatment recommendation. Temporary Court Wards Parent or legal guardian. Within three business days. After a in a Hospital Setting diligent effort has been made for parental signature with no response, the worker must seek an order for treatment by petitioning the court on the fourth business day. MCI/State Wards The supervising agency.* Within three business days. in a Hospital Setting *Foster care caseworker

30. Monitoring For each foster child prescribed psychotropic medications, medication compliance and treatment effect must be addressed by the assigned caseworker during the monthly home visit with the child and caregiver(s).

31. Questions?