Medication Administration Class

1. Medication Administration Class Catholic Community Services

2. Format for Class • Medicines • Giving them • Proving you gave them • Doctors, Nurses and Medicines • Core Competencies • Skills • And (Ahhhh) THE TEST

3. Protocol for Passing Medications • Medication Class • Pass test with 75% • Medication Assignment • Shadowing

4. Fatal Four • Aspiration • Constipation • Dehydration • Seizures • Why do we care?

5. Nursing Outcomes at CCS • Aspiration • Constipation • Dehydration • Seizures • Skin Care • Preventable ER visits

6. Six Rights • Right Medication • Right Dose • Right manner/route • Right time • Right person • Right documentation

7. Right Medication Double check that you obtained the right drug A drug order is written for specific medication Right medication Your responsibility: Obtain Prepare Administer the correct medication Check three times the medication container to the MAR

8. Right Dose Your responsibility it to confirm what dose within the dose range was ordered Never assume what dose of drug will be administered Right dose Make sure that the dose of the medication you are giving matches the MAR order You cannot give a different dosage than what is ordered

9. Right Manner or Route Most drugs have different routes for different needs Never assume what form of the drug will be administered Right Manner/Route Most used: PO = oral SL = sublingual Rectal = by rectum Topical = on skin Always confirm the right route with the MAR order

10. Right Time Double check with MAR when to administer med Administering doses • Too close together or • To far apart alter the therapeutic effect of the medication Your responsibility is to administer: • Stat meds ASAP • Single ordered medications at time ordered • Standing ordered meds on time • PRN medications when needed The drug’s • Purpose and • Pharmacokinetics Determine how often the medication is administered

11. Right Person Double check that you have the right resident Your responsibility is to: • Obtain • Prepare, and • Administer the medication to the correct person A drug order is written for a specific resident

12. Right Documentation Using the correct form to record the administration of the med assures that the resident does not receive another dose, preventing overdosing of the resident Right documentation includes correct drug order and a signature Your responsibility is to document the administration of the med immediately.

13. Five Always • Physician's order for every med/treatment • Wash your hands • Pour medication into cup • Identify and stay with resident until medication is swallowed • Keep med storage area locked, clean and orderly

14. Five Nevers • Never leave meds with client or out • Never give a med prescribed for one client to another • Never give meds prepared by another person. • Never use a med that is outdated or from an illegible or unlabeled container • Never give meds if you have questions.

15. Five Musts • Have correct MAR • Read label and compare it with MAR • Good position • Document • Understand the medicine

16. Storage of Medications • Locked • Clean • Refrigeration • Separate orals from topicals • Separate meds for different clients.

17. Preparing Medications • Changing the form • Crushing meds • Measuring liquids

18. Pharmacy • Use Olson’s Pharmacy • Not all clients use just one pharmacy • Important to know how each house connects with Olson’s • Use them as a resource

19. Medication Administration Record • Forever after known to you as MAR • Preparation of MAR • Transcription of orders • Signing back • Time limited medications • Discontinuing medications

20. Documentation If it isn’t written down, it did not happen.

21. Charting Codes YR

22. Practice • You give a medication. • Your HM tells you that Jessie needs to have a Dilantin blood test and not to give the 8 AM Dilantin. • Adam went home for the weekend. • Johnny spit out the medicine you gave him.

23. PRN Medications • Establish the need for the medication • Ensure there is a current order • Administer the medication • Sign the back of the MAR • Follow up within two hours

24. Practice on PRN Medications • Johnny complains that his head hurts. • Ronny has a cough • Mark has a groin rash • Susie has not pooped in two days.

25. Controlled Substances • Definition • Why they are handled differently • Examples • Special Tracking and charting

26. Abbreviations PRN QD PO noc supp TID tab g-tube

27. Charting You are telling a story with your charting Each house will want you to chart in their way

28. Self Administrated Meds • Self determination is determined through ISP process • At present we have no residents who self-administer • Please see packet for process

29. Different kinds of medications • Via the mouth! • Topicals • Sublinguals • Eye drops/ointments • Ear drops • Rectal meds • Vaginal meds • Nasal meds

30. PO Medications • Do not crush unless you have an order • Slower to be absorbed • Taste is important • Food can impact the medicine • Take with full glass of water • Do not mix in hot drinks • Shake all liquids before pouring out

31. Topicals • Usually used for skin conditions • Always use gloves • Check expiration dates • Privacy • Be aware of residents tendency to put body parts in their mouths • Make sure you note effectiveness

32. Sublinguals • Under the tongue • Do not offer water right away • Use gloves • Stay with resident until you are sure the medication has been absorbed

33. Eye Drops/Ointments • Used to treat infections, inflammation, irritation and lack of moisture • Wash hands • Use Gloves • Explain to client • Drops before Ointments

34. Ear Drops • Warm ear drops to body temperature • Wash hands • Wear gloves • Have resident lie on side opposite to the ear being treated • Have them stay that way 5-10 minutes

35. Rectal Medications • Used to stimulate bowel movements, relieve pain, relieve vomiting, reduce fevers, stop seizures • Wash hands • Wear gloves • Privacy!!!! • Usually kept in refrigerator • Documentation of this one is important

36. Vaginal Medications • Determine if administration will involve 1 or 2 staff • Wash hands • Wear gloves • Explain procedure • Privacy!!! • Best time to insert is after shower or bath

37. Nasal Medications • Wash hands • Wear gloves • Explain procedure • Spray vs. drops • Work with client

38. Medication Errors • Definition of a medication error • Examples • Forgetting to sign • Forgetting a follow up • Not giving a suppository when due • What happens • Intent

39. Where is the error?

40. Residents, Living and Meds • Our residents have lives • Some work or have lives outside our homes • They need their medication • Communication is the key

41. Work site responsibilities • Work site needs a copy of doctor’s order • Administered by designated staff person • Same rules apply: i.e. MAR, 5 rights

42. Home responsibilities • Provide work with necessary information • Inform worksite of any changes • What is the abbreviation for the MAR at home when a resident is at work?

43. When a client goes home • Pills in envelopes – one type of medication to an envelope • Whole bottles go home • Document on MAR • Never take medicine back

44. Hospitalized Residents • DO NOT TAKE MEDICINES TO HOSPITAL • What is the appropriate documentation?

45. Disposal of Non-controlled Medications “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit. Documentation of this! Any two staff can do this

46. Disposal of controlled medications • “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.” • Documentation! • Of the two staff, one must be an LPN or RN

47. Disposal Documentation • Date • Client’s name • Name of medication and dosage • Amount of medication disposed • Reason for disposal • Method of disposal • Two signatures

48. Practice

49. What is a medication “Medication means any drug, chemical, compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.” Any medication for our clients must be prescribed by a MD

50. Adverse reaction • Allergy • Side effects • Your part