NORTH DAKOTA DEPARTMENT OF CORRECTIONS & REHABILITATION CMT II

1. NORTH DAKOTADEPARTMENT OF CORRECTIONS & REHABILITATIONCMT II Correctional Medical Training IIPreviouslyMedication Assistant IPROGRAM IN COLLABORATION WITHMINOT STATE UNIVERSITY

2. Jo Ann Sund, RN Constance B. Kalanek PhD, RN November 16, 2007 November 16, 2007 NORTH DAKOTA BOARD OF NURSING CERTIFICATE OF APPROVAL Medication Assistant Program I Offered by NORTH DAKOTA DEPARTMENT OF CORRECTIONS AND REHABILITATION BISMARCK, NORTH DAKOTA Has met the standards for a medication assistant program I And is approved by the North Dakota Board of Nursing From November 2007 to November 2011

3. Requirements • Passed CMT I • CPR certification • Detailed start and finish date of course work. • Clinical check list score of 90% • Student written exam of 85% • North Dakota Board of Nursing regulations allow no more than one retake without further instruction.

4. Medication • Prevent Disease • Aid in diagnosis of disease • Treat a disease or reduce symptoms • Restore normal body function • Maintain normal body function

5. Why training to give medications in corrections? • Medications can be dangerous • Medications may be unfamiliar • Rules and procedures are required by law in correctional facilities. • Correctional facilities must control medication storage and delivery.

6. Correctional Delivery Model • Physician or dentist • Pharmacist • Nurse • Correctional staff or officer • ***As Correctional staff not allowed to make judgments about medication, only observe and report.

7. Medication Cycle • Observation (observe the offender and report changes, report side effects) • Prescription (report any known complications such as an allergy) • Administration (Monitor correct dose to be given) • Documentation (check and record on MAR)

8. Correctional staff responsibilities • Adherence to laws and correctional facility policies • Observing for side effects • Ensuing safety and sanitation policies are followed.

9. What are your institutions policies? • Prescription medication • Non prescription medication

10. Laws • Food and Drug Act • Controlled Substance Act of 1970

11. Observation Skills • Visual • Auditory • Smell • Touch

12. General Appearance • Body Posture • General State of Health and Appetite. • Physical Activity Level • Physical condition of skin • Facial expressions and speech • General emotional state and state of awareness • Bowel and bladder

13. Report any observed concerns to licensed nurse or shift supervisor

14. Medication Verification • Proper label on medication • Name of pharmacy • Address of pharmacy • Number of prescription • Offenders name • Physician name • Date filled • Type of medication and amount • Instructions for taking medication • Initial of pharmacist

15. References for verifying medications • Call pharmacy • Call physician • Call nearest hospital or poison control • Call facility nurse • Mosby or Sanders Nursing Drug Reference Handbook • Facility nurse or supervisor should be notified if problems or questions.

16. MAR or Medication Administration Record • Keep on person medications • Storage in a cool dry area unless otherwise instructed.

17. 6 rights to medication delivery Right Individual Right Documentation Right Dose Right Route Right Time Right Medication

18. Before meals a.c. • Every q • Every hour qh • Every six hours q6h • After meals p.c. • Three times an day tid • Two times a day bid • As needed prn

19. By mouth p.o. • Intramuscular I.M. • Intravenous I.V. • Suppository supp. • Pertaining to eyes Ophth • Pertaining to the ear Otic • Subcutaneous SQ • Sublingual SL • Inside cheek buc

20. Body systems • Skeletal • Bones and joints • Body support, protect organs • Muscular • Muscles • Body movement

21. Nervous • Brain and spinal cord • Control body activity • Circulatory • Heart and blood • Carry oxygen and nutrients to the cells

22. Respiratory • Nose and lungs • Provide air • Urinary • Kidneys and bladder • Remove wastes

23. Gastrointestinal • Mouth, stomach and bowel • Digest food remove waste • Endocrine • Thyroid and pancreas • Secrete hormones

24. Skin • Skin • Protection • Sensory • Eye, ears, nose • Sight, hearing and sound

25. Effects of medication • Follows the same route as food • Body Weight • Age • Sex • Pregnancy and lactation • Genetic factors • Psychological factors • Illness/disease

26. Desired effects • Side effects (allergy) • No apparent effect

27. Medication Interactions • Potentiation • Antagonism • Unique effect

28. Any change in behavior or physical condition the first few days of starting a new medication should be reported to nurse or shift supervisor.

29. Medication names • Trade or brand names • Generic names • Chemical names • Family or category

30. Steps in oral medication procedure • Correct time or medication times schedule • Hand washing • Unlock storage area • Check label, Remove right dose from container • Report changes in appearance of medication to nurse, supervisor, or pharmacist • Observe swallowing of medication • Replace medication in locked storage area. • Chart medication • Observe for desired or side effects

31. Steps in liquid medication delivery • Time schedule • Hand washing • Unlock storage area • Check label • Shake before pouring and pour away from label side. • Pour at eye level and pour right before giving • Don’t mix other medications or with other liquid medication • Observe swallowing of liquid • Replace in locked storage area • Chart medication • Observe and report medication effects

32. Special Medication ProceduresCorrectional staff • What is the purpose and desired effect of medication given. • Response time • Side effects • Possible interactions with other medications. • Special storage or administration procedures. • Controlled substance counted and controlled • Controlled substances are not advocated to be used in correctional facilities.

33. What is your facility’s procedure if offender is away from facility regarding medication delivery? • Procedures for verbal orders. Only a licensed nurse can take a verbal order. • Procedures for prn medications. Most correctional facilities don’t allow. Must be documented appropriately.

34. Eye drops or ointments • Wash hands soap and water. Use gloves • Avoid touching around the eye with dropper or vehicle for dispensing. Keep dropper and eye area clean. • Lying down position or head tilted back. • Index finger pull eye lid down to form a pocket. Support rest of hand on nose and cheek. • Drop desired amount in pocket • Replace cap and have offender close eye gently • Wash hands after removing gloves and return to storage area.

35. Ear drops • Wash hands soap and water • Check medication delivery system • Medication bottle and ear are clean • Warm drops in hand shake • Tilt ear up. Hold ear lobe down and back • Place prescribed amount in ear. • Don’t put dropper into the ear canal. • Keep ear tilted awhile and then insert cotton plug. • Wash hands

36. Topical medication • Position offender in a comfortable position • Wash hands wear gloves • Check label • Follow directions on label can use a tongue blade • Creams rub gently • Lotions pat or dab on skin • Liniments rub vigorously • Aerosol sprays 3-6 inch away • Form medication place next to skin and spray • Remove gloves wash hands and store properly.

37. Nebulizer treatment • Wash hands: prepare supplies and set up equipment • Offender sit upright check heart rate and respiration rate and record. • Check MAR and appropriate dosage of medication • Place mouth piece in mouth and start machine. When medication is gone, shut off machine. • Check heart rate and respiration rate and record. • Wash equipment and hands

38. Transdermal patches • Wash hands wear gloves • Check medication label with MAR • Date and initial patch before applying • Remove old patch • Apply to non-hairy area as directed • Place patch on skin and hold down with palm 30 seconds • Remove gloves, wash hands and document in MAR

39. Difficulty swallowing • Sitting position • Small sips water • Take one tablet at a time • Rest between tablets • Put medication in a teaspoon of pudding etc. • Check if comes in a liquid.

40. Refusal of medication • Document the reason for refusal and follow facility policy for medication refusal. • Allow time to pass and reoffered medication? • Notify nurse or shift supervisor

41. Errors in medication administration • Use facility policy such as an incident report or variance. • Wrong individual • Wrong medication • Wrong dose • Wrong time • Wrong route • Wrong procedure/documentation

42. Anticonvulsant • Control seizures • Side effects • Drowsiness • Upset stomach • Constipations • Sore throat/infection • Dizziness/unsteadiness • Slurred speech

43. Antibiotic • Purpose treat infections given for 4-10 days. It is important to take all medication. • Side effects • Rash or hives • Itching • Nausea or vomiting

44. Analgesics • Relieve pain • Side effects • Drowsiness • Constipation • Headache • Nausea/vomiting • Slow respirations

45. Psychotropic • Reduce symptoms of emotional disorders • Side effects • Nausea and loss of appetite • Weight gain and metabolic syndrome (diabetes and high cholesterol) • Diarrhea

46. Hormones • Stimulate metabolism • Birth Control • Insulin • Steroids • Hormone replacement therapy.

47. Antacid • Relieve upset stomach • Side effect • Constipation

48. Anti hypertensive • Cardiovascular • Anti-inflammatory • Protein pump inhibitors