med tech manual final draft
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Legacy House ofBountiful
Med TechManual
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HIPPA Disclamer
Allofthenamesthatareusedinthismanualarecitousandinnowayreectrealpeople
andtheirmedicalhistories.Anyreferncetoarealpersonandtheirmedicalhistorywasunintental.
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ContentsHIPPA Disclamer..................................................................................................................3Preface...................................................................................................................................7Glossary.................................................................................................................................9Section One: Handling Medication...................................................................................13 MedicationCartOrination..........................................................................................15
PullingMedication.....................................................................................................16 TheNightBox............................................................................................................18 PassingMedications...................................................................................................20 MedicationErrors.......................................................................................................20Section Two: Docmentation.............................................................................................22 DocumentingMedications.........................................................................................22 MedicationAdministrationRecord(MAR).....................................................24 DocumentingNarcotics..............................................................................................24 NarcoticRecord................................................................................................24
NarcoticCard/NarcoticSheetCount...............................................................25 DocumentingResidentsCondition.............................................................................27 DailyCharting..................................................................................................27 IncidentReports...............................................................................................29 TakingandRecordingVitalSigns..............................................................................32 DailyVitals.......................................................................................................32 DalyVitalsintheMAR....................................................................................32 BloodSugars....................................................................................................33 OxygenLevel(O
2)............................................................................................33
PulsesandBloodPressures..............................................................................34 PulseinMar......................................................................................................34 UsingtheBinders.............................................................................................35Section Three: New Orders andOrdering From Pharmacies.........................................37 NewOrders.................................................................................................................37 OrderingFromThePharmacy....................................................................................38 SuperiorCarePharmacy...................................................................................38 OrderingPriorityMedications...............................................................39 OrderingAfterHours.............................................................................39
MountianWestApothacary..............................................................................39 OtherPharmacies.............................................................................................39 NewOrderChecklist..................................................................................................40 ReorderChecklist.......................................................................................................40Section For: Emergency Sitations.................................................................................41 FirstAid......................................................................................................................41 TransportingtotheHospital.......................................................................................42 EmployeeInjuryProcedure........................................................................................42HospitalProcedure43
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BuildingEvacuation...................................................................................................44 DeathProcedures........................................................................................................45Section Five: Otside Agencies..........................................................................................46 HomeHealth...............................................................................................................46 Hospice.......................................................................................................................46 FlexCare....................................................................................................................47Section Six: Caring For Residents with Diabetes and Dementia....................................48 Residentswithdiabetes..............................................................................................48 Residentswithdementia.............................................................................................49Section Seven: Addtional Information..............................................................................50 Supplies......................................................................................................................50 DoctorsApointments.................................................................................................50 HIPAA.........................................................................................................................51Appendices ..........................................................................................................................53 AppendixA:CommonNarcoticsandAntibiotics......................................................54 AppendixB:SymbolsandAbbreviations..................................................................55
AppedixC:ConversionChart....................................................................................57 AppedixD:MilitaryTime..........................................................................................57 AppendixE:ResidentsCharts....................................................................................58 AppendixF:HowtoUseaNebulizer........................................................................59 AppendixG:HowtogiveaSuppository...................................................................59
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Preface
Thismanualwaswrittentohelpbettertrainthemedicationtechnicians(medtechs)ofLegacyHouseofBountiful.Thismanualistailoredtothepoliciesandproceduresthatareusedinthisfacility.Thismanualisacomprehensivedocumentthatdescribeshowtocompletetasksthatamedtechperformsonadailybasis.Italso
providesexamplesofhowtocorrectlylloutthedocumentsthatmedtechsarerequiredtouse. Thegoalofthismanualistohaveamorehandsonapproachtothetrainingofnewmedtechs,sothattheyarebetterpreparedtoworkwhentheirtrainingiscomplete.Also,thismanualismeanttobeusedasaref-erencemanualforcurrentmedtechswhentheyhavequestions.
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GlossaryAdministrator The person that is the director o the bilding. Also reered to as the Bliding Director.
AM (Shift): The med tech shit rom 0600 to 1430.
Assistant
Administrator:The manager that is over the aides and creates the schdle or the med techs and the aides.
Changein Stats:
Any change in the residents condition, either or better or worse, which changes the assistance that the residentneeds.
Code
(Fll Code):
This means that the resident has a ll recitation order. I needed the med tech or aide wold need to perorm lie
saving measres, sch as CPR
Ekit:
A kit o medications or residents that are on hospice. The kit is provided by hospice. The medications are to be sed
or comort measres and its se needs to be approved by the hospice nrse. Any resident on hospice needs to have
an ekit.
Face Sheet:
The cover sheet o a residents chart. This contains pertinent inormation sch as birthday, emergency contact
inormation and insrance inormation. A copy o this sheet needs to accompany the resident when they are sent
to the hospital, another acility, or a doctors appointment. And i a lab specimen is taken the ace sheet needs to
accompany the specimen.
Grave: The shit rom 2200 to 0630.
MAR:Stands or the Medication Administration Record. This is the record that is signed by the med techs to docment the
time and dosage o a medication given.
Med Cart:Oten reerred to as the cart. The med cart is where the medication that the med techs administer are kept. It locks
and has three narcotic drawers that also have a lock.
Med Room or
Wellness
Center:
This is the room where the medication and charts are kept. This is also where the Assistant Administrator has her
ofce.
Med Strip: The packaging that medication comes in rom Sperior Care. Also called ato med.
Narc: Short or narcotic
O2:The vital sign that measres the amont o oxygen in the blood stream.
Order:A signed prescription rom the doctor that can be or medication, a treatment or assessment or Home Health or
Hospice.
PLOST:Sometimes is reerred to as the DNR Order or simply the DNR. This is a legal docment that states the residents
DNR stats. The POLST is kept in the back cover o a residents chart.
PM: The med tech shit rom 1400 to 2230.
POAPower o Attorney. This is a person that has legal power to make medical decisions or the resident when the resident
is no longer able to make sch decisions.
Profle Only:The term that is sed when sending an order to Sperior Care, so that the order will appear on the MAR and
Sperior will not send the medication.
RCC:Resident Care Coordinator. The nrse that is in charge o the med techs and coordinates resident care with otside
agencies and the assistant administrator.
Sharps:Any syringe or lancet with a sharp edge. These need to be pt in a sharps container either in the residents room or
in the Med Room.
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Legacy House ofBountiful
Med TechManual
By
AmberNielsenMTCNA
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Theprimaryjobofamedtechishandlingofmedications.Tohandlemedications,allmedtechsneedtohve erstig of the six rightsofmedicationadminastration.Allmedicationerrorsoccurbecauseoneormoreoftheserightswasntfollowed.Thesixrightsareasfollows:
Right
Resident
Itisveryimportantthateachresidentreceiveshisorherownmedicationsandnotanotherresi-dentsmedications.Bydoublecheckingnamesonmedicationpackagingandtheresident,youinsuretht the rightresidentisrecievingtheright ei-cation.Ifyouareunsure,asktheresidenthisorhername,itisbetterinsureaccuracythanitistolooksillybyaskingaresidenthisorhername.
Right Time
Eachdoseofamedicationhasbeenassignedaspecictimeunlessitisanasneeded(PRN)medi-cation.Itisveryimportantthatallscheduledmedi-cationbegivenonehourbeforeorafterthesched-uledtimetoinsurethataresidentisntreceivingtoomuchofamedicationtooclosetogether.Ev-enthoughPRNmedicationsdonthaveanassignedtime,dosesmustbegivenacertainamountoftimeapart.(Theorderforthemedicationtellshowlongthatamountoftimeshouldbe.)Bycheckingthe
assignedtimeontheMARandgivingmedicationatthattime,youinsurethatthemedication right is
beingrecievedattherighttime.
Right
Medication
Eachresidenthasbeenprescribedspecicmedicationsbyhisorherdoctor.Itistherespon-sibilityofthemedtechtoinsurethateachresidentreceivestherightmedicationasprescribedas
percribedbythedoctor.
Right Dose
Everyperscibedmedicationhasbeenassignedaspecicdose.Itisimportanttotriplecheck
medicationwhenpullingittoinsurethattherightdoseisgiven.Failuretoreceivetherightdoseofamedicationcanbedetrimentaltotheresidentshealth.Forexample,evenifacoumadindoseisoff
by0.5mgitcancausebloodclottingissues.
Section One: Handling Medication
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Right Route
Eachmedicationisprescribedaroute,orplaceon/inthebodythatitistobeadministered:bymouth(PO),byeye(gtts/OU),bynose,byrec-tum.Itisveryimportantthatamedicationisdeliv-eredbytherightroute.(Noonewantstoswallowasuppository!)
Right
Documentation
Whenhandlingmedicationyoumustcorrectly
documentthatthepillwasgiven,ifitwasntgivenyouneedtodocumentwhyitwasntgiven.RightdocumentationincludessigningthepilloutintheMAR;andifitisanarcsigningoutintheNar-coticRecordBinder.Ifforsomereasonapillisnotgivenit,thatneedstobedocumentedaswell.Rememberifapillisntdocumentedcorrectlyasgiventhenitwasntgivenandisamedicationer-ror.
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Medication Cart OrinationThemedicationcart,oftencalledthemedcartorcart,iswhereallofthemedicationiskept.Therearetwomedcarts,thebigcartandthesmallcart.ThebigcartiskeptintheMedRoom.ThesmallcartiskeptinthecottageofceduringAMandPMshift;anditismovedbackintotheMedRoomattheendofPMshiftandkept
thereonthegraveyardshift.BothcartsarekeptintheMedRoomatnightbecausetheyneedtobekeptinalockedroom. Bothcartsaresetupasfollows: Top of the cart:TheMARBinderiskeptontopofthemedcart,alongwithabloodsugarschedule,andanyimportantnotices.Thebloodsugarscheduleisalistofresidentsthatneedbloodsugarstakenandatwhattimethebloodsugarneedstobetaken. Top Drawer:Thetreatmentsarekeptinthetopdrawerofthemedcart.Treatmentsincludeeyedrops,inhalers,nosesprays,andcreams.Alltreatmentsaregroupedtogetheraccordingtocategory.Pens,sharpies,smallnotebooksandtheoximeterarealsokeptinthetopdrawer. Second Drawer:Beginningintheseconddrawerandcontinuingdownasfarasneedediswheresched -uledmedicationiskept.Thescheduledmedicationisputinalphabtical orderbytheresidents last name.Each
residenthasanautomedstripormedbubbles.Also,anynonnarcoticpatches,anymedicationsnotincardsorthemedpackets,andekitsforhospiceresidentsarekeptwithautomed/medbubbles.Anyremainingdrawersuntilthebottomdrawerarewhereanymedicationsthatdonttnexttothemedicationspacketsarekept. Bottom Drawer:Thebottomdraweriswheremedicationcardsarekept.ThemajorityofthesecardsarePRNmeds.However,thereareafewmedsthatarescheduledandcomeinmedicationcardsthatarekeptinthebottomdrawer.Ifspaceallowspowdermedications,suchasMiralaxarealsokeptinthisdrawer.Themedicationcardsinthebottomdrawerinalphabetical orderbytheresidents last name strtig i the frontofthedrawer.Adividerwiththeresidentsnameisplacedinfrontofhisorhermedicationcardstokeepresidentmedicationsseperateandhelppreventmedicationerrors.Thereisalsoanarcdrawerinthebottomdrawer.Thisnarcdraweriswhenthenarcsthatcomeinekits,liquidnarcs(insryniges)andpatchesarekept.(Basicallyany
narcthatisnotpackagedinamedicationcardiskeptinthebottomnarcdrawer.) Side Drawers: Offtothesideofthemaindrawersofthemedcartarefoursmallerdrawers.Thetopdrawercontainsbothbigandsmallmedcups,medbaggies,andpillcrusherbags.Thesecondandthirddrawerarenarcdrawers,theybothhavelockboxesthatlltheentirespaceofthedrawer,thesedrawersneedtobelockedatendofthePMshift.Narccardsareorganizedinalphabetical orderbyresidents last namebeginningi the backofthedrawer.Dividersarealsousedtoseperatestheresidentsnarccards.Coumadinandantibiot-icsarealsokeptinthenarcdrawer.Thefourth/bottomsidedraweriswherepowderandextrasuppliesarekept.
The top of the cartis where the MAR, blood sgar schedleand important notices are kept.
The top drawer is where the treatments, pens and markers,and the oximeter are kept.
The top side drawer is were the med cps and baggies are
kept
Begining in the second drawer all o the ato med strips or
med bbbles are kept.
The second and third side drawers are narc drawers.
The bottom side drawer is were powder meds and extra sp
plies are kept
The bottom drawer is were med cards, powder and liqid
meds, and the third narc drawer are kept.
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Pulling Medication Eachmedtechhashisorherownwayofpullingmedications.Somepullallthepillsthattheywillpassontheirshiftinonelongpullandotherspullaccordingtothetimethattheywillpassthepills.Whetheryoupullallofyourpillsatonceordivideyourpullsup,therearesomeimportantguidelinestoremember.
Medicationpackets,automedstrips(Superior)andmedbubbles(MountainWest),arelocatedinthemedcartstartingintheseconddrawerdownbeginningi alphabetical orderbytheresidents last name.Printedoneachmedpackettheresidentsname,thedateandtimethatthepacketshouldbeadministered,andthemedicationsthatareinthepacket.
Ato Med Strip Med Bbble
Whenpullingmedications,eachmedicationthatis
listedonthepacket,oronthemedicationcardsinthenarcdrawerorbottomdrawermustbetriplechecked
againsttheMARtoinsurethatitistheRIGHT MEDI-
CATION, RIGHT DOSE, RIGHT ROUTE, is
give t the RIGHT TIME tht the RIGHT MEDI-
CATIONisbeingpulledforthe RIGHT RESIDENT.
Anymedicationsthatyouputintoaplasticbaggieormedicationcupmusthavevethingswrittenonit:
TheresidentsnameScheduledtimeofthemedication
NameofthemedicationDoseofthemedicationRouteofthemediction
Marty Fenwick2000
Coumadin
7.5mgPO
Anymedicationthatisplacedinabaggieandtapedbackontoacardmusthavefourthingswrittenonit:
TheresidentsnameThenameofthemedicaiton
DoseofthemedicationRouteofthemedication
Stan WalkerBenadryl25 mgPO
Medicationsthatarepulledneedtobeputintoa
purplebox.Theseboxesareusedtocarrymedicationwhenpassing.Whenyouarepullingmedicationsyouwillputthemedicationandanytreatmentsneededintoapurplebox.Useadifferentpurpleboxforeachmedpass.Thiskeepsmedicationseperatedandhelps
preventgivingamedicationatthewrongtime.Thepurpleboxesneedtobelockedupuntilitistimetopassoutthemedicationinthem.
Prple Medication Box
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The Night Box
Duringthegraveyardshitthereisnomedtechonduty.InsteadagravemedaidepassesthemedicationongraveyardandanyrequestedPRNmedication.Thismedicationiskeptinthenightbox.AndthemedicationthatgoesinthenightboxispulledandpreparedbythePMmedtechs.WhilethePMmedtechspreparethemedicationthatgoesinthenightboxbothAMandPMshiftshaveresponsibilitieswiththenightbox.
AM Shift: Checkthenightboxwithgraveyardmedaide.Anymedicationthatis
stillinthenightboxneedstobewrittenontheNightBoxMAR.AftertheremainingmedicationischeckedanddocumentedbothAMmedtechsandthegraveyardmedaidewillsigntheNightBoxMAR.
ReceiveabriefreportfromthegraveyardmedaideaboutanyPRNme-icationgiven,anysheduledmedicationnotgiven,fallsandinjuries,andifanyresidentwassenttothehospital.Ifaresidentwassenttothehop- italduringgraveyardthatisonFlexCaretheAMmedtechwillneedtocontactFlexCareandtellthemthatoneoftheirresidentshasgonetothe hospital.
Receive48HourFollowUps,NewIncidentReports,andanyRecordsofDeathfromthegraveyardmedaide.
ResponsiblefordestroyinganyscheduledmedicationthatwasleftinthenightboxanddocumentingontheNightBoxMARthatthemedicationwasdestroyed.
UseanyleftoverPRNmedicationinthenightbox,ifpossible.Ifthe
PRNmedicationisntusedonAMshift,itcanbeleftforthePMshifttouse. ReportanyrequestedPRNmedicationtothePMmedtech.
PM Shift: Pullallofthescheduledmedicationforgraveyard(between2230and
0700.IntheMAR,graveyardmedicationsarehighlightedinpurple); commonlyusedPRNmedicationsandanynewrequestedPRNmedications.Allmedicationneedstobelabeledwiththeresidentsname,themedicationname,dose,andtime.MedicationthatisinautomedstripsfromSuperiorcanbeleftinitspackaging.Everyt-
hingelseneedstobeplacedinabaggiewithanightboxlabel. DestroyanyPRNmedicationthatwasntusedonthePMshift. CheckthenightboxwiththegraveyardmedaideandsigntheNight
BoxMAR. GiveabriefreporttothegraveyardmedaideaboutPRNmedsgiven
andanyotherpertinentinformation. Give48HourFollowUpstothegraveyardaide.
ToseeacopyoftheNightBoxMARgotopage8.
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ThisillstrationshowstheNightBoxMARandhowtoproperly
llitout.ThePMshiftmedtechswillcheckthemedicationthattheyhave
pulled
andputintothenightboxwiththe
graveyardmedaide.Once
themedicationsarecheckandEVERYm
edicationthatislistedintheScheduledandPRNcolumnsare
present,themed
techsandgraveyardmedaideneedto
signanddateundertheP
M/GraveyardShiftChangecolumn.Th
egraveyardmedaidewill
lltheouttheNightBoxMARastheygivemedicationthroughtthenight.Ifthethereare
anyrequestsforPRNmedsnotinthenightbox,theywillalsorecordthose.WhenAMShiftarrives,thegra
veyardmedaideandtheAMshiftmedtechswillchecktheboxandrecordany
remainingmedications.Oncethemedicationsarerecordedalongwiththereasonthattheywerentgiven,thegraveyardmedaid,andtheAMshiftm
edtechneedtosignanddateunderthe
Graveyard/AMShiftChangecolumn.
An
gle
a
Rod
gers
02/12/12
2230
02/12/12
2230
02/12/12
2230
02/13/12
063002/13/12
0630
02/13/12
0630
RileyJames
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachR
ichards
ZachR
ichards
ZachR
ichards
ZachR
ichards
Z
achRichards
ZachR
ichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
ZachRichards
5/500
Mg
5/500
Mg
7.5/325
mg25/100
25MG
10MG
25MG
15MG
15Mg
60Mg
75Mcg
75Mcg
50mg
75MG
7.5/500
5/500
15Mg
5Mg
10Mg
BrynnThomas
RacheFieldng
PRN
PRN
PRN
PRN
22300600
ThomasLund
MargretSimpson
NathtanMartin
JosephPeterson
LucyMarberry
AudreyThompson
Temazepam
Tylenol
Percocet
Xanax
Simvastatin
Tramadol
NotRequested
NotRequested
NotRequested
NotRequested
ResidentRefused
ResidentwasSenttotheHospital
BillRichard
Tylenol
Lortab
Lortab
JamesPerkins
MaryDavis
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Passing Medications TheMARliststhetimesthatscheduledmedicationsneedtobeadministered.Youhaveanhourbeforeorafterthattimetoadministerthatmedication.Forexample,ifamedicationisscheduledtobegivenat
1600,youmaygiveitstartingat1500andupuntil1700.However,thetwohourwindowdoesntapplytoPRNMedications,especiallynarcot-ics.PRNmedicationsneedtobespacedaccordingtothedirectionsintheMAR.Forexample,ifaPRNmedicationiseveryfourhoursanditisgivenat1200,itcannotbegivenagainuntil1600. Forscheduledmedicationstherearevemainpasstimes:0800,1200,1400,1600and2000.Ifforsomereasonamedicationcannotbegivenbetweenthetwohourblockallot-ted,itmustbeclearedbyanursetogivethemedication.Theexceptionthatdoesntneedtobecleared;isifamedicationismissedatthe2000(bedtimepass)becausearesidentisout
ofthebuilding(duringthe2000pass)themedicaitonmaybegivenupuntil2400withoutconsultingwiththenursebeforehand. Whenyouarepassingyourmedicationsitisveryimportantthatyoudoublecheckthenameonthemedicationpacketandtheactualresi-dentthatyouaregivingthemedication.Thisinsuresthateveryresidentisreceivingthecorrectmedication.(SeeTheResidentsRightsonpage3)Ifyouareunsureofaresidentsnamebecausetheyhavejustmovedin,askthemtheirname.Itisbetterthatyouasktheresidenthisorhernameandnotanotherresidentorcoworkertoinsurethatyouaregivingtherightresidenthisorherpills.
Medication Errors Amedicationerroroccursanytimethatoneofthesixrightsisnotfollowed.Examplesofmederrorsare:givingthewrongmedicationtotheresident,notgivingamedicationattherighttime,notgivingamedication,ornotproperlysigningoutamedication.WhenamedicationerroroccursaMedicationErrorReportneedsto
belledoutandtheproperpeopleneedtobeinformed.Thesepeoplearethenurse,theresidentsdoctorandtheemergencycontactperson.InadditiontollingoutamedicationErrorReport,anIncidentReportneedsto
belledoutand48HorFollowupinneedstobestarted.Givingthewrongmedicationisanincidentthatcanchangethestatusofaresidentswellbeingandtheyneedtobemonitoredtoinsurethatnocomplicationsarisefromreceivingthewrongmedication.
ToseehowtocorrectlylloutaMedicationErrorReportgotopage10.
Remember that or all schedled medication
there is a two hor passing window.
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Boyd, Fredrick 24/15/252/12/12 1600 X Thomas, Brynn
X
XX
X
Nurse okayed not calling
2/12/122/12/12
2/12/12
16301635
1640George Garcia
Katlyn Smith
One lortab 5/500 mg every 4 hours as needed for pain.
I gave two 5/500 mg lortab at 1600instead of just one. The wrong dose of lortab was given.
The residents vitals were taken at the time of the med error, andagain an hour later and then three hours later per the nurses request. The staff will continue to
X
X
98.7 97.9 98.585 87 80
The resident for any changes.
22 21 18160/8095 94 97
156/82 154/73
116 256 220
ThisillstrationshowshowtocorrectlylloutaMedicationErrorReport.Whenyoucontactthenurseaboutthemedicationerror
she will instrct yo to check the residents vital signs oten. (Based on the med error she will tell yo how oten and how many time yo will
need to check the residents vitals.) Yo need to write those vital signs on this report and start a 48 Hor follow up and write the vitals on
that orm as well.
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Section Two: Documentation
Documenting Medications WhenmedicationisgivenitmustbeproperlydocumentedintheMARandifitisanarcthenitneedsto
besignedoutinthenarcoticRecordBinder.IfforsomereasonapillwasntgivenbecausetheresidentisLOA,refuses,orisunabletotakemedicationitmustbeproperlydocumented.Thissectioncovereshowtoproperlydocumentmedication.
TheMARBinderforeachcartislocatedontopofthecart.ResidentsMARarelist-e i alphabetical orderbylast name.AlistofthePRNmedicationthataresidenthasbeen
prescribedarelistedrst.However,ifitisanewPRNorderitmaybefoundwrittenamongthescheduledpills.OnthenextMARcycleitwillbemovedtothePRNsection.AfterthePRNmedicationsthescheduledmedicationsarelisted.Theyarelistedbythedatethattheywereprescribedorwhenthemostrecentchangewasmade. WhetheramedicationisscheduledorPRNitmustbesignedoutwhenitisgiven.Ifitisscheduledtherewillbeasquare(oftencalledbubble)thatcorrespondstothedateandtimethatamedicationwillbeadministered,youmustinitialthissquare.IfthemedicationisaPRN,putyourinitials,writethetime,andhowmanypillsweregiveninthecorrectdatecolumn.Rememberthatthisisamedicalrecordandifyoudontcorrectlydocumentthata
pillwasgiven,thenitwasntgivenandthatisamedicationerror.Toseehowtochartinthe
MARseepage13. Ifapillisrefused,spitout,ornottakenforanyreason;circleyourinitialsandlloutthebackoftheMARtoexplainwhythemedicationwasntgiven.Whyitwasntgiven,thetimethatitwassupposedtobegiven,thetimethatyouarerecordingthisinformationandyoursignature.ToseehowtodocumentmedicationsonthebackoftheMAR,gotopage12.Youwillalsoneedtorecordthisinformationinthe24HorReportandCommunica-tionBook.Toseehowtocharttheinthe24hourReportandtheCommunicationBooktogo
pages16and17.
Medication Administration Record (MAR):
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Metormin 500 MGOne Tablet Twice Daily
Cymbalta 75 MGOne Tablet Daly
Ranitidine 25 MGOne Tablet Four Daly
0800
0800
16001200
0800
2000
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RF
RJ RJ RJ RJ RJ
RJRJRJ
RJRJRJRJ
RJRJRJRJ
RJ
RJAR ARAR AR
AR
AR
ARARARAR
ARAR
ARARAR
AR
BT
BT
BT
BT
BTBT BTBTBTBT
BTBT
BT
BT BT
BTScheduledTies MedTech
Iitls
Medications
This illstration o a MAR ront shows where the medication order is printed, where the times o the medication are
listed, and the place that the med techs initial that they have given the medication.
ThisillustrationshowshowtocorrectlylloutthebackofaMAR.WhenamedicationisnotgiventhebackoftheMAR
mustbelledoutexplainingwhythemedicationwasntgiven.
02/15/12Ranitidine 25 MG 2000 2100Resident refused due to agitation A Rogers
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Narcotics(narcs)arecontrolledsubstancesandeachpillordoseofanarcmustbeaccountedfor.Whennarcarereceivedfromapharmacytheymustbecountedtoverifythatthecorrectnumberwasdelivered.Ifthenumberthatwassupposetobedeliveredandtheactualnumberdelivereddontmatchthepharmacyneedstobecontactedsothatthecorrectamountofmedicationcanbedelivered.Afterthenarcsaredeliveredandcheckedforaccuracy,theyneedtobesignedinonaNarcoticRecordSheetandaddedtothenarccountandcardcount.Thefollowingstepsshowhowtocorrectlysigninanarc: 1.Onthetopofthesheetthereisaplacefortheresidentsname,thenameofthemedication,strengthofthemedicationandthedirectionsforadministeringthemedication.UsethedirectionsthatarelistedontheMAR,nottheonelistedonthecardorbottle.IfforsomereasontheorderonthecardorbottledoesntmatchtheonelistedontheMARnotifythenurse,theordermayhavechangedandwewerentnotiedandneedtoobtainacurrentordersowecangivethecorrectdoseofamedication. 2.Whensigninginanarctherstlinemustbelledinwiththedatethatyoureceivedthemedicationin
the datecolumn;theshift(AMorPM)shouldbelledoutintheTimecolumn;countshouldbewritteninthedosagecolumn;yoursignaturein aiistere bycolumn;andthetotalnumberofpillsormillilitersthatwerereceivedinthe#Remainingcolumn. 3.Whenyougiveanarcyouneedtowritethedatethatitwasgiveninthedatecolumn;theexacttimethatyougaveitintheTimecolumn;forthedosageyouneedtowriteTforonetablet(ifyouaregivingmorethanonetabletyouneedtolloutonelineforeachtabletthatisgiven.EachlineofthenarcsheetrepresentsONEnarc.);signyourrstintialandlastnameinthe aistere bycolumnandwritehowmanyareremain-inginthe#Remainingcolumn.
NarcoticRecordResident:Martha JonesMedication:Lortab Strength:5/500 mg
Dosage:1-2 Tabs Q 4-6 hours PRN
dte Tie dosge AdminsteredBy #Remaining
2/20/2012 PM Count ARogers 302/21/2012 080 T RFln 292/21/2012 120 T RFln 282/21/2012 120 T RFln 27
2/21/2012 1600 T RJames 26
2/21/2012 1600 T RJames 25
Documenting Narcotics:
This illstration shows how narc need to be signed in when they are recieved rom the pharmacy; and how to sign them ot when they are given
Remember, every line on the narc orm rempersents ONEpill. I yo give more than one pill at a time yo need to sign each one ot individaly
Narcotic Record:
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Toinsurethatallnarcoticswerecorrectlygivenandhavebeenaccountedfor,medtechsperformanarccountduringeachshiftchange.ThemedtechcomingondutywillcountallofthenarccardsinthedrawersandthemedtechgoingoffshiftwillcountthenarcsheetsintheNarcoticRecordBinder.ThesenumbersMUSTmatcheachotherandMUSTmatchthenarcCardandNarcSheetCountafterthenumberofcardsaddedand
subtractedisguredintothecount.Thiscountmustbedonetoinsurenarccardsand/orsheetshaventbeenlostorstolen.Ifthiscountisoffthenurseneedstobenotiedimmediatelysothattheappropriateactioncanbetaken.Afterthiscount,themedtechswillthenproceedtocounttheindividualsheetsandcards.Thisisdone
bythemedtechcomingonshiftreadingthenumberofnarcsinthecardorbottleandthenameofthenarc;andtheothermedtechwillreadthenumberonthesheetandthenarcname.Ifthenumbersdonotmatch,thenarccountisoffandthemedtechsmustgureoutwhybeforeproceeding.Ifanarcismissingorwasgiventothewrongresidentoratthewrongtimethenursemustbenotiedimmediately.Ifthenarcwasgiventothewrongresidentoratthewrongtimeamedicationerrorhasoccurredandmedicationerrorproceduresmustbefol -lowed.(SeeMediccationErrorspages9and10)Inthiscasethemissingnarccanbesignedoutspecifyingthatitwasgiventothewrongresidentoratthewrongtime.Ifthenarcismissingandcaninnowaybeaccountedfor, missig narcoticFormmustbelledoutbythemedtechthatlostthenarcandthenursemustbenotiedim-
mediately.Shewilldecidewhetherthepoliceneedtobecontactedtoinvestigatethemissingnarcandifadrugtestneedstobeperformed.Shewillthengiveinstructionsonhowtoproceed.Toseehowtolloutamissig
NarcoticFormtogopage15.
NarcoticCard/NarcoticSheetCountdte Shift #ofCards #ofNarc
Sheets#Disposed
Cards#Added
CardsTotl t
shift e
MedTech/Witess
2/20/2012 PM 123 123 -5 +10 128 AR RJ2/21/2012 M 128 128 0 0 128 RF BT2/21/2012 M/M 128 128 0 0 128 RF RJ2/21/2012 PM 128 128 -3 -5 130 RJ AR
ThisillstrationshowshowtocorrectlyllouttheNarcoticCard/NarcoticSheetCount.ThisMUST belledouteverytimeashiftchange
narccounttakesplaceandmustbesignedbythemedtechsthatparticipatedinthatcount.Thissheetshouldbelledoutthreetimesaday:
OncewhentheAMmedtechscounttogether,oncewhentheAMmedtechcountswiththePMmedtech,andnallywhenthePMmedtechs
cont together at the end o their shit.
Narcotic Card/ Narcotic Sheet Count:
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Missing Narcotic
dte 02/20/12
Tie 1400
MedTechsonDuty Brynn Thomas and Rachel Fielding
NameofResidentNarcoticbelogs to Martha Jones
NameofNarcotic Morphine
DosageofNarcotic 15 MG
NumberofNarcoticsissig 1 Tablet
Comments:When I was preforming NARC count with Riley James we noticed that one morphine tabletwas missing from the card. We searched the med cart and med room, but were unable to find it.____________________________________________________________
____________________________________________________________
Signatre of RN_____________________________________ Date______________
Signatre of Administrator____________________________ Date______________
ThisillstrationshowshowtocorrectlylloutaMissing Narcotic form. Along with a description o the pill that is missing, the med tech
needstolloutadetaileddescriptionofwhathappendwhenthenarcwentmissing.Forexample:wasitdroppedandyouwereunableto
ndit;didyounoticethatitwasmissingduringanarccount?Youalsoneedtodescribewhatyoudid:Wheredidyoulookforit?whowas
therewhenthepillwentmissingorwhenitwasnoticedmissing?
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Daily Charting: Themedtechshavetwoformsofchartingthatmustbecompletedoneachshift:The24 Hor Report the Commnication Book.Bothareimportantindocumentingandcommunicatingtheoccurrencesofeachshift.
The 24 Hor Reportisacondensedversionofthedailycharting.Thissheetincludesthenameofeachresidentassignedtothecartwhetherthemedtechhandlesthatresidentsmedicationornot;andaplaceforeachofthethreeshiftstochartanythingthathashappenedduringtheirshift. Thingsthatshouldbechartedoninthe24HourReport: Anymedicationsthatwereorderedordelivered Neworchangedorderstomedications Ifamedicationwasntgiven/takenandwhy Afallorotherincidient 48HourFollowUpthatwasstarted,countinedorcompleted
PRNmedicationsadministereddurningtheshift,andwhattimetheyweregiven IftheresidentwastransportedtothehospitalorwasLOAforanyreason(iftheresident leavesonyourshiftforwhateverreasonandwillbegoneforasigncantamountoftime chartwheretheywentandifpossiblewithwhom).
Date:__________
Room Resident AMShift PMShift Graveyard
101 mrth Joes 1 L @ 0802 L @ 120
Rere L
2 Lortab @ 1600
Lortab Delivered
102 StanWalker Ha f tody,/ ba p .Gv 2 Tn @10.
Still C/O back pain, gave2 tylenol @ 1500 and1700.
103 MartyFenwick Rein Reuei 080 AmTri. H sta-e ha i me i. I e 3
e t v i.
Resident recieved thewrong dose of Lortabtonight. Vitals were takenand 48 hour follow upwas started. Please moni-tor for any changes.
This illistration shows how to chart on the 24 Hor Report.
Documenting Residents Conditions
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TheotherchartingthatmustbecompletedduringeachshiftistheCommnication Book.Inthisbookeachresidenthasasheetthatthemedtechmustchartanychangesintheresidentsstatus;iftheresidentfellyouneedtochartwhathappenedasitwrittenontheIncidentReport;anyPRNmedicationsgivenandtheresultofthemedication;andiftheresidentisLOAorwastransportedtothehospital.CommunticationSheetsarepartoftheresidentsmedicalrecords.Whenyouarechartingonlyincludeobjectiveinformationandleaveoutandsubjectiveinformation.
Whe CommunticationSheetisfulltakeitoutofthebinder,leitintotheresidentschart,andreplacetheoldsheetwithanewone.Whenyouputanewsheetinthebindermakesurethattheresidentsfullnameis
onbothsidesofthesheet.Becausethisisamedicalrecordyouneedtowritetheirfullname,dontuseashort -enedversionoftheirnameoranickname.
Mh Je 101
2/2/12
2/2/12
2/3/12
2/3/12
Rein / n , i to ry f ekfas
Resident Stated that she is feeling better. Came to lunch__________________RJ
n Ln_____________________________________________________________RF
Resident c/o back pain at breakfast, I gave 1 Lortab at 0800. C/O pain again at lunch, I gaveanother lortab at 1200. Please monitor for any more c/o pain.__________________BT
Resident had a fall when she was walking down to dinner, aides were
able to help her up and she came to dinner. No apparent injuries, butshe did c/o back pain and pain in her upper left leg. Please monitorfor changes._______________________________________________________AR
2/4/12
2/4/12
Resident is still complaining of back and left leg pain. I gave 2 lortab at breakfast and lunch.I reordered lortab from the pharmacy,_______________________________BTResident is still c/o pain in back and left leg, I gave her 2 lortab at 1600 and 2000. If
pain continues family will take her to the doctor. Lortab was delivered tonight____RJ
This illistration shows how to chart in the commnication book
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Incident Reports: Anincidentreportislledouttodocumentfalls,injuries,changesinaresidentsstatus,oraltercationswithotherresidents.Afallisdenedasanycontactwiththegroundthatisntintentional.Ifaresidentislowedtotheoorbyastaffmemberthisstillcountsasafall,andneedstobewrittenupinanIncidentReport.Inju-riesinclude:bruises,skintears,scrapes,burns,etc.Thesealsoneedtobedocumentedwithan IncidentReport.Changesinaresidentsstatusinclude:changeinvitalsigns,orbehaviorthatisntnormalforthatresident.Allofthesethingscansignifyprogressionofadiseaseprocess,ormedicalproblemsthatneedtobeaddressed.Thatiswhyitisimperativethattheseincidentsareproperlydocumented.
The other tie tht IncidentReportistobelledoutiswhenthereisaphysicalaltercationbetweentworesidents.Ifaphysicalaltercationoccursbetweentworesidents,thenthenurseneedstobenotiedimme -diately.Thenursewillassessthesituationandnotifytheappropriatepeople:thedoctor,family,AdultProtectiveServices(APS),ect. The48HourFollowUpaccompainstheIncidentReport.ThepersonthatllsouttheIncidentReportwillalsoneedtolloutthedescriptionofwhathappenedandtherstlineofvitalsandresidentcondtiononthe48HourFollowUp.ThesetwoareasneedtoMATCHtheinformationontheIncidentReport.BoththeIncidentReportandthe48HourFollowUpneedtobelledoutinBLACKpen.Itistheresponsiblityofthemedtech
thatrecievestheIncidentReportandthe48HourFollowUp,tocheckthattheyarelledoutproperlyandtheinformationthatgivenisclear,conciseandusesobjectivedetail.IfyoureceiveanIncidentReportor48HourFollowUpthatisntlledoutcorrectly,orisunclear,youwillneedtondthepersonthatlleditoutandhavethemxanyproblems. ToseehowtocorrectlylloutanIncidentReportand48HourFollowUpgotopages19and20.
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Bu Knd1/6/12 10 Rein BaroNm , A n ne
I we t ein ro t v i 10ed, n wa n o i baro. H stae ha e t t ml t baro n losi bln n . H stae ha i ba , u ha n clnt p, n ha n pn je. I e n ba nt ih n ne t pag ed .
Ye
Ye
D. Sld 1030
1030Be P, duhNN
N
N/AN/A
N/AN/A
N/A
N/AN/A
C/O L Ba P
A n One
97.5 65 18 145/75
1/6/12 Ra Fln
I e ein n t i h. An ne t pag f .
ThisillistrationshowshowtolloutanIncidentReport.Rememberthatitneedstobelledoutcompletelyinblackpen,withclearand
concisedetails.IfyoureceiveanIncidentReportthatisnotlledoutproperlyitisyouresponsibilitytondthepersonthatlleditoutand
havethemxtheproblems.
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1/6/12Bu Knd
I we t ein ro t v i 10ed, n wa n o
1/6/12
1/6/12
1/7/12
1/7/12
1/7/12
10
1800
0600
1030
2030
145/75
140/75
137/68
158/80
148/81
97.5
98.5
98.2
99.0
98.9
65
63
70
79
79
18
18
20
20
20
N pn je, C/O l bap .
R . FlnMT
Resident still C/O Lower back pain
R. James MT
No C/O PainS. Jenkins
CNA
Resident C/O of some back pain
B. Thomas MTNo C/O Pain
A. Rogers MT
Thisillistrationshowshowtollouta48HourReport.Rememberthatitneedstobelledoutcompletelyinblackpen,withclearand
concisedetails.Ifyoureceivea48HourReportthatisnotlledoutproperlyitisyouresponsibilitytondthepersonthatlleditoutand
havethemxtheproblems.
i baro. H stae ha e t t ml t baro n los i bln n .H stae ha i ba
, u ha n clnt p , n ha n pn je. I e
n ba nt i h n ne t pag ed .
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Taking and Recording Vital Signs: Vitalsaretakenoneachshiftandmustberecordedintheappropriateplace.Thefourmainvitalsthatarecollectedoneachshiftarethedailyvitalstheaidestake,bloodsugars,pulsesorbloodpressuresthatmedtechsmusttakebeforeadministeringmedication,andoxygenlevels(O2).
Daily Vitals: Theaidesareresponsibleforgettingthedailyvitals.Whenthemedtechreceivesthem,theyneedtoberecordedinMAR.Itistheaidessresponsibilitytocollectthedailyvitalsthatareonthedailyvitalsheet,anditisthemedtechsresponsibilitytomakesurethatvitalsgetdone.Eachshifthasanassignedtimethatvitalsmustbecompletedby:AMvitalsaretobedoneby1000,PMvitalsby1600andgraveyardvitalsby0630.Iftheaideshaventtakenthevitalsbythesetimes,itistheresponsibilityofthemedtechtoremindtheaidestogetthevitalsdone.Ifthemedtechshaveaproblemwithgettingthedailyvitalsfromtheaides,thentheyneedtonotifytheRCCsothatshecancorrecttheproblem.
Take BP Once a Day 0800 12085
136
7212779
1596
15390
14990
Daly Vitals in the MAR
Med techs need to record the daily vitals that the aides collect every shit in the MARs. There are also vitals that the med techs are responsibleto collect (it will speciy in the MAR that the med tech need to take a vital sign), these vitals also need to be recorded in the MARs.
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Blood Sugars:
Oxygen Level (O2):
BloodsugarsaretakenbythemedtechsontheAMandPMshift,onthegraveyardshiftoneoftheaidesisassignedtotakethebloodsugars.Bloodsugarsthataretakenneedtoberecordedinthe bloo Sgr bierfoundintheMedRoom.Bloodsugarsaretakenusingeitherhousesuppliesortheresidentsownsupplies;itistheresponsibilityofthemedtechtoknowwhichsuppliestousewhentakingaresidentsbloodsugar.Whenthehousebloodsugarstripsarerunninglowthemedtechneedstonotifytheassistt administratorsoshecan
ordermore.Becausebloodsugarsvaryaccordingtothetimeofday,whethertheresidenthasrecentlyeaten,ortakenabloodsugarmedication(insulinoranoralagent);itisveryimportantthatbloodsugarsaretakenattheassignedtimes.Doctorsmakechangestomedicationbasedonthebloodsugarsthatarerecorded.Thereisabigdifferencebetweenabloodsugarof97beforelunchanda197afterlunch.
BloodSugarLogResident:_Joan Murdock_____________ Month/Year:Dec. 2011______
DATE PRE-BREAKFAST PRE-LUNCH PRE-DINNER BEDTIME
2/21/2012 60 250 200 3012/22/2012 70 179 128 2532/23/2012 103 315 249 151
2/24/2012 83 104 300 365
Oxygenlevel(O2)measuresthepercentofoxygenthattheredbloodcellsarecarryinginthebodyand
ismeasuredwithanoximeter.Generally,residentsthatneedtheiroxygenlevelscheckedhaveitcheckedtwiceaday,onceonAMandonceonPMshift.MedtechstakethisvitalandthenrecorditintheMAR.(MostmedtechstaketheoximeterwiththemononeoftheirpillpassesandtaketheO
2duringthatpass.)
Take Oxygen Level Every Shif 0800
2000
RF RF RF
93 98
98 94 9495
95 9595
95 93 98BT BT BT
RJ RJ RJAR AR AR
Thisillstrationshowshowtolloutabloodsugarform.AMandPMmedtechsneedtorecordthebloodsugarsthatarescheduledontheir
shits in the Blood Sgar Log. Graveyard blood sgars are collected by an aide on that shit and given to the AM med tech, it is the AM med
techs responsiblity to record the graveyard blood sgars.
Some residents need their O2taken, this is sally done twice a day (once a shit). Ater yo have taken an O
2yo need to record it in the
MAR along with yor intails.
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Pulses and Blood Pressures:
Therearesomemedicationsthatrequirethatapulseorbloodpressurebetakenbeforethemedicationisadministered.Thisisbecausethemedicationbeingadministeredcausesachangeinthisvitalsign.Forexample,digoxincontrolstheheartratebyloweringit,sobeforeadministeringitanapicalpulsemustbetaken.Ifthe
pulseislowerthan60beatsperminutethedigoxenneedstobeheld.Givingitwhentheheartrateislowerthan60beatsperminutecancauseanunsafedropinheartrate.Reverselygivingamedicationthathelpscontrollow
pulseorbloodpressurewhenthevitalsareabovetheapprovedlevelcancauseanunsaferiseinthevital.MAkesurethatyoutaketherequiredvitalsbeforegivingamedication.
Pulse in Mar:
Digoxin 25 MCG1 Tablet Every Day
0800Pluse
RF RF RF 103 97 89
BT BT BT 88 84 75
Some medication reqire that a plse or blood pressre be taken beore they are given. The MAR will speciy which medications. These vitals are
the med techs responsiblity to collect. Ater the vital is taken and the medication given the vital needs to be recorded in the MAR along with
the med techs initals. I the vital is to low or high then the med tech needs to circle their initals and pt an H nder the vital to show that the
medication was held becase the vital was too low/high.
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Using the Binders: Therearedifferentbindersthatareusedtoleandstoreinformationonresidents,newmedicationorders,medicationsthataredeliveredandreorderedfromthepharamacy.Eachbinderhasdifferentinforma-tionstoredinitandhasacertainwaythatitisled.Thissectionoffersabriefdescriptionofthebindersthatareusedtostoredifferentmedicalinformation.
Communication Book:
New Orders Book:
Reorder Book:
ThisbinderiswherethecurrentCommunicationSheetsforeachresidentarekept.InadditiontotheCommunicatonSheets,acopyofanynewordersandinstructionsaboutaresidentscare.Thesecopiesare
placedinfrontofthecommunictionsheet.MedtechsneedtoreadtheCommunicationSheetseveryshiftsothattheyareawareofhoweachresidentisdoing.Copiesofneworderesareputinthisbookforthesamereason.AsyoureadtheCommunicationSheets,youshouldalsoreadtheneworders,soyouareawareofmedicationchanges.BothcartshavetheirownCommunicationBookandresidentsaredividedintoeachbookaccordingiftheyliveonthebigcartsideorsmallcartsideofthebuilding.Withineachbindertheresidentsareputinalpha-
beticalorderbylastname.TheCommunicationBooksarekeptwiththecorresponingmedcartatalltimes.
TheNewOrdersBookiskeptintheMedRoom.Acopyofeachneworderthatisreceivedisplacedintothisbinderforquickrefernce.Thereisatabdividerforeachletterofthealphabetandthenewordersareledunderthesetabsaccordingtolastname.Whenyouleaneworderinthebook,gotothecorrectlettertaband
placetheorderonthetopoftheotherinthatsection.Thiswaythemostrecentorderisontop. Ifthereisaquestionofaneworderthisbookcanbeusedasquickrefernceinsteadoftryingtondtheorderthatmaynotyetbeledintheresidentschart.
TheReorderBookiskeptintheMedRoom.ThisbookiswherethereordersheetsthataresentSuperiorareledoncetheyhavebeenfaxedtoSuperior.IfthereisaquestionaboutwhensomethingwasorderedfromSuperioryoucanrefertothesheetsthatareinthebookforaspecicdate.AlsopackagingslipsthataresentfromALLpharmaciesareledinthisbook.Thiswaywehaverecordofthemedicationthatisdeliveredfromthepharmacies.Thesheetsinthisbookareledinchronologicalorderwiththemostrecentsheetsontop.Afteryouhavefaxedareordersheetorreceivedapackingslipfromthepharmacyputthatsheetonthetopofalloftheothersinthebook.Thatwaythesheetsstayinorder.
Narc Hard Copy Book:
Whenahardcopyorderforanarcisreceivedfromadocotor,youwilneedcallthepharmacyandletthemknowthatwehaveahardcopyforanarcthatneedstobepickedup.TheNarcHardCopyBookiswherethoseordersarestoreduntilthepharmacysendssomeonetopickthemup.Afteryouhavecalledthepharmacyyouwillneedtomakeanextracopyoftheorderandputitalongwiththehardcopyintothebook.Whenthedriverfromthepharmacydoescometopickupthehardcopy,youneedtohavethemsignanddatethecopy.Thiswaywehavearecordofwhotooktheorderandwhenitistake,incaseitislost.
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Blood Sugar Log:
BloodsugarsaretheonlyscheduledvitalsthatarenotrecordedintheMAR.TheyarerecordedintheBloodSugarLog.Thisbinderislocatedintheme Room.Eachresident,whosebloodsugarwetake,hasatabdividerwiththeirnameonit.TheBloodSugarLoghasenoughspaceforonemonthofbloodsugars.Onceyouhavetakenabloodsugaryouneedtorecorditintheappropriatepalce.Toseehowtorecordabloodsugarseepage22.OnceaBloodSugarLogisfullitneedstobeplacedintheRCCsboxsothatshecanreviewit.
Aftershehasdonethis,thelogneedstobeledintheresidentschartundertheBloodSugartab.
Medication Disposal Book: TheStaterequiresthatarecordiskeptforallofthedestroyedmedication.TheMedicationDisposalBookiswherewekeepourrecords.Todestroymedicationyouwillneedawitnesstoverifythatyouhavedestroyedthemedication.Thisisusuallytheothermedtechorthenurse.Ifthemedicationisanarc,thenthenursemustdestroythenarcandyoucanactasthewitness.Whenyoudestroyanymedicationyouneedtore -cordthatyoudidsointhisbook.OntheDisposalSheetinthebookyouneedtowritethedate,thenameoftheresidentthatthemedicationbelongsto,themedicationname,thestrength,thequanityofmedicationdestroyed,
thereasonfordestroyingthemedication(expired,theresidenthaspassedaway,ect.),andyouandthewitnesswillneedtosignthethesheet.
The Supply Book: TheSupplyBookiswereallofthesuppliesgiventotheresidentsarerecorded.Thebookhasasheetwitheveryresidentsnameandroomnumberonit.Thesesheetsare organized by room number.Whenyouuserstaidsupplies,labspecimensupplies,orgiveresidentssuppliesfromthecagesdownstairsyouneedtorecordthesuppliesthatyougavethemthedatethatyougavethemandsignthatyougavethem.ThisbookislocatedbythephoneintheMedRoom.
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Section Three: New Orders and
Ordering From Pharmacies
New Orders: Newordersorchangestocurrentordersarereceivedalmostdaily.Whenaneworderorachangetoanexistingorderisreceivedtherearecertainstepsthatmustbefollowedtoinsurethattheneworderisdocument -edproperly,themedicationisreceivedfromthepharmacyandisstartedinatimelymanner.
Step One Whenaneworderisreceiveditneedstobefaxedtotheappropriatepharmacies.IftheresidentreceivesmedicationfromSuperiorthenacopyoftheorderonlyneedstobesenttoSuperior.Iftheresidentrecevies
medsfromMountainWest,thenacopymustbesenttoMountainWest,andacopythatismarkedasproleonlyneedstobesenttoSuperior.IfacopyisntsenttoSuperiorthenitwontappearonthenextMAR.Aftertheorderhasbeensenttothepharmacyitneedstobestampedwiththefaxedstampthatislocatedbythefaxmachineinthemedroom.Andthenthedateneedsto
bewrittennexttothestamp.
Step Two Aftertheneworderisfaxedtothepharmacy,youneedtomakethreecopiesoftheorder.Onecopygoesi the newOrer bier i the me Room,onecopy
goes i the Communicationbook i frot of the resi-dentsCommunicationSheet,andthethirdcopygoesinAssistantRCCsboxintheme Roo so tht shecanchecktheorderonthenextMAR.
Step Three ThelaststepistogivetheoriginalordertothenursesothatshecanwriteitintheMAR.IfthenurseisntavailablethentheassistantRCCwillwriteitintheMAR.IfsheisntavailablethenthemedtechcanwritetheorderintheMAR.Todothis,calltheon-callnursethatisoncallandshewillokayyoutowriteinthe
orderandtellyouhowitshouldappearontheMAR.OncetheorderhasbeenwrittenontheMAR,theorderneedstobeputinthenursesboxinthemeRoososhecannote(sign)it.Oncethenursehasnotedtheorderitcanbeledintheresidentschart.
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Ordering From The Pharmacy: CurrentlytherearetwomainpharmaciesthatsupplythemedicationforLegacyHouse.TheyareSupe-riorCarePharmacy,whichistheprimarypharmacy,andMountainWestApothecary,thesecondarypharmacy.Onoccasionduetoinsuranceissuesaresidentmayneedtogothroughanotherpharmacy,butthisisrare,and
onsuchoccasionsthepharmacymustbeapprovedbythenursebecausestateregulationsrequirethatallmedi -cationsbepackageinbubblepacks.Medicationsneedtobereorderedwhenthereisaboutsevendaysworthofmedicationleft.Thiswayifthereisanyproblemwithllingtheprescriptionitcanberesolvedbeforethemedicationrunsout. Foreverypharmacy,whenyoureorderanarc,youneedtoplaceacoloredstickernexttothenumberonthenarccardwhenyoureorderedit.Youneedtosignanddatethesticker.Thisshowsthatthenarchasbeenreordered.Whenthenarccomes,placeanXonthesticker.Thisshowsthatmorenarcshavearrived. Reorderingneedstobedoneearlyintheday.IfaPMmedtechnoticesthatamedicaionneedstobere-orderedafterthepharmacyisclosed,thenthatmedicationneedstobechartedinthe24HourReport,sothattheAMmedtechcanreorderitthenextday. Whenamedicationisdeliveredfromapharmacyonlythemedtechsondutycansignforthatdelivery.
Beforeyoucansignformedicationsyouneedtocheckthelistthatissentwiththedeliveryandmakesurethateverythingthatisinthebagandonthelistmatch.Iftheydontyouneedtotellthedriverandcallthepharmacyimmediately.Alsoifapharmacytriestosendanymedicationinabottle(liquidorpillform)thenyouneedtorefusethatmedicationandcallthepharmacyimmmediatelyandtellthemthatyoucanonlyacceptmedicationinamedcardorsingledosesyringes. TheRCCneedstonotiedimmedatelywithanyproblemswhenorderingmedications;orifapharmacychangesitsorderingproceedures.
Superior Care Pharmacy:
SuperiorCarePharmacyisthepharmacythatsuppliesthemedicationstothemajorityoftheresidents.TheyalsoprintMARforalloftheresidentsregardlessofthepharmacythatsuppliesaresidentsmedication.Superiordeliversscheduledmedicationsinweeklyincrements;thepackagingisreferredtoasautomedstrips.EveryweekSuperiorfaxesoveracensusformoftheresidentsthattheyprovidemedicationsfor,anyresidentsthatareLOAforanyreasonneedtobemarkedoffthecensusformsothatSuperiorwillnotsendanautomedthatweekforthatresident.AutomedstripsaredeliveredeveryThursdayeveningandareputawayonThursdaynightsbytheassistantRCCormedtechonduty.ThenewautomedbeginsonFridaywiththe1700dose.Whenthesestripsaredeliveredtheyneedtobecheckedforaccuracy.Anyproblemsneedtobereportedtothephar-macyimmediatelysothattheerrorcanbecorrected.Errorsinclude:wrongmedicationormissingmedication.ErrorsneedtobereportedtotheRCCaswellsothatproblemscanbereportedandcorrected. SuperioralsodeliversPRNmedication,narcs,andvariousothermedicationssuchasCoumadin,an-
tibiotics,andmedicationsinmedicationcards.Thesemedicationshavenosetdeliveryschedule.Whenthereisaboutaweekleftofthemedication,itneedstobereordered.Themedcardshaveastripthatcanbepulledoffandstucktoareordersheetthatisfaxedtothepharmacy.Anymedicationsthatdonthaveastripthatcan
beplacedonthereordersheetneedtobephonedintothepharmacy.Everyshiftshouldcheckthecartforanymedicationsthatarerunninglowandneedtobedelivered.ThereordersheetforSuperiorneedstobesentinev -eryweekdaybefore1000.Anymedicationsornewordersthatareneededassoonaspossibleneedtobecalled-intothepharmacy,sothattheyknowtosenditoutthesameday.Forexample,whenyoureceiveaneworderfaxittothepharmacy,andthencallthepharmacyverifythattheyreceivedtheorder,andtellthemthatitneedstobesentoutsameday.
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Ordering Priority Medications:
Ordering After Hours:
WhenorderingamedicationfromSuperiorthatarehighpriority,suchasanantibioticorCoumadin,thepharmacyneedstobenotiedthatthemedicationneedstobesentpriority.Thiscanbedonebyfaxingtheorderasnormal,thencallingSuperiorandtellingthemthatthemedicationneedstocomepriority.Thepharmacythenhasfourhourstodeliverthemedication.IfyouhaveanyproblemswiththepharmacywhenorderingprioritymedicationsnotifytheRCCsoshecancommunicatetheseproblemstothepharmacy.
IfamedicationneedstobeorderedafterhoursorduringtheweekendcallSuperiorsweekendnumber.Anoncallpharmacistwillbepagedandcallthemedtechbackandthenitwillbedecidedhowtobestllthe
prescriptionandhaveitdeliveredtoLegacyHouse.
Mountian West Apothacary:
Other Pharmacies:
MountainWestApothecaryisthesecondarypharmacythatisused.Thispharmacyisgenerallyusedbyresidentsthatgetthemedicationsfromanotherpharmacy,usuallymailorderorVApharmacy.Thesemedica-tionsneedtoberepackagedaccordingtostateregulations.MountainWestpackagestheirmedicationsintomed
bubbles,anddeliversmedicationbubblesinaweeklyincrement.AlsolikeSuperior,MountainWestsendsmedi-cationcardsforPRN,narcs.TheassistantRCCorPMmedtechalsochangesoutthemedbubblesatnight.Andliketheautomedstrips,thebubblesneedtobecheckedforaccuracy.IfthereisanerrorthenMountainWestneedstobecontactedsotheerrorcanbecorrected.AlsoifanorderchangesduringtheweekMountainWestneedstobenotiedsothattheycanpickupthebubblesandcorrectlypackagethem. AnymedicationthatneedstobereorderedfromMountainWestneedstobephonedinby1300.Iftheorderisphonedinanylaterthan1300,itmaynotbedelivereduntilthenextday.TheAMmedtechneedstobeawareofanymedicationsneededandorderthempromptlysothattheywillbedeliveredwhentheyareneeded. MountainWestrepackagesmedicationsthatcomefromotherpharmacies,suchastheVAandmailorder
pharmacies.ThesemedicationsareoftendeliveredtoLegacyHouse.Whentheyaredelivered,themedtechneedstocallMountainWestandletthemknowwhatmedicationsneedtobepickedupandrepackaged.Whenthepharmacycomesandpicksupmedicationtheyneedtosignforthemedicationthattheyarepickingup,sothatthereisarecordofwheremedicationhasgoneandwhohastakenit.
Hospiceagenciesprovideanymedicationsfortheirpatientsthatrelatetotheadmittingdiagnosisandcomfortmedications.Thesemedicationsareprovidedbyapharmacythatthehospiceusesbecausehospicepaysforthem.Rememberthathospicepharmacieswillonlysend14daysworthofmedicationsandgenerallywontrellmedicationsuntilafewdaysbeforetheyrunout.Toreordermedicationsthatareprovidedbyahospiceagency,calltheagencyortheresidentshospicenurseandgivealistofthemedicationsthatareneeded.Theywillordertheneededmedicationfromthepharmacy,andthepharmacywilldeliver.Someresidentsuseotherpharmaciesforinsurancereasons.Whenthishappensandmedicationsneedtobereor-dered,callthepharmacyandgivealistofthemedicationsthatareneeded.Thepharmacywillllthemedica-tionanddeliverit.
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New Order Checklist
Reorder Checklist
1. Afterreceivingtheorder,faxittoSuperiorandanyotherpharmacy2. Make3copiesoftheorder:
OnecopygoestheCommunicationBook OnecopygoestheNewOrderBook
OnecopygoesintheAssitantRCCsbox3.Callthepharmacyandverifythattheyreceivedtheorder,andaskthemtosendoutthenewmedication.4.AsktheRCCorAssitantRCCtowritetheneworderintheMAR.5.PuttheorginalorderintheresidentchartorRCCsbox(ifnotsigned).
Sperior Care Pharmacy Montian West Apothacary Hospice Pharmacies
Whenpossiblepulloffthereorderstickersandplaceonthereorder
sheetsthatarefaxeddailytoSupe-riorby1000.
Callinallreorders Callthehospicenurseforallreor-ers
Callinordersthatdonthaveastickerornewordersthatneedto
besentout.
Reorderallmedicationsdailybe-fore1300
Rememberthathospicepharmaciesonlysend14daysofmedications.
Whenamedicationisneedrightawaycallitinandtellthephar-
macyitisneededpriority.
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Section Four: Emergency Situations
First Aid: AllaidesthatworkforLegacyHousearerequiredtoberstaidandCPRcertied.However,whenrstaidneedstobeadministered,itistheresponsibilityofthemedtechondutytoproviderstaid.Partofprovid -ingrstaidistodeterminewhetherornottheinjurycanbeattendedtowithinthefacilityoriftheresidentneedstobesenttothehospital.Generally,medtechsproviderstaidforskintears,cuts,lessseriouswounds,andsmallburns.FirstaidsuppliesarekeptinthecupboardsoftheMedRoom.Anysuppliesthatareusedneedtobesignedoutinthebinderthatiskeptinwiththerstaidsupplies.Tosignoutsuppliesfollowthesesteps:Inthesupply
bindereachresidentsnameisonapieceofpaper.Theseareorganizedaccordingtoroomnumber.Whenasup-plyisusedit,alongwiththedateneedtobewrittenonthepaperwiththeappropriateresidentsnameandthen
themedtechneedstosign.Somesupplieshavestickersonthemthatsaywhattheyare.Ifthesupplieshaveastickerthenplacethestickeronthepaperandinitialanddatenexttothesticker.ToreadmoreaboutusingtheSupplyBookgotopage25. ThesuppliesthatLegacyHousestocksare: b ies Bacatracin no aheret Ps TegadermPatches GauzeSquares Iftheinjurythatisbeingdressedissmallenoughthatthetegadermandpadcanbecutdownandstill
coverthewoundthanthiscanbedone.Afterward,theextrasuppliesneedtobelabeledwiththeresidentsnameandplacedintheirspotinthemedcartforfutureuse. AnyinjuriesandrstaidethatisadministeredneedstobechartedintheCommunicationBookandthe24HourReport,andanIncidentReportand48HourFollowUpneedtobelledout.Alsoremindthenextmedtechtocheckanybandagesthatyouputonaresidentforexcessbleeding/dischargeandcleaniness.
The pictre to the let shows the spply cpboard in the med room
wheretherstaidsuppliesarekept.
Thepictureaboveshowssomeoftherstaidesuppiesthatwekeepa
Legacy Hose and the spply stickers that are sed to sign ot these
spplies.
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Transporting to the Hospital:
Employee Injury Procedure:
Whenthereisasignicantchangeintheresidentsstatus,seriousillnessorinjurythatcannotbehandledwithinthefacilitythenitisnecessarytotransporttheresidenttothehospital.Ifthesituationisanemergencythentheambulanceneedstobecalled.Ifthechange,illnessorinjuryisnonemergentthenfamily
needstobecontactedandaskedwhetherornottheywanttheresidenttakentothehospitalvianonemergentambulanceoriftheyprefertotaketheresidenttothehospitalthemselves.WhensendingaresidenttothehospitaltwocopiesoftheMAR,FaceSheet,PLOSTform,andanyotherformsthatarenecessary(suchasH&P)needtoaccompanytheresident.OnecopyisfortheEMTsandtheotherisforthehospitalstaff. Whenaresidentissenttothehospitaltheon-callnurse,administrator,andemergencycontactmust
benotiedthataresidenthasleftthebuilding.Also,ifsomeonethatwassenttothehospitalreturns,thentheon-callnurse,administrator,andemergencycontactneedtobenotiedaswell.However,ifaresidenthasbeeninthehospitalformorethanthreeormoredays,theymaynotreturntothefacilityuntiltheRCCorRNassessestheresidentandclearsthemtocomeback.Ifforsomereasonthehospitaltriestosendaresi -dentbackthathasbeengoneforthreedaysandtheyhavenotbeenassessed;thenthemedtechneedstotellthehospitalthattheresidentcannotreturnuntilassessed.Andthenthemedtechneedstocontacttheon-call
nursesothatappropriateactioncanbetakentoreadmittheresident.Oncearesidentreturnsfromthehospi -tala48hourfollowupneedstobestarted.Seepage32forachecklisttosendaresidenttothehospital.
IfanemployeeisinjuredonthejobandtheRCCorassistantadministratorisnotpresentthenitisthemedtechsjobtoassisttheemployeeinfollowingthecorrectprocedures. Procedureforanonthejobinjuryare:1. Callandreporttoassistantadministrator/supervisor2. FilloutaWorkmansCompensationFormlocatedintheWellnessCenterinthegreenbinder3. FilloutanIncidentReportthatincludes: Whathappened Whenithappened Howithappened Whatyoudidaboutit Vitalsignsoftheemployee TheemployeemustgotoFirstMed(MondaythroughFridayduringregularbusinesshours)locatedat214West1500SouthBountiful,Utah.801-295-6483.IftheinjuryoccursonaSaturday,Sunday,Holiday,oraf-terregularbusinesshourstheemployeeneedstogotoInstaCare,locatedonMainStreet.Iftheinjuryisserious
anditisdeemedappropriatetodosotheemployeeshouldgotoLakeviewHospital. ForWorkersComptopayforanymedicalservicesprovidedforanonthejobinjurytheemployeeMuST: Beseenwithin24hoursoftheinjury Receivefollowupinstructions Gotoanyfollowupappointments.Iftheyfaildoso,theWorkers
Compclaimwillbedeniedandtheemployeewillberesponsibleforthebill. Keepallofthepaperworktheyreceiveandturnitintohisorher
supervisor. Themedtechthatisassistingtheemployeeneedstoinformtheemployeeabouttheserules.
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Hospital Procedure
1. Assess the situation
What is happening (Injury, Illness, Strange Behavior)? Can you idenfy any specicsymptoms?Can this wait to be addressed by a doctor or by the nurse?
(If youre not sure ask the nurse)2. What are the residents vitals?
Blood Pressure PulseTemperature ResperationsO
2Stat Blood Sugar
Is a vital sign contrubing to this situation? (i.e. low/high blood sugar, low O2Stat)
3. Is the situation emergent? Does the ambulance need to get here now? Or can a fam-ily member be contacted to transport to the hospital or Instacare? (If the family cannot provide transportation, call for a nonemergent ambulance.)
4. Do you have the correct paperwork? Remember you need to make two copies ofeach
Current MAR or Med ListFacesheetPLOST Form
5. Have you contacted the correct people? (The building administrator, RCC and
emergency contact person)
Calling the Ambulance:
When you call the ambulance you need to know a few things:1. The Address: 79 East Center Street Bountiful and the residents room number2. The med tech cell phone number you are calling from:
Big Cart: (801)834-4261Small Cart: (801)634-8267
3. The residents name, age and brief medical history4. The reason that you are calling. (Injury, Illness, and any symptoms)5. Vital signs that you have just taken.
Non Emergent Ambulance:
(801) 298-6000
Emergent Ambulance: 911
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Building Evacuation: Whethebuidlingneedstobeevacuated,itistheresponsibilityofthemedtechson-dutytosupervisetheevacuationandensurethateveryoneandeverythingthatisneededisevacuatedsafely. Whentherealarmsoundseveryemployeeinthebuildingneedstogotothefrontdesktoreceive
instructionsonwhattodo.Thealarmautomaticallynotiestheredepartment.Ifthemedtechsaretheonlysu-pervisorspresentthentheyneedtoreadtherealarmpaneltodeterminewherethereis.Oncetheyhavedonethistheyneedtosendsomeonetoinvestigatetheareawheretherealarmhasgoneoff.Thispersonwillreport
backifthereisareorifsomethinghastrippedthealarm.Whenthealarmgoesoffregardlessifitisarealreorafalsealarmtheaiistrtor maintenancemanagerneedtobenotied.Whentheredepartmentarrivestheremenwillneedtospeakwithoneofthesemanagers.Ifforsomereasonneitherofthesemanagerscanbereachedthentheassistt administratorcanbecontacted. Ifthereisareorsomeotherdisasterthatrequiresthebuildingtobeevacuatedthestaffwillgotoeachroomandnotifyeachresidentthatthebuildingneedstobeevacuated.Iftheresidentneedshelpbecausetheyareinawheelchair,thenthestaffneedstohelptheresidentintothewheelchairandescorttheresidenttotheevacuationsite.Iftheresidenthasapet,thepetwillneedtobeevacuatedaswell.If,duetothedisastera
residentcannotbesafelyreached,donotattempttodoso,waitfortheredepartmenttoarriveandtheywillsafelyevacuateresidentsthatthestaffcannotsafelyevacuate.Whenevacuatingthebuildingallhallwaysmust
becleared.Someofourresidentsleavejazzywheelchairsinthehallway,andthisisne.However,inanevacu-ationsituationthesechairsandanythingelsethatisinthehallwaysuchasdcorneedstobemovedinaresi -dentsroom. ThetwootherthingsthatneedtobeevacuatedaretheresidentschartslocatedintheWelless CeterandthemedicationincludingMARSandNarcRecords.Whentheevacuationofresidentsissafelyunderwaythemedtechsareresponsibletoevacuatethemedcarts.Themedcartscanbeloadedupwiththenecessarychartingbindersandanymedicationsthatarekeptinthecupboardsintheme Roo the Cottge Ofce.Ifforsomereasonthemedcartscannotbeevacuatedthentheircontentsneedtobeloadedintoboxessothatthemedicationscanbetakentotheevacuationsite. Theevacuationsiteisthechurchacrossthestreet.Ifthebuildingisopenthenthemeetingsitewillbethegym.TheCottageresidentswillbeevacuatedtoasmallerclassroomtopreventthemfromwanderingoff.Ifthebuildingisnotopenthenthemeetingplacewillbethechurchparkinglot.Cottge resiets resietsthatliveinthenewadditionneedtobeevacuatedtothebackofthebuildingintothebackparkinglot.Ifitissafetodosotheycanthenbetakenovertothechurchwiththerestoftheresidents.Thiscanbedonebywalk-ingthemaroundtheblock,iftheyareable,orusingcarsifpossible. Onceeveryoneandeverythingisevacuatedarollcallneedstobetakenofalloftheresidentsandstafftoinsurethateveryoneisaccountedfor.Also,amakeshiftmedareawillbesetupandthemedtechsandnurseswilltakeaccountofthemedicationtoinsurethatitisallaccountedfor. Ifthebuildingcannotbereinhabitedthenalloftheresidentswillneedaplacetostay.Theycangowith
family,besenttoanotherfacilityorifnecessarytheywillbeputupinahotel.Nomatterwheretheresidentgoeshisorhermedicationsneedtogowiththem.Themedtechswillpulltheappropriateamountofmedicationtobesentwitharesidentandsignoutanypillsthataresent.Ifresidentsareputupinahotel,theywillbetherewithotherresidentsandstaffwillaccompanythem.Inthiscasemedicationswillnotbesentaheadoftime.Theywillbepulledasusualwhentheyarescheduledtobegiven.Amedtechandtheappropriatenumberofaideswillremainatthehotelatalltimes.
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Death Procedures: Whenaresidentpassesawaytheappropriatepeopleneedtobenotied.Thesepeoplearetheemergencycontactoftheresident,thenurse,andtheadministrator.Iftheresidentisonhospicethenthehospicenurseneedstobenotiedaswell.Ifitisafterhours,weekend,orholidaythentheon-callhospicenurseneedstobecalled.Oncethefamilyhascomeinandasks,thenthemedtechcannotifythefuneralhome.Thefuneralhomeislistedonthefacesheetoftheresidentschart.Ifthereisntafuneralhomelistedthenthemedtechneedsto
askthefamilywhatfuneralhometheywouldliketobecontacted.Iftheresidentisonhospicethenhospicewillcallthefuneralhome,unlesstheyaskthemedtechtodoso. Medtechs,withthehelpoftheaides,willneedtoperformpostmortemcare.Thisincludescorrectly
positioningthelimbs,changingthebriefandclothes.Iftheresidentisonhospice,hospicemayelecttodothisandmayaskforthemedtechoraideshelpinperformingthiscare.Eitherwaypostmortemcareneedstobe
performedinatimelymannerbeforerigormortissetsin.YouwillalsoneedtolloutaRecordofDeathandhaveitsignedbythemorticianwhentheytakethebody.
BOUNTIFUL HOUSE ASSISTED LIVING
RECORD OF DEATH
NAMEOFRESIDENT:Marth Jones Room#:361D.O.B.:2/3/1919 AGE:91 SEX:Female RACE:White RELIGION:LDSDATEOFADMISSION:3/4/2005DATEOFDEATH:11/15/2011 HOUR: 2145ATTENDINGPHYSICANNOTIFIED: Dr. Geogre Gracia
801-555-1234 @2200FAMILYNOTIFIED:Lisa Johnson, Daughter
801-555-2288MORTICIANNOTIFIED:
Downunder Mortuary 801-555-3491 @ 2230NAMESOFTHOSEPRESENTATTHETIMEOFDEATH,ANDTHEIRRELATIONSHIPTOTHEDECEASED:Lisa Johnson, Daughter, Justin Johnson, grandson and Hailey Johnson, grand-daughterREMARKS:THEFOLLOWINGPERSONALITEMSWERETAKENBY:
*****************************************************************************
MORTICIANSREPORTRECEIVEDFROM
Brynn Thomas, Med Tech THEREMAINSOF: Martha Jones
RELEASETOSIGNATURE EMPLOYEESIGNATURE
DATEANDTIME DATEANDTIME
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Section Five: Outside Agencies
InadditiontotheassistancethattheresidentreceivesfromthestaffoftheLegacyHousetheymayreceivehelpformanoutsideagency.Therearethreeoutsideagenciesthatprovideassitancetoourresidents:FlexCareandhomehealthorhospice(neverbothatthesametime).Itisnotuncommonforaresidenttotrans -ferbetweenhomehealthandhospice.Nursesandmedtechsworkcloselywiththeseagenciestoinsurethattheresidentisreceivingappropriatecare.Forthisreason,goodcommunicationisimportant.Ifaresidenthasachangeinstatus,isLOAfromthefacilitybecausetheywenttothehospitalthentheagencyneedstobenoti-ed.Eachresidentonhomehealthandhospiceisassignedtoanurse;thisisthepersonthatneedstobenotiedaboutanychangesorconcernsabouttheresident. Theresidentandhisorherfamilytodecideonanagency.Thenursingstaffcanofferrecommendations
butcannottellthefamilywhichagenciescanorcannotbeused.
Home Health:
Hospice:
HomeHealthagenciesprovideskillednursingcaresthatthestaffofLegacyHousecannotprovide.Thesecaresincludediabeticcare(admisteringinsulin),cathetercare,physicaltherapytobuildstrengthand
balance,andwoundcarethatrequiresanursetodressandcleanwounds.Ifaresidentqualiestoreceivethesecaresfromanagency,thentheywillalsoqualifyforhomehealthaidevisitstohelpwithADLs.Eachagencyisdifferentinthecaresthattheywillprovideforresidentslivinginafacility.TheagencyalongwiththefamilyandRCCwilldecidewhatcarestheagencywillhelpwith.Itistheresponsiblityofthemedtechsandaidestoknowwhatcaresaresidentreceivesandonwhichdays.
Asamedtechyouinteractwitheachresidentonadailybasisandwillnoticeanychangesintheresi-dentsstatusthatmaysignifythattheresidentmayqualifyforhospice.WhensuchchangesarenoticedthemedtechneedstonotifytheRCCthattheresidentmayqualifyandbenetfromhospicecare.TheRCCwillcontactthefamilyanddoctortoobtainthepermissionandorderforanassessmenttoadmittohospice.Caresthathos -
piceprovidesforaresidentincludes:weeklynursingvisitstoassesstheresidentsstatus,skillednursingcares,
andaidevisitsforassistanceofADLssuchas:eating,andbathing.Aidevisitscanbeasfrequentasthefamily,hospicenurseandRCCagreearenecessary. Hospicewillalsoprovideanymedicationsthatrelatetotheresidentsadmittingdiagnosis,ekitsandanyothercomfortmedicationsnotintheekit.Anexamplewouldbe:ifaresidentwasadmittedtohospiceforthe
progressionofparkinsdisease,thehospiceagencywillprovideanyparkinsonsmedicationssuchascarvadopalevodopaandcomatin,medicationssuchaslortabforpainmanagement,andanekitforcomfortmeasures.Mostofthemedicationthatcomesinanekitwillbeinliquidform.Thesemedicationsneedtobeinsingledosesy-ringes.Whenorderingliquidmedicationoranekitfromhospicemakesurethatyouspecifythatliquidmedica-tionsneedtobeinsingledosesyringes.Itisthemedtechsresponsibilitytoknowwhatmedicationsareprovid-edbyhospiceandtoreorderthosemedicationsfromhospice.Reorderingcanbedonebycallingtheresidents
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Flex Care:
hospicenurseandtellinghimorherthemedicationsareneeded.Thenursewillthencallthepharmacyreorderthemedicationandhaveitdelivered.Hospicealsoprovidesbasicsuppliessuchaschucks,briefs,andgloves.Whenitisnecessarytheywillalsoprovidehospitalbeds,wheelchairs,andwalkers. HospiceistheretohelptheLegacystaffwiththeassistancethatweneedtogivetheresidentthebestqualityoflife.Thatiswhyitsveryimportanttocommunicatechangesinconditionandneedstothehospice.Appropriatetimestocallhospicewouldbe:signicantchangesintheresidentsstatus,falls,injuries,ifitap-
pearsthataresidentwouldbenetfromcomfortmedication,changingmedicationtohelptheresidentsstatus,reorderingmedicationsandsupplies,andwhentheresidentpassesaway.Iftheyouarentsurewhetherornottocallthehospicenurseaboutsomething,itisbetterthatyoudocall.Mostnursesareappreciativeoftheextrainformationthatyoucansharewiththem,especiallysincetheyarenotwiththeresidentonadaytodaybasis.Andyourobservationsmayhelpindeterminingabetterplanofcarethatwillbenettheresident. Inanemergencysituationorseriousinjuryofahospiceresident,thehospicenurseneedstobenoedandokaysendingthatresidenttothehospital.Anyresidentthatisonhospiceandissenttothehospitalwillau-tomaticallybedischargedfromhospicewhentheygotothehospital.Therefore,thereneedstobeagoodreasonthatisapprovedbythehospicenurse.
Flexcareisastateagencythathelpsresidentspayforthecostoflivinginourfacility.FlexCarealsoprovidesmanysuppliesfortheresidentsthatreceivetheirservices.IfaresidentisonFlexCareyoucannotgivethemLegacyHousesupplies.IftheyneedmoresuppliesthenyouneedtocontactFlexCareandtellthemwhichresidentneedssuppliesandwhatsuppliesareneeded. WhenaresidentonFlexCarehasafallorinjury,oristransportedtothehospitalFlexCareneedstobenotifed.AcurrentlistofresidentsonFlexCareislocatedinthefrontofbothMARs.
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Section Seven: Caring For Residents
with Diabetes and Dementia:
Residents with diabetes : Manyoftheresidentsthatliveinthefacilityhavediabetes.Theseresidentsgenerallyrequirediabeticcarefromthefacility,andoftenoutsideservicessuchashomehealth.Asmedtechyouareresponsibletomoni-torbloodsugarsofdiabeticresidents,givemedicationsthathelpcontroldiabetes,andwhennecessarygivearesidentaprelledsyringeofinsulinsothattheresidentcanadministertheinsulin.Itisimportantthatbloodsugarsaretakenattheappropriatetimesandrecordedinthecorrectplaces(SeeVitalsonpage13-14).Whenaresidentsbloodsugaristakenbyamedtechandthatresidentisonhomehealth,thebloodsugarneedstoberecordedinboththehomehealthfolderintheresidentsroomandthebloo SgrLog i the me Room. Partofprovidingdiabeticcareistobewareofsignsofhyperglycemia(highbloodsugar)orhypoglyce-
mia(lowbloodsugar).Ifanyresidentdisplayssignsofeitheroftheseconditions,thentheresidentsbloodsug -arshouldbetaken.Anabnormalreadingshouldbereportedtothenurseimmediately.Iftheresidentisdiabeticandonhomehealthorhospiceservicesthentheagencyshouldalsobecontactedimmediately.Thegurebelowshowsthesignsofhyperglycemiaandhypoglycemia.Manyofthesignsofhyperglycemiaandhypoglycemiaarethesame,soitimportantthatyouchecktheresidentsbloodsugarbeforetakingaction.
Hyperglycemia Hypoglycemia
Increased Thirst Nausea
Headache Extreme Hunger
Difficulty Concentrating Feeling Nervous or Jittery
Blurred Vision Cold Clammy Wet Skin
Frequent Urination Rapid Heartbeat
Fatigue Trembling
Blood Sugar over 180 Increased Confusion
Anxiety
Blurred Vision
Headache
Fatigue
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Residents with dementia : TheCottageisourDementiaunit.Theresidentsinthisunitneedspecialcare.Becauseoftheirdisease,theseresidentsoftenbecomememoryagitated,aggressive,andarenotabletoverbalizecomplaintsofpain,or
ofnotfeelingwell.Asamedtech,youneedtobeabletorecognizesignsofthesethingsandhelptheresident.Thiscanbedoneeitherbymedicationorredirection. MostoftheCottageresidentshaveanti-anxietymedicationthatcanbegivenwhenaresidentisanxious,aggressiveofagitated.Often,whenaresidentstartstoshowsignsofanyofthese,redirectionshouldbeattempt -edrst.Thiscanbedonebytakingtheresidentsattentionawayfromwhatiscausingthemtofeelthewaythattheydoandprovidingthemwithanotheractivity.Ifaredirectionapproachdoesnotwork,oriftheresidentsstateisbadenoughthataredirectionapproachwillnotwork,thenananti-anxietymedicationneedstobegiven. Iftheresidentdoesnthaveananti-anxietymedicationanditcomestothepointthataoneisneededthenyouneedtonotifythenurse.Thenursewillcontactthedoctorandgetaanti-anxietymedication.Iftheresidenthasamedicationbutitnolongerworksoritisdiffuculttogivebytheprescribedroute,youneedtonotifythenursesothatthedosagecanbechangedoranothermedicationcanbetried.Anexamplewouldbe,ifaresident
haslorazepaminpillformbutwhentheresidentisagitatedhewillnottakethemedication,thenaliquidorcreamformofthemedicationcanbeordered. OftenwhenyouattempttogiveaCottageresidentmedicationtheywillnottakeit.Whenthisoccursyouneedtowalkawayandgivetheresidentsometimetocalmdown.Attemptingredirectionalsohelpstochangetheresidentsfocus.Afterthatyouneedtotryadifferentapproachtogivingthemedication.Differentresidentsrespondbettertodifferentapproaches. Someresidentshaveahardtimetakingmedicationortakeitbetterwhenitiscrushedandinapplesauce.Todothis,wemusthavesignedorderfromthedoctor.Whenyouaregivingmedications,andnoticethataresidentishavingahardtimetakingmedicationortheresidentwouldtakemedicationbetterifitiscrushed,thennotifythenurseandshewillgetanordertocrushthemedication. ResidentsintheCottageareoftennotabletocomplainofpainorillness.Oftenwhenaresidentisin
painorilltheywillbecomeagitated.Asamedtechyouneedtobeabletoreadaresidentsbodylanguagesuchas:limping,favoringonelimpoveranother;andfacialexpressionssuchas:grimacing,tensionintheeyebrowstotelliftheyareinpain.Whenyounoticesignsthataresidentisinpain,thenyouneedtogivethemthepropermedication. ThemedtechthatisintheCottageduringtheAMandPMshiftactsasathirdaide.AsathirdaideyouneedtohelptheCottageaidescarefortheresidentswhentheyneedhelp.Asamedtech,youarealsointheCottagetoobservetheresidentsthatarebacktheretobettercareforthem.Byconsistentlyobservingtheresi -dents,youwillknowwhentheyneedmedicationorredirection.
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Supplies:
Doctors Apointments:
LegacyHousehassuppliesthatareavailableforresidentstouse.Thesesuppliesarebriefs,chucks,andgloves.Weneedtochargeforthesuppliesthatareavailable.Forthisreasonmedtechsaretheonlypeoplethathaveaccesstothesupplies.Whenaresidentneedssuppliesthentheaidewillnotifythemedtechanditisthenthemedtechsresponsibilitytogetthesupplies,signthemoutandgetthemtotheresident.NotallresidentsusethesuppliesthatareprovidedbyLegacyHouse,somearesuppliedbythefamilyhomehealth,hospiceorFlexCare.Itisthemedtechsresponsibilitytoknowwhetherornothousesuppliescanbegiventoaresident. Suppliesarelocatedinthebasementinthestorageroom.Theyarekeptincagesthatarelockedbecausetheyhavetosignedoutandchargedtoaresident.Thekeysforthecagesarelocatedintheme Room.Supplies
aresignedoutjustlikerstaidsuppliesintheSupplybinder.(Seepage25) Ifaresidentdoesnotuseoursupplies,themedtechmustnotifythecorrectpersonsothatsuppliescan
bebroughtin.
Oftenmedtechswillneedtoscheduledoctororvariousothermedicalappointments.Whenyoudothisyouneedtoknowifthefamilywill/cantransporttheresidenttotheappointmentoriftheActivitiesDepartmentneedstotransport.IfLegacyHouseistransportingtoanappointmentthentheappointmentneedstobemadeonthedaysandduringthetimesthatthebusisavailabletotransport.Thetimesthatthebusisavailabletotrans-
portislistedintheMedRoombythephone.Aftermakingtheappointment,anappointmentslipneedstobelledout.Themedtechmustrecordthefollowinginformationontheslip:theresidentsname,roomnumber,
phonenumber,thedateandtimeoftheappointment,thedoctorsnameandtheaddressoftheofce,yournameandanynotesthattheactivitiespersonwillneedtoknow.Oncetheslipislledoutitneedstobeplacedintheactivitiesmanagersboxorgiventoherdirectlysothatshecanscheduletransportationtotheappointment. Whenaresidentgoestothedoctorsappointmentthemedtechneedstocopyacurrentmedlist(MAR),the FaceSheet,anyotherpaperworkrequestedbythedoctor.Oftenthenursewillsendaletteraddressingthe
concernsthatshehasabouttheresident.Thispaperworkneedstobegiventothepersontakingtheresidenttotheappointment,eitherfamilyortheactivitiesperson.
Section Seven: Addtional Information
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HIPAA:
HIPAAstandsfortheHealthInsurancePortabilityandAccountabilityAct.Thisactinsurestheprivacyofpatientsmedicalrecordsandhealthplansprovidedbydoctors,hospitals,andcarefacilities.Itistherespon-
sibilityofalltheemployeesofthefacilitytoprovidetheprivacythatHIPAAinsurestoourresidents. Specicallyformedtechs,thismeansthatyoucannotdiscloseanymedicalinformationaboutaresidenttoanyonethattheresidentorPOAoftheresidenthasnotokayed.Partofthisincludeshavingconversationsaboutresidentinpublicplaces,orwithotherresidentsorfamilymembersofotherresidents.Asamedtechwhenyouhearotheremployeesdiscussingresidentsinthiswayyouneedtopolitelyremindthemthatthedis-cussiontheyarehavingisinappropriatebecauseofthelocationorthepersonthattheytalkingwith.Ifapersonasksaboutaresidentandyoucannotdiscussthatresidentwiththem,politelytellthemthatyoucannotdiscussthatinformationwiththem.IftheyhaveanyquestionsorpressureyoufurtheryoucanreferthemtotheRCC,or bilig administrator. Whenaresidentistransferredfromthefacility,employeesarenotallowedtodiscusswherethatresidenthasgoneandwhywithotherresidentsorfamilymembers.IftheypressureyoureferthemtotheRCCorBuild -
ingAdministrator. AspartofHIPAA,medtechsneedtodestroymedicationpacketsthathaveresidentnames,medicationnames,anddoctornamesonthem.Todothisshredbubblepackswhentheyareemptyandafterpassingmedi-cationshredthemedstrips.Aswellcopiesofnewordersthatdonotendupinthechartsneedtobeshreddedwhentheyarenolongerneeded.Agoodruletofollowisthatanythingthathaspersonalinformationanddoesnotendupintheresidentschartmustbeshredded.
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Appendices
AppendixA:CommonNarcsandAntibiotics
AppendixB:CommonMedications
AppendixC:SymbolsandAbbreviations
AppendixD:ConversionTable
AppendixE:MilitaryTime
Appendix F: Residents Charts
Appendix G: How to Give a Nebulizer Appendix H: How to Give a Suppository
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Appendix A: Common Narcotics and Antibiotics
ThisisalistofthenarcoticsthatarecommonlyusedatLegacyHouseofBountifuland
theformsthattheygenerallycomein.Medication Type Forms
Alprazolam(Xanax) Antianxiety Pill,Liquid,andCream
Ambien SleepAid Pill
Ativan(Lorazepam Antianxiety Pill,Liquid,andCream
Darvocet Pi Pill
Endocet Pi Pill
Fentanyl Pi Patch
Hydrocodone Pi PillandLiquid
Lorazepam(Ativan) Antianxiety Pill,Liquid,andCream
Lortab Pi PillandLiquid
methoe Pi Pill
Morphine Pi Pill,andLiquid
Narco Pi Pill
Oxycodone Pi Pill
Oxycotin Pi Pill
Percocet Pi Pill
Tylenol3 Pi Pill
Valium Pi Pill
Xanax Antianxiety Pill,Liquid,andCream
ThisisalistofthenarcoticsthatarecommonlyusedatLegacyHouseofBountifuland
theformsthattheygenerallycomein.Medication Type Forms
Alprazolam(Xanax) Antianxiety Pill,Liquid,andCream
Ambien SleepAid Pill
Ativan(Lorazepam Antianxiety Pill,Liquid,andCream
Darvocet Pi Pill
Endocet Pi Pill
Fentanyl Pi Patch
Hydrocodone Pi PillandLiquid
Lorazepam(Ativan) Antianxiety Pill,Liquid,andCream
Lortab Pi PillandLiquid
methoe Pi Pill
Morphine Pi Pill,andLiquid
Narco Pi Pill
Oxycodone Pi Pill
Oxycotin Pi Pill
Percocet Pi Pill
Tylenol3 Pi Pill
Valium Pi Pill
Xanax Antianxiety Pill,Liquid,andCream
ThisisalistoftheantibioticsthatarecommonlyusedatLegacyHouseofBountiful.
Antibiotic
Amoxicillin
Macrobid
Preisoe
ReexZPack
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Appendix B: Common Medications:
ThisisalistofmedicaitonthatiscommonlyusedatLegacyHouseofBountiful,andwhatthemedica-
tiontreats.
Medication Type
Aricept deeti
Carvedilol HeartFailure
Citalapram Depression
Counadin bloo Thier
Cymbalta Depression
digoxi HeartFailure(SlowsHeartRate)
Ditalizem HighBloodPressure
Flomax EnlargedProstateFurosemide WaterPillandHighBloodPressures
Glipizide Diabetes
Haldol Anxiety(NonNarcotic)
Lexapro Depression
Lisinopril HighBloodPressureandHeartFailure
m
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