medication administration class
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Medication Administration
Class
Format for Class
Medicines Giving them Proving you gave them Doctors, Nurses and Medicines Core Competencies Skills And (Ahhhh) THE TEST
Protocol for Passing Medications
• Medication Class
• Pass test with 75%
• Medication Assignment
• Shadowing
Fatal Four
• Aspiration
• Constipation
• Dehydration
• Seizures
• Why do we care?
Nursing Outcomes at CCS
• Aspiration
• Constipation
• Dehydration
• Seizures
• Skin Care
• Preventable ER visits
Six Rights
Right MedicationRight DoseRight manner/routeRight timeRight personRight documentation
Right Medication
A drug order is written for specific medication
Double check that youobtained the right drug
Your responsibility:Obtain
PrepareAdminister
the correct medication
Check three times themedication container
to the MAR
Right medication
Right Dose
Your responsibility it to confirm what dose within the
dose range was ordered
Make sure that the dose of the medication you are giving matches the MAR order
Never assume what dose of drug will be administered
You cannot give a different dosage than what is ordered
Right dose
Right Manner or Route
Most drugs have
differentroutes for different
needs
Never assume what form of the drug will
be administered
Always confirm the right route with the MAR
order
Most used:
PO = oral
SL = sublingual
Rectal = by rectum
Topical = on skin
Right Manner/Route
Right Time
Administering doses
•Too close together or
•To far apart
alter the therapeutic effect of the medication
Double check with MAR when to
administer med
The drug’s
•Purpose and
•Pharmacokinetics
Determine how often the medication is administered
Your responsibility is to administer:
•Stat meds ASAP
•Single ordered medications at time ordered
•Standing ordered meds on time
•PRN medications when needed
Right Person
A drug order is written for a
specific resident
Double check that you have
the right resident
Your responsibility is to:
•Obtain
•Prepare, and
•Administer
the medication to the correct person
Right Documentation
Right documentation includes correct drug order and a signature
Using the correct form to record the administration of the med assures that the resident does not receive another dose, preventing overdosing of the resident
Your responsibility is to document the administration of
the med immediately.
Five Always
• Physician's order for every med/treatment
• Wash your hands
• Pour medication into cup
• Identify and stay with resident
until medication is swallowed
• Keep med storage area locked,
clean and orderly
Five Nevers
• Never leave meds with client or out
• Never give a med prescribed for one client to another
• Never give meds prepared by another person.
• Never use a med that is outdated or from an illegible or unlabeled container
• Never give meds if you have questions.
Five Musts
• Have correct MAR
• Read label and compare it with MAR
• Good position
• Document
• Understand the medicine
Storage of Medications
• Locked
• Clean
• Refrigeration
• Separate orals from topicals
• Separate meds for different clients.
Preparing Medications
• Changing the form
• Crushing meds
• Measuring liquids
Pharmacy
• Use Olson’s Pharmacy
• Not all clients use just
one pharmacy
• Important to know how
each house connects with Olson’s
• Use them as a resource
Medication Administration Record
• Forever after known to you as MAR
• Preparation of MAR
• Transcription of orders
• Signing back
• Time limited medications
• Discontinuing medications
Documentation
If it isn’t written down, it did not happen.
Charting Codes
Charting Code When do you use it
YR
(your initial)
When you sign for a medication
When the medication is not given
W When the client is at work
YR
Practice
1. You give a medication.
2. Your HM tells you that Jessie needs to have a Dilantin blood test and not to give the 8 AM Dilantin.
3. Adam went home for the weekend.
4. Johnny spit out the medicine you gave him.
PRN Medications
Establish the need for the medication
Ensure there is a current order
Administer the medication
Sign the back of the MAR
Follow up within two hours
Practice on PRN Medications
• Johnny complains that his head hurts.
• Ronny has a cough
• Mark has a groin rash
• Susie has not pooped in two days.
Controlled Substances
• Definition
• Why they are handled differently
• Examples
• Special Tracking and charting
Abbreviations
Charting
You are telling a story with your charting
Each house will want you to chart in their way
Self Administrated Meds
• Self determination is determined
through ISP process
• At present we have no
residents who self-administer
• Please see packet for
process
Different kinds of medications
• Via the mouth!• Topicals• Sublinguals• Eye drops/ointments• Ear drops• Rectal meds• Vaginal meds• Nasal meds
PO Medications
• Do not crush unless you have an order
• Slower to be absorbed
• Taste is important
• Food can impact the medicine
• Take with full glass of water
• Do not mix in hot drinks
• Shake all liquids before pouring out
Topicals
• Usually used for skin conditions
• Always use gloves
• Check expiration dates
• Privacy
• Be aware of residents tendency
to put body parts in their mouths
• Make sure you note effectiveness
Sublinguals
• Under the tongue
• Do not offer water right away
• Use gloves
• Stay with resident until you are sure the medication has been absorbed
Eye Drops/Ointments
• Used to treat infections, inflammation, irritation and lack of moisture
• Wash hands
• Use Gloves
• Explain to client
• Drops before Ointments
Ear Drops
• Warm ear drops to body
temperature
• Wash hands
• Wear gloves
• Have resident lie on side opposite to the ear being treated
• Have them stay that way 5-10 minutes
Rectal Medications
• Used to stimulate bowel movements, relieve pain, relieve vomiting, reduce fevers, stop seizures
• Wash hands
• Wear gloves
• Privacy!!!!
• Usually kept in refrigerator
• Documentation of this one is important
Vaginal Medications
• Determine if administration will involve 1 or 2 staff
• Wash hands
• Wear gloves
• Explain procedure
• Privacy!!!
• Best time to insert is after shower or bath
Nasal Medications
• Wash hands
• Wear gloves
• Explain procedure
• Spray vs. drops
• Work with client
Medication Errors
• Definition of a medication error
• Examples– Forgetting to sign– Forgetting a follow up– Not giving a suppository when due
• What happens
• Intent
Where is the error?
Residents, Living and Meds
• Our residents have lives
• Some work or have lives outside
our homes
• They need their medication
• Communication is the key
Work site responsibilities
• Work site needs a copy of
doctor’s order
• Administered by designated
staff person
• Same rules apply: i.e.
MAR, 5 rights
Home responsibilities
• Provide work with necessary
information
• Inform worksite of any changes
• What is the abbreviation for
the MAR at home when a
resident is at work?
When a client goes home
• Pills in envelopes – one type of
medication to an envelope
• Whole bottles go home
• Document on MAR
• Never take medicine back
Hospitalized Residents
• DO NOT TAKE MEDICINES TO HOSPITAL
• What is the appropriate
documentation?
Disposal of Non-controlled Medications
“Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.
Documentation of this!
Any two staff can do this
Disposal of controlled medications
• “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.”
• Documentation!
• Of the two staff, one must
be an LPN or RN
Disposal Documentation
• Date
• Client’s name
• Name of medication and dosage
• Amount of medication disposed
• Reason for disposal
• Method of disposal
• Two signatures
Practice
What is a medication
“Medication means any drug, chemical, compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.”
Any medication for our clients
must be prescribed by a MD
Adverse reaction
• Allergy
• Side effects
• Your part
Kinds of medications
• Anticonvulsants• Antipsychotics• Antibiotics• Antidepressants• Multivitamin/Minerals/Dietary Supplements• Antidiabetic• Topicals• Analgesics• Laxatives
Timing of Medications
• Know when to give medicines to gain most benefit
• No laxatives within 1 hr of any other medication
• Iron should not be taken with milk
• GERD meds – ½ hr before meal
• Use your drug guide
• As the doctor
Nurses at CCS
• Nurse patient relationships
• When to call
• Protocol for paging
Doctors and Medicines
• They have the degree
• They also do the prescribing
• They prescribe based on information we provide
• We know the resident better than they do
• It is in the resident’s best interest to work closely and respectfully with the physician
Doctors Visit
• Who decides
• How to prepare
• What to do afterwards
A prescription
• Written by a doctor
• Parts of a prescription– Client name – first and last– Name of drug– Dosage of drug– How frequent to take it and how long– What route
Telephone orders
• Who can take them– Nurses – LPNs or RNs– House Managers– Assistant House Managers
• Getting them on the MAR
Rights regarding medications
• Right to:– know what they are getting– have an explanation– refuse or consent– confidentiality and privacy– appropriate services
Medication Resources
• Policies
• Drug Books
• Drug information sheets
• Pharmacy
Handwashing
• List times to wash hands
• Use plenty of soap
• Lots of friction
• Dry hands with paper towel
• Turn off faucet with paper towel
Blood pressure
• Why do you have a blood pressure
• What does it represent
• What is normal
• How to take it
• What to do if it is abnormal
Practice
Respiration
Definition
How to count
What is normal
What to do if it is abnormal.
Practice
Pulse
A pulse is the throbbing of a vessel in response to the heart beating.
What is normal
How to count
What to do if it is abnormal
Practice
Temperature
Just as a motor is warm from working, our body is warm from its metabolism.
Normal Temperature – USUALLY 98.6º orally – may be different for different residents
A fever is an elevation of the body temperature above normal
Differences between oral, axillary, and rectal
When should you be concerned?
Practice
Pain
• Defined by the resident
• Will be manifested differently by different residents
• Can lead to other symptoms/behaviors which are not desirable
• What to do first if you suspect someone is in pain
• When should you be concerned
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