MEDICATION MEDICATION ADMINISTRATION ADMINISTRATION

TIPS: TIPS: MED ERRORS BE MED ERRORS BE GONE!GONE!

SLIDE PRESENTATION DEVELOPED BY:

GEORGIA SWANK MS, RN, CDDN

SAFESAFE MED PASSING MED PASSING

MED PASSINGIS REQUIRED

FOR YOU TO DO YOUR JOB

BUT…

SAFE MED PASSING

IS REQUIRED FOR YOU TO KEEP YOUR JOB!

THE 6 RIGHTS OF THE 6 RIGHTS OF MED ADMINISTRATIONMED ADMINISTRATION

RIGHT CONSUMERCONSUMERRIGHT MEDICATIONMEDICATIONRIGHT DOSEDOSERIGHT ROUTEROUTERIGHT TIMETIMERIGHT DOCUMENTATIONDOCUMENTATION

The 6 RIGHTS MUST BE IN THE The 6 RIGHTS MUST BE IN THE PHYSICIAN ORDER ALSO!PHYSICIAN ORDER ALSO!

RIGHT PERSON

RIGHT TIMERIGHT

MED

RIGHT ROUTE

RIGHT DOSE

DON’T FORGET THE 6TH RIGHT…TO DOCUMENT CORRECTLY

CAKY Henderson

SAFE MED PASSING INCLUDES:SAFE MED PASSING INCLUDES:

• IDENTIFYING THE CLIENT

• GETTING OUT MAR AND USE IT FOR MED PASS

• REVIEWING WHAT MEDS YOU WILL BE GIVING PRIOR TO PREPARING

• GATHERING ANY SPECIAL EQUIPMENT• (WATER, CUPS, APPLESAUCE, PILL CRUSHER, GLOVES)

OTHER SAFETY TIPSSAFETY TIPS

• MEDS SHOULD NEVER BE OUT OF YOUR SIGHT• NO INTERRUPTIONS• ALL MEDS LABELED

• (Never give a med that does not have a legible label)

• YOU MUST READ & COMPARE LABEL TO MAR 3 TIMES• INSURE MEDS ARE SWALLOWED• NEVER GIVE MEDS SOMEONE ELSE MEASURED OUT

• IF THE CLIENT QUESTIONS, STOP!! CHECK MED AGAIN.• OBSERVE EFFECTS OF MEDS UP TO SEVERAL HOURS,

REPORT ANY ADVERSE REACTIONS OR SIDE EFFECTS• NEVER BORROW MEDS

MEDICATION DO’SDO’S AND DON’TSDON’TS

DO KEEP LABELS CLEAN

DON’T GIVE ANY MED IF LABEL IS NOT ABLE TO BE READ

DON’T USE EXPIRED MEDS

DO CHECK IN & COUNT ALL MEDS DELIVERED BY PHARMACY

DON’T ACCEPT ANYTHING YOU CANNOT READ

DO KEEP MED STORAGE AREA LOCKED

CORRECT PROCEDURES ARE CORRECT PROCEDURES ARE IMPORTANTIMPORTANT

Whether you are giving pills, creams, eye drops, inhalers, or meds through a tube….using the correct procedures are vital!

Making sure your consumers get the medications exactly as prescribed by the physician makes sure that their medical issues are treated properly.

Tablets & CapsulesTablets & Capsules• Crushing pills

• Extended Release, Sustained Release, and all pills that have these actions, should NOT BE CRUSHED!

• Pharmacy can tell you if a pill can be crushed• Request a DO NOT CRUSH LIST from Pharmacy for your

MAR if you have a need to crush pills for a particular consumer

• Opening capsules• Pharmacy can tell you if this is OK

• Mixing medications with food• Must have an order from the physician for this• Put order right on MAR at the top so all can see• Can ease swallowing for those with swallowing problems or

anxiety about taking meds• Can increase compliance for some

Liquid MedicationsLiquid Medications

• Liquids prepLiquids prep• Check instructions to see if liquid med needs to be

shaken or mixed before giving• Use a Med cup with measurement markings or

dosing syringe (best if you want to be exact and not waste)

• Get your eyes level to the markings to read• Syrups and other liquids can get sticky—KEEP

BOTTLES CLEAN & LEGIBLE• Do NOT give any liquid that has spilled down the

outside over the label, making it illegible or hard to read—request a new label from Pharmacy

• Offer a drink of water after the med is given

Powdered MedicationsPowdered Medications

• These are meds like fiberlax, Metamucil, some potassiums, etc.

• If not pre-packaged in already measured packs, use a med cup and measure like a liquid• Set med cup or measuring cup on counter and get

your eyes level to the measuring line• Pour out or level off until top of powder is level• Can mix with liquids according to instructions

LotionsLotions, , creamscreams, , ointmentsointments

• Wash hands before & after• Wear gloves• Apply ONLY to area prescribed for !• Use applicator like a cotton swab or, in some cases,

like applying over large skin areas, you can use your gloved hand to spread lotions etc.

• If for infection, rash or other medical problem, can squeeze small amt onto clean gauze pad and use from there (to avoid contaminating tip of tube)

• If lotion for non-medical purposes can pour directly into hand or consumer can apply if able

Transdermal PatchesTransdermal Patches• Might have for heart problems, pain, smoking

cessation, birth control• Wear gloves, wash hands after new patch applied &

old patch disposed of• Always remove previous patch before applying new

one• Rotating sites will reduce potential for skin irritation

(follow directions for which sites are best—for example, may move from chest to upper back)

• Date, time, and sign patch with pen• Document location in MAR

Eye Meds (Ophthalmic)Eye Meds (Ophthalmic)• Wash hands• Wear gloves• Avoid touching end of dropper to eye or anything

else• Some eye drops may need to be shaken first (read

directions)• Have client tilt head back slightly• Place fingers on cheek below eye, and gently pull

downward to pull the bottom eyelid down and out to form a pocket

• Put drops gently into pocket of lower eyelid and have client close eye

• Administer eye ointments exactly the same way—these may cause blurred vision for a few minutes

Nasal Meds (in the Nasal Meds (in the nose)nose)

• Have client blow their nose gently first into a tissue• Wash hands• Avoid touching the dropper to any surface• Best to do with the client lying down or laying back in

a recliner with head back as far as possible• With client lying down and head back as far as it will

go, put drops into nose• Keep head tilted back for 3-5 minutes if possible so

the medicine can get where it needs to go• Monitor client closely as some drops may dribble

back into throat and cause them to cough• Wash hands, wipe client’s face if necessary• Rinse dropper under warm water• Do not share droppers between consumers!

Oral InhalersOral Inhalers• Shake the inhaler (attached to mouthpiece)• Have client breathe out normally• Holding inhaler directly in front of mouth, as client breathes slowly IN,

press the container DOWN into the mouthpiece to release a puff of medication

• Encourage the client to keep breathing slowly IN as deeply as they can• Have client hold their breath for 5-10 seconds to keep the medicine in

the lungs• Then breathe out slowly• Follow directions for number of puffs!• Monitor and document ongoing breathing of client• Can they talk normally without having to take extra breaths? Or not? Do

they get out of breath doing normal activities? Do they complain that they can’t catch their breath? These are all things to document and follow up on!

• Some oral inhalers (like Advair) is a powder and only requires the client to suck in like they are sucking on a straw (this is easier for most clients to do and the medication gets where it needs to better also)

Ear MedicationsEar Medications

• Wear gloves• Have client tilt head with ear pointing up• If client is over the age of 10, pull ear up as

you give ear drops or ointments• If client is a young child, pull ear down to give

ear drops or ointments• This straightens the ear canal so medicine will

get all the way in where it should go• Have client lay still for 5 minutes if possible

after instillation of ear drops

SuppositoriesSuppositories (rectal & vaginal)

• Rectal Suppositories:• Have client lay on left side• Wear gloves• Lubrication of suppository• Insert with 1 finger up high enough to get past internal

hemorrhoids (about 1 ½-2 inches)• Medication absorbed very quickly thru mucous

membranes• Works well for someone who is vomiting and cannot keep

food or medicine down• Some pain and nausea meds can be given this way

• Vaginal Suppositories:• Have client lay on back and spread legs• Gloves, lubrication• Insert 1-2 fingers and push suppository in as far as

fingertips can go

Meds thru Feeding Meds thru Feeding TubesTubes

• Insure stability of feeding tube before instillation• Flush with water before meds to decrease internal

stickiness of tube• Flush tube after meds with sufficient water to

completely clean tube and push meds through• This also helps with digestion & metabolism of meds• REMEMBER: Some meds cannot be crushed!

• If you do not know which meds, call the pharmacy.

• Other forms may be more suitable such as liquids, Soltabs (dissolve instantly in mouth), sprinkles

• Look at all options

AFTER AFTER GIVING MEDS….

DOCUMENT WHAT YOU GAVE AFTERAFTER GIVEN

DOUBLE CHECK YOURSELF LOOK THRU ALL PAGES OF MAR LOOK AT ALL BOXES, DID YOU INITIAL? ARE BACKS OF MARS SIGNED? WERE ALL TREATMENTS DONE?

NEVERNEVER DOCUMENT SOMETHING YOU DID NOT DO…THIS IS FALSIFICATION OF RECORDS

MED ERROR PROCEDURES

* TRUTHFUL REPORTING AS SOON AS POSSIBLE

* OBSERVATION OF CONSUMER FOR UNDESIRABLE EFFECTS

* COMPLETE A MED ERROR REPORT* PHYSICIAN MAY OR MAY NOT BE

CONTACTED depending on medication and circumstances

* DOCUMENT IN CHART, DESCRIBE ERROR, WHEN reported AND INSTRUCTIONS GIVEN & FOLLOWED

* CONSUMER/GUARDIAN INFORMED AS DIRECTED BY DR.

BE A SAFE MED BE A SAFE MED PASSER. PASSER.

YOUR CONSUMERS YOUR CONSUMERS DEPEND ON YOU!DEPEND ON YOU!

Do Your Part...Do Your Part...