pandemic (temporary) medication aide to medication aide

Pandemic (Temporary) Medication Aide to Medication Aide –

40 Hour Transition Programfacility manual

Pandemic (Temporary) Medication Aide to

Medication Aide - 40 Hour Transition Program

Nebraska Health Care Association, Inc.

Lincoln, Nebraska

Copyright © 2021

All rights reserved

No part of this publication may be reproduced, stored in a retrieval system, or

transmitted, in any form or by any means, electronic, mechanical, photocopying,

recording, or otherwise, without the prior permission of the Nebraska Health Care

Association, Inc.

Acknowledgments

Created By:

Connie Knorr, RN, BSN

Director of Professional Development

Nebraska Health Care Association

Resources

Nebraska Health Care Association. Temporary Medication Aide Online Course.

https://learn.nehca.org/courses/temporary-medication-aide-online-course/

Knorr, Connie; Truscott, Pamela (2017). Medication Aide Training: Instructor manual,

fourth edition. Nebraska Health Care Association

Disclaimer

This publisher does not warrant or guarantee any of the products described herein or

perform any independent analysis in connection with any of the product information

contained herein. The publisher does not assume, and expressly disclaims, any

obligation to obtain and include information other than that provided by the

manufacturer.

The reader is expressly warned to consider and adopt all safety precautions that might

be indicated by the activities described herein and to avoid all potential hazards. By

following the instructions contained herein, the reader willingly assumes all risks in

connection with such instructions.

The publisher makes no representations, recommendations, or warranties of any kind,

including but not limited to the warranties of fitness for particular purpose or merchant

ability, nor is any such representation implied with respect to such material. The

publisher shall not be liable for any special, consequential, or exemplary damages

resulting, in whole or in part, from the reader’s use of, or reliance upon, this material.

The authors and publisher have made conscientious effort to ensure that the drug

information and standards of practice in this book are accurate and in accordance

with accepted standards at the time of publication. However, pharmacology is a

rapidly changing science, so readers are advised, before administering any drug, to

check the package insert provided by the manufacturer for the recommended dose,

for contraindications for administration, and for added warnings and precautions. The

recommendation is especially important for new, infrequently used, or highly toxic

drugs.

Training Overview with Nebraska State Requirements

On March 31, 2020, Governor Pete Ricketts announced Executive Order No. 20-12

Coronavirus – Relief for Hospitals and Care Facilities and Expanded Use of Telehealth

Services. This executive order temporarily waived the provisions of Nebraska Revised

Statutes § 71-6725(4) and its implementing regulations which require certain training for

medication aides to help address staffing needs during the coronavirus emergency.

This Executive Order allowed individuals to be placed on the State Registry as

medication aides without fulfilling the 40-hour training and exam requirements to work

in a nursing facility, assisted living facility, or intermediate care facility for persons with

intellectual disabilities. As the requirement to be on the State Registry was not waived,

individuals were still required to complete and submit the application, pay the

associated fee, and submit any required materials to the Nebraska Department of

Health and Human Services (DHHS). Medication aides were also still required to be

competent to furnish the care they provided to facility residents.

Once the public health emergency (PHE) is lifted, Nebraska regulations will be in effect.

To continue to work in a facility, medication aides will be expected to complete the

required 40 hours of training and successfully pass the written state test to qualify to be

placed on the State Registry within thirty days of the end of the PHE.

The Pandemic (Temporary) Medication Aide – 40 Hour Transition program (PMAT) is

designed to meet the state requirements necessary to be eligible for state testing and,

once testing is successfully completed and the necessary materials submitted to the

DHHS, to be eligible for placement on the State Registry as a 40-hour medication aide.

The course has been divided into three sections:

• Section A — Nebraska Health Care Association’s eight-hour Temporary

Medication Aide Online Course

• Section B — Medication Aide Skills

• Section C — On-the-job Training

The intention is that the entire curriculum contains sufficient material to meet minimum

basic training for medication aides in assisted living communities, nursing facilities, and

intermediate care facilities for persons with intellectual disabilities.

172 NAC 95 ADMINISTRATION OF MEDICATIONS BY MEDICATION AIDES AND

MEDICATION STAFF

95-003 MINIMUM COMPETENCY AREAS AND STANDARDS

95-003.01 Competency Areas: Medication aides and medication staff must be

competent in the following areas:

1. Maintaining confidentiality;

2. Complying with a recipient’s right to refuse to take medication;

3. Maintaining hygiene and current accepted standards for infection control;

4. Documenting accurately and completely;

5. Providing medications according to the five rights;

6. Having the ability to understand and follow instructions;

7. Practicing safety in application of medication procedures;

8. Complying with limitations and conditions under which a medication aide

or medication staff may provide medications;

9. Having an awareness of abuse and neglect reporting requirements; and

10. Complying with every recipient’s right to be free from physical and verbal

abuse, neglect, and misappropriation or misuse of property.

95-003.02 Competency Standards: The standards for each of the competencies

set out in 172 NAC 95-003.01 are:

1. Does not share confidential information except when it affects the

recipient’s care and is to the appropriate person(s);

2. Does not force recipients to take medication. Uses appropriate measures

to encourage taking of medications when directed for recipients who are not

competent;

3. Utilizes appropriate infection control principles when providing

medications;

4. Accurately documents all medication provided including the name of the

medication, dose, route, and time administered and any refusal of

medication, and spoilage;

5. Provides the right medication, to the right person, at the right time, in the

right dose, and by the right route;

6. Comprehends written or oral directions;

7. Properly:

a. Stores and handles all medication in accordance with entity policy;

b. Intervenes when unsafe conditions of the medication indicate a

medication should not be provided; and

c. Provides medication to recipients in accordance with their age and

condition;

8. Knows that they must:

a. Be competent and have been assessed;

b. Always comply with the five rights of provision of medications;

c. Record all medication provided or refused; and

d. Have additional competencies to provide additional activities;

9. Identifies:

a. Occurrences of possible abuse of a vulnerable adult and reports this

information to the appropriate person/agency as required by the

Adult Protective Services Act; and

b. Occurrences of possible abuse or neglect of a child and reports this

information to the appropriate person/agency as required by Neb.

Rev. Stat. §§ 28-710 to 28-727; and

10. Does not misuse recipient property or cause physical harm, pain, or

mental anguish to recipients.

95-005 USUAL ACTIVITIES IN THE PROVISION OF MEDICATIONS

95-005.01 All medication aides and medication staff when directed and

monitored in accordance with 172 NAC 95-004 may provide routine

medications by the following routes:

1. Oral, which includes any medication given by mouth, including

sublingual (placing under the tongue) and buccal (placing between

the cheek and gum) routes and oral sprays;

2. Inhalation, which includes inhalers and nebulizers; Oxygen may be

given by inhalation;

3. Topical application of sprays, creams, ointments, and lotions and

transdermal patches; and

4. Instillation by drops, ointments, and sprays into the eyes, ears, and

nose.

95-005.02 All medication aides and medication staff must make an accurate

record of their provision of medication.

95-005.02A The record of provision of medication must include but is

not limited to:

1. Identification of the recipient;

2. Name of the medication given;

3. The date, time, dosage, and route for each medication

provided;

4. Identification of the person who provided the medication;

and

5. Any refusal by the recipient to take and/or receive a

medication.

95-005.02B The record must be given to the entity employing the

medication aide or medication staff. The record must be kept and

maintained as required by 172 NAC 95- 010.

95-005.02C Any medication error must be reported to the person

responsible for providing direction and monitoring immediately

upon discovery of the error.

172 NAC 96 MEDICATION AIDE REGISTRY

96-004.02 Medication aides providing services in an assisted-living facility,

ICF/MR, or nursing home must:

1. Successfully complete a competency assessment as identified

in 172 NAC 96- 005.

2. Successfully complete a 40-hour course. The course must be on

the competency standards identified in 172 NAC 96-005.01A. The

40-hour course may include the competency assessment

identified in 172 NAC 96- 005.

a. A medication aide who has, prior to January 1, 2003, taken

a 20-hour course and passed an examination administered by

the Department, may complete an additional 20-hour course

to meet the required 40- hour course.

b. These course requirements may be met by a person enrolled

in an approved program of nursing or other allied health

program after the content required for the competencies

identified in 172 NAC 96-005.01A have successfully been

completed.

c. These course requirements may be met by a person who has

taken a medication course in another state if the course

consisted of the required 40 clock hours.

3. Pass an examination administered by the Department.

a. The examination passing standard will be criterion referenced

using the Anghoff Method or equivalent method.

Program Completion Requirements

The Nebraska Health Care Association must be notified that the student has satisfied

the following requirements to be eligible to state test:

1. The student must have successfully completed the Nebraska Health Care

Association’s eight-hour Temporary Medication Aide Online Course and the

written competency exam with a minimum score of 72%.

2. The student must have completed a minimum of 32 hours of on-the-job training

(172 NAC 96-004.02) working as a pandemic medication aide in the facility

under the supervision of a registered nurse (or a licensed practical nurse under

the supervision of a registered nurse).

3. The student must have successfully demonstrated competency on the required

competency areas, standards, and skills by a registered nurse (or licensed

practical nurse under the supervision of a registered nurse), as required in 172

NAC 95-003 and 172 NAC 95-005.

The facility administrator or registered nurse must complete an attestation form verifying

the student’s successful completion and competency on the above requirements and

submit this documentation to the Nebraska Health Care Association.

Once these requirements are fulfilled and the attestation documents are received by

the Nebraska Health Care Association, the student is eligible to take the state written

test.

If the student does not pass the state written test within three attempts, the individual

must complete a traditional medication aide training course.

The Attestation Form and other documents can be found in the appendix section of this

manual.

The completed and signed forms can be electronically submitted at

https://www.nehca.org/pandemic-temporary-medication-aide-to-medication-aide-40-

hr-transition-program-submission/; scanned and emailed to

[email protected]; or mailed to:


1200 Libra Drive, Suite 100

Lincoln, NE 68512



https://www.nehca.org/pandemic-temporary-medication-aide-to-medication-aide-40-hr-transition-program-submission/

https://www.nehca.org/pandemic-temporary-medication-aide-to-medication-aide-40-hr-transition-program-submission/

Program

The Pandemic (Temporary) Medication Aide to 40-Hour Medication Aide Transition

Program is divided into three sections.

Section A –Nebraska Health Care Association’s eight-hour Temporary Medication Aide

Online Course

In this section, the student will be introduced to his/her work setting and job

responsibilities. Important concepts such as abuse and neglect, infection control, safety

precautions, and medications are covered. The student must successfully complete the

Nebraska Health Care Association Temporary Medication Aide course written

competency exam with a minimum score of 72%.

Section B – Medication Aide Skills

In this section, the student will learn the procedures for medication provision by the

basic routes including oral, topical, inhalation, and installation. Learning these skills can

count toward the 32 hours of on-the-job training described in section C.

Section C – On-the-job Training

In this section, the student will learn and participate in medication provision for at least

32 hours, while working as a pandemic medication aide in the facility under the

supervision of a registered nurse (or licensed practical nurse under the supervision of a

registered nurse). Learning these skills can count toward the 32 hours of on-the-job

training described in section C.

PLEASE NOTE: The student must have been placed on the registry as a medication aide

(non-40-hour) within thirty days of successful demonstration of the required

competencies in 172 NAC 95-003 and 172 NAC 95-005.

Unit Format: The program’s three sections are divided into a total of seven units.

Content: The student must understand the content to meet the objectives of the

program. The nurse may add other classroom activities relevant to the content to

facilitate learning. These activities may include videos, class discussion, role-play, skills

practice, and other teaching methods.

Procedures: Procedures must be demonstrated and practiced and the student

successfully demonstrate competency before the procedure is performed on a

resident. The student will need to demonstrate his/her competency on the procedures

listed on the Medication Aide Skills Sheet.

Skills Packet: Each individual skill is included in the Skills Packet. To be considered

competent, the student must demonstrate at least 70% of the skills steps correctly and

100% of the critical steps. The nurse may use the Skills Packet to check off and assess

competency for the student as he/she performs each skills step. The Medication Aide

Skills Sheet should not be signed unless the nurse has observed the student successfully

perform the skill.

Final Exam: The eight-hour Nebraska Health Care Association Medication Aide Online

Training includes a final exam that is used to assess learning. This exam can be

completed by the student online. The student must score a minimum of 72% to pass the

exam, which will generate a certificate. An oral exam is not allowed.

Program Grading (Pass/Fail): The student’s overall program grade is based on the final

exam score and successful competency demonstration of all skills. The overall grade will

be either pass or fail.

On-the-job Training: Students will utilize learned theory and skill content to care for

residents under the supervision of a registered nurse (or licensed practical nurse under

the supervision of a registered nurse). Students will work hands-on with residents,

learning valuable knowledge and skills from relevant staff.

PLEASE NOTE: The student must have been placed on the registry as a medication aide

(non-40-hour) within thirty days of successful demonstration of the required

competencies in 172 NAC 95-003 and 172 NAC 95-005.

General Information

Certificate: Nebraska regulations (172 NAC 96-004.03A) requires the student be given

documentation indicating completion of the training requirements. The certificate,

included in the appendix section, should be completed by the registered nurse or

administrator, which includes the information required by the state.

Equipment: To provide students with the best opportunity for developing skills

competency, it is recommended that a facility have a mannequin on which to

practice. It is also recommended that the students have the opportunity to practice

package opening and equipment manipulation prior to performing the actual skill in a

clinical setting or during their competency testing.

Completion of Program Requirements: The student must complete all the program

requirements to be eligible to take the state test.

Materials: This packet includes several forms, including the Attestation Form, which must

be completed and signed by the registered nurse or administrator. Instructions for

completing the Attestation Form are also included.

Employer: It is important that the employer have a thorough understanding of the role

and scope of work of the medication aide. The employer should also recognize that

even after completion of this course, the student will have a beginning knowledge of

medication provision and will require further orientation and supervision by other facility

staff. The student’s competency demonstration should be repeated regularly, at least

annually, and the documentation of the demonstration maintained. Continuing

education of the medication aide will also be necessary to maintain and enhance

clinical skills and knowledge.

To utilize medication aides, the employer should also ensure specific policies and

procedures are established. The person responsible for direction and monitoring

medications for each resident must be clearly identified in writing. This can be done

through job descriptions, admission agreements, policies, or other methods. Course

requirements, competency testing, and medication aide registry information must also

be maintained in the work setting. To provide any additional activities, as described in

172 NAC 95-006, the medication aide and the facility must meet the additional

requirements specified in 172 NAC 95-006, 172 NAC 95-007, 172 NAC 95-008, and 172

NAC 95-009.

Our Customers

There are many terms used to describe the individuals who are cared for by medication

aides, including customer, resident, patient, client, and consumer. For simplicity’s sake,

the term resident will be used throughout this manual. It is understood that you will use

the term that best suits your particular work situation.

Basic Competencies

Minimum Competency Areas and Standards: Medication aides and other unlicensed

persons who provide medication must:

• Maintain confidentiality. The medication aide must not share confidential

information except when it affects the resident’s care and is communicated to

the appropriate person(s). The medication aide must recognize the resident’s

right to personal privacy regarding health status, diagnosis of illness, medication

therapy, and items of a similar nature. Information of this nature should be shared

only with appropriate interdisciplinary team members.

• Recognize and honor that residents have the capability and capacity to make

informed decisions about medications and the right to refuse medications. At no

time should the medication aide force a resident to take medications. In the

case of a resident who does not have the capability and capacity to make

informed decisions about medications, the medication aide must recognize the

requirement to seek advice and consultation from the caregiver or licensed

health care professional providing direction and monitoring regarding the

procedures and persuasive methods to be used to encourage compliance with

medication provision. The medication aide must recognize that persuasive

methods should not include anything that causes injury to the resident.

• Maintain currently accepted standards for hygiene and infection control,

including handwashing. The medication aide must use appropriate infection

control principles when providing medications.

• Document accurately and completely. The medication aide must accurately

document all medication provided, including the name of the medication,

dose, route, time administered, any refusal of medication, and spoilage.

• Provide medications according to the five rights. The medication aide must

provide the right medication to the right person at the right time in the right dose

and by the right route.

• Have the capacity and ability to comprehend and follow written and oral

directions.

• Practice safety in application of medication procedures, including:

• Compliance with limitations and conditions under which a medication aide

or medication staff may provide medications. The medication aide must

recognize the limitations and conditions under which a medication aide or

other unlicensed person may provide medications and that he or she is

required to:

o Be competent and have been assessed as competent;

o Always comply with the five rights of provision of medications;

o Record all medication provided or refused; and

o If applicable, possess competencies to perform additional

activities.

o Possessing an awareness of abuse and neglect requirements,

including:

▪ Identification of occurrences of possible abuse of a

vulnerable adult or child and responsibility for reporting this

information to the appropriate person/agency as required

by Nebraska’s Adult Protective Services Act.

▪ Recognition of every resident’s right to be free from physical

and verbal abuse, neglect, and misappropriation or misuse

of property. The medication aide must not misuse resident

property or cause physical harm, pain, or mental anguish to

residents.

Pandemic (Temporary) Medication Aide to Medication Aide 40-Hour Transition Program

Schedule

Class On-the-Job

Section A

Part 1: Basic Competencies 2

Part 2: Basic Procedures 2

Part 3: Supporting Procedures 1

Part 4: About Drugs 1

Part 5: Body Systems and Drug Classifications 2

Subtotal: 8

Section B

Part 6: Medication Aide Skills 4

Subtotal: 4

Section C

Part 7: On-the-job Training 28

Subtotal: 28

Total 8 hours 32 hours

Please note that this is only a suggested timetable. Time needed to teach the required

content may vary according to number of students, student experience and abilities,

available resources, access to clinical experience, and many other factors. This

schedule is not to be used by the survey agency, training instructors, health care

administrators, or any other entity as a required class schedule.

Table of Contents

Section A – Eight-Hour Nebraska Health Care Association Online Temporary

Medication Aide Course

Unit 1: Basic Competencies

1. Medication Handling

2. Preventing Infection

3. Handwashing Skill

4. Removing Gloves Skill

5. Medication Administration

6. Drug Responses

7. Documentation

8. Resident Rights, Abuse, and Neglect

Unit 2: Basic Procedures

1. Preparing for Medication Provision

2. Oral Medications Skill

3. Topical Medications Skill

4. Sublingual/Buccal Medications Skill

5. Ear, Eye, and Nasal Medications Skill

6. Inhaler Medications Skill

7. Nebulizer Medications Skill

8. Oxygen Medications Skill

9. Precautions

Unit 3: Supporting Procedures

1. Oral Temperature Skill

2. Pulse Skill

3. Respirations Skill

4. Blood Pressure Skill

Unit 4: About Drugs

1. Drugs in the Body

2. Drugs and the Individual

3. Unexpected Responses

4. Drug Classifications

Unit 5: Body Systems and Drug Classifications

1. Musculoskeletal System

2. Skin and Mucous Membranes

3. Urinary System

4. Circulatory System

5. Respiratory System

6. Nervous System

7. Digestive System

8. Endocrine and Reproductive System

9. Sensory System

Section B – Medication Aide Skills

Unit 6 – Medication Aide Skills

1. Attachment A: Medication Aide Skills Sheet

Section C – On-the-job Training

Unit 7: On-the-job Training

1. Attachment B: Medication Aide Competency Sheet

Attachment A: Medication Aide Skills Sheet

Attachment B: Medication Aide Competency Checklist

Attachment C: Medication Aide Attestation Form

Attachment D: Medication Aide Certificate

Attachment E: Medication Aide Skills Packet

Attachment A: Medication Aide Skills Sheet

Medication Aide Skills Sheet Nebraska Revised Statute §71-6725.

Student Name: ________________________________________

Date_____________________

Demonstrated

Competency (Y/N)

Nurse Initials

Handwashing

Glove Removal

Oral Medication

Topical Medication

Sublingual Medication

Instillation Medication - Eyes

Instillation Medication – Nose

Instillation Medication - Ears

Inhaler Medication

Nebulizer Medication

Oxygen

Nurse ______________________________________ Date__________________________

Attachment B: Medication Aide

Competency Checklist

Competency Checklist Title 172, NAC 95-005.01

Student _______________________________________

Topic Section Demonstrated

Competency

(Y/N)

Nurse

Initials

Maintaining Confidentiality A, B, C

Complying with a recipient’s right to refuse to

take medications

A, B, C

Maintaining hygiene and current accepted

standards for infection control

A, B, C

Documenting accurately and completely A, B, C

Providing medications according to the five

rights

A, B, C

Having the ability to understand and follow

instructions

A, B, C

Practicing safety in application of medication

procedures

A, B, C

Complying with limitations and conditions

under which a medication aide may provide

medications

A, B, C

Having an awareness of abuse and neglect

reporting requirements

A, B, C

Complying with every recipient’s right to be

free from physical and verbal abuse, neglect,

and misappropriation of property

A, B, C

Nurse ___________________________________________________

Completion Date for Demonstration of Competency on Above

Tasks:_____________________

Attachment C: Medication Aide

Competency Attestation Form

Competency Attestation Form

This form is to be completed by the facility administrator or the registered nurse. Initial to

attest that each requirement is completed and sign below.

Student Name______________________________ Student DOB___________________

Training Location____________________________________________________________

I, _____________________________, attest that _____________________________ has (Please print nurse or administrator name) (Student name)

⎯ Successfully completed the eight-hour Nebraska Health Care Association

Temporary Medication Aide course and competency exam with at least a 72%

or higher.

⎯ Completed at least a minimum of 32 hours working as a temporary medication

aide in the facility under the supervision of a registered nurse

⎯ Is competent in all items listed in 172 NAC 95-003 and 172 NAC 95-005

Included proof of competency:

⎯ Nebraska Health Care Association Online Temporary Medication Aide Course

Certificate

⎯ Medication Aide Skills Sheet

⎯ Medication Aide Competency Checklist

Registered Nurse or Administrator Signature ________________________________________

Competency Date ________________

Attachment D: Medication Aide Certificate


Certificate of Completion

This is to certify that

Student Name: Date of Birth:

Has completed a 40-hour course that meets the Medication Aide requirement.

Pandemic (Temporary) Medication Aide to

Medication Aide 40-Hour Transition Program

Date Completed

Facility Name______________________________________

Facility Registered

Nurse______________________________________________

Attachment E: Medication Aide Skills Packet

Medication Aide Procedure Checklist

Handwashing

Name:

Score Required: 7 / 9 Actual Score:

Critical

Steps

Needs

Review Satisfactory Steps of the Procedure:

1. Gather the needed supplies

© 2017 Nebraska Health Care Association, Inc.

2. Turn on faucet

3. Wet hands and wrists holding the fingertips down

4. Apply soap and work into a lather *** 5. Rub all surfaces of the hands (between fingers, under

nails, and 2 inches above wrists) continuously for at least

15 seconds *** 6.

*** 7.

Rinse hands under running water without touching sink

or faucet, holding fingers down

Dry hands and wrists thoroughly using paper towels

without touching the towel dispenser or sink

8. Turn off faucet with a paper towel

9. Discard paper towel in waste container without

contamination Comments:

Date: Tester:


Glove Removal

Name:


Critical

Steps

Needs

Review Steps of the Procedure: Satisfactory


*** 1. With the fingertips of one hand, pinch the palm of the opposite glove, taking care to touch only the glove

*** 2. Pull the pinched glove toward the fingertips and

remove the glove off of the hand with the glove ending

3.

inside out Hold onto the loose glove with the gloved hand

*** 4. Place the fingers of the ungloved hand inside the cuff of

the gloved hand between the skin at the wrist and the

glove, taking care not to touch the outside surface of the

5.

gloved hands Pull the glove toward the finger tips, turning the glove

6.

inside out Remove the gloves and discard into the nearest waste

***

7.

container Wash and dry hands thoroughly

Comments:

Date: Tester:



Oral Medication

Name:


Critical

Steps

Needs

Review Steps of the Procedure:

Set Up the Medication:

Satisfactory

1. Wash and dry hands thoroughly *** 2. First safety check *** 3. Second safety check

4. Pour the correct dose of medication *** 5. Third safety check

6. Return the medication container to storage 7. Secure the other medications

Beginning Five: 8.

*** 9.

Knock on resident room door to gain entrance if

applicable

Identify the resident 10. Provide privacy 11. Wash and dry hands thoroughly

*** 12. Maintain Safety 13. Final preparations if indicated 14. Assist the resident to a comfortable upright position

*** 15. Provide the medications according to the five rights

Ending Five: 16. Assist the resident to a comfortable position 17. Open the room if appropriate 18. Wash and dry hands thoroughly 19. Record and report

*** 20. Maintain Safety Comments:

Date: Tester:



Topical Medication

Name:


Critical

Steps

Needs



Set Up the Medication: 2. Wash and dry hands thoroughly

*** 3. First safety check

*** 4. Second safety check

5. Measure the topical med, if applicable; pour

the correct dose if a liquid; or retrieve a patch

if ordered

*** 6. Third safety check

7. Return the medication container to storage

8. Secure the other medications

Beginning Five:

9. Knock on resident room door to gain entrance,

if applicable

*** 10. Identify the resident

11. Provide privacy

12. Wash and dry hands thoroughly *** 13. Maintain safety

14. Prepare a clean workspace

15. Apply gloves

16. Observe the skin

*** 17. Apply the topical medication according to

five rights

18. Remove gloves and discard into a waste container

19. Contain the used supplies for disposal

20. Discard the used supplies appropriately

Ending Five:

21. Assist the resident to a comfortable position

22. Open the room if appropriate

23. Wash and dry hands thoroughly

24. Record and report *** 25. Maintain safety

26. Return reusable supplies to storage Comments:

Date: Tester:



Sublingual or Buccal Medication

Name:


Check the type observed: Sublingual Buccal

Critical Steps Steps of the Procedure: Satisfactory


*** 2. First safety check *** 3. Second safety check

4. Pour the correct dose of the medication *** 5. Third safety check


7. Secure the other medications, if applicable

Beginning five:

Needs

Review

8.

*** 9.

Knock on resident room door to gain entrance,

if applicable

Identify the resident

10. Provide privacy


13. Assist the resident to an upright position, if

indicated

14. Apply gloves if indicated *** 15. Provide the medication according to five rights by the

specified route

16. Instruct the resident not to eat or drink until med

dissolves

17. Remove gloves if used and discard into a waste

container

18. Dispose of used supplies, if applicable

Ending five:


***

Comments:



22. Record and report 23. Maintain safety

Date: Tester:



Instillation Medication (Eye, Ear, and Nose)

Name:

Score Required: 17 /24 Actual Score:

Check the type observed: Eye Ear Nose








6. Return other medication to storage


Beginning five: 8. Knock on resident room door to gain entrance, if

applicable


10. Provide privacy


13. Position the resident appropriately: if eye drops,

position on back or seat upright with head tilted back;

if ear drops, position the treated ear facing up; if nose

drops, position on back or seat upright

14. Apply gloves if directed by facility policy

*** 15. Provide the medication according to five rights: if eye

drops or ointment, wait 5 minutes if more than two

types ordered; if ear drops, instruct the resident to

remain in the position for 5-15 minutes; if nose spray,

instruct resident to “sniff” in quickly with each spray

16. Use a tissue to remove excess medication if

applicable

17. Remove gloves and discard in a waste container

18. Discard used supplies

Ending five: 19. Assist the resident to a comfortable position




24. Return the medication container to storage, if

applicable

Needs

Review

Comments:

Date: Tester:


Inhaler Medication

Name:


Critical

Steps

Needs





2. Wash and dry hands thoroughly *** 3. First safety check *** 4. Second safety check *** 5. Third safety check


Beginning five:

7.

*** 8.

Knock on resident room door to gain entrance if

applicable


9. Provide privacy


12. Assist the resident to an upright position

13. Assemble the inhaler and shake well

14. Instruct the resident to tilt his head back slightly and

breathe out *** 15. Provide the medication according to the five rights by

pressing the inhaler as the resident breathes in

16. Instruct the resident to hold his breath for 10 seconds

17. Repeat puff at the appropriate time if ordered

18. Assist the resident with oral care

19. Discard used supplies

Ending five:





25. Clean and store the inhaler Comments:

Date: Tester:



Name: Nebulizer Medication

Score Required: 24/34 Actual Score: Critical

Steps Steps of the Procedure: Satisfactory



4. Retrieve the appropriate medications *** 5. Third safety check




Beginning five:

Needs

Review

9.

*** 10.

Knock on resident room door to gain entrance,

if applicable


11. Provide privacy


14. Assist the resident to an upright position

15. Take vital signs if indicated

16. Apply gloves

17. Measure and mix the medications

18. Place the medication in the nebulizer chamber

19. Connect the mouthpiece and compressor and place

the mouthpiece in the resident’s mouth

20. Turn on the compressor *** 21. Provide or assist with treatment according to the five

rights

22. Instruct the resident to breathe normally and

calmly, and to take a deep breath occasionally

23. Remove the mouthpiece when all of med is inhaled

24. Turn off the compressor

25. Repeat vital signs if indicated

26. Assist the resident with oral care 27. Remove gloves and discard into a waste container

Ending five:





33. Clean and store the equipment

34. Return the medicine container to storage Comments:

Date: Tester:



Oxygen

Name:


Critical Steps

Needs Review Steps of the Procedure: Satisfactory


*** 2. First safety check *** 3. Second safety check *** 4. Third safety check

5. Gather the needed supplies and equipment

Beginning five:

6. Knock on resident room door to gain entrance *** 7. Identify the resident

8. Provide privacy


11. Attach the flowmeter/flow regulator as indicated

12. Connect the tubing and delivery device *** 13. Turn on and adjust the flow rate to the correct dose

14. Apply to the resident

15. Verify the flow rate, humidifier if used, and the

cleanliness of the device. Inspect the condition of

the skin under the device

Ending five:





Comments:

Date: Tester:


Provision of an Ice Bag

Name:

Score Required: 13/19 Critical

Actual Score:

Needs


*** 1.

2.

Check record for type and length of time of

treatment

Gather the needed supplies/equipment

3. Fill the ice bag half full of ice and remove the excess

air

4. Place a cover on the ice bag

5.

Beginning five: Knock on resident room door to gain entrance


7. Provide privacy


10. Uncover the body part to be treated *** 11. Apply the ice bag to the ordered body part *** 12. Check the skin under the ice bag frequently; check

the ice bag for leakage

13. Remove the ice bag at correct time; reinspect the

skin

14.

Ending five: Assist the resident to a comfortable position




19. Clean and return the equipment to storage

Comments:

S teps Steps of the Procedure: Satisfactory Review

Date: Tester:



*** 1.

2.

Check resident record for the type of dressings and the type of procedure to be used

Gather the needed supplies/equipment

3.

Beginning five:

Knock on resident room door to gain entrance *** 4. Identify the resident

5. Provide privacy


8. Sanitize the overbed table including the sides.

Place a clean drape on the table and position the

equipment on a clean surface and within reach. Cut

tape and place on edge of table. Open trash bags

and place within reach. Open the clean dressings

and place on the clean barrier.

9. Assist the resident to a position to expose the old

dressings

10. Apply gloves

11. Remove the old dressings and discard in a trash bag

12. Inspect the wound *** 13. Clean the dry around the wound as directed/ordered

14. Place the material used for cleaning in the trash bag

15. Remove the soiled gloves and discard in a trash bag

16. Apply a clean pair of gloves *** 17. Place the clean dressings on the wound and tape

securely

18. Remove the gloves and discard into a trash bag

19. Close the trash bag(s) to be discarded outside of

the resident’s room

20.




23. Record and report *** 24. Maintain safety *** 25. Discard the trash bag containing the soiled

dressings into a trash container outside the resident

Comments:

room

Date:

Tester:

Dressing Change

Name:


Critical

Steps

Steps of the Procedure: Satisfactory

Needs

Review



Tympanic Temperature

Name:


Critical

Steps

Needs

Review Satisfactory Steps of the Procedure:

1. Gather the needed supplies/equipment



Provide privacy

2.

3.

4.

***


7. Turn on the thermometer unit

8. Apply a disposable cover to the temperature probe *** 9. Place the probe in the resident’s ear canal

10. Hold the probe in place until the thermometer

signals *** 11. Correctly read the temp from the display section of

the thermometer unit

12. Discard the probe cover into a waste container

13. Turn off the thermometer unit, if applicable

Ending five:




17. Record and report any abnormal reading to your

supervisor STAT *** 18. Maintain safety

19. Return the thermometer unit to storage and to the

recharger, if applicable

Comments:

Date: Tester:



Electronic Oral Temperature

Name:


Critical

Steps

Steps of the Procedure: Satisfactory


Beginning five:

Needs

Review

***

2. Knock on resident room door to gain entrance

3. Identify the resident 4. Provide privacy



8. Apply a disposable cover to the temperature probe *** 9. Place the probe under the resident’s tongue

10. Have the resident close his mouth around the probe

11. Hold the probe in place until the thermometer unit



13. Discard the probe cover into a waste container

14. Turn off the thermometer unit, if applicable

Ending five:




18. Record and report any abnormal reading STAT *** 19. Maintain safety


recharger, if applicable Comments:

Date: Tester:



Electronic Rectal Temperature

Name:


Critical Steps

Needs





Provide privacy

2.

3.

4.

***



8. Apply gloves

9. Apply a disposable cover to the temperature probe

10. Place a small amount of lubricating jelly on a tissue

and apply the lubricant to the end of the probe

11. Assist the resident on his side, the upper knee bent

12. Expose the buttocks *** 13. Lift the upper buttock and gently insert the probe 1

to 1½ inches into the rectum. Cover the buttocks

with the bed linen.




16. Discard the probe cover in a waste container

17. Remove the gloves and discard in a waste container

18. Turn off the thermometer unit

Ending five:







Comments:

Date: Tester:



Electronic Axillary Temperature

Name:


Critical

Steps

Needs





2.

3.

***

4. Provide privacy


7. Turn the thermometer unit on

8. Assist the resident to remove the resident’s arm

from the gown or clothing and wipe away any

moisture from under the arm with a tissue

9. Apply a disposable cover to the temperature probe *** 10. Place the probe in the center of the armpit and fold

the resident’s arm across his chest




13. Discard the probe cover and discard in waste

container

14. Assist the resident to place his arm into the gown

or clothing

15. Turn off the thermometer unit

Ending five:





supervisor STAT *** 20. Maintain safety



Comments:

Date: Tester:



Apical Pulse

Name:


Critical

Steps

Needs




Identify the resident Provide privacy

2.

3. 4.

***


7. Assist the resident to a position to access the

resident’s chest, if indicated; provide a quiet

environment

8. Clean the ear pieces and the diaphragm *** 9. Uncover the left side of the chest maintaining

privacy

10. Place the ear pieces of the stethoscope in ears and

the diaphragm on the resident’s chest under the left

nipple *** 11.

12.

Count the heart beat for 60 seconds

Ending five:

Assist the resident to a comfortable position

13. Open the room, if appropriate



17. Clean the equipment and return to storage *** 18. Pulse must be within 4 BPM of tester

Comments:

Date: Tester:



Radial Pulse

Name:


Critical

Steps

Needs


1. Gather the needed equipment Beginning five:


4. Provide privacy


7. Position the resident appropriately so the arm is

supported and comfortable for the resident

8. Press gently until a pulse is felt over the radial artery

9. Count the number of beats for one full minute

Ending five:





supervisor STAT *** 14. Maintain safety *** 15. Radial pulse should match the tester within 4 BPM

Comments:

Date: Tester:



Respirations

Name:


Critical

Steps

Needs




Identify the resident Provide privacy

2.

3. 4.

***


7. Position the resident appropriately

8. Count the number of respirations for one full minute

Ending five:




12. Record and report any abnormal reading STAT *** 13. Maintain safety *** 14. Respirations should match the tester within

two/minute Comments:

Date: Tester:



Blood Pressure

Name:


Critical

Steps

Needs


1. Gather the needed supplies/equipment 2. Clean the ear tips and diaphragm of the

stethoscope

Beginning five:

3. Knock on the resident room to gain entrance *** 4. Identify the resident

5. Provide privacy


8. Position the resident comfortably with arm

supported at the heart level

9. Wrap the cuff smoothly and snugly, 1-1½ inches

above the elbow

10. Locate and center the cuff tubing over the brachial

artery

11. Close the valve of the sphygmomanometer bulb *** 12. Place the diaphragm over the brachial pulse and the

ear pieces in your ears *** 13. Inflate the cuff to about 30 mm above the resident’s

usual blood pressure (if this is unknown inflate to 30

mm above the point where the radial pulse disappears) 14. Deflate the cuff slowly by turning the thumbscrew

counter-clockwise and listen for the sounds *** 15. Note the measurement of the first sound and the

last sound

16. When no sound is heard, deflate the cuff to zero

17. Remove stethoscope from your ears and remove the

cuff

Ending five:





23. Clean stethoscope ear tips and diaphragm and

return to storage *** 24. The blood pressure reading should match the tester

within 4 points of each number

Comments:

Date: Tester:



PRN Medication

Name:


Critical

Steps

Needs


1. Check when the PRN med was last given and how

often the medication can be given

Check the reason for the drug 2.

3. Verify with the person providing direction and

monitoring *** 4. Give the drug ONLY for the correct reason and at the

right time






Beginning five:


14. Provide privacy


17. Position the resident, if indicated

18. Final preparations, if indicated

19. Apply gloves, if indicated *** 20. Provide the medication according to the five rights

21. Remove gloves if used and discard in a waste

container

Ending five:




25. Record and report the time given and the reason *** 26. Maintain safety *** 27. Observe the resident as directed *** 28. Check medication results one hour later and record

29. Report observations as directed

Comments:

Date: Tester:



Vaginal Cream

Name:

Score Required: 23/ 33 Actual Score:

Critical

Steps Steps of the Procedure: Satisfactory



Needs

Review



7. Return medication container to storage 8. Secure the other medications

Beginning five: 9. Knock on resident room door to gain entrance


11. Provide privacy


14. Position the equipment on a clean barrier within

reach

15. Apply gloves

16. Final preparation

17. Position the resident on her back with knees bent

18. Drape the resident to expose only the genitalia

19. Inspect the external genitalia, vaginal canal

20. Separate the labia *** 21. Using the index finger or an applicator, insert the

medication 3-4 inches into the vagina

22. Remove the applicator and place on a paper towel

23. Wipe off residual cream from the labia

24. Instruct the resident to remain on her back for at

least 10 minutes

25. Remove the drape

26. Dispose of or clean supplies

27. Remove gloves and discard into a waste container

Ending five:




32. Record and report the time given and the reason

33. Rinse out the applicator and return to storage Comments:

Date: Tester:



Rectal Suppository

Name:


Critical Steps



Set up the medication

Comments:

Date: Tester:

2. Wash and dry hands thoroughly *** 3. First safety check


5. Pour the correct dose of medication




9.

Beginning five:

Knock on resident room door to gain entrance


11. Provide privacy


*** 13. Maintain safety

14. Position the equipment on a clean barrier within reach

15. Assist the resident on his left side, upper leg flexed

16. Drape the buttocks to expose the anus

17. Apply gloves

18. Remove the suppository from wrapper, apply lubricant

19. Lift buttocks to expose anus

20. Instruct the resident to take several deep breaths through

***

21.

the mouth Deliver the medication according to the five rights. Direct

22.

the tapered end of suppository toward umbilicus

Encourage the resident to retain the suppository for at

23.

least 20 minutes.

Wipe off excess lubricant from the anal area

24. Remove the drape

25. Dispose of supplies, and remove gloves and discard into

a waste container Ending five:


27. Open the room if appropriate 28. Wash and dry hands thoroughly 29. Record and report the time given with the reason *** 30. Maintain safety



Provision of One Type of Insulin

Name:



1. Gather the needed equipment and supplies



Needs

Review

5. If using intermediate or long-acting insulin, roll the

vial

6. Check how many units are needed

7. Wipe the top of the insulin vial with an alcohol prep

8. Pull back on syringe plunger to the amount of

insulin ordered

9. Insert the needle into the vial and push the air in the

vial *** 10. With needle in vial, turn upside down and draw up

the correct dose

11. If air bubbles are visible, tap the side of the syringe

and push out air bubbles and extra insulin

12. Remove the syringe and recap needle with one hand *** 13. Third safety check *** 14. Have insulin dose checked by another person per

policy

15. Return medication container to storage


17. Select injection site according to rotation plan

Beginning five:


20. Provide privacy


23. Position the equipment on clean barrier within

reach

24. Assist the resident to access the injection site

25. Apply gloves

26. Clean the injection site with alcohol in circular

motion and let air dry

27. Remove the protective needle sheath

28. With the nondominant hand, pinch the skin

29. Instruct the resident he/she will feel a prick

30. With the dominant hand, insert the needle at the



Critical Needs

appropriate angle

31. Inject the insulin in a steady slow motion

32. When the syringe is empty, pull the needle out at

the same angle

33. Apply pressure to the injection site to prevent

leaking

34. Pull the protective guard over the needle

35. Dispose of the syringe in a sharps container


37. Remove gloves and discard in trash container

38.


39. Open the room, if appropriate


41. Record medication with injection site and report *** 42. Maintain safety

43. Observe frequently for diabetic reactions

Comments:

Steps Steps of the Procedure: Satisfactory Review

Date: Tester:



Combining Two Insulins for Insulin Injection

Name:




Set Up the Medications:


Needs

Review

5. If using intermediate or long-acting insulin, roll

the vial

6. Wipe the tops of the insulin vials with alcohol

preps

7. Check how many units of intermediate or long-acting

(cloudy) insulin you need to inject. Pull back the

plunger to draw that amount of air into the syringe

that matches the ordered insulin dose.

8. Insert the needle into vial #1, push the air in;

remove syringe and needle

9. Check how many units of rapid or short-acting (clear) insulin you need to inject. Pull back the plunger to

that number of units that matches the insulin order.

10. Insert the needle into vial #2, push the air in *** 11. Invert vial #2, pull back the plunger to withdraw

the amount ordered

12. If air bubbles visible, tap the side of syringe and

push out or push the plunger all the way in and

withdraw again slowly to get rid of the bubbles *** 13. Have insulin dose checked by another nurse per

policy

14. Withdraw syringe from vial #2 and insert into

vial #1 *** 15. Invert vial #1 and withdraw the ordered amount

16. Remove syringe from vial #1 and recap the needle

without contaminating *** 17. Third safety check *** 18. Have insulin dose checked by another nurse as

per policy

19. Return containers to storage


21. Choose the injection site according to rotation

plan

Beginning five:




Critical Steps


24. Provide privacy



reach

28. Assist the resident to access the injection site

29. Apply gloves




32. With the nondominant hand, pinch the skin


34. With the dominant hand, insert the needle at the

appropriate degree angle

35. Inject the insulin in a steady slow motion

36. When syringe is empty, pull needle out at the

same angle

37. Apply pressure to the injection site to prevent

leaking


39. Dispose of the syringe in a sharps container

40. Remove gloves and discard into a trash container

Ending five:




44. Record the medication with the injection site

and report *** 45. Maintain safety

46. Observe frequently for diabetic reactions

Comments:

Date: Tester:




7. Return medication container to storage or dispose

of properly


9. Select injection site according to plan

10. Take the medication and alcohol wipe to the

resident.



13. Provide privacy



reach

17. Assist the resident to access the injection site Inspect site for bruises, tenderness or irritation

18. Apply gloves




21. With one hand, gently stretch skin between with

forefinger and thumb.


23. With your other hand, hold the syringe almost level with

the skin. Gently insert the needle in under the skin at a

5-15 degree angle with the bevel up until resistance is felt

24. Press the plunger in a gentle, steady motion until the

medication is gone. A small bleb will form


the same angle

26. Apply gentle pressure to the injection site to

prevent leaking

Provision of Intradermal Injection

Name:





Needs

Review


*** 3. First safety check *** 4. Second safety check

5. Withdraw medication into syringe from vial or

ampule using appropriate technique.



Critical Steps



28. Dispose of the syringe and needle in a sharps

container


30. Remove gloves and discard in trash container

Ending five:





36. Observe frequently for reactions Comments:

Date: Tester:



Provision of Subcutaneous Injection

Name:


Critical

Steps

Needs




Wash and dry hands thoroughly

First safety check

2.

3. ***



ampule using appropriate technique



of properly




resident



13. Provide privacy



reach


18. Apply gloves



20. Remove the protective needle sheath 21. With one hand, gently pinch skin between with

forefinger and thumb


23. With your other hand, hold the syringe like a pencil or

dart. Gently insert the needle quickly and firmly at a 45-

90 degree angle.

24. Release the skin. Do not let go of or move the syringe.

25. Pull back on the plunger. If no blood appears, press the

plunger in a gentle, steady motion until the medication is

gone


the same angle




Critical Steps

Needs Review Steps of the Procedure:

prevent leaking

Satisfactory

28.

29.

Pull the protective guard over the needle

Dispose of the syringe and needle in a sharps

container

Dispose of or clean supplies

Remove gloves and discard in trash container


Open the room if appropriate


30.

31.

32.

33.

34.



Date: Tester:



Provision of Intramuscular Injection

Name:


Critical

Steps

Needs




Wash and dry hands thoroughly 2.



ampule using appropriate technique



of properly




resident



13. Provide privacy



reach


18. Apply gloves



20. Remove the protective needle sheath 21. With one hand, gently spread skin between with

forefinger and thumb to one side


23. With your other hand, hold the syringe like a pencil or

dart. Gently insert the needle quickly and firmly at a

90 degree angle

24. Release the skin. Do not let go of or move the syringe.

25. Pull back on the plunger. If no blood appears, press the

plunger in a gentle, steady motion until the medication is

gone


the same angle





Critical Steps

Needs Review Steps of the Procedure:

prevent leaking

Satisfactory

28.

29.

Pull the protective guard over the needle

Dispose of the syringe and needle in a sharps

container

Dispose of or clean supplies

Remove gloves and discard in trash container


Open the room if appropriate


30.

31.

32.

33.

34.



Date: Tester:



Providing Medications via Feeding Tube

Name:


Critical Steps


1. Obtain the needed supplies/equipment Set Up the Medication(s):


5. Pour each medication in a separate med cup *** 6. Third safety check



9. Crush the meds that need crushing and place in

one cup

10. Add 30-45 cc of warm water to the cup of crushed

meds. Dilute thick liquids.

Beginning five:


13. Provide privacy



reach *** 17. Position the resident with the HOB at 30-45

degrees

18. Explain procedure to resident

19. Apply gloves

20. Position a protective barrier under the tube

connection site

21. Remove clamp or plug from end of tube *** 22. Check for proper placement of the feeding tube

23. Check the stomach for residual feeding

24. Remove plunger and attach syringe to tube end

25. Hold the syringe 6 inches above the level where the

tube enters the resident’s body

26. Flush the feeding tube with 30 cc warm water *** 27. Pour the liquefied meds into the syringe; allow to

flow by gravity *** 28. Flush the tube with 5-10 cc water between

crushed and liquid meds. Rinse medication cup

with water and pour into syringe



Critical Steps


*** 29. Flush the tube with a minimum of 30 cc water

after all the medications have flowed in

30. Reclamp or plug the feeding tube

31. Remove the protective drape

32. Instruct the resident to sit upright or on right side

for at least 20 minutes.


34. Remove gloves and discard into a trash container

35. Rinse equipment and store with protective cover

36. Ensure the syringe is labeled with the resident’s

name and the date opened; replace every 24 hours

Ending five:




40. Record and report the total amount of water

given *** 41. Maintain safety

Comments:

Date: Tester:

pandemic (temporary) medication aide to medication aide

Documents