Supervising ConsumerSupervising ConsumerSelf Administration of MedicationSelf Administration of Medication

(SAM)(SAM)

Information, Rules, and LawsInformation, Rules, and LawsPrepared by Scooter Brown, RN, Director of NursingPrepared by Scooter Brown, RN, Director of Nursing

Annual Refresher TrainingAnnual Refresher Training

For MR Staff, Foster Care Providers, For MR Staff, Foster Care Providers,

and Villa Del Sol Staffand Villa Del Sol Staff

Class ObjectivesClass ObjectivesUnderstand:Understand:

Role of UnlicensedRole of Unlicensed(non-nursing) Staff(non-nursing) StaffClassifications of Classifications of

MedicationsMedicationsPurpose/Intended Purpose/Intended

Effects of MedicationsEffects of MedicationsCommon Side Effects of Common Side Effects of

MedicationsMedicationsMedication Rules & Medication Rules &

LawsLaws

Medication RulesMedication Rulesand Lawsand Laws

Who Makes the Rules?Who Makes the Rules? Federal Drug Federal Drug

Enforcement Agency Enforcement Agency (DEA)(DEA)

Texas Legislature per Texas Legislature per Texas Administrative Texas Administrative CodeCode

Texas Board of PharmacyTexas Board of Pharmacy Texas Medical BoardTexas Medical Board Texas Board of Nurse Texas Board of Nurse

ExaminersExaminers Texas Department of Texas Department of

Public Safety (DPS)Public Safety (DPS) OtherOther

Why are the rules for prescription Why are the rules for prescription medications so strict?medications so strict?

Many medications require a Many medications require a prescription because they prescription because they are too dangerous without are too dangerous without

a doctor’s supervision. a doctor’s supervision. Most prescriptions fall into Most prescriptions fall into

this this “dangerous drug”“dangerous drug” category. Other category. Other

prescription medications prescription medications have potential to become have potential to become

habit forming, easily habit forming, easily abused, be sedating, or abused, be sedating, or

may interfere with may interfere with breathing. These are called breathing. These are called

“controlled substances”“controlled substances” and are monitored even and are monitored even

more strictly.more strictly.

History of the Psychiatric Patient History of the Psychiatric Patient and Person With Mental and Person With Mental

RetardationRetardation Years ago persons with Mental Retardation or Years ago persons with Mental Retardation or

Mental Illness had very limited treatment options. Mental Illness had very limited treatment options. Their care required 24 hour nursing staff.Their care required 24 hour nursing staff.

Medications and treatments have developed that Medications and treatments have developed that allow persons with Mental Retardation or Mental allow persons with Mental Retardation or Mental Illness to function more independently and Illness to function more independently and nursing tasksnursing tasks (such as medication issues and (such as medication issues and other health care functions) can be other health care functions) can be delegateddelegated to to non-nursing staff.non-nursing staff.

Community Mental Health settings and Group Community Mental Health settings and Group Homes allow consumers to Self Administer their Homes allow consumers to Self Administer their own medications with trained staff supervising own medications with trained staff supervising and an appropriate level of assistance. These staff and an appropriate level of assistance. These staff may supervise medications, but are may supervise medications, but are not allowed not allowed to administer medicationsto administer medications..

Criteria for Delegation to Criteria for Delegation to Unlicensed Assistive StaffUnlicensed Assistive Staff

Per Texas Board of Nurse ExaminersPer Texas Board of Nurse ExaminersCRITERIACRITERIA

Consumer or guardian is willing to participate in Consumer or guardian is willing to participate in consumer’s care.consumer’s care.

Consumer has a stable predictable condition Consumer has a stable predictable condition (chronic not recuperative).(chronic not recuperative).

Consumer is in an independent living Consumer is in an independent living environment.environment.

PROCESSPROCESS An RN assessment An RN assessment (or)(or)

An LVN evaluation with a physicianAn LVN evaluation with a physiciansignaturesignature

of the consumer to determine if of the consumer to determine if delegation of the nursing task is delegation of the nursing task is

appropriate and the level of appropriate and the level of assistance required.assistance required.

A medication class must be taught by A medication class must be taught by a Registered Nurse.a Registered Nurse.

A Nurse must verify the competency A Nurse must verify the competency of the unlicensed staff to of the unlicensed staff to perform the nursing task.perform the nursing task.

A Nurse should be available for A Nurse should be available for consultation andconsultation and questions.questions.

Staff’s RoleStaff’s Role

DefinitionsDefinitions

Definitions:Definitions: Self Administer Medications (SAM)Self Administer Medications (SAM)

A consumer taking his own medication out of the A consumer taking his own medication out of the container and taking or applying it.container and taking or applying it.

Supervising/Assisting with SAMSupervising/Assisting with SAM Staff gesturing, prompting, instructing consumer, or Staff gesturing, prompting, instructing consumer, or

offering hand-over-hand help and making sure the “five offering hand-over-hand help and making sure the “five rights” are correct.rights” are correct.

Administer MedicationAdminister Medication Taking a medication out of a container, placing a Taking a medication out of a container, placing a

medication in the mouth, or applying a medication.medication in the mouth, or applying a medication. (Only nurses may do this.)(Only nurses may do this.)

Dispense MedicationDispense Medication To place medication in a container or label a medication To place medication in a container or label a medication

container. (Staff or nurses may not label or fill bottles.)container. (Staff or nurses may not label or fill bottles.)

Who May Do These Tasks?Who May Do These Tasks?

Self AdministerSelf AdministerConsumerConsumer

AdministerAdministerLicensed NurseLicensed Nurse

Supervise Consumers Who Self Supervise Consumers Who Self AdministerAdminister Trained StaffTrained Staff

DispenseDispensePharmacist or DoctorPharmacist or Doctor

What is Staff’s Role With What is Staff’s Role With Medications?Medications?

Help the Help the Consumer Be Consumer Be IndependentIndependent

Help Keep the Help Keep the Consumer SafeConsumer Safe

Follow Federal and Follow Federal and State LawsState Laws

Teaching ConsumersTeaching ConsumersAbout Their MedicationsAbout Their Medications

We offer our consumers the opportunity We offer our consumers the opportunity to learn about their medication, but to learn about their medication, but

consumers are not requiredconsumers are not required to know or to know or recite medication information.recite medication information.

Expected Action of theExpected Action of theMedicationMedication

Sometimes different for Sometimes different for MR population than MR population than general population.general population.

Example: Antidepressants may Example: Antidepressants may be prescribed for obsessive be prescribed for obsessive

compulsive disorder,compulsive disorder,Antipsychotics may be Antipsychotics may be

prescribed for racing thoughts prescribed for racing thoughts or impulsivity,or impulsivity,

There may be an opposite There may be an opposite reaction (paradoxical reaction (paradoxical

response) to some response) to some medicationsmedications

Possible Side Effects to the Possible Side Effects to the MedicationMedication

May be temporaryMay be temporaryHelp the consumer track Help the consumer track

the frequency and the frequency and severity so the doctor severity so the doctor or nurse will know if or nurse will know if

the medication should the medication should be continued or is mild be continued or is mild

enough to tolerate.enough to tolerate. The consumer may The consumer may

not necessarily not necessarily have to discontinue have to discontinue

the medication.the medication.

What are the rules for What are the rules for consumer’s medications?consumer’s medications?

There must be a doctor’s order or prescription for the medication.There must be a doctor’s order or prescription for the medication. In a group home or foster care provider home there must be a In a group home or foster care provider home there must be a

Medication Administration Record (MAR) that matches doctors’ orders Medication Administration Record (MAR) that matches doctors’ orders or prescriptions.or prescriptions.

The medication container must be labeled by a pharmacist or The medication container must be labeled by a pharmacist or doctor/practitioner.doctor/practitioner.

Only a doctor, pharmacist, or consumer may place the medications in Only a doctor, pharmacist, or consumer may place the medications in the prescription bottle. A nurse may fill a consumer’s “pill minder”, the prescription bottle. A nurse may fill a consumer’s “pill minder”, “pill planner”, or similar container specifically designed for “pill planner”, or similar container specifically designed for medication storage (or an RN may specifically delegate this function medication storage (or an RN may specifically delegate this function in accordance with the Nurse Practice Act guidelines.)in accordance with the Nurse Practice Act guidelines.)

Only the person on the prescription may use the medication.Only the person on the prescription may use the medication. Only a nurse or doctor may call in new medications or changes in Only a nurse or doctor may call in new medications or changes in

medication doses or instructions to a pharmacy.medication doses or instructions to a pharmacy. In our MR setting the consumer must self administer his own In our MR setting the consumer must self administer his own

medication with supervision of staff.medication with supervision of staff. Only a licensed nurse can administer medication.Only a licensed nurse can administer medication. If there is a medication error the nurse or doctor must be notified for If there is a medication error the nurse or doctor must be notified for

instructions.instructions.

The Medication LabelThe Medication Label

Every medication Every medication label should have label should have

the following the following information:information:

Consumer NameConsumer Name

Medication NameMedication Name

Medication DoseMedication Dose

Time to Take ItTime to Take It

Way (route) to Take ItWay (route) to Take ItThis should be verified This should be verified

with the MAR.with the MAR.

Items to Check When Items to Check When Supervising SAMSupervising SAM

TheThe““Five Rights” of Five Rights” of

MedicationMedicationRight PersonRight Person

((Correct Consumer Name on the Med Correct Consumer Name on the Med Bottle)Bottle)

Right MedicationRight Medication(Correct Name of Medication on the Med (Correct Name of Medication on the Med

Bottle)Bottle)

Right DoseRight Dose(Correct Amount or Size of Pill)(Correct Amount or Size of Pill)

Right TimeRight Time(Correct Time of Day)(Correct Time of Day)

Right RouteRight Route(Correct Way)(Correct Way)

Supervising Consumer’s Self Supervising Consumer’s Self Administration of MedicationAdministration of Medication

1.1. Notify consumer it is time for medication.Notify consumer it is time for medication.

2.2. Have consumer clean area and wash hands.Have consumer clean area and wash hands.

3.3. Have consumer gather equipment and meds (glass Have consumer gather equipment and meds (glass of water, pill cup).of water, pill cup).

4.4. First check: verify “five rights” and pill count First check: verify “five rights” and pill count before consumer removes pill from container.before consumer removes pill from container.

5.5. Second check: as consumer places pill in pill cup Second check: as consumer places pill in pill cup verify “five rights” again.verify “five rights” again.

6.6. Third check: as consumer places medication back Third check: as consumer places medication back in med container verify “five rights” again.in med container verify “five rights” again.

7.7. Documentation: staff initial, number of pills Documentation: staff initial, number of pills remaining.remaining.

Medication Medication Administration RecordAdministration Record

It is a LegalIt is a LegalDocumentDocument

1.1. Use correct Use correct documentation documentation procedures.procedures.

2.2. Use black ink only.Use black ink only.3.3. No White Out.No White Out.4.4. Sign at the time Sign at the time

you supervise the you supervise the medication being medication being taken. taken.

PRN MedicationsPRN Medications1.1. ““PRN” means “as needed” and there has PRN” means “as needed” and there has

to be a doctor’s order (Standing Orders) to be a doctor’s order (Standing Orders) and the same SAM procedure must be and the same SAM procedure must be followed as for prescription medications, followed as for prescription medications, except that it is not necessary for the staff except that it is not necessary for the staff to enter a pill count for prn medications.to enter a pill count for prn medications.

2.2. Staff documents consumer’s symptoms or Staff documents consumer’s symptoms or reason for prn medication and time prn is reason for prn medication and time prn is taken.taken.

3.3. Staff monitors consumer for desired effect Staff monitors consumer for desired effect and documents results.and documents results.

4.4. If symptoms persist call the nurse.If symptoms persist call the nurse.

Medication StorageMedication StorageMedications must be stored Medications must be stored

separately from other separately from other items.items.

Topicals (creams or Topicals (creams or ointments) and drops must ointments) and drops must be kept separate from oral be kept separate from oral

meds.meds.Medications must be in a Medications must be in a

locked cabinet.locked cabinet.Controlled substances must Controlled substances must

be in a locked box inside a be in a locked box inside a locked cabinet.locked cabinet.

A pill count must be A pill count must be maintained for maintained for

prescription medications.prescription medications.Medications must remain in Medications must remain in

their original containers.their original containers.

Transporting Transporting MedicationsMedications

Never leave Never leave medications in medications in

a vehiclea vehicle

-theft risk-theft risk

-heat or cold -heat or cold can damage or can damage or alter alter medicationsmedications

Medication Errors Can Be Medication Errors Can Be Dangerous!Dangerous!

Medication Errors Are Strictly Monitored By Local, State, and Medication Errors Are Strictly Monitored By Local, State, and Federal OversightFederal Oversight

TYPES OF MEDICATION ERRORSTYPES OF MEDICATION ERRORSDocumentation ErrorsDocumentation Errors

Administration and Dosage ErrorsAdministration and Dosage ErrorsOmission ErrorsOmission Errors

Missing Pills or Incorrect Pill CountsMissing Pills or Incorrect Pill CountsMOST MEDICATION ERRORS OCCUR WHEN STAFF IS IN A MOST MEDICATION ERRORS OCCUR WHEN STAFF IS IN A

HURRY OR DISTRACTED BY OTHER TASKSHURRY OR DISTRACTED BY OTHER TASKS

Poison ControlPoison Control

1-800-222-12221-800-222-1222

Do not throw away Do not throw away medication!medication!

Several agencies Several agencies regulate how expired regulate how expired

and contaminated and contaminated medication must be medication must be

disposed of.disposed of.These medications These medications must be given to the must be given to the nurse who will follow nurse who will follow

the appropriate the appropriate disposal process. disposal process.

NEVER throw away a NEVER throw away a pill, a liquid, or a pill, a liquid, or a

container of container of medication.medication.

Questions?Questions?Questions about the content of this refresher training, medications, or the SAM Questions about the content of this refresher training, medications, or the SAM

process should be directed to Scooter Brown, RN, Director of Nursingprocess should be directed to Scooter Brown, RN, Director of Nursing830-792-3300 ext 2068 (or) sbrown@hillcountry.org830-792-3300 ext 2068 (or) sbrown@hillcountry.org

TestTest

After completing the test, please send it to:After completing the test, please send it to:

Suzanne LindellSuzanne Lindell

Director, Staff DevelopmentDirector, Staff Development

By e-mail: By e-mail: slindell@hillcountry.orgslindell@hillcountry.org

(Fax) 830-896-4448(Fax) 830-896-4448