table of contents -...

TABLE OF CONTENTS

Written Examinations

Multiple Choice Exam ...........................................................................................................1

Multiple Choice Exam Answer Key ......................................................................................5

MAR Review Exam Materials ...............................................................................................9

MAR Review Exam Answer Key ........................................................................................ 29

MAR Review Alternate Exam Materials ............................................................................. 37

MAR Review Alternate Exam Answer Key ........................................................................ 57

PA DPW MEDICATION ADMINISTRATION PROGRAM

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MULTIPLE CHOICE EXAM


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Practicum Observer Multiple Choice Examination

Read each question carefully. Circle the answer on the examination. There is only one correct answer for each question.

1. A Practicum Observer is a person who: a. Reviews Medication Administration Records (MARs). b. Observes medication administration. c. Conducts medication training. d. A and B only

2. A medication administration observation involves: a. Preparation, administration, and completion. b. Preparation, administration, communication, and completion. c. The medication administration cycle. d. Mindfulness, maximizing capabilities, and communication.

3. When conducting a medication administration observation the practicum observer should:

a. Behave in a manner so as to avoid distracting the administrator. b. Explain to the administrator what is expected during the administration. c. Assure that the administrator correctly identifies the five rights. d. All of the above

4. The rights of medication administration are: a. Person, medication, time, documentation, and route. b. Person, medication, dose, time, and route. c. Person, medication, time, dose, route, and strength. d. Person, medication, method, position, time, and dose.

5. You will know that the person has completed the correct medication administration steps because:

a. They will write all the steps down. b. They will tell you the steps as they do them. c. A and B d. None of the above


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Practicum Observer Multiple Choice Examination (cont.)

6. Tanya Green is preparing to give Freddy his Lipitor. She pulls out the bottle dated 7/1/05 for Lipitor 10mg, give 1 tablet twice a day and compares it to the MAR which reads Lipitor 10mg, give 2 tablets twice a day. She counts out 2 tablets. What should you do?

a. Nothing. Tanya gave the correct dose of medication. b. Change the directions on the label so they are the same as on the MAR. c. Stop the administration and verify the correct dose of the Lipitor. d. Tell Tanya to inform other staff at shift change.

7. Foster is preparing Melissa’s morning medication. He hears yelling and a thump on the floor. There is no one in the area where he is preparing medication and he is the only person on duty. What should Foster do?

a. Leave the medication container open, shut the door and go to investigate. b. Nothing, he should not disrupt the medication administration process. c. Close the medication container, shut the door and go to investigate. d. Close the medication container, lock the door and go to investigate.

8. Sheldon prepares and administers Chip’s morning medication. Just after he administers the medication the phone rings and he goes to answer it. His supervisor instructs him to make copies of some documents from Freddy’s record. What should Sheldon do next?

a. Document Chip’s medication administration. b. Pull Freddy’s record out and make copies. c. Call the administrative office to make copies of Freddy’s records since he

doesn’t have access to a copy machine. d. Make copies of Chip’s records.

9. In order to properly identify a person for medication administration you should? a. Ask the person their name. b. Compare them to a current picture. c. Ask another staff person who knows the person. d. A and B

10. Observation for side effects occurs: a. After giving the medication. b. By reading the chart. c. Over time. d. A and C


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MULTIPLE CHOICE EXAM ANSWER KEY


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Practicum Observer Multiple Choice Examination

Answer Key

Read each question carefully. Circle the answer on the examination. There is only one correct answer for each question.

1. A Practicum Observer is a person who: a. Reviews Medication Administration Records (MARs). b. Observes medication administration. c. Conducts medication training. d. A and B only

2. A medication administration observation involves: a. Preparation, administration, and completion. b. Preparation, administration, communication, and completion. c. The medication administration cycle. d. Mindfulness, maximizing capabilities, and communication.

3. When conducting a medication administration observation the practicum observer should:

a. Behave in a manner so as to avoid distracting the administrator. b. Explain to the administrator what is expected during the administration. c. Assure that the administrator correctly identifies the five rights. d. All of the above

4. The rights of medication administration are: a. Person, medication, time, documentation, and route. b. Person, medication, dose, time, and route. c. Person, medication, time, dose, route, and strength. d. Person, medication, method, position, time, and dose.

5. You will know that the person has completed the correct medication administration steps because:

a. They will write all the steps down. b. They will tell you the steps as they do them. c. A and B d. None of the above


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Practicum Observer Multiple Choice Examination (cont.)

6. Tanya Green is preparing to give Freddy his Lipitor. She pulls out the bottle dated 7/1/05 for Lipitor 10mg, give 1 tablet twice a day and compares it to the MAR which reads Lipitor 10mg, give 2 tablets twice a day. She counts out 2 tablets. What should you do?

a. Nothing. Tanya gave the correct dose of medication. b. Change the directions on the label so they are the same as on the MAR. c. Stop the administration and verify the correct dose of the Lipitor. d. Tell Tanya to inform other staff at shift change.

7. Foster is preparing Melissa’s morning medication. He hears yelling and a thump on the floor. There is no one in the area where he is preparing medication and he is the only person on duty. What should Foster do?

a. Leave the medication container open, shut the door and go to investigate. b. Nothing, he should not disrupt the medication administration process. c. Close the medication container, shut the door and go to investigate. d. Close the medication container, lock the door and go to investigate.

8. Sheldon prepares and administers Chip’s morning medication. Just after he administers the medication the phone rings and he goes to answer it. His supervisor instructs him to make copies of some documents from Freddy’s record. What should Sheldon do next?

a. Document Chip’s medication administration. b. Pull Freddy’s record out and make copies c. Call the administrative office to make copies of Freddy’s records since he

doesn’t have access to a copy machine. d. Make copies of Chip’s records.

9. In order to properly identify a person for medication administration you should? a. Ask the person their name. b. Compare them to a current picture. c. Ask another staff person who knows the person. d. A and B

10. Observation for side effects occurs: a. After giving the medication. b. By reading the chart. c. Over time. d. A and C


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MAR REVIEW EXAM MATERIALS


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MAR Review Examination

Melissa Sullivan

Pharmacy Label 1

Pharmacy Label 2


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Pharmacy Label 3


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Medication Administration Record (MAR) Exam – MAR Review for Brenda Boyer on 7/15/2003

MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Mysoline 500 mg Take one tablet four times a day for seizures.

8 am SC FG FG FG FG FG SC SC JC BB BB BB BB SC

12 noon SC FG FG FG FG FG SC SC BB BB BB BB BB SC

4 pm AC JM JM JM JM JM AC AC JM JM JM JM JM AC

8 pm AC GD GD GD GD GD AC AC GD GD GD GD GD AC

Diastat rectal gel 10 mg Insert one rectally as needed for seizures lasting longer than 15 minutes. Call if no response.

Amoxicillin 250 mg/5 cc Take 5 cc by mouth three times a day for 7 days for infection.

8 am SC JC BB BB BB BB 4 pm SC SC JM JM JM JM JM 8 pm AC AC JM JM JM JM JM

Benadryl 25 mg Give one capsule by mouth every 6 hours as needed for itch or rash for 3 days. Return if not improved in 3 days.

9 am BB JM

Dates of administration from: 7/1/2003 to 7/31/2003 PHYSICIAN(S): Leo Smith, Tim Barn ALLERGIES: None DIAGNOSES: Seizures, Aicardi, scoliosis, congenital encephalopathy, quadriplegia, infection NAME: Melissa Sullivan DOB 12/1/1978 ID NUMBER: 000-0000-00

6 pm


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Medication Administration Record (MAR) - Back

DATE TIME GIVEN

MEDICATION & DOSE ROUTE REASON RESPONSE INITIALS

7/5/2003 6 pm Benadryl 25 mg Mouth Itching Improved JM

INITIALS ADMINISTRATOR’S SIGNATURE INITIALS ADMINISTRATOR’S SIGNATURE

TG Tanya Green JC Julie Christy FG Foster Grant SC Sheldon Collins JM Jim Morgan BB Brenda Boyer GD Glenda Dopson AC Amanda Coulter


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Melissa Sullivan

ER Visit Sheet

Melissa Sullivan DOB 12/1/1978 #000-0000-00 Date of visit: 7/4/2003 Reason for visit: Rash after walking in the woods Impression: Poison ivy Recommendations:

1. Benadryl 25 mg – Give one capsule by mouth every 6 hours as needed for itch or rash for 3 days.

2. Keep area clean and dry. 3. Return if not improved in 3 days.

Physician: Tom Brown MD Hospital: Anytown General Hospital Chart Notes

Melissa Sullivan DOB 12/1/1978 #000-0000-00 7/4/2003 6 pm Melissa was scratching her arm where the rash is. Gave Benadryl 25 mg by mouth as ordered for itching.—JM 7/4/2003 8 pm Melissa seems more comfortable. Not scratching.—JM


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Physician Visit Sheet

Melissa Sullivan DOB 12/1/1978 #000-0000-00 Date of visit: 7/7/2003 Reason for visit: Hitting her right ear Impression: Otitis media (ear infection) right ear Recommendations:

1. Amoxicillin 250 mg liquid three times a day for 7 days. 2. Keep ear dry, no swimming 3. Tylenol for pain if needed. 4. Return if not improved in 3 days or sooner if getting worse. 5. Return visit for ear check in 3 weeks.

Physician: Leo Smith, MD Office #: 123-654-2800


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Chip Flowers

Pharmacy Label 1

Pharmacy Label 2


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Pharmacy Label 3

Pharmacy Label 4


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MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Digoxin 0.125 mg

Take 1 tablet by mouth one time per day for arrhythmia. Hold for heart rate less than 60.

8 am SC FG FG FG FG FG V V JC BB BB BB BB SC

Pulse 62 70 65 60 80 78 - - 64 74 72 60 76 64

Hydrochlorothiazide 50 mg Take 1 tablet by mouth for high blood pressure.

8 am SC FG FG FG FG FG V V JC BB BB BB BB SC 10 pm AC GD GD ® GD V V V GD GD GD GD GD AC

Levothyroxine 200 mcg Take 1 tablet by mouth one time per day for hypothyroidism before breakfast.

8 am SC FG FG FG FG FG V V JC O BB BB BB SC 10 am BB

Nitroglycerine 0.4 mg Place 1 tablet under the tongue every 30 minutes for chest pain. Call MD if unresponsive after 2 doses.

BB

BB

BB

Dates of administration from: 7/1/2003 to 7/31/2003 PHYSICIAN(S): Steven Mayo, Howard Burns ALLERGIES: DIAGNOSES: Trisomy 21, hypothyroidism, hypertension, arthritis, COPD, GERD, heart disease NAME: Chip DOB 11/12/1948 ID NUMBER: 000-0000-00

12:30 pm

1:00 pm

1:30 pm


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DATE TIME

GIVEN MEDICATION &

DOSE ROUTE REASON RESPONSE INITIALS

7/9/2003 12:30 pm Nitroglycerine Mouth Chest Pain None BB 7/9/2003 1:00 pm Nitroglycerine Mouth Chest Pain None BB 7/9/2003 1:30 pm Nitroglycerine Mouth Chest Pain None BB




Page | 21


Chip Flowers

Chart Notes

Chip Flowers DOB 11/12/1948 #0000-000-00 7/3/2003 2 pm Chip doing well today. Went on an outing to grocery shop. Planned the meals for the holiday.--FG 7/5/2003 10 pm Chip watching favorite show on TV. Quiet evening.—GD 7/6/2003 5 pm Chip was picked up by his sister for a family event. Medication given to sister. —GD 7/8/2003 11 pm Chip returned from the family event. He stated he had a good time. Sister said Chip took his medication without problems. —GD 7/9/2003 3 pm Chip complaining of chest pain. Gave his nitroglycerine without response. Called his PCP who had him seen in the emergency room. Chest pain seemed not to be related to his heart, but might be GI. Follow-up evaluation scheduled. —GD 7/10/2003 10:15 am Chip missed morning Levothyroxine. Called PCP who faxed order to give it to him now. —BB


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Frederick Smith

Pharmacy Label 1


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MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Penicillin VK 500 mg

Take 1 tablet by mouth every 6 hours for 10 days for strep throat.

6 am FG FG FG SC SC JC BB BB BB BB

12 noon FG FG FG FG SC SC BB BB BB BB

6 pm JM JM JM JM AC AC JM JM JM JM

12 am GD GD GD GD AC AC GD GD GD GD

Propranolol HCL 40 mg Take 2 tablets by mouth two times per day for migraine prophylaxis.

8 am SC FG FG FG FG FG SC SC JC BB BB BB 10 pm AC JM JM JM JM JM AC AC JM JM Discontinued

7/12/2003 JM


11:30 pm JM

Dates of administration from: to PHYSICIAN(S): Howard Burns, Tim Barn ALLERGIES: Sulfa DIAGNOSES: Migraine headaches, high cholesterol, high blood pressure, bipolar disorder, strep throat NAME: Frederick Smith DOB 12/1/1965 ID NUMBER: 000-0000-00


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DATE TIME

GIVEN MEDICATION &



TG Tanya Green FG Foster Grant SC Sheldon Collins JM Jim Morgan BB Brenda Boyer GD Glenda Dopson AC Amanda Coulter


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Frederick Smith

Chart Notes

Freddy Smith DOB 12/1/1965 #00-00-000 7/3/2003 3 pm Freddy complained of a sore throat. Took him to see Dr. Burns who did a test and said that he had strep throat. Got his Penicillin prescription filled at the pharmacy and started the medication. No response noted.—FG Physician Visit Sheet Freddy Smith DOB 12/1/1965 #00-00-000 Date of visit: 7/3/2003 Reason for visit: Complaining of sore throat Impression: Probable strep throat with positive rapid strep test Recommendations:

1. Penicillin VK 500 mg by mouth every 6 hours for 10 days. 2. Call office to check culture results in 2 days. 3. Tylenol for pain if needed. 4. Return if not improved in 3 days or sooner if getting worse.

Physician: Howard Burns MD Office #: 123-654-7375


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MAR REVIEW EXAM ANSWER KEY


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MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MELISSA SULLIVAN ANSWER KEY MEDICATION ADMINISTRATION PROGRAM

AUGUST 2013 Page 1 of 2

PRACTICUM OBSERVER’S NAME: ____________________________________________________________________________________________ Trainers will use the checklist below to document the Practicum Observer’s performance on the task of reviewing MARs for the Annual Practicum. The first two columns provide the information for the trainer to complete their own review of the MAR reviewed by the Practicum Observer. The trainer indicates the number of errors found for each item in the # of Errors Trainer Found column. Then, trainers compare the Practicum Observer’s MAR Review Checklist to the Trainer Review column. In the # of Errors PO Found column, the trainer indicates the number of errors that the Practicum Observer correctly identified for that item, i.e. those that match the errors found by the trainer. In the # of Errors Not Errors PO Found column, the trainer indicates the number of errors the Practicum Observer identified that are not errors. Indicate in the Comments column any discrepancies between the trainer and Practicum Observer review. TRAINER REVIEW

# ERRORS TRAINER FOUND

# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT July 15, 2003

EMPLOYEE NAME FROM MAR REVIEWED Brenda Boyer

NAME ON MAR Melissa Sullivan

MONTH/YEAR OF MAR REVIEWED (PREVIOUS AND CURRENT)

July 2003/July 2003

1. There is a corresponding entry on the current MAR for each labeled medication container that matches the pharmacy label.

PASS ____ FAIL __X__ List each error found. • Mysoline is missing the route of by mouth. • Diastat rectal gel pharmacy label says call if

longer than 10 minutes but MAR has 15.

2

2. All general information is present (e.g. name, allergies, diagnoses, etc.) using the current MAR.

PASS __X__ FAIL _____ List each error found. 0

3. Initials and signature of the employee are present on the MAR or central record using the current MAR. If central record used, there is a copy of that record with the MAR.


4. All applicable date/time blocks are initialed correctly using the current MAR.


MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MELISSA SULLIVAN ANSWER KEY MEDICATION ADMINISTRATION PROGRAM


PRACTICUM OBSERVER’S NAME: ____________________________________________________________________________________________

TRAINER REVIEW # OF

ERRORS TRAINER FOUND

# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND

COMMENTS USING A PREVIOUS MONTH’S MAR

RESULTS P=PASS F=FAIL

A=ABSENT

LIST EACH ERROR FOUND ON THE MAR

5. DISCONTINUATION OF A MEDICATION A 0

6. NEW OR TIME LIMITED MEDICATION F Only 20 doses of Amoxicillin were allowed

on MAR when it should have been 21 1

7. PRN MEDICATION F On 7/6/2003, time for Benadryl belongs in box with BB - No documentation about why dose was given on 7/6/2003 on back of MAR.

2

8. OMISSION OF A MEDICATION A 0

9. REFUSAL OF A MEDICATION A 0

10. LATE ADMINISTRATION OF OMITTED OR REFUSED MEDICATION A 0

11. ABSENCE OF A PERSON AT TIME OF MEDICATION A 0

12. CONTROLLED SUBSTANCE AND COUNT A 0

13. EXTERNAL DOCUMENTATION A 0

SCORING INSTRUCTIONS TOTAL (ADD # OF ERRORS FOR EACH COLUMN) 5

PASSED _______ FAILED _______

DATE OF FEEDBACK ____________

TRAINER SIGNATURE ______________________________

% OF ERRORS CORRECTLY IDENTIFIED BY PRACTICUM OBSERVER (MUST BE 75% OR GREATER TO PASS)

% OF ERRORS THAT ARE NOT ERRORS IDENTIFIED BY PRACTICUM OBSERVER (MUST BE 25% OR LESS TO PASS)

# OF ERRORS PO FOUND

=

x 100 = %

# OF ERRORS NOT ERRORS PO FOUND

=

x 100 = % # OF ERRORS

TRAINER FOUND 5 # OF ERRORS TRAINER FOUND 5

ATTACH A BLANK SHEET OF PAPER IF ADDITIONAL SPACE IS NEEDED FOR COMMENTS

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE CHIP FLOWERS ANSWER KEY MEDICATION ADMINISTRATION PROGRAM




# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT July 15, 2003 EMPLOYEE NAME FROM MAR REVIEWED Brenda Boyer

NAME ON MAR Chip Flowers


July 2003/July 2003


PASS ____ FAIL __X__ List each error found. • Hydrochlorothiazide is missing “two times per day”

on the MAR in order to match the pharmacy label. • Nitroglycerine instructions on MAR are incomplete

as “May repeat for 2 doses” is missing.

1


PASS ____ FAIL __X__ List each error found. • Allergies should never be left blank – indicate none

if there are no allergies. • Chip’s last name is missing from the MAR.

2


PASS _X___ FAIL _____ List each error found. 0


PASS __X__ FAIL _____ List each error found.

0

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE CHIP FLOWERS ANSWER KEY MEDICATION ADMINISTRATION PROGRAM



TRAINER REVIEW # OF


# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND



A=ABSENT



6. NEW OR TIME LIMITED MEDICATION A 0

7. PRN MEDICATION F Special instructions read to call the MD after 2 doses without response and BB gave 3. 1

8. OMISSION OF A MEDICATION P 0

9. REFUSAL OF A MEDICATION F Entry on MAR is correct, but there is no corresponding note about what occurred. 1

10. LATE ADMINISTRATION OF OMITTED OR REFUSED MEDICATION F There should be a separate entry on the

MAR to document a late administration. 1

11. ABSENCE OF A PERSON AT TIME OF MEDICATION P 0


13. EXTERNAL DOCUMENTATION P 0








=

x 100 = %


=




MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE FREDERICK SMITH ANSWER KEY MEDICATION ADMINISTRATION PROGRAM




# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT 8/1/2003


NAME ON MAR Frederick Smith


July 2003/July 2003


PASS ____ FAIL __X__ List each error found. The Propranolol HCL bottle should have been removed as it was discontinued on 7/12/2003.

1


PASS ____ FAIL __X__ List each error found. MAR does not identify dates of administration 1


PASS _____ FAIL __X__ List each error found. On 7/9/2003 JC documented administration of two medications but there is no signature for this person on the back of the MAR.

1


PASS _____ FAIL __X__ List each error found. There is a blank on 7/9/2003 for Propranolol which probably should have been documented as an omission since there is a late administration.

1

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE FREDERICK SMITH ANSWER KEY MEDICATION ADMINISTRATION PROGRAM



TRAINER REVIEW # OF


# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND



A=ABSENT


5. DISCONTINUATION OF A MEDICATION F Already initialed boxes should not be

lined out. 1

6. NEW OR TIME LIMITED MEDICATION P 0

7. PRN MEDICATION A 0



10. LATE ADMINISTRATION OF OMITTED OR REFUSED MEDICATION F

• There is no diagonal line after the last dose given. • There is no note about this.

2











=

x 100 = %


=




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MAR REVIEW ALTERNATE EXAM MATERIALS


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Melissa Sullivan

Pharmacy Label 1

Pharmacy Label 2


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Pharmacy Label 3


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MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Mysoline 500 mg

Take one tablet by mouth four times a day for seizures.

8 am SC FG FG FG FG FG SC SC JC BB BB BB BB SC

12 noon SC FG FG FG FG FG SC SC BB BB BB BB BB SC

4 pm AC JM JM JM JM AC AC JM BB JM JM JM AC

8 pm AC GD GD GD GD GD AC AC GD GD GD GD GD AC

Diastat rectal gel 10 mg Insert one rectally as needed for seizures lasting longer than 10 minutes. Call if no response.

Amoxicillin 250 mg/5 cc Take 5 cc by mouth three times a day for 7 days for infection.

8 am SC JC BB BB BB BB SC 4 pm SC SC JM JM JM JM 8 pm AC AC JM JM JM JM JM

Benadryl 25 mg Give one capsule by mouth every 6 hours as needed for itch or rash for 3 days. Return if not improved in 3 days.

JM

Dates of administration from: 7/1/2003 to 7/31/2003 PHYSICIAN(S): Tim Barn ALLERGIES: None DIAGNOSES: Seizures, Aicardi, scoliosis, congenital encephalopathy, quadriplegia, infection NAME: Melissa Sullivan DOB 12/1/1978 ID NUMBER: 000-0000-00

6 pm


Page | 42


DATE TIME GIVEN

MEDICATION & DOSE ROUTE REASON RESPONSE INITIALS

7/5/2003 6 pm Benadryl 25 mg Mouth Itching Improved JM


TG Tanya Green FG Foster Grant JC Julie Christy JM Jim Morgan BB Brenda Boyer GD Glenda Dopson AC Amanda Coulter


Page | 43


Melissa Sullivan

ER Visit Sheet

Melissa Sullivan DOB 12/1/1978 #000-0000-00 Date of visit: 7/4/2003 Reason for visit: Rash after walking in the woods Impression: Poison ivy Recommendations:

1. Benadryl 25 mg – Give one capsule by mouth every 6 hours as needed for itch or rash for 3 days.

2. Keep area clean and dry. 3. Return if not improved in 3 days.

Physician: Tom Brown MD Hospital: Anytown General Hospital Chart Notes

Melissa Sullivan DOB 12/1/1978 #000-0000-00 7/4/2003 6 pm Melissa was scratching her arm where the rash is. Gave Benadryl 25 mg by mouth as ordered for itching.—JM 7/4/2003 8 pm Melissa seems more comfortable. Not scratching.—JM 7/10/2003 6 pm Melissa refused her dose of Amoxicillin after multiple attempts to encourage her to take it. —BB


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Physician Visit Sheet

Melissa Sullivan DOB 12/1/1978 #000-0000-00 Date of visit: 7/7/2003 Reason for visit: Hitting her right ear Impression: Otitis media (ear infection) right ear Recommendations:

1. Amoxicillin 250 mg liquid three times a day for 7 days. 2. Keep ear dry, no swimming 3. Tylenol for pain if needed. 4. Return if not improved in 3 days or sooner if getting worse. 5. Return visit for ear check in 3 weeks.

Physician: Leo Smith, MD Office #: 123-654-2800


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Chip Flowers

Pharmacy Label 1

Pharmacy Label 2


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Pharmacy Label 3


Page | 47


MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Digoxin 125 mcg

Take 1 tablet by mouth one time per day for arrhythmia. Hold for heart rate less than 60.

8 am SC FG FG FG FG FG V V JC BB BB BB BB SC

Pulse 62 70 65 55 80 78 - - 64 74 72 60 76 64

Hydrochlorothiazide 50 mg Take 1 tablet by mouth two times a day for high blood pressure.

8 am SC FG FG FG FG FG V V JC BB BB BB BB SC 10 pm AC GD GD R GD GD V V GD GD GD GD GD AC Discontinued

7/14/2003 BB

Levothyroxine 200 mcg Take 1 tablet by mouth one time per day for hypothyroidism before breakfast.

8 am SC FG FG FG FG FG V V JC BB BB BB BB SC 10 pm V V

Nitroglycerine 0.4 mg Place 1 tablet under the tongue every 30 minutes for chest pain. May repeat for 3 doses. Call MD if unresponsive after 3 doses.

BB

BB

BB

Dates of administration from: 7/1/2003 to 7/31/2003 PHYSICIAN(S): Steven Mayo, Howard Burns ALLERGIES: None DIAGNOSES: NAME: Chip Flowers DOB 11/12/1948 ID NUMBER: 000-0000-00

12:30 pm

1:00 pm

1:30 pm


Page | 48


DATE TIME

GIVEN MEDICATION &


7/9/2003 12:30 pm Nitroglycerine Mouth Chest Pain None BB 7/9/2003 1:00 pm Nitroglycerine Mouth Chest Pain None BB 7/9/2003 1:30 pm Nitroglycerine Mouth Chest Pain None BB




Page | 49


Chip Flowers

Chart Notes

Chip Flowers DOB 11/12/1948 #0000-000-00 7/3/2003 2 pm Chip doing well today. Went on an outing to grocery shop. Planned the meals for the holiday.--FG 7/4/2003 11:30 pm Chip refused his 10 pm dose of hydrochlorthiazide. Tried multiple times to give it to him but he continued to refuse to take it. Reviewed PCP orders which stated to not give the dose if refused. --BB 7/5/2003 10 pm Chip watching favorite show on TV. Quiet evening.—GD 7/6/2003 5 pm Chip was picked up by his sister for a family event. Medication given to sister. —GD 7/8/2003 11 pm Chip returned from the family event. He stated he had a good time. Sister said Chip took his medication without problems. —GD 7/9/2003 3 pm Chip complaining of chest pain. Gave his nitroglycerine without response. Called his PCP who had him seen in the emergency room. Chest pain seemed not to be related to his heart, but might be GI. Follow-up evaluation scheduled. 7/14/2003 10:15 pm PCP called to discontinue Hydrochlorthiazide. Faxed order received. —BB


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Freddy Smith

Pharmacy Label 1

Pharmacy Label 2


Page | 52


Page | 53


MEDICATION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Penicillin VK 500 mg

Take 1 tablet by mouth every 6 hours for 10 days for strep throat.

6 am FG FG FG SC SC JC BB BB

12 noon FG FG FG FG SC SC BB BB BB BB

6 pm JM JM JM JM AC AC JM JM JM JM

12 am GD GD GD GD AC AC GD GD GD GD


8 am SC FG FG FG FG FG SC SC JC SC FG FG FG FG FG SC SC JC BB BB SC FG FG FG FG FG SC SC SC 10 pm AC JM JM JM JM JM AC AC JM JM JM AC JM JM JM JM JM AC AC JM JM JM AC JM JM JM JM JM AC AC AC

Ritalin 10 mg Take one tablet by mouth three times a day for attention problems.

8 am SC JC SC FG FG FG FG FG SC SC JC BB BB SC FG FG FG FG FG SC SC SC 4 pm AC AC JM JM JM AC JM JM JM JM JM AC AC JM JM JM AC JM JM JM JM JM AC AC AC 10 pm AC AC JM JM JM AC JM JM JM JM JM AC AC JM JM JM AC JM JM JM JM JM AC AC AC

Dates of administration from: 7/1/2003 to 7/31/2003 PHYSICIAN(S): Howard Burns, Tim Barn, Leo Smith ALLERGIES: Sulfa DIAGNOSES: Migraine headaches, high cholesterol, high blood pressure, bipolar disorder, strep throat, attention problems NAME: Mr. Smith DOB 12/1/1965 ID NUMBER: 000-0000-00


Page | 54


DATE TIME

GIVEN MEDICATION &



TG Tanya Green FG Foster Grant SC Sheldon Collins JM Jim Morgan BB Brenda Boyer GD Glenda Dopson AC Amanda Coulter JC Julie Christie


Page | 55


Freddy Smith

Chart Notes

Freddy Smith DOB 12/1/1965 #00-00-000 7/3/2003 3 pm Freddy complained of a sore throat. Took him to see Dr. Burns who did a test and said that he had strep throat. Got his Penicillin prescription filled at the pharmacy and started the medication. No response noted.—FG 7/10/2003 10 am Freddy went to the emergency room at 5 am this morning complaining of sharp pains in his stomach. No cause was found and he returned home at 10 am. Morning medications not given because was at the emergency room. –BB 7/11/2003 5 am Freddy again complained of stomach pain. PCP faxed order to hold morning medications until Freddy could be seen in the office. PCP diagnosed heart burn. Sent him home with instructions to take a Tums the next time Freddy has stomach pain. –BB Physician Visit Sheet Freddy Smith DOB 12/1/1965 #00-00-000 Date of visit: 7/3/2003 Reason for visit: Complaining of sore throat Impression: Probable strep throat with positive rapid strep test Recommendations:

1. Penicillin VK 500 mg by mouth every 6 hours for 10 days. 2. Call office to check culture results in 2 days. 3. Tylenol for pain if needed. 4. Return if not improved in 3 days or sooner if getting worse.

Physician: Howard Burns MD Office #: 123-654-7375


Page | 56

Controlled Substance Count Sheet

NAME MEDICATION AND DOSE STARTING COUNT

Freddy Smith Ritalin 10 mg one table three times a day 90 NIGHT/ DAY SHIFT DAY/AFTERNOON SHIFT AFTERNOON /NIGHT SHIFT DATE SIGNATURE COUNT SIGNATURE COUNT SIGNATURE COUNT 7/1/2003

7/2/2003

7/3/2003

7/4/2003

7/5/2003

7/6/2003

7/7/2003

7/8/2003

7/9/2003

7/10/2003

7/11/2003

7/12/2003

7/13/2003

7/14/2003

7/15/2003


Page | 57

MAR REVIEW ALTERNATE EXAM ANSWER KEY


Page | 58

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MELISSA SULLIVAN ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM




# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT July 15, 2003


NAME ON MAR Melissa Sullivan


July 2003/July 2003


PASS __X_ FAIL _____ List each error found. 0


PASS _____ FAIL __X__ List each error found. Leo Smith is not listed under physicians on the MAR.

1


PASS _____ FAIL __X__ List each error found. SC did not sign and initial the back of the MAR. 1


PASS _____ FAIL __X__ List each error found. • Time box for Mysoline on 7/4/2003 at 4 pm is

blank. • Time box for Amoxicillin is blank for 4 pm on

7/10/2003.

2

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MELISSA SULLIVAN ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM



TRAINER REVIEW # OF


# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND



A=ABSENT



6. NEW OR TIME LIMITED MEDICATION P 0

7. PRN MEDICATION F Missing the diagonal slash lines after the last dose. 1


9. REFUSAL OF A MEDICATION F There is a note indicating a refusal of Amoxicillin on 7/10 at 4 pm but the refusal is not correctly documented on the MAR.

1












=

x 100 = %


=



MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE CHIP FLOWERS ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM




# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT July 15, 2003 EMPLOYEE NAME FROM MAR REVIEWED Brenda Boyer

NAME ON MAR Chip Flowers


July 2003/July 2003


PASS ____ FAIL __X__ List each error found. • Strength of Digoxin is incorrect on MAR. • For Levothyroxine, hour of administration

entries do not match the number of times a day it is to be given.

2


PASS ____ FAIL __X__ List each error found. No diagnoses are listed. 1


PASS _X___ FAIL _____ List each error found. 0


PASS __X__ FAIL _____ List each error found.

0

MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE CHIP FLOWERS ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM



TRAINER REVIEW # OF


# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND



A=ABSENT


5. DISCONTINUATION OF A MEDICATION P 0

6. NEW OR TIME LIMITED MEDICATION A 0

7. PRN MEDICATION P 0

8. OMISSION OF A MEDICATION P 0

9. REFUSAL OF A MEDICATION F There is no circle around the R on 7/4/2003 for the hydrochlorothiazide. 1


11. ABSENCE OF A PERSON AT TIME OF MEDICATION F

Chart notes indicate an absence from 7/6 – 7/8 yet there is documentation that on 7/6 the hydrochlorothiazide 10 pm dose was given.

1


13. EXTERNAL DOCUMENTATION F The Digoxin was given even though the pulse was under 60 on 7/4/2003. 1








=

x 100 = %


=




MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE FREDERICK SMITH ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM




# ERRORS

PO FOUND

# ERRORS

NOT ERRORS

PO FOUND

COMMENTS

DATE OF REVIEW/AUDIT 8/1/2003


NAME ON MAR Frederick Smith


July 2003/July 2003


PASS __X_ FAIL _____ List each error found. 0


PASS ____ FAIL __X__ List each error found. MAR does not identify the entire name of the person.

1





MAR REVIEW AUDIT PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE FREDERICK SMITH ALTERNATE EXAM ANSWER KEY MEDICATION ADMINISTRATION PROGRAM



TRAINER REVIEW # OF


# OF ERRORS

PO FOUND

# OF ERRORS

NOT ERRORS

PO FOUND



A=ABSENT



6. NEW OR TIME LIMITED MEDICATION F The spaces prior to the Ritalin being filled

are not lined out. 1

7. PRN MEDICATION A 0

8. OMISSION OF A MEDICATION F Ordered omission of medications on 7/11 was documented incorrectly on MAR as there are Xs instead of Os.

1



11. ABSENCE OF A PERSON AT TIME OF MEDICATION F Absence was documented using a non-

standard designation on 7/10/2003. 1

12. CONTROLLED SUBSTANCE AND COUNT F The controlled substance count sheet

shows no counts for the Ritalin. 1









=

x 100 = %


=



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