trainer resource guide licensed health care professionals can administer medication with a...

4. Medication Management: Part 1

Trainer Resource Guide

Cautionary Statement

The material in this session is not intended to be medical advice on personal health matters. Medical advice should be obtained from a licensed physician. This session highlights medication. This session does not cover all situations, precautions, interactions, adverse reactions, or other side effects. A pharmacist can assist you and the doctor with questions about medications. We urge you to talk with pharmacists, nurses and other professionals (e.g. dietitians) as well, to broaden your understanding of the fundamentals covered in this module.

Year 1, Session 4: MED

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Materials• LCDprojectorandcomputer• FlashDrive

Skill Check Materials• WorkwithyourServiceHubadministratororalocalpharmacisttogather necessarysuppliesincluding: — Properlylabeledbubblepacksandcapsuleortabletcontainersfor eachstudent — Properlylabeledliquidcontainers — Calibratedplasticcupsorspoons• Smallcupsforcapsulesandtablets• Water• PensShow Slide #1: Medication Management: Part 1

Show Slide #2: Practice and Share, Session 3• Reviewthequestions.• Askforvolunteerswhowouldliketosharewhattheylearned.• Notetotrainer:Confirmthatstudentshavethecorrectlocalcontact

informationforagenciestowhomspecialandunusualincidentsshouldbereported.Ifnecessary,providethecorrectinformation.

• Inthelastsession,youlearnedaboutmanagingriskandreportingunusualincidents.

• Inthissession,youwilllearnhowtosafelyassistindividualswithprescribedmedications(DepartmentofSocialServices,CommunityCareLicensing-Title22§87465).

• Askstudentstosharesomeoftheskillstheythinkarenecessarytosafelyassistwithmedications.Show Slides #3 and #4: Outcomes• Reviewoutcomesforthesession.

Show Slide #5: Keywords• Reviewkeywordsforthesession.• Givestudents5minutestothinkaboutandrewritedefinitionsintheirown

wordsinthespacesprovided.

T r a i n e r G u i d e : S E S S I O N 4


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Medication Management: Part 1 S t u d e n t R e s o u r c e G u i d e : S E S S I O N 4

O U T C O M E S

Whenyoufinishthissessionyouwillbeableto:

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• Demonstratehowtoassistindividualsintheself-administrationofmedication.

• Identifyresourcesforinformationaboutmedicationsthatindividualsaretaking.

• ListtheSevenRightsofassistinganindividualwithself-administrationofmedication.

• Explainthedifferencebetween“prescription”,“over-the-counter”,and"PRN"medications.

• Identifykeyinformationonprescriptionmedicationlabels.

• Explainthereasonfordocumentingself-administrationofmedication.

• Documentmedicationrelatedinformation,includingself-administration,misseddoses,sideeffects,anddruginteractions.

K E Y W O R D S

Drug Key Word Meaning In My Own Words

Anotherwordformedication;asubstanceusedasamedicine.

Generic Name

Thenamegivenbythefederalgovernmenttoadrug;notthebrandname.

Medication Substancetakenintothebodyorappliedtothebodyforthepurposeofprevention,treatment,reliefofsymptoms,orcure.

Medication (Drug) Interactions

Theresultofdrugs,foods,alcohol,orothersubstances,suchasherbsorothernutrients,havinganeffectoneachother.

Ophthalmic Referstotheeyes.

Otic Referstotheears.

Over-the-Counter (OTC) Medications

Medications,includingaspirin,antihistamines,vitaminsupplements,andherbalremedies,thatmaybeobtainedwithoutawrittenprescription.


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Key Words cont.Show Slide #6: Keywords• Reviewkeywordsforthesession.• Givestudents5minutestothinkaboutandrewritedefinitionsintheirown

wordsinthespacesprovided.


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Pharmacist Licensedpersonwhopreparesandsellsmedicationsandisknowledgeableabouttheircontents.Apharmacistcannotprescribemedications.

Physician Apersonlicensedtopracticemedicine.Forthepurposeofprescribingmedicationsonly,thetermincludeshealthcareprofessionalauthorizedbylawtoprescribedrugs,i.e.,physician/doctor,psychiatrist,dentist,dermatologist,etc.

Anursepractitioner(NP)orphysician’sassistant(PA)canalsoprescribemedicationsunderthesupervisionofaphysician.

Prescription Medications

Medicationsthatmustbeorderedbyaphysicianorotherlicensedhealthcareprofessionalwithauthoritytowriteprescriptions,suchasadentistornursepractitioner.

K E Y W O R D S ( C O N T . ) Key Word Meaning In My Own Words

Side Effects Anextraandusuallybadreactionoreffectthatadrughasinadditiontotreatinganillness.Somesideeffects,suchasasevereallergicreaction,canbedeadly.

Topical Putdirectlyontheskinoracertainareaofthebody.

Trade Name/Brand Name

Thenamegivenbythecompanythatmadethemedication.

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PRN (pro re nata)Medication

PRNisanabbreviationthatmeans"asneeded."PRNmedicationmaybetakenwhentheindividualneedsitratherthanatasettime,andonlyfortheconditionstatedonthelabel.Requiresaphysician'sorder.

NP/PA


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Activity: What Do You Want to Know?• Readdirectionsaloud.• Askforstudentvolunteerstoshareanswers.• Makenoteofstudentanswersandlinkbacktostudentknowledge

andinterestsasappropriateasyoureviewsessioncontent.• Attheendofthissession,youwillreturntothisactivitytogive

studentsanopportunitytoanswerthethirdquestion.


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What Do You Want to Know?

Directions: Think about the topic of this training session. Answer the first two questions in the space provided below. You will come back to this page at the end of the session to answer the last question.

Whatdoyoualready knowaboutassistingindividualswithprescriptionmedication?

Whatdoyouwant to knowaboutassistingindividualswithprescriptionmedication?

Tobeansweredattheendofthesession,duringreview:Whathave you learnedaboutassistingindividualswithprescriptionmedication?

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Overview• Reviewstatisticsandkeywordsasyougothroughthissession.• Medicationsaresubstancestakenintothebody(orappliedto)forthe

purposeofprevention,treatment,reliefofsymptoms,orcure.

Show Slide #7: How to Safely Assist with Medication Self-Administration• BrieflyexplaintheSevenRights,whichwillbecoveredindetaillaterin thesession.

Show Slide #8: Key Health Care Professionals• BrieflydiscussinformationonpageS-2pertainingtohealthcare professionals.• DiscusswiththestudentsthatasaDSPtheycanONLYassistwith theself-administrationofmedication.Whereas,licensedhealthcare professionalscanadministermedicationwithaphsyician’sorder.

Outcome: Name health care professionals that are authorized to order medications.



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Overview

Thenumberofprescriptionswrittenbyhealthcareprofessionalshassteadilyincreasedoverthe

years.FailureofAmericanstotaketheirmedicationasinstructedcostsmorethan$100billionayearinincreasedhospitalandnursinghomeadmissions,lostworkerproductivity,andprematuredeath.

Manyoftheindividualsyousupporttakemedicationsonanongoingbasis.Everyoneyousupportwillneedtotakemedication(s)atonetimeoranother.

Someofyouhavebeenassistingwithmedicationforalongtime.Forothersthismaybeanewresponsibility.Whateveryourlevelofexperience,assistingwithmedicationisaveryhigh-riskactivity.Thecriticalskillsyouwilllearninthenexttwosessionsaredesignedtoincreasesafetyandreducetheriskoferror,therebyprovidingmaximumprotectionfortheindividualsyouassistaswellasyourself.Noonewantstoberesponsibleforcausinginjuryorharmtosomeoneelse.Theinformationbeingsharedinthistrainingwillhelppreventthat.

TheDSP’sroleistoassistindividualstotaketherightmedication,intherightdose,bytherightroute,attherighttime,fortherightreason,andensuretherightdocumentation.Alloftheseareveryimportantfunctions.

Medicationsaresubstancesusedtopreventortreatanillness.Knowingaboutmedications,theiruseandabuse,andhowtoassistindividualsinusingthemisvitaltothehealthandwell-beingofthoseyousupport.

Inthissectionyouwilllearnhowtosafelyassistpeoplewithprescribedmedications.Youwilllearnhowto:• Getinformationaboutmedications

fromthedoctorandpharmacist.

• Readandunderstandthemedicationlabel.

• FollowtheSevenRights(fullydiscussedonpagesS-14andS-15formedicationmanagement:• Rightperson• Rightmedication• Rightdose• Righttime• Rightroute• Rightreason• Rightdocumentation

• Documenteachdoseofmedicationtaken,aswellasanymedicationerrors.

• Observetheindividualforbothintendedeffectsandunintendedsideeffects.

• Report,documentandcommunicateanysideeffects.

Key Health Care ProfessionalInthissection,wewillbetalking

aboutthehealthcareprofessionalswithwhomyouandtheindividualsyousupportwillcommunicateandinteractinordertogetandusemedicationssafely.Aphysician,ordoctor,isapersonlicensedtopracticemedicine.Forthepurposeofprescribingmedicationsonly,theterm doctor meansanyhealthcareprofessionalauthorizedbylawtoprescribedrugs:physician,dentist,optometrist,podiatrist,andpsychiatrist.Inaddition,anursepractitionerorphysician’sassistantwhowritesprescriptionsisactingunderthesupervisionofaphysician.Apharmacistisapersonwhoislicensedtoprepareandsellmedications.Pharmacistsusuallyworkindrugstoresorhospitals.

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T r a i n e r G u i d e : S E S S I O N 4Requirements for Assisting with Medications

Show Slide #9: Requirements for Assisting with Medications• Medicationmanagementrepresentsanareaofgreatresponsibility.Ifnotmanaged

properly,medicationsintendedtohelpanindividualmayplacehisorherhealthandsafetyatrisk.

• InCalifornia,CommunityCareLicensinghasoversightforAdultResidentialFacilitiesorSmallFamilyHomes.ReferstudentstoAppendix4-G:CCLD’sSelf-AssessmentGuideonMedications,foranoverviewofstaterequirementsformedicationsincommunitycarefacilities.Encouragestudentstoreadthisinformation.

• HavethestudentslookatthePRNsectionofCCLDregulationsinAppendices4-GpagesS-37/38#10,andreviewwiththem.ThereisadditionalinformationonCCLrequirementsforchildrenthatyouwillreviewwiththestudentslaterinthesession.Discuss that the CCLD regulations for Adult Residential Facilities are in the process of being updated. New regulations have not been completed at the time of this printing.

• DSPscanonlyassistindividualswithself-administrationofmedicationsthathavebeenorderedandprescribedbyadoctor,dentist,ornursepractitioner.

• Informstudentsthatthefollowinginformationrelatestoanoutcomeandmaybecoveredonthequiz.

Outcome: Explain the difference between “prescription”,“over-the-counter”, and “PRN” medications.

Outcome: Explain when a DSP may assist with the self-administration of a PRN.• Prescription medicationsarethoseorderedbyadoctororotherpersonwithauthorityto

writeaprescription.• Over-the-counter (OTC) medicationsarethosethatcanbeboughtwithoutadoctor’s

prescription.• PRNsmustbeorderedbyadoctororotherpersonwithauthoritytowrite

aprescription.Thesearegivenonan“asneeded”basisonlyforaspecificcondition.

Effects of MedicationShow Slide #10: Effects of Medication• Define“intendedeffects”ofmedications.

— Thereasonmedicationistaken(Forexample,to control seizures, lower blood pressure, relieve pain, etc.).

• Define“sideeffects”ofmedications.Anyreactiontoorconsequenceofa medicationortherapy.

— Manydrugshaveotherknownactionsbesidestheintendedone.Manyoftheeffectsarepredictableandsomearenot.BothprescriptionandOTCdrugshavesideeffects.

• Itisnotuncommonfortwoormoremedicationstointeractcausingunwantedsideeffects.• Medicationclassificationsinclude: — Anticonvulsants — Antibiotics — Painmedications — Topicalointmentsorcreams — Psychotropicmedications


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Effects of Medication

Medication InteractionsItisnotuncommonfortwoormore

medicationstakentogethertohaveaneffectoneachother.Thisiscalledmedication or drug interactionandcancauseunwantedsideeffects.AnexampleofthiswouldbewhenIronorPenicillinisgivenwithanantacid.TheantacidpreventstheIronorPenicillinfrombeingabsorbedinthestomach.

Medication ClassificationsDrugsaredividedintoclassifications,

orgroups,withothermedicationsthataffectthebodyinsimilarways.Manydrugswithmultipleusescanbefoundinmorethanoneclassification.

Someofthecommonclassificationsofmedicationsusedbyindividualswithintellectual/developmentaldisabilitiesincludeanticonvulsants(seizuremedications),antibiotics,painmedications,topicalointmentsorcreamsthatareapplieddirectlytotheskin,andpsychotropicmedicationsthatincludeantidepressantsandantipsychoticsfortreatingmood,psychotic,oranxietydisorders.

InCalifornia,communitycarelicensingregulationsareveryspecificregardingrequirementsforassistingwith

medications.Someoftheregulationsaredifferentbasedupontheageofindividualslivinginthehomeandthehome’slicensingcategory;forexample,AdultResidentialFacilityorSmallFamilyHome.SpecificinformationontheseregulatoryrequirementsisincludedintheCommunityCareLicensingDivision’sSelf-Assessment Guide, Medications Booklet publishedinSeptember2002,andfoundinAppendix4-G.

TheDSPmayonlyassistindividualswithself-administrationofmedicationsthathavebeenorderedandprescribedbyadoctor,dentist,ornursepractitioner.

Requirements for Assisting with Medications

Thisincludesbothprescriptionandover-the-countermedications.Thedoctor’ssigned,datedorderorprescriptionprovidesinstructionsforpreparingandusingthemedication.

Prescription medicationsarethosethatarealwaysorderedbyadoctororotherpersonwithauthoritytowriteaprescription.Over-the-counter (OTC) medicationsarethosethatcanbeboughtwithoutaprescriptionandincludevitaminsupplements,herbalremedies,andcommonlyusedmedicationssuchasTylenolandBenadryl.PRNsmustbeorderedbyadoctororotherpersonwithauthoritytowriteaprescription.Thesearegivenonan“asneeded”basisonlyforaspecificcondition.

Intended EffectsMedicationsarepowerfulsubstances

andshouldbeusedwithrespectandcare.Medicationsaffecteachindividualdifferently.Theycandoalotofgoodforindividuals;however,theymayalsocauseharm.Usuallyamedicationistakenforaspecificorintendedeffectoraction,suchascontrollingseizures,loweringbloodpressure,orrelievingpain.

Side Effects Manydrugshaveotherknownactions

besidestheintendedone.Theseactionsarecalledside effects.Manyofthesesideeffectsarepredictable;however,somearenot.Sideeffectsmaybemildorserious,harmlessordangerous.Sometimestheycanevenbedeadly.BothprescriptionandOTCdrugshavesideeffects.

Examplesofsideeffectsinclude,butarenotlimitedtonausea,confusion,dizziness,oranxiety.Otherexamplesofsideeffectsincluderashesandchangesinbodilyfunctions,suchaschangesinappetite,sleeppattern,orelimination.

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Reading and Understanding Medication Labels

Remember:DSPscanonlyassistindividualswithself-administrationofmedicationsthathavebeenorderedbyorprescribedbyadoctor,dentist,ornursepractitioner.Thisincludesprescription,OTC,andPRNmedications.

• Medicationshavebothagenericandtradenamelisted.— Generic name:Thenamegivenbythefederalgovernmenttoadrug.— Trade or brand name: Thenamegivenbythemanufacturer.— Forexample,acetaminophen is the generic name given to Tylenol,

which is the trade name.• Pharmacylabelsmayhaveeitherthegenericortradename.• PrescriptionandPRNmedicationmustbekeptintheoriginalcontainer

withthepharmacylabelattached.

Show Slide #11: Medication Labels• Reviewinformationthatthepharmacymedicationlabelincludesusing thebulletedinformationonpageS-6.Thisinformationandtherelated activitiesrelatetoasessionoutcomeandmaybecoveredonthequiz. Outcome: Identify key information on prescription medication labels.• HighlightPharmacyAbbreviationsandSymbolsonpageS-6.Explainthat

therewillbeanactivityonpageS-7.• TheInstituteforSafeMedicationPractices(ISMP)recommendserror

proneabbreviationsnotbeused.Wherepossible,writeouttheword.Forexample:insteadof“D/C”writediscontinueordischarge.

• FollowISMPrecommendations,butstudentswillcontinuetoseetheabbreviationsthroughoutthetrainingbecausetheyarestillbeingusedbyhealthcareprofessionals.



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Remember,theDSPcanonlyassistindividualswithself-administrationofmedicationsthathavebeenorderedorprescribedbyadoctor,dentist,ornursepractitioner.ThisincludesbothprescriptionandOTCmedications.Thepharmacistpreparesthemedicationusingthedoctor’swrittenorderandplacesalabelonthemedicationcontainerthatprovidesinstructionsfortakingthemedication.

Medicationshavebothageneric name andatrade name.Thegenericnameisthenamegivenbythefederalgovernmenttoadrug.Thetradeorbrandnameisthenamegivenbythecompanythatmakesamedication.Forexample,acetaminophenisthegenericnameforTylenol.Tylenolisthetradename.Theprescribingdoctormayorderthemedicationbyeithername.Thepharmacylabelmayhaveeithernameaswell.

Eachprescribedmedicationmustbekeptinitsoriginalcontainerwiththepharmacylabelattached.Carefulreadingofthelabeliscriticaltoensuringmedicationsafety.Theinformationonthepharmacymedicationlabelincludes:

Reading and Understanding Medication Labels• Pharmacy/pharmacistname,phone

number,andaddress• Prescriptionnumberorothermeans

ofidentifyingtheprescriber(usedinrequestingrefills)

• Individual’sname• Prescriber’sname(doctor)• Nameofmedication• Strength• Dose• Directionsforhowtousethe

medication(includingrouteandfrequency)

• Manufacturer• Quantity(forexample,numberofpills,

orothermeasurementoftheamountoftheprescription)

• Datetheprescriptionwasfilled• Expirationordiscarddate• Numberofrefillsremaining• Conditionforwhichprescribed(most

pharmaciesincludethisinformationifitisonthedoctor’sorder.)

Thefollowingabbreviationsandsymbolsarecommonlyusedonmedicationlabels.Inordertoreadandunderstandmedicationlabels,theDSPmustbefamiliarwiththeseabbreviationsandsymbols.TheInstituteforSafeMedicationPractices(ISMP)recommendserrorproneabbreviationsnotbeused.Wherepossible,writeouttheword.Forexample:insteadof“D/C”writediscontinueordischarge.(Source:http://ismp.org/)

• RX=Prescription• OTC=Over-the-Counter• PRN=whennecessary,orasneeded• Qty=quantity• q(Q)=every• qd=daily• b.i.d.(BID)=twicedaily• t.i.d.(TID)=threetimesaday• q.i.d.(QID)=fourtimesaday• h.=hour• h.s.(HS)=hourofsleep(bedtime)• tsp.=teaspoon(or5mL)

• Tbsp.=Tablespoon(3tspsor15mL)• oz=ounce(30mL)• mg=milligram• GM,gm=grams(1,000mg)• Cap=capsule• Tab=tablet• A.M.=morning• P.M.=afternoon/evening• D/Cord/c=discharge/discontinue• mL(milliliter)=cc(nolongerused)• mcg=microgram

Pharmacy Abbreviations and Symbols

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Activity: Medication Label Abbreviations

Show Slide #12: Activity: Medication Label Abbreviations• Groupings:individualorlargegroup.• Readthedirectionsaloudandaskstudentstotrytomatchthe

abbreviationanditsmeaningwithoutlookingatpageS-6.• TurnbacktopageS-6tocheckandreviewanswersasalargegroup.

Answers

q.i.d.(QID) milliliter

Tab morning

mL microgram

Tbsp. twiceaday

b.i.d.(BID) capsule

A.M. milligram

t.i.d.(TID) fourtimesaday

cap tablespoon

mg tablet

mcg threetimesaday

Reading and Understanding Medication Labels (cont.)• Define“dose.”

— Doseorstrengthisatermusedtodescribehowmuchmedicationorhowmanyunitsaretobetakenatanytime.

• Askstudentstocovertherightsideofthepagewiththeirhand.• Askstudentstotellyouthesingle dosageforeachmedicationonthe

partialprescriptionlabelsonthispage.• Askthemtofigureoutthedaily doseforeachmedication.Answers:• Amoxicillin (capsules) — Single dose = 500 mg — Daily dose = 1500 mg• Tegretol (tablets) — Single dose = 400 mg — Daily dose = 1000 mg• Robitussin (liquid) — Single dose = 10 mL — Daily dose = not to exceed 6 doses in a 24 hour period



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Medication Dose Abbreviations

Directions: Draw a line from each abbreviation to its meaning.

Abbreviation Meaningq.i.d(QID) milliliterTab morningmL microgramTbsp. twiceadayb.i.d(BID) capsuleA.M. milligramt.i.d(TID) fourtimesadayCap tablespoonmg tabletmcg threetimesaday

Aliquidmedicationmaybeprescribedas:

AMOXICILLIN500mgcapsulesorallyforinfection

Take1capsule3timesdailyx10days

TEGRETOL200mgtabsorallyforseizures

2tabsat7A.M.•2tabsat2P.M.and1tabat9P.M.

Inthisexampletheindividualistakinga500mgsingledoseanda1500mgdailydose.

Inthisexampletheindividualistakinga400mgsingledoseanda1000mgdailydose.

Inthisexampletheindividualistakinga10mLsingledoseandamaximumof6dosesa24hourperiod.

ROBITUSSIN10mLGive10mLorallyevery4hoursas

neededforcoughx3days.Maximum6dosesina24hourperiod

Reading and Understanding Medication Labels (cont.)

Thedoseisatermusedtodescribehowmuchmedicationorhowmanyunitsaretobetakenatanytime.Adosecanbedescribedasasingledoseoradailydose.Forexample,anoralmedication(capsulesortablets)maybeprescribedas:

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• ReviewthemedicationlabelonpageS-8.• Ifthelabeldoesn’tcontainthatinformation,askthedoctororpharmacist

toaddtheneededinformation.• Youshouldneverscratchoutorwriteonthemedicationlabel.• The medication label can ONLY be changed by a pharmacist.AdditionalinformationforDSPs-somelabelslistspecificallyhowmanydaysitshouldbetaken,forexampletheAmoxicillinisbeingtakenfor10days.Anotherwaytodeterminethelengthofamedicationorwhenitshouldbereviewedbythephysiciancanbenotedbylookingatthehowmanyrefillsremain.

Show Slide #13: Activity: Sample Medication Label Worksheet• Groupings:individual,pairs,smallgroup,largegroup.• Readdirectionsaloud.• Reviewanswersasagroup.

Answers:— WhatistheRXnumber? 10575 — Whoprescribedthemedication? Dr. Diaz— Whatisthenameofthemedication? Amoxicillin— Whatisthesingledose? 250 mg — Whenshoulditbetaken? 3x’s a day at 12 A.M., 8 A.M., 4 P.M.— Forhowlong? 10 days—Whatisthediagnosisorconditionthatthe Infection medicationisprescribedfor? — Whatdatedidthepharmacyfillthemedication? 9/30/17— Whoisthemedicationprescribedfor? Jordan Bird— Howmanyrefills? No refills— Whatistheexpirationdate? 3/31/19— Isthereanyinformationmissing? Pharmacy phone number and address— Whoisthemanufacturer? Many Medications, Inc.




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Sample Medication Label Worksheet

Directions: Use the sample medication label above to answer the following questions.

WhatistheRXnumber?_________________________________________

Whoprescribedthemedication?__________________________________

Whatisthenameofthemedication?_______________________________

Whatistheindividualdose?______________________________________

Whenshoulditbetaken?________________________________________

Forhowlong?_________________________________________________

Whatisthediagnosisorconditionthatthemedicationisprescribedfor?_________

Whatdatedidthepharmacyfillthemedication?______________________

Whoisthemedicationprescribedfor?______________________________

Howmanyrefills?______________________________________________

Whatistheexpirationordiscarddate?______________________________

Isthereanyinformationmissing?__________________________________

Whoisthemanufacturer?________________________________________

Oralmedications(capsulesortabletsthatareswallowed)areusuallyprescribedinmg(milligrams)orgm(grams).

LiquidmedicationsareusuallyprescribedinmL(milliliters),oroz(ounces).Liquidmedicationsmayalsobeprescribedintsp(teaspoon),orTbsp(tablespoon).Topicalmedicationsareusuallyprescribedingm(grams).

Atypicalmedicationlabellooksliketheoneshownontheright.

Donot“scratchout,writeover,orchange”adruglabelinanyway.Anychangetoaprescriptionrequiresanewdoctor’sorderthatmustberefilledbythepharmacist.The medication label can ONLY be changed by a pharmacist.

ABCPharmacy101725thSt.,SacramentoCA

(123)555-7890Dr.Diaz

RX10575 9/30/17

JORDANBIRDTAKE1CAPSULE3XPERDAYORALLYFOR10DAYSFORINFECTION12A.M.,8A.M.,4P.M.

AMOXICILLIN250mg#30CAPSULES

EXPIRES:3/31/19 NOREFILLS

MFG:MANYMEDICATIONS,INCFILLEDBY:BRS

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Label Warnings• Somemedicationcontainershavewarninglabelsthatprovideadditional

information.• Ablackboxwarningisthestrictestwarningplacedonthemedicationlabelor

packageinsertofcertainprescriptiondrugsbythepharmaceuticalcompany.AblackboxwarningisrequiredbytheFoodandDrugAdministration(FDA)toindicatethatthemedicationcarriesasignificantriskofseriousorevenlife-threateningadverseaffects.

• ReviewexamplesonpageS-9.



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Label WarningsMedicationcontainersmayalsohaveseparatewarninglabelsputonbythe

pharmacistthatprovideadditionalinformationontheuseofthemedication;forexample,“MedicationShouldBeTakenwithPlentyofWater.”Ablackboxwarningisthestrictestwarningplacedonthemedicationlabelorpackageinsertofcertainprescriptiondrugsbythepharmaceuticalcompany.AblackboxwarningisrequiredbytheFoodandDrugAdministration(FDA)toindicatethatthemedicationcarriesasignificantriskofseriousorevenlife-threateningadverseaffects.

Someadditionalexamplesarelistedbelow:

For External Use Only.

Do Not Take With Dairy Products, Antacids or Iron Preparations Within

One Hour of This Medication.

Finish All of This Medication Unless Otherwise Directed

by Prescriber.

May Cause Discoloration of the Urine or Feces.

May Cause Drowsiness or Dizziness.

Take Medication on an Empty Stomach 1 Hour Before or 2 Hours

After a Meal Unless Otherwise Directed by Your Doctor.

It May Be Advisable to Drink a Full Glass of Orange Juice or

Eat a Banana Daily.

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Learning About Medications

• Thefollowinginformationrelatestoasessionoutcomeandmaybecoveredonthequiz.

Outcome: Identify 3 resources for information about medications that individuals are taking.

• Thereareseveralthingsyouneedtoknowaboutthemedicationsyouareassistingindividualstotake.

• ReviewbulletedquestionsonpageS-10.• Youcanobtainthisinformationfromtheprescribingdoctorandthepharmacist

whofillsthedoctor’sorder.• ReviewotherplaceswhereDSPscanfindinformationaboutmedications.Show Slide #14: DSP TV video• ClickontheicontoviewScene10:MedicationInformation.• DiscussandanswerquestionsattheendofScene10.Answers:

— WheredidAprilandDarrellgetmedicationinformation?April got information from the medication information sheet that the pharmacist provided. Darrell got his information from April and from the medication information sheet.

— Howwastheinformationhelpful?The people who support David are aware that he is taking a new medication that may cause side effects. With this information, they can use their Observation, Communication, Decision Making, and Documentation tools to ensure that David is not harmed by the medication. In other words, it helps April, Darrell, and other DSPs prevent or mitigate risks.

— Whatcouldhappenwithoutthatinformation?David could become seriously ill or even die if unintended side effects go unnoticed.

Activity: Medication Safety Questionnaire• Thefollowinginformationrelatestoasessionoutcomeandmaybecovered

onthequiz. Outcome: Document medication-related information, including self-

administration, late doses, side effects, and drug interactions.• Medication errors and missed doses will be covered in Session 5.Show Slide #15: Activity: Medication Safety Questionnaire• Groupings:Individual,pairs,smallgroups,largegroups.• ReaddirectionsaloudandreferstudentstotheMedicationSafety

QuestionnaireonpageS-11.• ReferstudentstoAmoxicillinInformationSheetonpageS-12foradditional

informationnecessarytofillouttheMedicationSafetyQuestionnaire.• Havethestudentfindthecorrectmedicationinthemedicationboxthat

matchesthelabel.



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Medication Safety Questionnaire

ABCPharmacy101725thSt.,Sacramento,CA

(123)555-7890Dr.Diaz

RX 10575 9/30/17JORDAN BIRD TAKE1CAPSULE3XPERDAYORALLYFOR10DAYSFORINFECTION12A.M.,8A.M.,4P.M.

AMOXICILLIN250mg

#30CAPSULES

EXPIRES:3/31/19 NOREFILLSMFG:MANYMEDICATIONS,INCFILLEDBY:BRS

Directions: Using the sample medication label and the medication information sheet on page S-12, fill in the answers on the Medication Safety Questionnaire on page S-11. There is a blank copy of the Medication Safety Questionnaire in Appendix 4-H for you to use with the individuals you assist. Find the correct medication in the medication box that matches this label.

Learning About Medications

Medicationsafetyincludeslearningaboutthemedicationsthatyouareassistinganothertotake.Youneedtoknowtheanswerstoallofthefollowingquestions:• Whatisthemedicationandwhyisit

prescribed?• Whatistheproperdosage,frequency,

andmethodfortakingthemedication(forexamplebymouth,topical)?

• Howmanyrefillsareneeded?• Whatarethestartandenddatesfor

themedication?Shoulditbetakenfor7days,10days,amonth?

• Aretherepossiblesideeffectsandtowhomshouldthesesideeffectsbereported?

• Whatshouldbedoneifadoseismissed?

• Arethereanyspecialstoragerequirements?

• Whatistheexpirationdate?

• Arethereanyspecialinstructionsforuseofthismedication?Forexample,shouldcertainfoods,beverages,othermedicines,oractivitiesbeavoided?

• Whatimprovementsshouldbeexpected,andwhenwilltheystartshowing?Theprescribingdoctor/pharmacist,

acurrentPhysician’sDeskReference(PDR),andnursingdrughandbooksareallvaluableresourcesforlearningaboutmedication.Youcanalsofindinformationonlineatwww.drugs.com.

Whentalkingtothedoctororpharmacist,usetheMedicationSafetyQuestionnaireontheoppositepagetomakesureyougetallyourquestionsanswered.

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Activity: Medication Safety Questionnaire (cont.)• ReviewtheMedicationSafetyQuestionnairewiththelargegroup.• SomeoftheanswerstothequestionsontheQuestionnaireweredifficulttofind.Advise

studentstoconsultwiththepharmacisttogetallquestionsansweredclearlywhenassistingindividualswithself-administrationofnewmedications.

Answers:Name:Jordan BirdBrand:Amoxil; Biomox; Polymox; Trimox; WymoxGeneric:AmoxicillinDoseandform: mg and capsWhentotakeeachdose?12 A.M., 8 A.M., 4 P.M.Forhowlong?10 days1. Whatisthemedicationsupposedtodo?It is supposed to treat Jordan’s infection.2. HowlongbeforeIknowitisworkingornotworking?After a few days if Jordan improves or worsens. 3. IfJordanmissesadose,howshouldIassisther?Have her take the missed dose as soon

as you remember it, if it is within ordering time. Notify the doctor if it is outside the one hour time frame for further instructions. Do not have her take a double dose to make up for a missed one.

Trainer Note: Review with the students that the Amoxicillin Information Sheet states that if a dose is missed, take it as soon as you remember. Let students know that they are to follow the ordering time it states on the prescription and not to make that judgement on their own.

4. Whatistheexpirationdate?3/31/195. Shouldthemedicationbetakenwithfood?Only if the doctor says so. The medication label does not state that. - Atleastonehourbeforeortwohoursafterameal?No.6. Arethereanyfoods,supplements,drinks,oractivitiesthatshouldbeavoidedwhiletaking

thismedication?No.7. Arethereanyotherprescriptionorover-the-countermedicationsthatshouldbeavoided?

Potentially. Tell the doctor if Jordan is taking other antibiotics, chloramphenicol, or probenecid.

8. Whatarecommonsideeffects?Some side effects include upset stomach, diarrhea, vomiting. More serious side effects include severe skin rash, hives, seizures, yellowing of the skin or eyes, unusual bleeding or bruising, pale skin, excessive tiredness, lack of energy.

9. Ifthereareanysideeffects,whatshouldIdo?HowdoIknowwhethertotaketheindividualtoemergency,callthedoctorrightaway,ormakeanappointmenttoseethedoctor?Call the doctor if any of these symptoms are severe or do not go away: upset stomach, diarrhea, vomiting. Call the doctor immediately if the following symptoms are present: severe skin rash, hives, seizures, yellowing of the skin or eyes, unusual bleeding or bruising, pale skin, excessive tiredness, lack of energy.

10.Ifthedrugisbeingprescribedforalongperiodoftime,arethereanylong-termeffects?None stated.



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Medication Safety Questionnaire

1.Whatisthemedicationsupposedtodo(whatconditiondoesittreat)?

2.HowlongbeforeIwillknowitisworkingornotworking?

3. Iftheindividualmissesadose,whatshouldIdo?

4. Whatistheexpirationdate?

INTERACTIONS5.Shouldthismedicationbetakenwithfood? YesNo

Atleastonehourbeforeortwohoursafterameal? YesNo6.Arethereanyfoods,supplements(suchas,herbs,vitamins,minerals),drinks

(alcoholic,forexample),oractivitiesthatshouldbeavoidedwhiletakingthismedication?

Yes(Whichones?)_________________________________________________No_____________________________________________________________

7.Arethereanyotherprescriptionorover-the-countermedicationsthatshouldbeavoided?Yes(Whichones?)_________________________________________________No_____________________________________________________________

SIDE EFFECTS IF SO, RESPONSE?

8.Whatarecommonsideeffects?

9. Ifthereareanysideeffects,whatshouldIdo?

10.Ifthedrugisbeingprescribedforalongperiodoftime,arethereanylong-termeffects?

Name

Brand:________________

Generic:______________

Whentotakeeachdose?

Forhowlong?Dose(e.g.,mg)andform(e.g.,tabs)

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Amoxicillin Information Sheet

AmoxicillinistheGenericname-brandnamesarelistedbelow

Brandnames:Amoxil;Biomox;Polymox;Trimox;Wymox


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Amoxicillin Information Sheet Brandname:Amoxil;Biomox;Polymox;Trimox;Wymox

Why is this medication prescribed?Amoxicillinisusedtotreatcertaininfectionscausedbybacteria,suchaspneumonia;bronchitis;gonorrhea;andinfectionsoftheears,nose,throat,urinarytract,andskin.ItalsoisusedincombinationwithothermedicationstoeliminateH.pylori,abacteriathatcausesulcers.Amoxicillinisinaclassofmedicationscalledpenicillin-likeantibiotics.Itworksbystoppingthegrowthofbacteria.Antibioticswillnotworkforcolds,flu,orotherviralinfections.

How should this medicine be used?Amoxicillincomesasacapsule,atablet,chewabletablet,asuspension(liquid),andpediatricdropstotakebymouth.Itisusuallytakenevery12hours(twiceaday)orevery8hours(threetimesaday)withorwithoutfood.Tohelpyouremembertotakeamoxicillin,takeitaroundthesametimeeveryday.Followthedirectionsonyourprescriptionlabelcarefully,andaskyourdoctororpharmacisttoexplainanypartyoudonotunderstand.Takeamoxicillinexactlyasdirected.Donottakemoreorlessofitortakeitmoreoftenthanprescribedbyyourdoctor.

Shaketheliquidandpediatricdropswellbeforeeachusetomixthemedicationevenly.Usethebottledroppertomeasurethedoseofpediatricdrops.Thepediatricdropsandliquidmaybeplacedonachild’stongueoraddedtoformula,milk,fruitjuice,water,gingerale,orothercoldliquidandtakenimmediately.

Thechewabletabletsshouldbecrushedorchewedthoroughlybeforetheyareswallowed.Thetabletsandcapsulesshouldbeswallowedwholeandtakenwithafullglassofwater.Takeamoxicillinuntilyoufinishtheprescription,evenifyoufeelbetter.Stoppingamoxicillintoosoonmaycausebacteriatobecomeresistanttoantibiotics.

What special precautions should I follow?Beforetakingamoxicillin,• tellyourdoctorandpharmacistifyouareallergictoamoxicillin,penicillin,cephalorsporins,oranyothermedications.

• tellyourdoctorandpharmacistwhatprescriptionandnonprescriptionmedications,vitamins,nutritionalsupplements,andherbalremediesyouaretaking.Besuretomentionanyofthefollowing:chloramphenicol(Chormycetin),otherantibiotics,andprobenecid(Benemid).Yourdoctormayneedtochangethedosesofyourmedicationsormonitoryoucarefullyforsideeffects.

• tellyourdoctorifyouhaveorhaveeverhadkidneydisease,allergies,asthma,hayfever,hivesorphenylketoonuria.

• tellyourdoctorifyouarepregnant,plantobecomepregnant,orarebreast-feeding.Ifyoubecomepregnantwhiletakingamoxicillin,callyourdoctor.

What special dietary instructions should I follow?Unlessyourdoctortellsyouotherwise,continueyournormaldiet.

What should I do if I forget a dose?Takethemisseddoseassoonasyourememberit.However,ifitisalmosttimeforthenextdose,skipthemisseddoseandcontinueyourregulardosingschedule.Donottakeadoubledosetomakeupforamissedone.

What side effects can this medication cause?Amoxicillinmaycausesideeffects.Tellyourdoctorifanyofthesesymptomsaresevereordonotgoaway:• upsetstomach• vomiting• diarrheaThefollowingsymptomsareuncommon,butifyouexperienceanyofthem,callyourdoctorimmediately:• severeskinrash• hives• seizures• yellowingoftheskinoreyes• unusualbleedingorbruising• paleskin• excessivetiredness• lackofenergyAmoxicillinmaycauseothersideeffects.Callyourdoctorifyouhaveanyunusualproblemswhiletakingthismedication.Ifyouexperienceaserioussideeffect,youoryourdoctormaysendareporttotheFoodandDrugAdministration’s(FDA)MedWatchAdverseEventReportingprogramonline[athttp://www.fda.gov/MedWatch/report.htm]orbyphone[1-800-332-1088].

What storage conditions are needed for this medicine?Keepthismedicationinthecontaineritcamein,tightlyclosed,andoutofreachofchildren.Storethecapsulesandtabletsatroomtemperatureandawayfromexcessheatandmoisture(notinthebathroom).Throwawayanymedicationthatisoutdatedornolongerneeded.Theliquidmedicationpreferablyshouldbekeptintherefrigerator,butmaybestoredatroomtemperature.Throwawayanyunusedmedicationafter14days.Donotfreeze.Talktoyourpharmacistabouttheproperdisposalofyourmedication.

In case of emergency/overdoseIncaseofoverdose,callyourlocalpoisoncontrolcenterat1-800-222-1222.Ifthevictimhascollapsedorisnotbreathing,calllocalemergencyservicesat911.

What other information should I know?Keepallappointmentswithyourdoctorandthelaboratory.Yourdoctorwillordercertainlabteststocheckyourresponsetoamoxicillin.

Ifyouarediabetic,useClinistixorTesTape(notClinitest)totestyoururineforsugarwhiletakingthismedication.

Donotletanyoneelsetakeyourmedication.Yourprescriptionisprobablynotrefillable.Ifyoustillhavesymptomsofinfectionafteryoufinishtheamoxicillin,callyourdoctor.

LastRevised-07/01/2003TheMedMaster™PatientDrugInformationdatabaseprovides

informationcopyrightedbytheAmericanSocietyofHealth-SystemPharmacists,Inc.,Bethesda,Maryland.Copyright©2007.

AllRightsReserved.

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Seven Rights of Assisting with Self-Administration of Medication

• TheSevenRightsrelatetoasessionoutcomeandmaybecoveredonthequiz. Outcome: List the Seven Rights of assisting an individual with self-administration of

medication.

Show Slide #16: Seven Rights• Brieflyrevieweachright.• FollowingtheSevenRightsisthebestwaytopreventmedicationerrors.

Show Slide #17: VERY IMPORTANT!• ReadaloudtheparagraphmarkedbytheDecisionMakingicononpageS-13.• ReviewwhentheDSPshouldchecktheRightsusingtheboxatthebottomofpageS-13.



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Remember, Prevention is the #1 Priority!

TheSevenRightsarethebasicinformationneededtoassurethatmedicationisbeingtakensafely.TheDSPneedstobesureheorshehasthe:

• Rightperson• Rightmedication• Rightdose• Righttime• Rightroute• Rightreason• RightdocumentationFollowingtheSevenRightseach

timeyouassistanindividualwithself-administrationofmedicationisthebestwayfortheDSPtopreventmedicationerrors.

Whenassistinganindividual,youmustreadandcomparetheinformationonthemedicationlabeltotheinformationontheMedicationAdministrationRecord(MAR)threetimesbeforetheindividualtakesthemedication.Bydoingso,youarehelpingtoensurethatyouareassistingtherightindividualwiththerightmedication,therightdoseattherighttimeintherightroute,fortherightreason,andensuringrightdocumentation.Never assist an

individual with medication from a container that has no label!

If,atanytime,youdiscoverthatanyoftheinformationdoesnotmatch,stop.Youmayhave

thewrongindividual,bepreparingthewrongmedicationinthewrongdoseatthewrongtime,ortheindividualmaybeabouttotakethemedicationinthewrongway,orforthewrong reason.Thinkthrougheachofthesepossibilitiesanddecidewhattodo.Ifyouareunsure,youmayneedtogethelp.AskanotherDSP,theadministrator,orinsomesituations,youmayneedtocallthedoctororpharmacist.

Seven Rights of Assisting with Self-Administration of Medication

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Insomecases,anadultmayindependentlytaketheirownmedication.Ifanadultistoindependentlyself-administermedication,aphysicianmustprovideawrittenstatementthattheindividualisabletoadministerandstore

First Check – VerificationWhenyouremovethemedicationfromthestoragearea.

Second Check – PreparationWhenyoupreparethemedicationinindividualdosesfromtheoriginallabeledcontainer.

Third Check – PresentationWhenyouprovidethemedicationtotheindividual,justbeforeyouassistthemtotakethemedication.

Check the medication label 3 times by comparing it to the MAR as follows:

hisorherownmedications.Inallcases,themedicationsmustbeproperlystoredinalockedcabinet.TheDSPshouldmonitortheindividualanddocumentandreporttothedoctoranychangesintheindividual’sabilitytoindependentlytakemedications.

Label Checks vs. the MAR


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Seven Rights of Assisting with Self-Administration of Medication (cont.)Show Slide #18: Seven Rights (with media link)• ReviewthedetailsoftheSevenRightswiththestudents.Explaintothestudentsthattherearenowseven

rights,butthisvideoonlytalksabout5.Theadditional2rightsareRightReasonandRightDocumentation(seefollowingpagefordefinitions).

• Remindthemthattheywillhavetopassaskillcheckdemonstratingthattheycanassistwithself-administrationofmedicationusingtheSevenRights(thisincludesrightreasonandrightdocumentation).Theadditional2rightsareexplainedindetailonpageT/S-15).

1. Right Person:

— ReadthenameoftheindividualonthelabelandcompareittotheMAR.— Knowtheindividualsthatyouassistwithself-administrationofmedicationusing2identifiers(askthe

individual,askanotherstaff,checkanyrecordsthatwouldhavephotoidentificationinthehome,DOB).— Ifyouareuncertainoftheirnameoridentityconsultwithastaffmemberwhoknowsthem.

2. Right Medication:— Readthenameofthemedicationonthelabel(3times)andcompareittotheMAR.— Comparethenameofthemedicationonthelabeltotheinformationontheindividual’sMAR.Askthe

individual,“Doyouknowwhyyouaretakingthismedication?”Iftheindividualisnotabletorespondtothistypeofquestion,explainwhytheindividualistakingthemedication.

3. Right Dose:— ReadthemedicationlabelforthecorrectdosageandcompareittotheMAR.— Bealerttochangesindosage.— Questiontheuseofmultipletabletsforasingledoseofmedication.— Questionanychangeinthecolor,size,orformofmedication.— Questionsuddenlargeincreasesinmedicationdosages.

4. Right Time:— Readthemedicationlabelfordirectionsaboutwhenandhowoftenthemedicationshouldbetakenand

compareittotheMAR.— Medicationmustbetakenataspecifictimeofday.Verifythetimebycheckingyourwatch;checkingyour

watchisonlynecessaryonceper“medicationcheck.”— Staywiththeindividualuntilyouarecertaintheyhavetakenthemedication.— Itisagoodpracticetocheckwiththeindividual’sdoctorifmedicationscanbetakenanhourbeforeorafter

theorderingtime. 5. Right Route:

— ReadthemedicationlabelfortheappropriaterouteorwaytotakethemedicationandcompareittotheMAR.

— Routesinclude:-- Oral-- Oralinhalers-- Nasalsprays-- Topical–includesdermalpatchesorointmentstobeappliedtotheskin-- Eyedrops-- Eardrops

— Moreintrusiveroutesareonlytobeadministeredbyalicensedhealthcareprofessional.

Additionalinformationaboutassistingwithself-administrationofmedicationsafely:— OnlyoneDSPshouldbeassistinganindividualwiththeself-administrationofmedicationatanygiventime.— TheDSPshouldassistwiththeentireprocessfrombeginningtoend— TheDSPshouldneverhandamedicationtoonepersontopasstoanother.— TheDSPshouldalwayspreparemedicationinaclean,well-lit,andquietarea.— TheDSPshouldallowplentyoftimefortheindividualtoself-administermedicationandstayfocusedon

assistinghimorher.• Click on the media link to show the Five* Rights for Assisting with the Self-Administration of Medication

video.Remindthestudentsthattwoadditionalrightshavebeenaddedandwewilldiscussandclarifywhatthestudentswillneedtoknowinadditiontothefiverightsforthemedicationskillcheck.Tellthestudentstopaycloseattention.Thisvideodemonstratesthestepstheywillneedtopasstheskillcheck.

* ThevideoisstilltitledtheFiveRightsforAssistingwiththeSelf-AdministrationofRights,butanewvideowillbeprovidedinthenextyear.



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Seven Rights of Assisting with Self-Administration of Medication (cont.)

Whenassistinganindividualwithanymedication,itisessentialthatyouidentifytherightindividual.First,readthenameoftheindividualonthepharmacylabelforwhomthemedicationisprescribedandcompareittotheMAR.•Tobecertainofanindividual’snameoridentity,consultanotherstaff memberwhoknowstheindividual,asktheindividual“Whatisyour name?”•Use2identifierssuchasaphotoor nameanddateofbirth.•BestPractice:Confirmidentityby placingacurrentphotooftheindividualontheMARcoversheet.

2. Right MedicationAfteryouhaveverifiedthatyouhavetherightindividual,readthenameofthemedicationonthelabel.Tomakesurethatyouhavetherightmedicationfortherightindividual,readthelabelthreetimesandcompareittotheinformationontheindividual’sMAR.

3. Right Dose ReadthemedicationlabelforthecorrectdosageandcompareittotheMAR.Bealerttoanychangesinthedosage.•Questiontheuseofmultipletabletsprovidingasingledoseofmedication.•Questionanychangeinthecolor,size,orformofmedication.•Besuspiciousofsuddenlargeincreasesinmedicationdosages.

The Seven Rights

1. Right Person

4. Right TimeReadthemedicationlabelfordirectionsastowhenandhowoftenthemedicationshouldbetakenandcompareittotheMAR.Medicationmustbetakenataspecifictime(s)oftheday.Staywiththeindividualuntilyouarecertainthatheorshehastakenthemedication.Youneedtoknow:• Howlonghasitbeensincetheindividualtookthelastdose?

• Arefoodsorliquidstobetakenwiththemedication?

• Aretherecertainfoodsorliquidstoavoidwhentakingthemedication?

• Isthereacertainperiodoftimetotakethemedicationinrelationtofoodsorliquids?

• Isittherighttimeofday,suchasmorningorevening?

• Whattimeshouldamedicationbetakenwhenitisorderedforonceaday?Inthemorning?At12:00noon?Atdinnertime?Usuallywhenamedicationisorderedonlyonceaday,itistakeninthemorning;however,itisbesttocheckwiththedoctororpharmacist.

5. Right RouteReadthemedicationlabelfortheappropriaterouteorwaytotakethemedicationandcompareittotheMAR.Theroutefortablets,capsules,andliquidsis“oral.”Thismeansthatthemedicationentersthebodythroughthemouth.Otherroutesincludenasalsprays,whichareinhaledthroughthenose,topical,whichincludesdermalpatchesorointmentstobeappliedtotheskin,eyedrops,ophthalmic,andeardrops.

Note: Other more intrusive routes, such as injections; suppositories; or enemas are only to be administered by a licensed health care professional.

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6. Right Reason (for PRN and Routine medication):— ReadwhattherightreasonmeansintermsofaPRN.— ReviewthelabeltoconfirmwhatthemedicationisprescribedforandcompareittotheMAR.— ReviewtheMARtoidentifywhenthelastPRNdosewastaken.— Countthehourtomakesurewhenthenextdosemaybesafelytaken.— IfthereisanydoubtaboutwhenthePRNistobetaken,checkwithyouradministrator.— UnderstandthedifferencebetweenaroutinemedicationandaPRNandhowthatinformationis

writtenonthemedicationlabel.— Ensuretheindividualisstatingtherightcondition/reasonforthePRN.

7. Right Documentation— Explainthereasonfordocumentingself-administrationofmedication.— ReferstudentstoSampleMedicationAdministrationRecord(MAR)inAppendix4-C.— ReferstudentstothePRNAuthorizationLetter;thismustaccompanyANYPRNmedication(see

sampleletterinAppendix4-FS-34).ThePRNAuthorizationLettermaylookdifferentlyatthefacilitywheretheDSPswork;thisisonlyasample.

— Documentmedicationrelatedinformation,includingself-administration,misseddoses,errors,sideeffects,drugreactions,refusals,PRNmedication,andwhetheroffsite.

— Initialtherighttime/datethemedicationwastaken.—SigntheMARassoonasthemedicationistaken.— WhatweretheresultsafterthePRNmedicationwastaken?— DidthePRNmedicationrelievedthecondition.—TheinformationontheMARmustmatchtheinformationontheprescriptionlabel.—AdvisethestudentsthattheMARintheStudentGuideisonlyasampleandmaylookdifferently

thantheMARintheirfacility.— Wheneveraprescriptionischanged,theMARmustbeupdated(thispolicyorprocedurecanbe

donedifferentlyateachfacility;followthepolicyandproceduresatyourfacility).

• Teacher Note: The medication label for the Amoxicillin prescription depicted in the video is unusual; it does not give an end date or a number of days for administering the medication. Additionally it indicates that there are 90 capsules in the container, implying that the prescription is to be taken for 30 days. If a student asks about this medication label, acknowledge the student’s observation skills. Ask the students what they would do if they saw a medication label like this one. Advise the students to contact the prescribing physician or the pharmacist whenever they have questions about a prescription or if a prescription seems unusual.

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Taking simple steps such as following the Seven Rights and keeping careful MARs can help ensure

the safety and comfort of the individual you support.


6. Right Reason for PRN and Routine MedicationsEverymedicationhasacondition/reasonforwhyitisprescribed.Mostmedicationlabelshavethecondition/reasonprintedonthelabel.Itisthephysician’sresponsibilitytowritethecorrectinformationontheprescriptionforthepharmacy;whetheritbeamedicationthatisroutineoraPRN.ForPRNmedications,theremustalsobeaPRNAuthorizationLetterfromtheprescribingphysician(seesamplePRNAuthorizationLetterinAppendix4-F).APRNmedicationlabelmustindicatethatistakenona“asneeded”basis.DSPsmustreviewtheMARtoidentifywhenthelastPRNdosewastakenandcountthehourtomakesurewhenthenextdosemaybesafelytaken.Forexample:thePRNisTylenolanditisprescribedforheadaches.Itcanbetakenevery4hoursforpainas needed. This does not mean every 4 hours during the day. Ifanindividualtellsyoutheyhaveaconditionotherthanaheadache,thismedicationcannot betaken.• IfthereisanydoubtaboutwhenthePRNistaken,checkwithyouradministrator.

• OncethePRNwastakenwhatweretheresults?

• DidthePRNrelievethecondition?

7. Right DocumentationDocumentationmustbecompletedontheindividual’sMAReverytimeamedicationistaken.• Documentationofmedicationincludesnotingself-administration,misseddosages,errors,sideeffects,druginteractions,refusals,andwhethertheindividualwasoffsite.

• DSPsmustcompleteaone-timesignature,theirintial,andtheirtitleatthebottomoftheMAR.

• DSPsmustinitialtherighttime/datethemedicationwastaken.

• InitialtheMARassoonasthemedicationistaken.

• DocumenttheresultsafterthePRNmedicationwastaken.

• ChecktomakesurethePRNmedicationrelievedthecondition.

• TheinformationontheMARmustmatchtheinformationontheprescriptionlabelfromthepharmacy.

• MARscanlookdifferentlyandtheoneinyourStudentGuideisonlyasample.

• WheneveraprescriptionischangedtheMARmustbeupdated(thispolicyorprocedurecanbedonedifferentlyateachfacility;followthepolicyandproceduresatyourfacility).


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Show Slide #19: Documentation• ReviewcontentonpageS-16.• Wheneveraprescriptionischanged,theMARmustbeupdated.• Documentationmustbedoneatthetimethemedicationistakenbytheindividual,notbeforeand

nothourslater.• AdvisethestudentsthattheMARintheStudentGuideareonlysamplesandmaylookslightly

differentfromtheformusedintheirworksetting.However,aMARshouldcontainallofthekeyinformationindicatedintheillustrations.

• AdvisestudentsthatitispreferabletoplacestickersprovidedwithprescriptionsontheMAR.Transcribing(transferringinformationinhandwriting)fromthemedicationlabeltotheMARismorelikelytoresultinerrors.

Documentation• Thefollowinginformationrelatestoalearningoutcomeandmaybe

coveredonthequiz. Outcome: Explain how and when to document medication taken or

refused by the individual.

Medication Administration Record (MAR)• ReferstudentstoSampleMARinAppendix4-D.(LargerviewofMAR thatisonS-16)• Thefollowinginformationrelatestoalearningoutcomeandmaybe

coveredonthequiz.• Outcome: Document medication related information, including self-

administration, late doses, side effects, and drug reactions.• Medication errors and missed doses will be covered in Session 5.


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Documentation

Medication Administration Record (MAR)Medicationsafetyincludesrecordingeachdoseofmedicationtaken,ormissedforanyreason.TheDSPcanusethesampleMAR(Appendix4-D)oraskthepharmacisttoprovideaformfordocumentationofmedication.MostpharmacieswillprintaMARforhomeuse.

TheuseofaMARincreasesmedicationsafetyandreducestheriskoferrors.TheMARprovidesawayfortheDSPtodocumenteachdoseofmedicationtaken,anymedicationerrors,andotherpertinentinformationrelatedtoassistingwithself-administrationofamedication.

TheMARincludeskeyinformationabouttheindividual,includinganyknowndrugallergies,andinformationabouttheindividual’smedications,includingthenameofthemedication,dose,andthetimesandthewaythemedicationistobetaken(route).

Toavoiderrors,itisadvisedthatpre-mademedicationlabelsfromthepharmacybeplacedontheMAR.Whenpossible,appropriatepre-madewarninglabelsshouldalsobeplacedontheMAR(suchas“takewithfood”).Whenever a prescription is changed, the MAR must be updated.

Todocumentthatamedicationhasbeentaken(includingthePRN),theDSPshouldwritedownthedateandtimeintheplaceprovidedandinitialforeachdoseofmedication.This must be done at the time the medication is taken by the individual.

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Documentation for PRN Medication

• Thefollowinginformationrelatestoasessionoutcomeandmaybecoveredonthequiz.

Outcome: Identify how PRN medications are documented.

Show Slide #20: Documentation for PRN Medication• ReviewcontentonpageS-17.• PRN labels require the same information as routine medication• ReferstudentstothesampleMARforPRNsonpageS-18(alarger

viewoftheMARisinAppendix4-E).• ThereistypicallyaPRNAuthorizationLetterfromtheprescribing

physician(seeAppendix4-Fforasampleletter).• ThereareseveralthingsDSPsneedtoknowaboutPRNmedicationswhen

assistingindividuals.• ReviewbulletsonpageS-17andtheinformationontheMARforPRNs.• DiscusswiththestudentsthatPRNdocumentationispartoftheskillcheck

andtheywillneedtofillinalltheanswersontheMARforPRNsduringtheskillcheck.

*Please note that the PRN medication also needs to be initialed on the front of the MAR, with follow up documentation on the PRN MAR on the back.

Additional Requirements for Assisting Children with PRN Medications

Show Slide #21: Assisting Children with PRN Medications• ReviewtheinstructionsthatDSPsmustfollowtoassistchildrenwithPRN

medicationsusingthebulletedinformationintheStudentGuide.


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Documentation for PRN Medication

S-17

PRN DocumentationMedicationlabelsforPRNmedicationscontainmoreinformationthanlabelsforroutinemedication.Theprescriptionfromthedoctorwillhaveallthesamepertinentinformationasaroutinemedicationlabel.Inaddition,withPRNmedications,thephysicianmustclarifythemedication“asneeded”,thespecificcondition/reasonwhichindicatestheneedfortheuseofthemedication,themaximumdosage,theminimumnumberofhoursbetweendoses,andthemaximumnumberofdosesallowedineach24hourperiod.ThissimplymeansthatthePRNmedicationisnottakenroutinely,justasneededandforspecificconditions/reasons.RefertothePRNMedicationLabeltotherighttoseetheinformationthatisincluded.ThereistypicallyaPRNAuthorizationLetterfromtheprescribingphysician(seeAppendix4-Fforasampleletter).DocumentingPRNmedicationshasmorerequirementsthandocumentingroutinemedicationonaMAR.TodocumentPRNmedications,aDSPmustinitialthedateontheMARinadditiontoprovidinginformationonthebackofthePRNMAR:•DatePRNwastaken.•HourofthedayPRNwastaken.•Thenameofthemedicationandthe“asneeded”information.•Thedosage.•Thereasonwhythemedicationwas taken.•Theresultsafterthemedicationwas taken.•Thehour(time)theresultswere determined.

ABC Pharmacy101725thSt.,Sacramento,CA

Phone:(123)555-7890Dr.Diaz

RX 10484 9/30/17

JORDAN BIRD

TAKE10mLORALLYEVERY4HOURSASNEEDEDFORCOUGHX5DAYSMAXIMUMDOSESFORA24HOURPERIODARE6DOSES

ROBITUSSIN10mLQTY:100mL

DISCARDBY:3/31/19 NOREFILLSMTG.:MANYMEDICATIONSLIQUID

Additional Requirements for Assisting Children With PRN Medications Inasmallfamilyhomeforchildren,theDSPmayassistachildwithaprescriptionorover-the-counterPRNmedicationwithoutcontactingthedoctorbeforeeachdosewhenthechildisunabletodetermineand/orcommunicatehisorherneedforthePRNmedicationwhen:• Inadditiontotheinformationonthe

doctor’sorderandthemedicationlabelrequiredforallCCFs,thedoctor’swrittenorderforchildreninasmallfamilyhomemustalsoprovideinstructionsregardingwhenthemedicationshouldbestopped,andinstructionsforwhenthedoctorshouldbecontactedforreevaluation.

• Themedicationmustbetakenfollowingthedirectionsinthewrittendoctor’sorder.

• Arecordofeachdose,includingthedate,timeanddosagetaken,andtheindividual’sresponse,mustbekeptintheindividual’srecord.

Remember:For both children and adults, for every PRN medication for which the DSP provides assistance there must be a signed, dated, and written order from a doctor, on a prescription form, maintained in the individual’s record, and a label on the medication.


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Documentation for PRN Medication (cont.)

Activity: Scenario for Jordan Bird’s PRN•Groupings:smallgroups•HavethestudentsreadthescenarioonpageS-18.•IntheirgroupstheywillanswerthefollowingquestionsregardingassistingJordanwiththeself-administrationofherPRN.

— WhatconditiondoesJordansaysheisexperiencing?A cough.— HowistheDSPinformedaboutthePRNmedication?Jordan told the DSP she had a

PRN for Robitussin.— WhatshouldtheDSPdowhenJordanstatesshehasacough?The DSP should check

to see that there is written documentation from the doctor meeting the CCL requirements for PRN medication. The DSP should check when the last dose was taken. If it is 4 hours or more since the last dose was taken, then the DSP should gather all supplies and prepare to assist Jordan in the self-administration of medication.

—ListthestepstoassistingJordanwiththeself-administrationofherPRN(referstudentstotheprescriptionlabelforthePRNonpageS-17forneededinformation).

1. Obtain the medication from the medication storage area and check the prescription for the condition/reason the medication is taken.

2. Check the MAR to see when the last PRN dose was taken. 3. Write in the date the PRN was taken. 4. Write your initials in the Initial column at the time the medication is taken. 5. Write the hour the medication was taken. 6. Write in the medication name and dosage that was taken. 7. Write in the reason the PRN was taken (make sure it is the reason stated on the

medication label). 8. Write what the results were after the medication was taken? Did Jordan stop

coughing? 9. When were the results determined (time of day). 10. Sign and initial the MAR for the PRN at the bottom of the page.

Trainer Note: When comparing documentation of routine and PRN medications that the individual has taken: 1) Both medications should be initialed in the date column in front of the MAR after the medications were taken; 2) Ensure they have initialed and signed the bottom; and 3) PRN medication would require other information documented on the back of the PRN MAR.

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Youareworkingtheafternoonshift(whichstartsat4P.M.)atthefacilitywhereJordanlives.Jordancomestoyouandstatesshehasacough.ShetellsyoushehasaPRNforRobitussinforacoughandthelastdosewastakenat11A.M.Youwillbeassistingherintheself-administrationofmedication.YoupreparetogiveherthePRNforRobitussin.Answerthefollowingquestions:WhatconditiondoesJordansaysheisexperiencing?_______________________________HowistheDSPinformedaboutthePRNmedication?________________________________WhatshouldtheDSPdowhenJordanstatesshehasacough?_________________________ListthestepstoassistingJordanwiththeself-administrationofherPRN.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A C T I V I T Y

Scenario for Jordan Bird's PRN

Documentation for PRN Medication (cont.)

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Steps for Assisting with Medication

• ReviewinformationonpagesS-19throughS-21withstudents.• RefertoAppendix4-BfortheMedicationSkillCheck.• RefertoAppendix4-Cthrough4-EfortheMARs.


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Thefollowingisastep-by-stepprocessforassistinganindividualwithself-administrationofmedications.

1. GettheMARfortheindividualyouareassisting.DoublecheckthatyouhavetheMARfortherightindividual.It’simportantforyoutoworkwithonlyoneindividualatatimeandtocompletethetaskwiththatindividualbeforeassistinganother.

2. Gathersupplies:• Getpapercupsfortabletsand

capsulesandaplasticcalibratedmeasuringcupormedicationspoonforliquid.

• Getaglassofwater.• Getapen.

3. Washhands.• Helptheindividualwhomyouareas-

sistingtowashhisorherhands.• Washyourhands.Handwashingreducestheriskofcontamination.

4. Takethemedicationsoutofthelockedstoragecontainerorarea.Itisagoodideatokeepallmedicationsforoneindividualinonestorageunitlabeledwiththeindividual’sname.

5. Verification Check Asyoutakeeachmedicationcontainer

fromtheindividual’sstorageunit,readthemedicationlabelandcompareittotheMARfortheSevenRights:• Rightperson• Rightmedication• Rightdose• RighttimeCheckthetimeonyourwatchorclock• Rightroute• Rightreason• Rightdocumentation(completedafter

medicationistaken)

6. Preparation Check Beforepouringthemedication,readthe

medicationlabelandcompareittotheMARfortheSevenRights:

• Rightperson• Rightmedication• Rightdose• RighttimeCheckthetimeonyourwatchorclock• Rightroute• Rightreason• Rightdocumentation(completedafter

medicationistaken) Fortabletsorcapsules,pourthecorrect

doseintothelidofthecontainerandthenintoasmallpapercup.• Pourthecorrectdoseintothebottle

capandthenintoasmallpapercuporothercontainerusedforholdingtabletsorcapsulesbeforetheindividualtakesthem.Pouringatabletorcapsuleintothebottlecapfirstreducestheriskofcontamination.Iftoomanypillspourout,returnthepillsfromthebottlecapintothecontainer.

• Itisagoodideatouseaseparatedisposablepapercupforeachmedication.Pouringallthemedicationsinonepapercupincreasestheriskofmedicationerrors.

Steps for Assisting with Medication

Often, a DSP will assist an individual with self-administration of multiple medications

scheduled to be taken at the same time of day. Checking the watch or clock for the right time only needs to be done for the first medication

at each of the Three Checks described on page S-13 (Verification, Preparation and

Presentation).

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T-20

Steps for Assisting with Medication (cont.)



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7. Forbubblepacks,pushthetablets/capsulesfromthebubblepackintoasmallcup.Matchtablets/capsulesinbubblepackwithcorrectdayofthemonth.

8. Forliquidmedication,pourthecorrectdoseintothecalibratedmeasuringcuporspoon,ororalsyringe,heldateyelevel.• Locatethemarkingforthedose.• Viewthemedicationinthecupon

aflatsurface.Holdthespoonorsyringeateyelevel.

• Filltocorrectdosagemarking.• Pourawayfromthemedicationlabel

toavoidspills.• Wipeoffanyspills.Additionaltipsforliquidmedication:• Checkthelabeltoseeifthebottle

needstobeshaken;medicineinsuspensionformmustbeshakenwellbeforeusing.

• Oralsyringesareusefulbecausetheyareaccuratelymarked,easytouse,and,whencapped,maybeusedtotakeliquidmedicationonoutingsinsingledosages.

• Alwayschecktomakesuretheunitofmeasurement(teaspoon,tablespoon,mL)onthemeasuringcup,spoon,orsyringematchestheunitofmeasurementforthedoseyouwanttogive.

• Useonlyacalibratedmeasuringcuporspoonwithmeasurementsclearlymarkedontheside.Regular eating spoons are not accurate enough and should never be used.

• Iftoomuchliquidispoured,donotpouritbackintothebottle—discardit.

• Washthecalibratedmeasuringcuporspoonandairdryonapapertowel.

9. Talkwiththeindividualyouareassistingaboutwhatyouaredoingandaboutwhyheorsheistakingeachmedication.

10. Presentation Check Again,justbeforeputtingthemedication

withintheindividual’sreach,readthemedicationlabelandcomparetotheMARfortheSevenRights:• Rightperson• Rightmedication• Rightdose• RighttimeAgain,checkthetimeonyourwatchorclock.• Rightroute• Rightreason• Rightdocumentation

11.Placethemedicationwithintheindividual’sreach.

12.Offeraglassofwater(atleastfourounces).• Itisagoodideatosuggesttothe

individualthathetilthisheadforwardslightlyandtakeasmallsipofwaterbeforeplacingthepillinthemouth.Wettingthemouthmaymakeswallowingeasierandtiltingtheheadslightlyforward(asopposedtobackward)maydecreasetheriskofchoking.Ifpillsarenottakenwithliquidstheycanirritatethethroatandintestinaltractandtheymaynotbecorrectlyabsorbed.

• Somemedicationsmustbetakenwith food,andtheremaybeotherspecialinstructions.Makesurethatyouhavereadanywarninglabelsandarefamiliarwithanyspecialinstructionsfortakingthemedication.

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T-21


Onceyouhavefinishedreviewingthestepsforassistingwithmedication,begintheskillcheck.• Thisactivityrelatestoalearningoutcome. Outcome: Demonstrate how to assist individuals in the self-administration

of medication including PRN medication.

Skill Check #1 (Appendix 4-B)

Show Slide #22: Skill Check #1Assisting Individuals with Self-Administration of Tablets, Cap-sules, and Liquid Medications• Allstudentsmustpasstheskillcheckforassistingwithself-

administrationofmedication.• Assurestudentsthattheywillhavetimetopracticetheskillcheckwith

otherstudentsuntiltheyarecomfortabledemonstratingtheskill,andthatyouareavailabletohelpthemiftheyneedit.

• ReferstudentstoAppendix4-B,theSkillCheckWorksheet.• Readthedirectionsaloudandassiststudentsinfindingpartners.• Demonstratetheprocessforassistingwithself-administrationusingthe

materialssuppliedandtheSkillCheckWorksheet.• Handoutmaterialstostudentstopracticetheskillcheckandinstruct

themtobeginpracticing.ThereareroutinemedicationsandaPRNmedicationontheMAR.DocumentationofaPRNmedicationwillbecompletedonthebackoftheMAR.

• Walkaroundtheroomtoobservethepartnersandprovideassistanceifneeded.

• ScheduletimesforstudentstocompletetheskillcheckbeforetheendoftheYear1training.

• WhenstudentsindicatetheyarereadyfortheTeacherCheck,checkoffeachstepthatiscorrectlycompleted,andfillouttheCertificationforthosewhopasstheskillcheck.

Summary• Askstudentstoturnbacktothe“What Do You Want To Know?”activity

atthebeginningofthesession.Givestudents5minutestothinkabout

Show Slide #23: Practice and Share• DirectstudentstothePracticeandSharedirections.•Readthedirectionsandmakesurestudentsunderstandtheassignment.



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13.Makesurethattheindividualtakesthemedicationanddrinkswater.• Staywiththeindividualuntil

youaresurethatheorshehasswallowedthemedication.

• Iftheindividualhasdifficultydrinkinganadequateamountofwaterorswallowingliquids,theDSPcanaskthedoctorabouttheindividualtakingthemedicationwith:–Jell-Othatissemi-liquidorjellied.–Applesauce,applejuiceorother“medication-compatible”juicethickenedwithcornstarchorotherthickeningagent.

Medicationsshouldneverbedisguisedbyputtingtheminfoodorliquid.Tabletsshouldneverbecrushedunlesstheprescribingphysiciangivesthespecificdirectiontodoso.Capsulesshouldnotbeopenedandtheircontentsemptiedout.Iftheindividualhastroubletakingamedication,talktotheindividualabouttheirneedsandpreferencesandthentalktothedoctoraboutoptionalwaystotakethemedication.

14.RecordthattheindividualtookhisorhermedicationbyenteringyourinitialsintheboxthatmatchesthedateandtimeontheMAR.

S-21

P R A C T I C E A N D S H A R E

Thinkabouttheindividualsyousupportandthemedicationstheytake.Pickonemedicationandlearnaboutthepossiblesideeffects.


15.Returnthemedicationcontainersand/orbubblepacktotheindividual’sstorageunit.Asyoudoso,readthelabelstocheckthattheindividual’snameonthemedicationcontainerlabelisthesameasthenameonthestorageunit.Key point:Never leave the medication container unattended or give to someone else to return to the locked storage container or area.Whenassistinganindividualwith

othertypesofmedicationssuchastopicalcreamsandointments,eardrops,nosedrops,andeyedrops,consultwiththeprescribingdoctorandthepharmacistforspecificproceduresforself-administrationofthemedication.Also,refertoadditionalmaterialinAppendices4-Athatdescribetheprocessforassistingwiththesetypesofmedications.

IF YOU HAVE ANY DOUBT AS TO WHETHER THE MEDICATION IS IN THE CORRECT FORM AS ORDERED OR THAT YOU CAN ASSIST THE INDIVIDUAL WITH SELF-ADMINISTRATION AS DIRECTED ON THE LABEL, CONSULT WITH THE PRESCRIBING DOCTOR OR THE PHARMACIST.


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T-22

QUIZ: Medication Management, Part 1

Show Slide #24: Quiz Time• Givestudents20minutestotakethequiz.

Show Slide #25: Quiz Answers• Discussquestionsandanswersasaclass.Remindstudentsto

markthecorrectanswerssotheycanusethecorrectedquizzesasastudyguideforthetestaftertraining.

Answers: 1. C2. C3. B4. B5. C6. B7. A8. C9. B10.C

End of Session 4



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Session 4 Quiz

Medication Management, Part 11. Community Care Licensing regulations

say that a DSP may only assist with self-administration of medications that have been ordered or prescribed by a doctor, dentist or a:A)DSPwithtwo-yearsofrequired

trainingB)FacilityadministratorC)NursepractitionerD)Parentorotherclosefamilymember

2. Prescription medications are those that:A)Areveryexpensiveandrequirecareful

monitoringB)Maybepurchasedinastorewithouta

doctor’sorderC)Mustbeorderedbyadoctor,dentist

ornursepractitionerorotherlicensedhealthcareprofessionalwhoisauthorizedtoprescribemedication

D)Haveserioussideeffects

3. Over-the-counter medications are those that:A) Areveryexpensiveandrequirecareful

monitoringB) Maybepurchasedinastorewithouta

doctor’sorder,butintheCCLhomes,aphysician’sorderisrequired.

C)Mustbeorderedbyaphysicianorotherlicensedhealthcareprofessional.

D) Haveserioussideeffects.

4. A DSP may assist an individual with self-administration of a PRN medication, as long as:A)ItisnottoocostlyB)Itisorderedbyadoctorforaspecific

condition,andmeetsallCCFrequirements.

C)Itwillhelptheindividualhavebetterhealthorcomfort

D)Theindividualasksforthemedicationbyname

5. When the right dose of medication is taken, the individual receives the correct:A) BrandnameofmedicationB) CategoryofmedicationC) AmountofmedicationD) Sideeffectsofmedication

6. Documenting self-administration of medication:A)Isn’tnecessaryB)Increasesmedicationsafetyand

reducesriskofmedicationerrorsC)SavestimeduringdoctorvisitsD)Reducestheamountoftimeneeded

foradministrationofmedication

S-22

7. One good way to learn more about a prescription drug is to:A) Getacopyofthemedication

informationsheetfromthepharmacistB) Talkwiththepersontakingthe

medicationtofindoutwhattheythinkaboutit

C) Watchthedrugcompany’sadvertisementsontelevision

D) Talkwithotherpeoplewhohaveusedthemedicationtolearnmoreaboutwhatitdoes

8. Which of these is one of the “Seven Rights” of Assisting with Self-Administration of Medication?A)RightDSPB)RightDoctorC)RightTimeD)RightFacility

9. If at any time you see that one of the Seven Rights does not match, you should:A)GoontothenextRightB)StopandgethelpfromanotherDSP,

yoursupervisor,thedoctororthepharmacist

C)ChangetheRightD)Stopandtrytoassistadifferent

individualinstead

10. When an individual’s medication dosage has increased, the MAR must be:A)Thrownoutandstartedonanew

sheetB)LeftunchangedC)UpdatedtorecordthechangeD)Initialed


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Appendices

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Appendix 4-A

Guidelines for Assisting with Self-Administration of Medication

1.Theremustbeawritten,dated,andsignedphysician’s order intheindividual’srecordbefore a DSP can assisttheindividualwithself-administrationofanymedication,prescription,orover-the-counter medication.

2.Only one DSPshouldassistanindividualwithmedicationsatanygiventime.ThatDSPshouldcompletetheentireprocess.Neverhandamedicationtooneindividualtopassontoanother.

3.Always wash your handsbeforeassistinganindividualwithself-administrationofmedication.

4.TheDSPshouldalways prepare medication in a clean, well-lit, quiet area.Allowplentyoftime,avoidrushing,andstayfocused.ChecktheSevenRightsbyreadingtheMedicationLabelandcomparingtotheMARthreetimesbeforetheindividualtakesthemedication.

5.To avoid errors, it is recommended that the medications be set up immediately before assisting an individual with self-administration of medications. WhileCommunityCareLicensingregulationspermitthesetupofmedicationsupto24hoursinadvance,therearemanypotentialproblemswiththispractice,includingthepossibilityofthewrongindividualtakingthewrongmedicationandwrongdoseatthewrongtime.

6.DSPs should ask for help from the prescribing doctor or pharmacistifheorsheisunsureaboutanystepinthepreparationof,assistancewith,ordocumentationofmedications.

7.Medication should never be disguisedbyputtingitinfoodorliquid.

8.The DSP should always ask the physician (and pharmacist) to give the medicine in the proper form for the individual based on the individual’s needs and preferences.Forexample,oneindividualmayhavedifficultyswallowingcapsulesandpreferliquidmedication,whileanothermayprefercapsules.

9.Tablets should never be crushedunlesstheprescribingphysicianhasgivenspecificdirectionstodoso.Capsules should not be openedandtheircontentsemptiedout.Controlledreleasetabletscandeliverdangerousimmediatedosesiftheyarecrushed.Alteringtheformofcapsulesortabletsmayhaveanimpactontheireffectivenessbychangingthewayanindividual’sbodyabsorbsthem.

10.Read the medicine warning label if any. It will give you important information about how the medication should be taken.

11.Check for allergies prior to assisting with the self-administration of medication.

12.TheDSPshouldknowandfollowthepolicyandproceduresforthefacilitywheretheywork.

S-24

ASK! ASK! ASK!CHECK! CHECK!

CHECK!


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Appendix 4-B

SKILL CHECK #1

Directions: Partner with another member of the class. Each partner should have a Skill Check #1 Worksheet. Using the Worksheet, practice all the steps in this skill. Have your partner check off each step you correctly complete (PARTNER CHECK). When you are comfortable that you are able to correctly complete all the steps without using the Worksheet, ask the teacher to complete the Teacher Check.

Reminders for Assisting with Self-Administration• Alwaysstoremedicationinalockedcabinetand/orrefrigerator.

• Neverleavemedicationunattendedonceithasbeenremovedfromthelockedstoragearea.

• Alwayscheckforknownallergies.

• Alwaysreadthemedicationlabelcarefullyandnoteanywarninglabels.

• Assistonlywithmedicationfromlabeledcontainers.

• Assistonlywithmedicationthatyouhaveprepared.

HELPFUL HINT• Whencompletingthisskillcheck,rememberthatyouarecheckingtheSeven Rightsthree timesby

readingthemedicationlabelandcomparingittotheMAR.• Thefirstcheckiswhenyouremovethemedicationfromthelockedstorageareaorstoragecontainer.• Thesecondcheckiswhenyouremovethemedicationfromitsoriginallabeledcontainer.• Thethirdcheckisjustbeforeyouassisttheindividualwithself-administration.• Whenassistingwithself-administrationofseveralmedicationsscheduledtobetakenatthesame

timeofday,itisnecessarytocheckthewatchorclocktoconfirmtherighttimeateachoftheabovethreecheckpointsonlyforthefirstmedication.

COMPETENCY: Each student is required to complete Skill Check #1 Worksheet, Assisting Individuals With Self-Administration of Tablets, Capsules, and Liquid Medications, with no errors.

Assisting Individuals with Self-Administration of Tablets, Capsules, and Liquid Medications

____________________________________________________________________TEACHER

____________________________________________________________________STUDENT

____________________________________________________________________DATE

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STEPS1.GettheMAR(PRNMARshouldbeontheback)fortheindividualyouareassisting.

2.Gathersupplies:• Cupsfortabletsandcapsules,plasticcalibrated

measuringcup,ormedicationspoonforliquid

• Glassofwater

• Pen

3.Ifnecessary,helptheindividualwhomyouareassistingtowashhisorherhands.

• Washyourhands.

4.Takemedicationsoutofthelockedstorageunit,container,orarea.

5.Asyoutakeeachmedicationcontainerfromtheindividual’sstorageunit,readthemedicationlabelandcomparetotheMARforthe:

• Rightperson

• Rightmedication

• Rightdose

• Righttime(checkthetimeonyourwatch/clock)

• Rightroute

• RightreasonforroutineandPRNmedications

Please initial each stepwhen completed correctly.


Scenario: The time is 8:00 a.m. The date is the day of the class. The DSP is assisting Jordan Bird with self-administration of medication.

TeacherCheck Attempt#1 Attempt#2 Attempt#3 DateDateDate

PartnerCheck

S-26

Appendix 4-B (cont.)


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STEPS6.Again,asyoupreparethemedications,readthemedicationlabelandcomparetotheMARforthe:

• Rightperson

• Rightmedication

• Rightdose


• Rightroute


7.Fortabletsorcapsules,pourthecorrectdoseintothelidofthecontainerandthenintoasmallpapercup.

8.Forbubblepacks,pushtablets/capsulesfromthebubblepackintoasmallpapercup.

9.Forliquidmedication,pourthecorrectdoseintothecalibratedmeasuringcuporspoon,ororalsyringe,heldateyelevel.

• Locatethemarkingforthedose.

• Viewthemedicationinthecuponaflatsurface.Holdthespoonorsyringeateyelevel.

• Filltothecorrectdosagemarking.

• Pourawayfromthemedicationlabeltoavoidspills.

• Wipeoffanyspills.



TeacherCheck Attempt#1 Attempt#2 Attempt#3 Date DateDate

PartnerCheck

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STEPS 10.Talkwiththeindividualyouareassistingaboutwhatyouaredoingandaboutwhyheorsheistakingeachmedication.11.Again,justbeforeputtingthemedicationwithinthe

individual’sreach,readthemedicationlabelandcomparetotheMARforthe:

• Rightperson

• Rightmedication

• Rightdose


• Rightroute


12.Placethemedicationwithintheindividual'sreach.

13.Offeraglassofwater.

14.Makesurethattheindividualtakesthemedicationanddrinkswater.

15.DocumentthattheindividualtookhisorhermedicationbyinitialingthedateandtimeintheproperboxontheMARs.

• RightdocumentationforPRNincludesinitialandsignature.CompletetheMARbyfillinginalltheareas(date/hourtaken,medicationanddosage,reasonforPRN,theresultsofthePRN,andthehourwhenthePRNresultsweredetermined).

16.Returnthemedicationcontainersandbubblepacktotheindividual’sstorageunit.Asyoudoso,readthelabelstocheckthattheindividual'snameonthemedicationcontainerlabelisthesameasthenameonthestorageunit.



TeacherCheckPartnerCheck

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Attempt#1 Attempt#2 Attempt#3 Date DateDate


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Certification

This is to certify that

_________________________________________________________________(Nameofstudent)

Correctly completed all of the steps for Assisting Individuals with Self-Administration of

Tablets, Capsules, and Liquids.

_________________________________________________________________ TeacherSignature Date

Comments_________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

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When Assisting withSelf-Administration

of Medications, You Must Ensure That…

• The Right person...• Receives the Right medication…• In the Right dose…• At the Right time…• By the Right route...• For the Right reason...• With the Right documentation.



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Appendix 4-C


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Medication Administration Record (MAR) Without Signatures


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Appendix 4-D

Medication Administration Record (MAR) With Signatures

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Appendix 4-E

Medication Administration Record (MAR) for PRNs

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Appendix 4-F

PRN Authorization Letter

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COMMUNITY CARE LICENSING DIVISION“Promoting Healthy, Safe, and Supportive Community Care”

Self-Assessment Guide*MEDICATIONS

TECHNICAL SUPPORT PROGRAM

MEDICATIONS

Appendix 4-G

Medicationhandlingrepresentsanareaofgreatresponsibility.Ifnotmanagedproperly,medicationsintendedtohelpaclient’s/resident’shealthconditionmayplacethatindividual’shealthandsafetyatrisk.Theinformationcontainedinthishandoutoutlinesmedicationproceduresyouarerequiredtoperformbyregulation,aswellassomeproceduresnotrequiredbyregulationwhich,ifimplemented,willprovideadditionalsafeguardsinthemanagementofmedicationsinyourfacility.IfyouoperateaCommunityCareFacility(CCF),thespecificmedicationregulationsyoumustcomplywithareinTitle22§80075.IfyouoperateaResidentialCareFacilityfortheElderly(RCFE),thespecificmedicationregulationsyoumustcomplywithareinTitle22§87465.This guide cannot be used as a substitute for having a good working knowledge of all the regulations.

WHAT YOU (CARE PROVIDERS) SHOULD DO WHEN:

1. Client/resident arrives with medication:• Contactthephysician(s)toensurethat

theyareawareofallmedicationscurrentlytakenbytheclient/resident.

• Verifymedicationsthatarecurrentlytakenbytheclient/residentanddispensinginstructions.

• Inspectcontainerstoensurethelabelingisaccurate.

• Logmedicationsaccuratelyonformsforclient/residentrecords.TheCentrallyStoredMedicationandDestructionRecord(LIC622)isavailableforthispurpose.

• Discussmedicationswiththeclient/residentortheresponsibleperson/authorizedrepresentative.

• Storemedicationsinalockedcompartment.

2. Medication is refilled:• Communicatewiththephysicianorothers

involved(forexample,discussproceduresforpaymentofmedications,whowillorderthemedications,etc.withtheresponsibleperson).

• Neverletmedicationsrunoutunlessdirectedtobythephysician.

• Makesurerefillsareorderedpromptly.• Inspectcontainerstoensureall

informationonthelabeliscorrect.• Noteanychangesininstructionsand/

ormedication(forexample,changeindosage,changetogenericbrand,etc.).

• LogmedicationwhenreceivedontheLIC622.

• Discussanychangesinmedicationswiththeclient/resident,responsibleperson/authorizedrepresentativeandappropriatestaff.

3. A dosage is changed between refills:• Confirmwiththephysician.Obtainwritten

documentationofthechangefromthephysicianordocumentthedate,time,andpersontalkedtoinclient’s/resident’srecord.

• Prescriptionlabelscannotbealteredbyfacilitystaff.

• Haveafacilityprocedure(i.e.,cardfile/cardex,notebook,and/oraflaggingsystem)toalertstafftothechange.

• Discussthechangewithclient/residentand/orresponsibleperson/authorizedrepresentative.

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*Atthetimeofthisprinting,thenewCCLDregulationsforAdultResidentialFacilitieshasnotbeencompleted.


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4. Medication is permanently discontinued:• Confirmwiththephysician.Obtainwritten

documentationofthediscontinuationfromthephysicianordocumentthedate,time,andpersontalkedtoinclient’s/resident’srecord.

• Discussthediscontinuationwiththeclient/residentand/orresponsibleperson/authorizedrepresentative.

• Haveafacilityprocedure(i.e.,cardfile/cardex,notebook,and/oraflaggingsystem)toalertstafftothediscontinuation.

• Destroythemedications.Medicationmustbedestroyedbythefacilityadministratorordesigneeandoneotheradultwhoisnotaclient/resident.(Seedestructionrequirementsforpre-packagedmedicationsinsection#17.)

• Signthemedicationdestructionrecord/log.(ThereversesideofLIC622,CentrallyStoredMedicationRecord,maybeusedforthispurpose.)

5. Medications are temporarily discontinued (“dc”) and/or placed on hold:

• Medicationstemporarilydiscontinuedbythephysicianmaybeheldbythefacility.

• Discussthechangewithclient/residentand/orresponsibleperson/authorizedrepresentative.

• ObtainawrittenorderfromthephysiciantoHOLDthemedication,ordocumentintheclient’s/resident’sfilethedate,time,andnameofpersontalkedtoregardingtheHOLDorder.

• Haveafacilityprocedure(i.e.,cardfile/cardex,notebook,and/oraflaggingsystem)toalertstafftothediscontinuationandrestartdate.

• Withoutalteringthelabel,markoridentifyinaconsistentmannermedicationcontainersthathaveHOLDorders.

• Besuretocontactthephysicianafterthediscontinuation/holdorderexpirestoreceivenewinstructionsregardingtheuseofthemedication.

Appendix 4-G (cont.)

6. Medication reaches expiration date:• Checkcontainersregularlyforexpiration

dates.• Communicatewithphysicianandpharmacy

promptlyifamedicationexpires.• Donotuseexpiredmedications.Obtaina

refillassoonaspossibleifneeded.• Over-the-countermedicationsand

ointmentsalsohaveexpirationdates(forointmentstheexpirationdateisusuallyatthebottomofthetube).

• Destroyexpiredmedicationsaccordingtoregulations.

• Log/recordthedestructionofprescriptionmedicationsasrequired.TheLIC622maybeusedforthispurpose.

7. Client/residenttransfers,dies,orleavesmedication behind:

• Allmedications,includingover-the-counters,shouldgowithclient/residentwhenpossible.

• Iftheclient/residentdies,prescriptionmedicationsmustbedestroyed.

• Log/recordthedestructionasrequired.TheLIC622maybeusedforthispurpose.

• Documentwhenmedicationistransferredwiththeclient/resident.Obtainthesignatureofthepersonacceptingthemedications(i.e.,responsibleperson/authorizedrepresentative).

• Maintainmedicationrecordsforatleast1year(RCFE)Title22§87465(h)(6),(i)or1year(CCF)Title22§80075(k)(7),(o).

8. Client/resident missed or refused medications:

• Noclient/residentcanbeforcedtotakeanymedication.

• Missed/refusedmedicationsmustbedocumentedintheclient’s/resident’smedicationrecordandtheprescribingphysiciancontactedimmediately.

• Notifytheresponsibleperson/authorizedrepresentative.

• Refusalofmedicationsmayindicatechangesintheclient/residentthatrequireareassessmentofhis/herneeds.Continuedrefusalofmedicationsmayrequiretheclient’s/resident’srelocationfromthefacility.


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9. Medications need to be crushed or altered:• Medicationsmaybecrushedoralteredto

enhanceswallowingortaste,butnevertodisguiseor“slip”themtoaclient/residentwithouthisorherknowledge.

• Thefollowingwrittendocumentationmustbeintheclient’s/resident’sfileifthemedicationistobecrushedoraltered:1.Aphysician’sorderspecifyingthename

anddosageofthemedicationtobecrushed;

2.Verificationofconsultationwithapharmacistorphysicianthatthemedicationcanbesafelycrushed,identificationoffoodsandliquidsthatcanbemixedwiththemedications,andinstructionsforcrushingormixingmedications;

3.Aformconsentingtocrushingthemedicationsignedbytheclient/resident.Iftheclient/residenthasaconservatorwithauthorityoverhis/hermedicaldecisions,theconsentformmustbesignedbythatconservator.

10. Medications are PRN or “as needed:”• Facilitystaffmayassisttheclient/

residentwithself-administrationofhis/herprescription and nonprescriptionPRNmedication,when:–Theclient’s/resident’sphysicianhasstatedinwritingthattheclient/residentcan determine and clearly communicatehis/herneedforaprescriptionornonprescriptionPRNmedication.

–Thephysicianprovidesasigned,dated,writtenorderforthemedicationonaprescriptionblankorthephysician’sbusinessstationerywhichismaintainedintheclient’s/resident’sfile.

–Thephysician’sorderandthePRNmedicationlabelidentifythespecificsymptomsthatindicatetheneedforuseofthemedication,exactdosage,minimumhoursbetweendoses,andmaximumdosestobegivenina24-hourperiod.Mostnonprescriptionlabelsdisplaythisinformation.

• Facilitystaffmayalsoassisttheclient/residentwithself-administrationofhis/hernonprescriptionPRNmedication

iftheclient/residentcannotdeterminehis/herneedforanonprescriptionPRNmedication,butcancommunicatehis/hersymptomsclearly,when:–Theclient’s/resident’sphysicianhasstatedinwritingthattheclient/residentcannotdeterminehis/herneedfornonprescriptionmedication,butcancommunicatehis/hersymptomsclearly.

–Theclient’s/resident’sphysicianprovidesasigned,dated,writtenorderonaprescriptionblankorthephysician’sbusinessstationerywhichismaintainedintheclient’s/resident’sfile.

–Thewrittenorderidentifiesthenameoftheclient/resident,thenameofthePRNmedication,instructionsregardingwhenthemedicationshouldbestopped,andanindicationwhenthephysicianshouldbecontactedforre-evaluation.

–Thephysician’sorderandthePRNmedicationlabelidentifythespecificsymptomsthatindicatetheneedforuseofthemedication,exactdosage,minimumhoursbetweendoses,andmaximumdosestobegivenina24-hourperiod.Mostnonprescriptionmedicationlabelsdisplaythisinformation.

–Arecordofeachdoseismaintainedintheclient’s/resident’srecordandincludesthedate,time,anddosagetaken,andtheclient’s/resident’sresponse.

• Facilitystaffmayalsoassisttheclient/residentwithself-administrationofhis/herprescription or nonprescriptionPRNmedicationiftheclient/residentcannotdeterminehis/herneedforaprescriptionornonprescriptionPRNmedication,andcannotcommunicatehis/hersymptomswhen:–Facilitystaffcontacttheclient’s/resident’sphysicianbeforegivingeachdose,describetheclient’s/resident’ssymptoms,andreceivepermissiontogivetheclient/residenteachdose.

–Thedateandtimeofeachcontactwiththephysicianandthephysician’sdirectionsaredocumentedandmaintainedintheclient’s/resident’sfacilityrecord.


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–Thephysicianprovidesasigned,dated,writtenorderonaprescriptionblankorthephysician’sbusinessstationerywhichismaintainedintheclient’s/resident’sfile.

–Thephysician’sorderandthePRNmedicationlabelidentifythespecificsymptomsthatindicatetheneedforuseofthemedication,exactdosage,minimumhoursbetweendoses,andmaximumdosestobegivenina24-hourperiod.

–Arecordofeachdoseismaintainedintheclient’s/resident’srecordsandincludesthedate,time,anddosagetaken,andtheclient’s/resident’sresponse.

• SMALLFAMILYHOMESANDCERTIFIEDFAMILYHOMES

SmallFamilyHomestaffmayassistachildwithprescription or nonprescriptionPRNmedicationwithoutcontactingthechild’sphysicianbeforeeachdoseifthechildcannotdetermineand/orcommunicatehis/herneedforaprescriptionornonprescriptionPRNmedicationwhenTitle22§83075(d)):–Thechild’sphysicianhasrecommendedorprescribedthemedicationandprovidedwritteninstructionsforitsuseonaprescriptionblankorthephysician’sletterheadstationery.

–Writteninstructionsincludethenameofthechild,thenameofthePRNmedication,instructionsregardingwhenthemedicationshouldbestopped,andanindicationwhenthephysicianshouldbecontactedforre-evaluation.

–Thephysician’sorderandthePRNmedicationlabelidentifythespecificsymptomsthatindicatetheneedforuseofthemedication,exactdosage,minimumhoursbetweendoses,andmaximumdosesallowedina24-hourperiod.Mostnonprescriptionmedicationlabelsdisplaythisinformation.

–Thedate,time,andcontentofthephysiciancontactmadetoobtaintherequiredinformationisdocumentedandmaintainedinthechild’sfile.

–Thedate,time,dosagetaken,symptomsforwhichthePRNmedicationwasgivenandthechild’sresponsearedocumentedandmaintainedinthechild’srecords.

11. Medications are injectables:• InjectionscanONLYbeadministered

bytheclient/residentorbyalicensedmedicalprofessional.LicensedmedicalprofessionalincludesDoctorsofMedicine(M.D.),RegisteredNurses(R.N.),andLicensedVocationalNurses(L.V.N.)oraPsychiatricTechnician(P.T.).P.T.scanonlyadministersubcutaneousandintramuscularinjectionstoclients/residentswithdevelopmentalormentaldisabilitiesandinaccordancewithaphysician’sorder.

• FamilymembersarenotallowedtodrawuporadministerinjectionsinCCFsorRCFEsunlesstheyarelicensedmedicalprofessionals.

• FacilitypersonnelwhoarenotlicensedmedicalprofessionalscannotdrawuporadministerinjectionsinCCFsorRCFEs.

• Licensedmedicalprofessionalsmaynotadministermedications/insulininjectionsthathavebeenpre-drawnbyanotherlicensedmedicalprofessional.

• Injectionsadministeredbyalicensedmedicalprofessionalmustbeprovidedinaccordancewiththephysician’sorders.

• Thephysician’smedicalassessmentmustcontaindocumentationoftheneedforinjectedmedication.

• Iftheclient/residentdoesadministerhis/herowninjections,physicianverificationoftheclient’s/resident’sabilitytodosomustbeinthefile.

• Sufficientamountsofmedications,testequipment,syringes,needles,andothersuppliesmustbemaintainedinthefacilityandstoredproperly.

• Syringesandneedlesshouldbedisposedofina“containerforsharps,”andthecontainermustbekeptinaccessibletoclients/residents(locked).

• Onlytheclient/residentorthelicensedmedicalprofessionalcanmixmedicationstobeinjectedorfillthesyringewiththeprescribeddose.



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• Insulinandotherinjectablemedicationsmustbekeptintheoriginalcontainersuntiltheprescribedsingledoseismeasuredintoasyringeforimmediateinjection.

• Insulinorotherinjectablemedicationsmaybepackagedinpre-measureddosesinindividualsyringespreparedbyapharmacistorthemanufacturer.

• Syringesmaybepre-filledunderthefollowingcircumstances:– ClientsofAdultResidential,Social

Rehabilitation,AdultDayandAdultDaySupportCenterscanself-administerpre-filledsyringespreparedbyaregisterednurse,pharmacistordrugmanufacturer.

–ResidentialCareFacilitiesfortheElderly,GroupHomes,andSmallFamilyHomesmustobtainexceptionsfromthelicensingofficeforclients/residentstousepre-filledsyringespreparedbyaregisterednurse.

–Theregisterednurse(R.N.)mustnotsetupinsulinsyringesformorethansevendaysinadvance.

• Injectablemedicationsthatrequirerefrigerationmustbekeptlocked.

12. Over-the-counter (OTC) medications, including herbal remedies, are present:

• OTCmedications(e.g.,aspirin,coldmedications,etc.)canbedangerous.

• Theymustbecentrallystoredtothesameextentthatprescriptionmedicationsarecentrallystored(seecriteriaforcentralstorageinTitle22§80075(k)forCCFsandTitle22§87465(h)forRCFEs).

• Over-the-countermedication(s)thataregivenonaPRNbasismustmeetallPRNrequirements.(Seesection#10)

• PhysiciansmustapprovetheuseofallOTCmedicationsthatareormaybetakenbytheclient/residentonaregularbasis(e.g.,aspirinforheartcondition,vitamins,etc.)aswellasthoseusedonaPRNbasis.Havedocumentation.

• Client’s/resident’snameshouldbeontheover-the-countermedicationcontainerwhen:(1)itispurchasedforthatindividual’ssoleuse;(2)itispurchasedbyclient’s/resident’sfamilyor(3)theclient’s/resident’spersonalfundswereusedtopurchasethemedication.

13. You “set up” or “pour” medications:• Haveclean,sanitaryconditions(i.e.,

containers,countingtrays,pillcutters,pillcrushers,andstorage/setupareas).

• Pourmedicationsfromthebottletotheindividualclient’s/resident’scup/utensiltoavoidtouchingorcontaminatingmedication.

• Medicationsmustbestoredintheiroriginalcontainersandnottransferredbetweencontainers.

• Thenameoftheclient/residentshouldbeoneachcup/utensilusedinthedistributionofmedications.

• Havewrittenproceduresforsituationssuchasspillage,contamination,assistingwithliquidmedication,interactionsofmedications,etc.

• Havewrittenproceduresforfacilitystaffregardingassistingwithadministrationofmedication,requireddocumentation,anddestructionprocedures.

14. Assisting with medications (passing):• Staffdispensingmedicationsneedto

ensurethattheclient/residentactuallyswallowsthemedication(not“cheeking”themedication);mouthchecksareanoptionforstaff.

• Cupsorenvelopescontainingmedicationsshouldnotbeleftunattendedinthediningroom,bathrooms,bedrooms,oranywhereinthefacility.

15. You designate staff to handle medications:

• Havewrittenpoliciesandprocedures.• Trainallstaffwhowillberesponsiblefor

medications.• Ensurethatstaffknowwhattheyare

expectedtodo(i.e.,keys,storage,setup,clean-up,documentation,notification,etc.).

• Ensuredesignatedstaffknowwhatprocedurescanandcannotbedone(i.e.,injections,enemas,suppositories,etc.).

16. Medications are received or destroyed:• Everyprescriptionmedicationthatis

centrallystoredordestroyedinthefacilitymustbelogged.


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• Arecordofprescriptionmedicationsthataredisposedofinthefacilitymustbemaintainedforatleast3yearsinaResidentialCareFacilityfortheElderlyand1yearinaCommunityCareFacility(GroupHomes,AdultResidentialFacilities,etc.).

• Arecordofcentrallystoredmedicationsforeachclient/residentmustbemaintainedforatleast1year.

17. Medications are prepackaged:• Prepackagedmedications(bubblepacks,

trays,cassettes,etc.)areallowediftheyarepackedandlabeledbyapharmacy.

• Licenseesand/orfacilitystaffcannotremovediscontinuedmedicationsfromcustomizedmedicationpackages.

• Multi-dosepackagesmustbereturnedtothepharmacyforchangesindosesordiscontinuationofamedication.

• Facilitiesshouldhaveproceduresincaseonedoseiscontaminatedandmustbedestroyed.

• Facilities(EXCEPTRCFEs)utilizingprepackagedmedicationsmustobtainawaiverfromthelicensingofficeifmedicationsaretobereturnedtothepharmacyfordisposal.

• RCFEsdonotneedtoobtainawaiverifthemedicationsarereturnedtotheissuingpharmacyordisposedofaccordingtotheapprovedhospiceprocedures.

18. Sample medications are used:• Samplemedicationsmaybeusedifgiven

bytheprescribingphysician.• Samplemedicationsmusthaveall

theinformationrequiredonaregularprescriptionlabelexceptpharmacynameandprescriptionnumber.

19. Transferring medications for home visits, outings, etc.

• Whenaclient/residentleavesthefacilityforashortperiodoftimeduringwhichonly one dose of medicationisneeded,thefacilitymaygivethemedicationstoaresponsibleperson/authorizedrepresentativeinanenvelope(orsimilarcontainer)labeledwiththefacility’snameandaddress,client’s/resident’sname,nameofmedication(s),andinstructionsforadministeringthedose.

• Ifclient/residentistobegonefor more than one dosage period,thefacilitymay:a.Givethefullprescriptioncontainer

totheclient/resident,orresponsibleperson/authorizedrepresentative,or

b.Havethepharmacyeitherfillaseparateprescriptionorseparatetheexistingprescriptionintotwobottles,or

c.Havetheclient’s/resident’sfamilyobtainaseparatesupplyofthemedicationforusewhentheclient/residentvisitsthefamily.

• Ifitisnotsafetogivethemedicationstotheclient/resident,themedicationsmustbeentrustedtothepersonwhoisescortingtheclient/residentoffthefacilitypremises.

• Ifmedicationsarebeingsentwiththeclient/residentoffthefacilitypremises,checkthePhysician’sReport(LIC602or602A)toensurethattheyaregivenonlytoclients/residentswhosedoctorshaveindicatedthattheymaycontroltheirownmedications.

• Alwayshavethepersonentrustedwiththemedicationssignareceiptwhichidentifiesthenumberandtypeofmedicationssentoutandreturned.

20. House medications/stock supplies of over-the-counter medications are used:

• Centrallystored,stocksuppliesofover-the-countermedicationsmaybeusedinCCFsandinRCFEs.

• Licenseescannotrequireclients/residentstouseorpurchasehousesupplymedications.

• Clients/residentsmayusepersonalfundstopurchaseindividualdosesofOTCmedicationsfromthelicensee’sstockifeachdoseissoldatthelicensee’scostandaccuratewrittenrecordsaremaintainedofeachtransaction.

• AllregulationsregardingtheuseofOTCmedicationsmustbefollowed(seesection#12).

• Besuretoverifythattheclient’s/resident’sphysicianhasapprovedtheuseoftheOTCbeforegivinghim/heradosefromthehousesupply.



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21. Clients/residents use emergency medication(s) (e.g., nitroglycerin, inhaler, etc.):Clients/residentswhohaveamedical

conditionrequiringtheimmediateavailabilityofemergencymedicationmaymaintainthemedicationintheirpossessionifallofthefollowingconditionsaremet:• ThephysicianhasorderedthePRN

medicationandhasdeterminedanddocumentedinwritingthattheclient/residentiscapableofdetermininghis/herneedforadosageofthemedicationandthatpossessionofthemedicationbytheclient/residentissafe.

• Thisdeterminationbythephysicianismaintainedintheindividual’sfileandavailableforinspectionbyLicensing.

• Thephysician’sdeterminationclearlyindicatesthedosageandquantityofmedicationthatshouldbemaintainedbytheclient/resident.

• NeitherthefacilityadministratornortheDepartmenthasdeterminedthatthemedicationsmustbecentrallystoredinthefacilityduetoriskstoothersorotherspecifiedreasons.Ifthephysicianhasdetermineditis

necessaryforaclient/residenttohavemedicationimmediatelyavailableinanemergencybuthasalsodeterminedthatpossessionofthemedicationbytheclient/residentisdangerous,thenthatclient/residentmaybeinappropriatelyplacedandmayrequireahigherlevelofcare.

22. Blood pressure and pulse readings are taken:Thefollowingpersonsareallowedtotake

bloodpressureandpulsereadingstodeterminetheneedformedications:• Theclient/residentwhenhis/herphysician

hasstatedinwritingthattheclient/residentisphysicallyandmentallycapableofperformingtheprocedure.

• Aphysicianorregisterednurse.• Alicensedvocationalnurseunderthe

directionofaregisterednurseorphysician.• Apsychiatrictechnicianunderthedirection

ofaphysician,surgeon,psychiatrist,orregisterednurse.PsychTechsmaytakebloodpressureandpulsereadingsof

clients/residentsinanycommunitycarelicensedfacility.ThePsychTechinjectionrestrictionsnotedinsection#11donotapplytotakingvitalsigns.Thelicenseemustensurethatthefollowing

itemsaredocumentedwhentheclient’s/resident’svitalsignsaretakentodeterminetheneedforadministrationofmedications:• Thenameoftheskilledprofessionalwho

takesthereading.• Thedateandtimeandnameoftheperson

whogavethemedication.• Theclient’s/resident’sresponsetothe

medication.Laystaffmayperformvitalsignreadingsas

longasthereadingsarenotusedtodetermineaneedformedication.

23. Clients/residents need assistance with the administration of ear, nose, and eye drops:

• Theclient/residentmustbeunabletoself-administerhis/herowneye,earornosedropsduetotremors,failingeyesight,orothersimilarconditions.

• Theclient’s/resident’sconditionmustbechronicandresistanttosuddenchange(stable),ortemporaryinnatureandexpectedtoreturntoaconditionnormalfortheclient/resident.

• Theclient’s/resident’sNeedsandServicesPlan(CCF),Pre-AdmissionAppraisal(RCFE),orIndividualServicesPlan(RCFCI)muststatethathe/shecannotselfadministerhis/herowndropsandspecifyhowstaffwillhandlethesituation.

• Theclient’s/resident’sphysicianmustdocumentinwritingthereasonsthattheclient/residentcannotself-administerthedrops,thestabilityofthemedicalconditionandmustprovideauthorizationforthestafftobetrainedtoassisttheclient/resident.

• Staffprovidingtheclient/residentwithassistancemustbetrainedbyalicensedprofessionalandnamesoftrainedstaffmustbemaintainedinthestafffiles.

Thistrainingmustbecompletedpriortoprovidingtheservice,mustincludehands-oninstructioningeneralandclient/residentspecificprocedures,andmustbereviewedandupdatedbythelicensedprofessionalatleastannuallyormoreofteniftheconditionchanges.


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• Staffmustbetrainedbyalicensedprofessionaltorecognizeobjectivesymptomsobservablebyalaypersonandtorespondtotheclient’s/resident’shealthproblem.

• Staffmustbetrainedinandfollowstandardprecautionsandanyotherproceduresrecommendedbythelicensedprofessional.

• Writtendocumentationoutliningtheprocedurestobeusedinassistingtheclient/residentwiththedropsandallaspectsofcaretobeperformedbythelicensedprofessionalandfacilitystaffmustbemaintainedintheclient’s/resident’sfile.Priortoprovidingongoingclient/resident

assistancewithdrops,facilitystaffshouldconsidertheuseofassistivedevices,suchasaneyecup,whichwouldenabletheclient/residenttoself-administerthedrops.

24. Medications need to be stored:• Allmedications,includingover-the-

counters,mustbelockedatalltimes.• Allmedicationsmustbestoredin

accordancewithlabelinstructions(refrigerate,roomtemperature,outofdirectsunlight,etc.).

• Medicationinrefrigeratorsneedstobelockedinareceptacle,drawer,orcontainer,separatefromfooditems.(Cautionshouldbeusedinselectingstoragecontainersasmetalmayrust.)

• Ifoneclient/residentisallowedtokeephis/herownmedications,themedicationsneedtobelockedtopreventaccessbyotherclients/residents.

25. Miscellaneous:• Medicationsareoneofthemostpotentially

dangerousaspectsofprovidingcareandsupervision.

• Educateyourselfandstaff(signs,symptoms,sideeffects).

• Trainstaff.• Developaplantoevaluatestaff’sability

tocomplywiththefacility’smedicationprocedures.

• Communicatewithphysicians,pharmacists,andappropriatelyskilledprofessionals.


• Developasystemtocommunicatechangesinclient/residentmedicationstostaffandtotheclient/resident.

• Staffshouldbetrainedonstandardprecautionstopreventcontaminationandthespreadofdisease.

• Document.• Knowyourclients/residents.• Becareful.


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Medication Safety QuestionnaireName

Brand:_________________

Generic:________________Whentotakeeachdose?

Forhowlong?Dose(e.g.,mg)andform(e.g.,tabs)

Appendix 4-H

1.Whatisthemedicationsupposedtodo(whatconditiondoesittreat)?

2.HowlongbeforeIwillknowitisworkingornotworking?

3. Iftheindividualmissesadose,whatshouldIdo?

4. Whatistheexpirationdate?

INTERACTIONS5.Shouldthismedicationbetakenwithfood? YesNo

Atleastonehourbeforeortwohoursafterameal? YesNo6.Arethereanyfoods,supplements(suchas,herbs,vitamins,minerals),drinks

(alcoholic,forexample),oractivitiesthatshouldbeavoidedwhiletakingthismedication?

Yes(Whichones?)___________________________________________No_______________________________________________________

7.Arethereanyotherprescriptionorover-the-countermedicationsthatshouldbeavoided?Yes(Whichones?)___________________________________________ No_______________________________________________________

SIDE EFFECTS IF SO, RESPONSE?

8.Whatarecommonsideeffects?

9. Ifthereareanysideeffects,whatshouldIdo?

10.Ifthedrugisbeingprescribedforalongperiodoftime,arethereanylong-termeffects?

S-43

trainer resource guide licensed health care professionals can administer medication with a...

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