medication administration class

Medication Administration

Class

Format for Class

Medicines Giving them Proving you gave them Doctors, Nurses and Medicines Core Competencies Skills And (Ahhhh) THE TEST

Protocol for Passing Medications

• Medication Class

• Pass test with 75%

• Medication Assignment

• Shadowing

Fatal Four

• Aspiration

• Constipation

• Dehydration

• Seizures

• Why do we care?

Nursing Outcomes at CCS

• Aspiration

• Constipation

• Dehydration

• Seizures

• Skin Care

• Preventable ER visits

Six Rights

Right MedicationRight DoseRight manner/routeRight timeRight personRight documentation

Right Medication

A drug order is written for specific medication

Double check that youobtained the right drug

Your responsibility:Obtain

PrepareAdminister

the correct medication

Check three times themedication container

to the MAR

Right medication

Right Dose

Your responsibility it to confirm what dose within the

dose range was ordered

Make sure that the dose of the medication you are giving matches the MAR order

Never assume what dose of drug will be administered

You cannot give a different dosage than what is ordered

Right dose

Right Manner or Route

Most drugs have

differentroutes for different

needs

Never assume what form of the drug will

be administered

Always confirm the right route with the MAR

order

Most used:

PO = oral

SL = sublingual

Rectal = by rectum

Topical = on skin

Right Manner/Route

Right Time

Administering doses

•Too close together or

•To far apart

alter the therapeutic effect of the medication

Double check with MAR when to

administer med

The drug’s

•Purpose and

•Pharmacokinetics

Determine how often the medication is administered

Your responsibility is to administer:

•Stat meds ASAP

•Single ordered medications at time ordered

•Standing ordered meds on time

•PRN medications when needed

Right Person

A drug order is written for a

specific resident

Double check that you have

the right resident

Your responsibility is to:

•Obtain

•Prepare, and

•Administer

the medication to the correct person

Right Documentation

Right documentation includes correct drug order and a signature

Using the correct form to record the administration of the med assures that the resident does not receive another dose, preventing overdosing of the resident

Your responsibility is to document the administration of

the med immediately.

Five Always

• Physician's order for every med/treatment

• Wash your hands

• Pour medication into cup

• Identify and stay with resident

until medication is swallowed

• Keep med storage area locked,

clean and orderly

Five Nevers

• Never leave meds with client or out

• Never give a med prescribed for one client to another

• Never give meds prepared by another person.

• Never use a med that is outdated or from an illegible or unlabeled container

• Never give meds if you have questions.

Five Musts

• Have correct MAR

• Read label and compare it with MAR

• Good position

• Document

• Understand the medicine

Storage of Medications

• Locked

• Clean

• Refrigeration

• Separate orals from topicals

• Separate meds for different clients.

Preparing Medications

• Changing the form

• Crushing meds

• Measuring liquids

Pharmacy

• Use Olson’s Pharmacy

• Not all clients use just

one pharmacy

• Important to know how

each house connects with Olson’s

• Use them as a resource

Medication Administration Record

• Forever after known to you as MAR

• Preparation of MAR

• Transcription of orders

• Signing back

• Time limited medications

• Discontinuing medications

Documentation

If it isn’t written down, it did not happen.

Charting Codes

Charting Code When do you use it

YR

(your initial)

When you sign for a medication

When the medication is not given

W When the client is at work

YR

Practice

1. You give a medication.

2. Your HM tells you that Jessie needs to have a Dilantin blood test and not to give the 8 AM Dilantin.

3. Adam went home for the weekend.

4. Johnny spit out the medicine you gave him.

PRN Medications

Establish the need for the medication

Ensure there is a current order

Administer the medication

Sign the back of the MAR

Follow up within two hours

Practice on PRN Medications

• Johnny complains that his head hurts.

• Ronny has a cough

• Mark has a groin rash

• Susie has not pooped in two days.

Controlled Substances

• Definition

• Why they are handled differently

• Examples

• Special Tracking and charting

Abbreviations

Charting

You are telling a story with your charting

Each house will want you to chart in their way

Self Administrated Meds

• Self determination is determined

through ISP process

• At present we have no

residents who self-administer

• Please see packet for

process

Different kinds of medications

• Via the mouth!• Topicals• Sublinguals• Eye drops/ointments• Ear drops• Rectal meds• Vaginal meds• Nasal meds

PO Medications

• Do not crush unless you have an order

• Slower to be absorbed

• Taste is important

• Food can impact the medicine

• Take with full glass of water

• Do not mix in hot drinks

• Shake all liquids before pouring out

Topicals

• Usually used for skin conditions

• Always use gloves

• Check expiration dates

• Privacy

• Be aware of residents tendency

to put body parts in their mouths

• Make sure you note effectiveness

Sublinguals

• Under the tongue

• Do not offer water right away

• Use gloves

• Stay with resident until you are sure the medication has been absorbed

Eye Drops/Ointments

• Used to treat infections, inflammation, irritation and lack of moisture

• Wash hands

• Use Gloves

• Explain to client

• Drops before Ointments

Ear Drops

• Warm ear drops to body

temperature

• Wash hands

• Wear gloves

• Have resident lie on side opposite to the ear being treated

• Have them stay that way 5-10 minutes

Rectal Medications

• Used to stimulate bowel movements, relieve pain, relieve vomiting, reduce fevers, stop seizures

• Wash hands

• Wear gloves

• Privacy!!!!

• Usually kept in refrigerator

• Documentation of this one is important

Vaginal Medications

• Determine if administration will involve 1 or 2 staff

• Wash hands

• Wear gloves

• Explain procedure

• Privacy!!!

• Best time to insert is after shower or bath

Nasal Medications

• Wash hands

• Wear gloves

• Explain procedure

• Spray vs. drops

• Work with client

Medication Errors

• Definition of a medication error

• Examples– Forgetting to sign– Forgetting a follow up– Not giving a suppository when due

• What happens

• Intent

Where is the error?

Residents, Living and Meds

• Our residents have lives

• Some work or have lives outside

our homes

• They need their medication

• Communication is the key

Work site responsibilities

• Work site needs a copy of

doctor’s order

• Administered by designated

staff person

• Same rules apply: i.e.

MAR, 5 rights

Home responsibilities

• Provide work with necessary

information

• Inform worksite of any changes

• What is the abbreviation for

the MAR at home when a

resident is at work?

When a client goes home

• Pills in envelopes – one type of

medication to an envelope

• Whole bottles go home

• Document on MAR

• Never take medicine back

Hospitalized Residents

• DO NOT TAKE MEDICINES TO HOSPITAL

• What is the appropriate

documentation?

Disposal of Non-controlled Medications

“Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.

Documentation of this!

Any two staff can do this

Disposal of controlled medications

• “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.”

• Documentation!

• Of the two staff, one must

be an LPN or RN

Disposal Documentation

• Date

• Client’s name

• Name of medication and dosage

• Amount of medication disposed

• Reason for disposal

• Method of disposal

• Two signatures

Practice

What is a medication

“Medication means any drug, chemical, compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.”

Any medication for our clients

must be prescribed by a MD

Adverse reaction

• Allergy

• Side effects

• Your part

Kinds of medications

• Anticonvulsants• Antipsychotics• Antibiotics• Antidepressants• Multivitamin/Minerals/Dietary Supplements• Antidiabetic• Topicals• Analgesics• Laxatives

Timing of Medications

• Know when to give medicines to gain most benefit

• No laxatives within 1 hr of any other medication

• Iron should not be taken with milk

• GERD meds – ½ hr before meal

• Use your drug guide

• As the doctor

Nurses at CCS

• Nurse patient relationships

• When to call

• Protocol for paging

Doctors and Medicines

• They have the degree

• They also do the prescribing

• They prescribe based on information we provide

• We know the resident better than they do

• It is in the resident’s best interest to work closely and respectfully with the physician

Doctors Visit

• Who decides

• How to prepare

• What to do afterwards

A prescription

• Written by a doctor

• Parts of a prescription– Client name – first and last– Name of drug– Dosage of drug– How frequent to take it and how long– What route

Telephone orders

• Who can take them– Nurses – LPNs or RNs– House Managers– Assistant House Managers

• Getting them on the MAR

Rights regarding medications

• Right to:– know what they are getting– have an explanation– refuse or consent– confidentiality and privacy– appropriate services

Medication Resources

• Policies

• Drug Books

• Drug information sheets

• Pharmacy

Handwashing

• List times to wash hands

• Use plenty of soap

• Lots of friction

• Dry hands with paper towel

• Turn off faucet with paper towel

Blood pressure

• Why do you have a blood pressure

• What does it represent

• What is normal

• How to take it

• What to do if it is abnormal

Practice

Respiration

Definition

How to count

What is normal

What to do if it is abnormal.

Practice

Pulse

A pulse is the throbbing of a vessel in response to the heart beating.

What is normal

How to count

What to do if it is abnormal

Practice

Temperature

Just as a motor is warm from working, our body is warm from its metabolism.

Normal Temperature – USUALLY 98.6º orally – may be different for different residents

A fever is an elevation of the body temperature above normal

Differences between oral, axillary, and rectal

When should you be concerned?

Practice

Pain

• Defined by the resident

• Will be manifested differently by different residents

• Can lead to other symptoms/behaviors which are not desirable

• What to do first if you suspect someone is in pain

• When should you be concerned