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Medication Administration Program
Residential Program Medication System Overview
Spring 2015
ObjectivesTo become familiar with a
medication system Technical Assistance Tool sections
To know how to access MAP resources Required Informational Training
MAP Monitoring Tool
Tech Assist Tool Evaluates a medication system
Sections within the toolCorrespond with MAP Policies
MAP Technical Assistance Tool
Provider:Address:DPH MCSR:Contact(s):Date of Visit:MAP Coordinator/Reviewer:
A. HEALTH CARE PROVIDER (HCP) ORDERS & TRANSCRIPTIONS (SECTIONS 13 & 06) YES NO COMMENTS
1. There is a HCP order for all prescription meds, OTCs and herbal supplements or products
2. HCP orders are valid with HCP signature on the same page as orders and dated within 1 year
3. All HCP orders (including new orders and telephone orders) are posted and verified (includes signature, date and time) below HCP signature
4. Changes in medication orders are handled as new HCP orders
5. Staff are not using outdated HCP orders which have been superseded by newer orders or superseded by hospital discharge orders
6. On HCP order forms listing multiple meds, after med(s) are DC’d; staff indicate in the margin - DC, date, initials and see new order, if applicable
7. PRN orders have the specific reason for use and instructions (including hours apart from any regularly scheduled doses ordered) and guidelines when to notify HCP, if applicable.
8. Prescriptions are not substituted for HCP orders
9. HCP orders, pharmacy labels and medication sheets agree
10. HCP orders are correctly transcribed on the medication sheets
11. Telephone orders for med changes are documented on a HCP telephone order form and cosigned by HCP within 72 hours
12. Monthly med sheet accuracy check by 2 Certified and/or licensed staff
13. There is an internal MAP monitoring system
B. VITAL SIGNS (SECTIONS 03 & 08) YES NO COMMENTS 1. Each HCP is consulted to determine if vital signs are required for medication administration
MAP Resource
mass.gov/dph/map
MAP Resource 2
Health Care Provider (HCP) Orders
Health Care Provider OrdersTelephone/Fax OrdersHospital Discharge OrdersPRN Orders
MAP Policy Sections 06 & 13
Tech Assist Tool Section A
Telephone/Fax Order
Hospital Discharge Order
MAP Resource 3
mass.gov/dph/map 2
Transcriptions
Transcriptions• Agree with HCP Orders and Pharmacy Labels
Monthly Med Sheet accuracy check
MAP Monitoring System
MAP Policy Section 13
Tech Assist Tool Section A
Vital SignsHCP is Consulted
If required, HCP order includes Specific written parameters What to do if outside parameters
Documentation HCP Notification
Staff Training & Competency At Site and Provider main office
MAP Policy Sections 03 & 08
Tech Assist Tool Section B
Sample Med Sheet
Month and Year: DECEMBER (year) Medication SheetMedication or Treatment
Start: Generic: Digoxin Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
11/1/yr Brand: Lanoxin 8am CW CWDSDS DS DS
Stop: Strength: 125mcg Pulse 62 68 60 54 52
Cont. Amount: 1 tab Dose: 125mcg
Frequency: daily am Route: by mouth
Special Instructions: If pulse is less than 56 hold the dose. Notify HCP is does are held 2 days in a row,Notify HCP is dose is held 2 days in a row.if dose is held 2 days in a row.
Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Brand:
Stop: Strength:
Amount: Dose:
Frequency: Route:
Special Instructions:
Sample Progress Note
Date Time Medication Reason Response Signature
12/5/yr 9:30a Notified Dr. Jones that Digoxin was held for the second day in a row. Pulse was 54 yesterday and 52 this morning. Dr. Jones said to continue with the med as ordered. He said if the pulse is less than 56 tomorrow morning to call back. He may change the dose at that time. Don Stevens
Medication Documentation
Medication Sheets Organized Boxes initialed that meds are given
No blank spaces Corresponding signature of staff
MAP Policy Sections 06; 08 & 13
Tech Assist Tool Section C
Sample Med Sheet 2
Month and Year: DECEMBER (year) Medication SheetMedication or Treatment
Start: Generic: Digoxin Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
11/1/yr Brand: Lanoxin 8am CW CW DS DS DS CW CW DS DS CW CW
Stop: Strength: 125mcg Pulse 62 68 60 54 52 62 62 68 72 60
Cont. Amount: 1 tab Dose: 125mcg
Frequency: daily am Route: by mouth
Special Instructions: If pulse is less than 56 hold the dose. Notify HCP is does are held 2 days in a row,Notify HCP is dose is held 2 days in a row.if dose is held 2 days in a row.
Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Brand:
Stop: Strength:
Amount: Dose:
Frequency: Route:
Special Instructions:
Medication Documentation 2
Progress Note Examples of when to use
Med is not given as orderedPRN med givenLeave of absenceRefusalHeld
Medication Documentation 3
AllergiesData
PRN bowel meds PRN seizure meds
Seizure record
Staff CertificationOn SiteCurrentAll Staff Administering Meds
Regular Relief
Acceptable Proof Master list
MAP Certification expiration dates Certification letter
www.hdmaster.com
MAP Policy Section 02
Tech Assist Tool Section D
Certification Letter
www.hdmaster.com
Ancillary Practices
Blood Glucose Testing Certified Staff training
Documentation is on site HCP Order Requirements
Upper/lower parameters Steps to take when outside parameters
MAP Policy 08 Tech Assist Tool Section E
CLIA Waiver
Required if monitoring Blood Glucose Urine [dipstick]
Ketones, glucose, blood, etc.Pregnancy
MAP Policy 08 & 17Tech Assist Tool Section E
mass.gov/dph/map 3
mass.gov/dph/map 4
mass.gov/dph/clp
CLIA Waiver 2
Required if monitoring PT/INR
Licensed staff
MAP Policy 08 & 17Tech Assist Tool Section E
High Alert Medication
Warfarin sodiumClozapineBuprenorphine/naloxone
MAP Policy Section 08 Tech Assist Tool Section E
mass.gov/dph/map 5
Training Resource
Training Resource 2
Ancillary Practices 2
G/J Tube med administration Certified Staff training
Documentation is on site
Training is Individual specific
MAP Policy Section 14Tech Assist Tool Section E
Ancillary Practices 3
Injectable Epinephrine Certified Staff training
Documentation is on site
Training is Individual specific
MAP Policy Section 14Tech Assist Tool Section E
InsulinAdministered only by licensed staff
Unless Individual is self-administering Defined in MAP policy Section 07
“Self-injecting” does not automatically mean self-administering
MAP Policy Section 07; 14-1
Sample Med Sheet 3
Month and Year: DECEMBER (year) Medication SheetMedication or Treatment
Start: Generic: Insulin glargine Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
12/1/yr Brand: Lantus 7am
Stop: Strength: 100U/mL
Cont. Amount: 50 Units Dose: 50 Units
Frequency: daily am Route: SC
Special Instructions: ADMINISTERED BY VNA NURSING STAFF
Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Brand:
Stop: Strength:
Amount: Dose:
Frequency: Route:
Special Instructions:
ADMINISTERED BY VNA NURSING STAFF
Insulin 2
MAP Certified Staff may NOT Administer Insulin Dial a dose on an Insulin pen Double check
A dose dialed by an Individual The amount of insulin drawn up into a
syringe by an Individual
“Sharps” Disposal
DisposalNeedleSyringeLancet
Ancillary Practices 4
Oxygen Therapy All methods of delivery including
Oxygen cylinders Oxygen concentrators
MAP policies applyOxygen training guidelines
MAP Policy 08-4
Countable Substance Packaging
Schedule II-V meds must be Received from pharmacy In tamper resistant packaging
Blister pack OPUS Opti-Pak
MAP Policy Section 10Tech Assist Tool Section F
OPUS Medication System
Countable Substance Packaging 2
Schedule II-V meds must be Received from pharmacy In tamper resistant packaging
Schedule VI
DPH recommends Two Schedule VI meds
Add to countFioricetGabapentin (Neurontin)
MAP Policy Section 10Tech Assist Tool Section F
Blister Pack Monitoring
Tracking method to determine meds are given as prescribed Not required
Staff Initial Date Time
Backside of package
Blister Pack Monitoring 2
Countable Substance Documentation
Count Book Index
Complete Accurate
Count Sheets Countables subtracted as removed Entries not squeezed in between lines
Shift Count Sheets Reflect meds are counted
Each time key changes hands
MAP Policy Section 10Tech Assist Tool Section G
Countable Substance Documentation 2
Signature Requirements Two signatures when
Beginning a new count sheet Adding a refill onto a count sheet Transferring from
Bottom of old page/top of new An old count book to a new count book
Disposal
MAP Policy Section 10Tech Assist Tool Section G
mass.gov/dph/map 6
MAP Resource 4
Drug Loss (Schedules II-VI)
Include All prescription meds Written prescriptions
Reported to DPH First business day after discovery Drug Incident Report form required
MAP Policy Section 10Tech Assist Tool Section G
mass.gov/dph/dcp
mass.gov/dph/map 7
MAP Resource 5
Self-Administration
Achieved only when Medication is under complete
control of individual With no more than minimal
assistance from staff
MAP Policy Section 07Tech Assist Tool Section H
Transitioning to Self-Administering
Self-administering assessmentISP reflects statusPill organizer preparation
Only by Pharmacist Individual
Documentation
MAP Policy Section 07Tech Assist Tool Section H
mass.gov/dph/map 8
Off-Site Medication Administration
PreparationDocumentation
Med sheet Acceptable Codes
DP-day program W-work H-hospital, skilled nursing facility,
rehabilitation center S-school
Med-Release document Signatures
Releasing/Accepting MAP Policy Section 11Tech Assist Tool Section I
Leave of AbsencePreparationDocumentation
Med sheet Acceptable code
LOA-leave of absence
Med progress note LOA form
Signatures Releasing/Accepting
MAP Policy Section 11Tech Assist Tool Section I
Leave of Absence 2
Certified staff may prepare if Unexpected Pharmacy is unable LOA is less than 72hrs
MAP Policy Section 11Tech Assist Tool Section I
mass.gov/dph/map9
MAP Resource 6
Medication Ordering/Receiving
Prescription Deliveries Tracking
Pharmacy ReceiptsMaintained for 90 days
MAP Policy Section 10Tech Assist Tool Section J
Cleanliness and Security
Contains only med administration supplies Internal/External separated No more than 37 day supply of
prescription meds Unless prescription plan requires otherwise
Documentation
Locked Countable meds are double locked
MAP Policy Section 10Tech Assist Tool Section K
Medication Disposal
“Expired” or “discontinued” Disposal completed with
2 Certified staff present 1 must be a Supervisor
MAP Policy Section 10Tech Assist Tool Section L
Medication Disposal 2
“Dropped” or “refused” Disposal is with 2 MAP
Certified staff present If unavailable, a Supervisor is
not required to be presentUnless your agency requires it
MAP Policy Section 10Tech Assist Tool Section L
DPH Disposal Form
mass.gov/dph/map10
MAP Resource 7
Policies & Resources
Must be on site MAP policy manual Med Info sheets Drug reference MAP training manual Provider policies
MAP Policy Sections 01; 06; 08; 10 & 11Tech Assist Tool Section M & N
Policies & Resources 2
Staff Education
Training BinderOngoing med education Documentation is on site
MAP Policy Section 06Tech Assist Tool Section O
mass.gov/dph/map11
MAP Resource 8
MOR System Principles
Opportunity to improve Procedures or systems
That put people at risk
Focus on “cause” Rather than “who”
Made the mistake
MAP Policy Sections 09 &10Tech Assist Tool Section P
Medication Occurrence Process
Tracks Certified staff onlyOne of five rights went wrong
Individual Medication Dose Time
Omission Route
MAP Policy Sections 09 &10Tech Assist Tool Section P
MOR Process
Self reporting system Staff must immediately contact
MAP Consultant Follow recommendation
• Document recommendation
MAP Policy Sections 09 &10Tech Assist Tool Section P
Medication Occurrence Reporting
Emergency numbers include911Poison Control MAP Consultant(s)
Available 24/7
MAP Policy Sections 09 & 10Tech Assist Tool Section P
Reporting Requirements
MORs reported to MAP Coordinator Within 7 days of discovery
Via HCSIS
“Hotline” MORs reported Within 24 hours of discovery
DPH Clinical Reviewer MAP Coordinator
MAP Policy Sections 09 & 10Tech Assist Tool Section P
DPH Hotline Form
mass.gov/dph/map12
MOR Follow-Up
Retraining (usually) Should occur
Each time a med occurrence happens Can be determined jointly
Supervisor MAP Consultant
Documentation
MAP Policy Sections 09 &10Tech Assist Tool Section P
MOR Follow-Up 2
Tech assist visit Hotline Multiple MORs
Revocation Occasionally
MAP Policy Sections 09 & 02Tech Assist Tool Section P
DPH Registered Programs
Massachusetts Controlled Substance Registration Number (MCSR) Issued by DPH Original or copy stays on site
Where medication is stored
MAP Policy Section 01Tech Assist Tool Section Q
MAP CoordinatorsCarolyn Whittemore, RN
Central/West 413.205.0914
[email protected] Despres, RN
Metro 781.314.7506
MAP Resource 9
mass.gov/dph/map13
The End