countable controlled substances
DESCRIPTION
Medication Education Module 1. Countable Controlled Substances. Objectives. 1. Why count them so often?. 2. Why the extra documentation?. 3. Why the special packaging?. 4. Why the extra security?. Countable Substances. Higher incidence of abuse or addiction Count requirement - PowerPoint PPT PresentationTRANSCRIPT
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Countable Controlled Countable Controlled SubstancesSubstances
Medication Education Module 1Medication Education Module 1
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LOGO ObjectivesObjectives
1. Why count them so often? 1. Why count them so often? 1. Why count them so often? 1. Why count them so often?
2. Why the extra documentation? Why the extra documentation? 2. Why the extra documentation? Why the extra documentation?
3. Why the special packaging?Why the special packaging?3. Why the special packaging?Why the special packaging?
4. Why the extra security? 4. Why the extra security? 4. Why the extra security? 4. Why the extra security?
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LOGO Countable SubstancesCountable Substances
Higher incidence of abuse or addictionHigher incidence of abuse or addiction
Count requirementCount requirement Each time staff changes, 2 Certified staff count togetherEach time staff changes, 2 Certified staff count together
Documentation requiring 2 signaturesDocumentation requiring 2 signatures1.1. When beginning a new count sheet When beginning a new count sheet 2.2. Adding a refill onto a count sheetAdding a refill onto a count sheet3.3. Transferring fromTransferring from
bottom of old page/top of newbottom of old page/top of new an old count book to a new count bookan old count book to a new count book
4.4. DisposalDisposal
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LOGO The SchedulesThe Schedules
Schedule ISchedule ISchedule ISchedule I Schedule IISchedule IISchedule IISchedule II Schedule VISchedule VISchedule VISchedule VISchedule VSchedule VSchedule VSchedule VSchedule IVSchedule IVSchedule IVSchedule IVSchedule IIISchedule IIISchedule IIISchedule III
Historical Historical BackgroundBackground
Schedule Schedule DefinitionsDefinitions
MAP Program MAP Program RequirementsRequirements
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In the Medication In the Medication Administration Program Administration Program (MAP)(MAP) Any prescription meds in Any prescription meds in
Schedules II-V are categorized as Schedules II-V are categorized as Countable Controlled Countable Controlled
SubstancesSubstances
SchedulesSchedules
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Schedule VI Schedule VI All prescription meds All prescription meds
not included in not included in schedules II-Vschedules II-VExamplesExamples
PenicillinPenicillinDilantinDilantin
SchedulesSchedules
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LOGO Schedule VISchedule VI Although not required, Although not required,
DPH strongly DPH strongly recommends adding recommends adding to the countto the count Tramadol HCLTramadol HCL (Ultram)(Ultram) FioricetFioricet
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LOGO Why Count and Record?Why Count and Record?
ProtectProtect Safety of IndividualsSafety of Individuals Certified staff from being Certified staff from being
accused of mishandling accused of mishandling or misusingor misusing
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LOGO Why Count and Record?Why Count and Record?
Assist Certified staff in Assist Certified staff in adhering to laws, adhering to laws, regulations and policiesregulations and policies If countable substances or If countable substances or
prescriptions are taken by a prescriptions are taken by a Certified staff an investigation Certified staff an investigation will follow with possible police will follow with possible police involvementinvolvement
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LOGO Tamper Resistant PackagingTamper Resistant Packaging
PurposePurpose To minimize the chance that To minimize the chance that
the medication inside is the medication inside is replaced with anotherreplaced with another
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LOGO SecuritySecurityAccess to med storage Access to med storage
area is limitedarea is limited A Certified staff is A Certified staff is
assigned the task of med assigned the task of med administrationadministrationOnly the assigned Certified Only the assigned Certified
staff should have access to the staff should have access to the med storage areamed storage area
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LOGO Security-InventorySecurity-Inventory The Certified staff assigned The Certified staff assigned
to give meds is responsible to give meds is responsible for the inventory (supply) for the inventory (supply) during their assigned shiftduring their assigned shift Must Must
Count at beginning and end of shiftCount at beginning and end of shift Keep key with Certified staff Keep key with Certified staff
assigned as long as they are in assigned as long as they are in programprogram
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LOGO Security-InventorySecurity-Inventory
If there will be no Certified If there will be no Certified staff home during the day, the staff home during the day, the keys must be kept locked in keys must be kept locked in the homethe home Realtor type combination locked boxRealtor type combination locked box Count must be done before placing Count must be done before placing
keys in the locked box and after keys in the locked box and after removing keys from the locked boxremoving keys from the locked box
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LOGO Security-InventorySecurity-Inventory Whenever there are 2 Certified Whenever there are 2 Certified
staff available there must staff available there must always be a 2 person countalways be a 2 person count Conducting a 2 person count once Conducting a 2 person count once
every 24 hours is an “exception” every 24 hours is an “exception” to MAP policyto MAP policy If there is no one else available a If there is no one else available a
single person count should be donesingle person count should be done The count signature page should The count signature page should
indicate it was a “single person indicate it was a “single person count”count”
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LOGO Security-InventorySecurity-Inventory Due to staffing patternsDue to staffing patterns
The “exception” becomes the The “exception” becomes the “norm” when the typical staffing “norm” when the typical staffing pattern is 1 Certified staff pattern is 1 Certified staff throughout a 24 hour periodthroughout a 24 hour period
A Supervisor will ensure that at A Supervisor will ensure that at least once every 24 hours 2 MAP least once every 24 hours 2 MAP Certified staff are available to Certified staff are available to conduct a 2 person count togetherconduct a 2 person count together
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LOGO Security-InventorySecurity-Inventory Only Certified staff who may be Only Certified staff who may be
assigned to administer meds assigned to administer meds should know the locked box should know the locked box codecode The combination should be The combination should be
changed when a Certified staff is changed when a Certified staff is no longer working at a site or staff no longer working at a site or staff is no longer Certified (such as did is no longer Certified (such as did not pass recertification)not pass recertification)
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LOGO Security-InventorySecurity-Inventory
Whenever the Certified Whenever the Certified staff assignment to give staff assignment to give meds changesmeds changes Keys are passedKeys are passed A count must be doneA count must be done
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LOGO SecuritySecurity Count must be done Count must be done
Shoulder to shoulder with the Shoulder to shoulder with the off-going Certified staff and off-going Certified staff and the on-coming Certified staffthe on-coming Certified staff
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LOGO Security-InventorySecurity-Inventory On-coming Certified staff On-coming Certified staff
has blister packshas blister packs Off-going Certified staff Off-going Certified staff
has count bookhas count bookLeads the count using the indexLeads the count using the index
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LOGO Security-InventorySecurity-Inventory During the count processDuring the count process
Both staff look at blister Both staff look at blister pack and count book pack and count book Full legal signatures on shift Full legal signatures on shift
count verification pagecount verification page
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LOGO Count BookCount Book Must Must
Be boundBe bound Have an index and shift Have an index and shift
count signature verification count signature verification pagespages
Preprinted page numbersPreprinted page numbers Have pages that cannot be Have pages that cannot be
removedremoved
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LOGO IndexIndex Must be kept accurate Must be kept accurate
and up to date and up to date Assigned Certified staff can Assigned Certified staff can
add a countable substance add a countable substance into the indexinto the index
The Site Supervisor (or The Site Supervisor (or designated back up) is designated back up) is responsible for removing the responsible for removing the Countable from the indexCountable from the index
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LOGO Security-InventorySecurity-Inventory When entering a countable When entering a countable
in the book or transferring to in the book or transferring to a new page the assigned a new page the assigned Certified staff should Certified staff should complete the Heading complete the Heading section of the next available section of the next available pagepage Do not skip pagesDo not skip pages
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Name Medication Name
and Strength Page Number Signature of person
responsible for removing medication
from count
Sarah Brown
Phenobarbital 97.2mg 1 4 7 Karen Mason
Mike Stone
Ativan 1mg 2 5
Joseph Smith
Ativan 0.5mg 3 6 9 10 See below KM
William Mitchell
Percocet 5-325mg 8
Joseph Smith
Ativan 0.5mg 11
Sample Index PageSample Index Page
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Name: Joseph Smith q Original EntryDoctor: Paula Whiten Transfer from page 2 from page 10Pharmacy: Cornerstone Prescription Number: D388857Medication Prescription Date: 11/22/yr& Strength: Ativan 0.5mg Prescription Number: Directions: Take 1 tab by mouth every morning Prescription Date:
Take 2 tabs by mouth at bedtime
Date Time Amount Amount Amount Signatureon Hand Used Left
12/19/yr 8:00 AM 9 Transfer 9 Karen Mason/Lisa Long
12/19/yr 8:00 AM 9 One 8 Karen Mason
12/19/yr 8:00 PM 8 Two 6 Lisa Long12/20/yr 8:00 AM 6 One 5 Karen Mason
12/20/yr 11:00 AM 5 received 60 65 Karen Mason
12/20/yr 3:00 PM verifying 60 received 65 Reggie Newton
Count Sheet Scenario 1Count Sheet Scenario 1Page 11Page 11
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Name: Joseph Smith q Original EntryDoctor: Paula Whiten Transfer from page 2 from page 10Pharmacy: Cornerstone Prescription Number: D388857Medication Prescription Date: 11/22/yr& Strength: Ativan 0.5mg Prescription Number: Directions: Take 1 tab by mouth every morning Prescription Date:
Take 2 tabs by mouth at bedtime
Date Time Amount Amount Amount Signatureon Hand Used Left
12/19/yr 8:00 AM 9 Transfer 9 Karen Mason/Lisa Long12/19/yr 8:00 AM 9 One 8 Karen Mason
12/19/yr 8:00 PM 8 Two 7 Lisa Long
12/20/yr 8:00 AM 6 One 5 Reggie Newton
Count Sheet Scenario 2Count Sheet Scenario 2Page 11Page 11
12/20/yr 7am Math on 12/19/yr 8p entry is 12/20/yr 7am Math on 12/19/yr 8p entry is incorrect. Karen Mason, Supervisor incorrect. Karen Mason, Supervisor notified. Correct count is 6 left. notified. Correct count is 6 left. 66 Reggie NewtonReggie Newton
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Name: Joseph Smith q Original EntryDoctor: Paula Whiten Transfer from page 2 from page 10Pharmacy: Cornerstone Prescription Number: D388857Medication Prescription Date: 11/22/yr& Strength: Ativan 0.5mg Prescription Number: Directions: Take 1 tab by mouth every morning Prescription Date:
Take 2 tabs by mouth at bedtime
Date Time Amount Amount Amount Signatureon Hand Used Left
12/19/yr 8:00 AM 9 Transfer 9 Karen Mason/Lisa Long
12/19/yr 8:00 AM 9 One 8 Karen Mason
12/19/yr 8:00 PM 8 Two 6 Lisa Long
12/20/yr 8:00 PM 5 Two 3 Lisa Long
Count Sheet Scenario 3Count Sheet Scenario 3Page 11Page 11
12/20/yr 7:45p Morning dose not subtracted when removed. K. Mason notified. Lisa Long
12/21/yr 6a Late entry On 12/20/yr 8a med was given and not documented at that time. Reggie Newton
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Name: Joseph Smith q Original EntryDoctor: Paula Whiten Transfer from page 2 from page 10Pharmacy: Cornerstone Prescription Number: D388857Medication Prescription Date: 11/22/yr& Strength: Ativan 0.5mg Prescription Number: Directions: Take 1 tab by mouth every morning Prescription Date:
Take 2 tabs by mouth at bedtime
Date Time Amount Amount Amount Signatureon Hand Used Left
12/19/yr 8:00 AM 9 Transfer 9 Karen Mason/Lisa Long
12/19/yr 8:00 AM 9 One 8 Karen Mason
12/19/yr 8:00 PM 8 Two 5 Lisa Long12/19/yr 8:00 AM 6 One 5 Reggie Newton12/20/yr 8:00 AM 6 One 5 Reggie Newton
Count Sheet Scenario 4Count Sheet Scenario 4Page 11Page 11
Error
LL
6Error RN
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LOGO QuestionsQuestions
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Beth Steele, RN Fidelity House, Countable ExercisesBeth Steele, RN Fidelity House, Countable Exercises
Mary Rota, RN DPH Clinical Reviewer, Mary Rota, RN DPH Clinical Reviewer, 10-11-12 MAP Trainer PowerPoint Presentation10-11-12 MAP Trainer PowerPoint Presentation
MAP Curriculum MAP Curriculum www.medicationadministration.comwww.medicationadministration.com
MAP Policy Manual MAP Policy Manual www.mass.gov/dph/dcpwww.mass.gov/dph/dcp
ResourcesResources