d ] ] } v u ] v ] ] } v ]

1

Medication Administration BasicsOAR Chapters 411-049 and 411-051

ODHS Safety, Oversight and Quality Unit April 2021 1

MEDICATION ADMINISTRATION

Medications treat a wide variety of chronic conditions and diseases, allowing people to live longer, healthier and more independently than they may have in the past. Medications not administered properly can have serious consequences including:• Unintended side effects• Being more or less effective than the intended therapeutic use• Significant injury to major organs such as the kidneys or liver• Death


1

2

2

MEDICATION ADMINISTRATION

The AFH rules require that AFH owners and all caregivers are able to demonstrate they:

• Understand why the medication is being taken• Know how the medication is expected to work• Know the potential side effects of the medication • Understand any resident specific instructions

All substitute caregivers must have training on how to administer medications properly and knowledge of each residents medications BEFORE they administer any medication.


AGE-RELATED CHANGES

Normal aging alters medication absorption and elimination, which means the action of many medications in the elderly is less predictable than in younger adults.Each person reacts differently to medication therapy.Age-related changes can cause changes in how the person reacts to the medication in part due to:

• Natural decline in kidney and liver function; or• Damage to kidney or liver function due to disease or other causes


3

4

3

AGE-RELATED CHANGES

Decline in gastrointestinal function results in medication absorption being delayed.Older adults tend to have more body fat than muscle. Because fatty tissue stores some medications, unpredictable and delayed medication action may occur.For older adults with a lower body weight, a normal adult dosage may cause overdose – lower doses are required with low body weight.


AGE-RELATED CHANGES

Decrease in volume of blood and water in the body can result in medication being distributed throughout the body in a more concentrated form.

Decrease in liver and kidney function means:• The organs are slower in breaking down and eliminating medication• Medications remain active in the body longer and may build to toxic

levels


5

6

4

MEDICATION ADMINISTRATION SYSTEM

A medication administration system includes:• Obtaining medical orders• Transcribing medical orders on to the medication administration record (MAR)• Verifying medical orders against the MAR• Dispensing and delivering/administering• Monitoring and documenting• Storing• Proper disposal of discontinued, unused, contaminated or expired medication• Re-ordering medications


MEDICATION ADMINISTRATION SYSTEM

When dispensing medications all caregivers must use infection control procedures, including:• Proper hand washing techniques – wash hands before and after

administering medications for each resident• Wear gloves when administering

• Topical medications• CBG testing• Subcutaneous injections


7

8

5

MEDICAL ORDERS

The resident’s healthcare provider or specialist (prescriber) is responsible for approving all medications and treatments. You must have a written order for:• All medications• Treatments, therapies and any special diet requirements• Over-the-counter (OTC) supplements and herbal treatments

requested by the resident• Home remedies


WHAT ARE MEDICATIONS?

Medications include:• Prescription medications — prescribed by a medical professional and

dispensed through a pharmacy• Over-the-counter medications (OTC) — can be purchased without a

prescription, including:• Cold remedies, aspirin etc.• Alternative medications — herbal remedies such as Saint John’s

Wart, nutritional supplements such as Ensure, and vitamins• Home remedies


9

10

6

ALERT

No matter the type of medication, the risk for a medication interaction increases with each additional medication the person takes.


THERAPEUTIC EFFECT

All medications have a therapeutic effect known as desired effects. Examples include:• Pain relief from pain medication• Reduced high blood pressure from blood pressure medication• Maintenance of appropriate blood sugar levels in diabetes• Reduced psychotic symptoms in psychiatric conditions


11

12

7

SIDE EFFECTS

Side effects may be desirable or undesirable. Examples of undesirable effects (not intended) include:• An antihistamine (allergy medication) may stop you from sneezing

and having a runny nose, but it may also make you sleepy• An antacid may relieve stomach irritation and discomfort, but may

also cause constipation and interference with the effectiveness of other medications


SIDE EFFECTS

Side effects may be minor and may not interfere with the individual’s quality of life.Side effects can also be enough of a problem that it interferes with the person’s quality of life.You are required to document all side effects and work with the resident’s healthcare provider if side effects negatively impact the resident.


13

14

8

ALERT

Do not minimize an individual’s complaints regarding side effects. What may seem insignificant to you can be significant to someone else. Side effects are frequently the reason people stop taking their medications.


ADVERSE DRUG REACTION (ADR)

An adverse medication (drug) reaction (ADR) is a less common or unexpected effect that generally means a medication is not right for that person:• Severity can range from moderate to extremely serious• An ADR can occur soon after beginning a medication


15

16

9

ADVERSE DRUG REACTION (ADR)ADRs must be:• Reported to the prescriber immediately• Documented in the resident’s record

ODHS Safety, Oversight and Quality Unit April 2021

Examples of ADRs:• Sedation (sleepiness)/insomnia• Confusion• Unsteady gait• Blurred vision• Movement disorders• Memory loss

• Rash• Agitation, anxiety• Seizures• Stomach ulcers or bleeding• Incontinence• Hallucinations

17

SIDE EFFECTS AND ADRs

Side effects and adverse drug reactions (ADRs) can be subtle and hard to identify. For example:• A red, bumpy rash from head to toe would be a clear indication of an

adverse medication reaction• It would be harder to identify an ADR if the same person stopped

reading the newspaper due to blurred vision


17

18

10

SIDE EFFECTS AND ADRs

Side effects and ADRs often go unnoticed or are misdiagnosed in seniors. This is due to:• Physical reactions such as fatigue, falling or weight loss that may be

mistaken as “normal” aging• Symptoms may be mistaken for decline of an existing health condition

or a new health condition• Side effects and ADRs may mimic diseases such as the confusion

associated with dementia or Alzheimer’s disease


ALERT

Consider any sudden change in an older adult’s physical ability or personality, especially after beginning a new medication, to be an adverse medication reaction until proven otherwise.


19

20

11

MEDICATION INTERACTIONS

A medication interaction is when a medication, food or beverage, or disease changes or alters the function of a medication. This includes:• Pharmacy-dispensed medications• Medications purchased over-the-counter• Alternative medications and supplements• Home remedies

Keep in mind foods and beverages can also interact with medications.



Types of medication interactions include:

Medication to medication examples:• Calcium supplements can reduce the effectiveness of medications

used to treat low thyroid levels; or• Two different medications that cause drowsiness can significantly

increase the risk of injury or falls


21

22

12


Medication to food or beverage examples:• Grapefruit juice and fresh grapefruit can increase the amount of

active ingredient for certain medications leading to increased adverse medication reactions

Medication to disease examples:• An existing medical condition can make certain medications

potentially harmful – for example someone with liver damage may have to restrict or avoid acetaminophen or other medications that can be harmful to the liver



Seniors, persons with chronic health conditions or developmental or physical disabilities are at higher risk for medication-related problems.

Many of these individuals take several medications, which increasesthe risk for an adverse reaction.

One or more chronic conditions, such as heart disease, high blood pressure, diabetes and arthritis, can affect how a medication works in the individual’s body.


23

24

13

ACCESS TO INFORMATION

Caregivers must have immediate availability to medication references. These include:• Online resources such as drugs.com• Current medication reference such as updated medication reference

books. These are generally available annually in October/November.• Current product inserts or medication summary that are included

with new and refilled prescriptions. These must be replaced each time a prescription is picked up and each time an OTC is purchased.


MEDICATION ERRORS

Medications are used to treat disease and ease discomfort or pain. However, when medication errors occur, it may cause harm or even death.• Medication errors are a common problem resulting in ER visits,

hospitalizations and even death• It is estimated that 98,000 individuals die each year due to

medication errors – this includes:• Taking too much• Not taking; or• Taking inappropriately


25

26

14

MEDICATION ERRORS

All medication errors have the potential to be serious and cause harm.Negative effects of a medication error may not be visible for years. Overuse or overdose can cause damage to major organs such as kidneys and liver. Overdose can even occur when the doses of a medication ordered multiple times a day are given too close together.Medication errors may lead to corrective action and/or a finding of abuse.


MEDICATION ERRORS

• Giving a medication at the wrong time

• Not giving a scheduled medication• Not giving a PRN medication when

indicated• Giving a medication using the

wrong route• Giving an incorrect dose• Not rotating subcutaneous

injections or transdermal patches

• Giving the wrong medication• Giving a discontinued medication• Giving an expired medication• Giving a medication to wrong

resident• Improperly stored medication• Missing or incomplete

documentation• Improper disposal


Common medication errors include but are not limited to:

28

27

28

15

HOW TO READ LABELS - PRESCRIPTIONS


HOW TO READ LABELS - OTC


29

30

16

HOW TO READ LABELS -SUPPLEMENTS


HOW TO READ LABELSACTIVITY

1. Review the label of an OTC medication you have either in your home or in the AFH.

2. Answer the following questions:1. What are the active ingredients?2. What are the medication uses?3. What are the medication warnings?4. Are there any side effects listed? If so, what are they?5. How are you supposed to use the medication?6. What other ingredients are listed?

ODHS Safety, Oversight and Quality Unit January 2021 32

31

32

17

HOW TO READ LABELS – HERBAL TEAS

Herbal tea remedies can interfere with other medications or certain conditions. It is critical to read all labels even for herbal teas. A few examples to be aware of are:Chamomile

• Negatively interacts with estrogen, tamoxifen and coumadin; and• Isn’t recommended for individuals with allergies to ragweed

Licorice has a major interactions with coumadin and negatively interacts with digoxin, estrogen and LasixGinger can increase the risk of bleeding


HOW TO READ LABELS –HERBAL TEAS


33

34

18

MEDICATION ROUTESMedications can be introduced into the body through many routes. The prescribing practitioner will write what route the medication must be given. This must be on the written order, prescription label, and MAR.If medications are not given as ordered it may result in the medication not working properly or harm to the resident.


MEDICATION ROUTESMedications routes include:• G-tube/j-tube• Intramuscular (IM) injection• Intravenous (IV)• Nasal (drops or inhalers)• Ophthalmic (eye)• Oral (taken by mouth)

• Otic (ear)• Rectal• Subcutaneous injections• Sublingual• Transdermal (via skin)• Vaginal


35

36

19

MEDICATION ROUTES

Intramuscular (IM) injections cannot be delegated. Arrangements must be made with a licensed practitioner to administer. Available options are:• Request a referral for home health or, if the resident is on hospice,

make arrangements with hospice• Contract with a nurse to perform the task; or• Make arrangements with the resident’s primary health care

practitioner


MEDICATION DELEGATIONS

An RN must delegate a task of nursing before you can perform the task.Common tasks of nursing include but are not limited to:• Subcutaneous injections, for example insulin• Food, fluid or medication administration through a gastrointestinal (g-

tube) or jejunostomy tube (j-tube)• Peritoneal dialysis• Other tasks as determined by the RN


37

38

20

MEDICATION DELEGATIONS

The delegation process requires the RN to:• Evaluate the resident and caregiver(s)• Provide training to the caregiver(s)• Observe the caregiver(s) perform the task on the resident• Leave step-by-step instructions on the task• Provide on-going supervision for the task that has been delegated• Each delegation is for one specific resident and cannot be transferred

to other residentsThe delegated caregiver cannot teach other caregivers to do the task.


INTRAMUSCULAR INJECTIONS

Intramuscular (IM) injections are allowed for anticipatory emergencymedications. Examples include: • Epinephrine for allergic reaction emergencies• Glucagon for severe low blood sugar emergencies

Giving IM injections is taught and cannot be delegated.Caregivers must be trained by an approved trainer following the training curriculum outlined by the Health Division’s Anticipatory Emergency rules.


39

40

21

MEDICAL ABBREVIATIONS

While gathering information and medical orders you may encounter medical abbreviations. If you do not understand, it is your responsibility to ask for clarification from an appropriate medical professional.

Let’s review some common medication abbreviations.Drugs.com has a helpful list you can print out and keep in the AFH for easy reference. Click here to access the list.


MEDICAL ORDERS

Before you give a medication to a resident, you are responsible for reviewing the written orders and understanding:

• The reason for the medication• How the medication is expected to work; and• Any special instructions from the prescribing practitioner about the

medications

You are responsible for carrying out the written orders. If don’t understand the written orders, it is your responsibility to seek clarification before you administer the medication.


41

42

22

MEDICAL ORDERS

The following must all have a written medical order from a prescribing practitioner:• Prescription medications• Prescribed over-the-counter (OTC) medications including vitamins

and other nutritional supplements• Prescribed dietary supplements; and• Prescribed treatments and therapies


MEDICAL ORDERS

OTC medications, vitamins, nutritional supplements or home remedies not prescribed, but requested by the resident, must be reviewed by the resident’s primary health care practitioner, approved and documented in the resident’s record.


43

44

23

ALERT

Written orders from a hospital, emergency room or nursing home sent with the resident can be used initially if signed by a prescriber. These orders are temporary and must be followed up with written orders from the resident’s primary healthcare practitioner immediately.


MEDICAL ORDERS

Changes to medical orders may not be made without the prescribing practitioner’s approvalAll medical orders must be followed as prescribed unless the resident or their legal guardian declines:

• If a medical order is declined, the prescribing practitioner must be notified immediately and documented in the resident’s record


45

46

24

MEDICAL ORDERS Changes to medication or treatment orders obtained by telephone must be followed up with a signed order from the prescribing practitioner, immediately:• Phone orders must be recorded in the resident’s record with the

printed name and signature of the person taking the phone order• Requests for signed orders must be made promptly after receiving

any telephone order• All attempts to request written orders must be documented in the

resident’s record


MEDICAL ORDERSChanges in dose or frequency of an existing medication must be clearly identified:• Be sure to inform the pharmacist of the changes before it is

time to refill the order• DO NOT have the prescription refilled without the pharmacist

contacting the prescriber for the correct information


47

48

25

MEDICATION ADMINISTRATION RECORD

A written medication administration record (MAR) must be kept for each resident:• Frequent changes to the dosage of some medications are common.

The MAR must be kept current at all times

Failure to keep the MAR up-to-date could result in a medical emergency for the resident and a finding of abuse or neglect for the caregiver.



The MAR must identify all medication, treatments or therapies AFH staff administers to a resident including, but not limited to:

• Prescription medications• Over-the-counter medications• Dietary supplements, including vitamins and minerals• Treatments• Vital signs• Blood sugar checks (CBGs)


49

50

26


The MAR must be legible and clearly indicate:• Name of each medication• Dose• The reason the medication is being given• Route (how it is to be administered) if other than by mouth • Day and frequency (i.e. daily or t.i.d.)• The time the medication must be given



Immediately after administering a medication or performing a treatment, therapy or procedure, the person doing the task must write his or her initials in the appropriate place and note any information required:• Every set of initials must have a legible signature on the MAR for

identification purposes• If multiple caregivers have the same two initials, decide who will need

to add an initial for a middle name• Make sure there is a matching signature for every set of initials on the

MAR


51

52

27


For each new month, write the month and year on the new MAR sheet:• Carefully write the medication, dose, route, days and times the

medications are to be administered on each resident’s MAR according to the written medical orders

• If you receive an order to stop a medication during the month, note that on the MAR after the last dose is given and draw a line to the end of the month


SAMPLE MAR


53

54

28

MAR INFORMATION

All fields must be filled out:• Resident’s full name• Name of resident’s healthcare provider

• Recommended to also list phone number• List of all allergies• Month and year


MAR INFORMATION• Name of the medication (write exactly as written)• Strength of medication – for example 20 mg• Write dose if strength and dose are not equal – for example give 10 mg (1/2

tablet)• Frequency – for example BID in AM and PM• How to administer – for example PO• Any special instructions such as hold if pulse less than 60 or blood sugar less

than 100 etc.• Reason for the medication


55

56

29

MAR INFORMATION


MAR INFORMATION


57

58

30

MAR INFORMATION


MAR - PRN MEDICATIONS

Some medications, such as those used for pain, are written as “PRN” this means the medication is given as needed.AFH rules require that all PRN medications, including over-the-counter medications, have specific parameters indicating:• What the medication is for; and • Specifically when, how much and how often the medication may be

administered


59

60

31


The prescribing practitioner must write the parameters when ordering PRN medication:• Ask your pharmacist to request this information when accepting a

prescription order• If a PRN medication does not include specific written parameters, you

may ask the RN to assess the resident’s condition and write the parameters

RNs cannot write parameters for any medication including OTCs and supplements that do not have a medical order.



The parameters must be recorded on the medication administration record (MAR).Any caregiver dispensing medications for that specific resident must follow the written instructions.If a caregiver does not have a clear understanding of the instructions, ask the RN, pharmacist or prescribing practitioner to explain to them using more details.


61

62

32

MAR - PRN MEDICATION

PRN medication documentation on the MAR must include the:• Time given• Dose (how much was given)• Reason the medication was given; and • Whether or not it was effective




63

64

33



Documentation example for a verbal resident:

65



Documentation example for a non-verbal resident:

66

65

66

34


The caregiver giving the PRN medication needs to document in the resident’s record the response to the medication. For example:

• 01/02/2011 Ms. M.M.A. complained of a headache at 10 am. Gave her two

Tylenol tablets at 10:15 a.m. At 11 a.m. Ms. M.M.A. reported that she no

longer had a headache.

• 01/05/2001 Ms. M.M.A. has not had a BM for three days, gave 2 tablespoons

of Milk of Magnesia at 8 a.m.

• 01/06/2011 Ms. M.M.A. had a BM this morning.


MARMEDICATIONS GIVEN ON ALTERNATING DAYS

Most scheduled medications are for the same dose each day however, there are some medications that are not given every day:

• For example, a medication used to treat hypothyroid disease frequently is scheduled for only five days a week;

• The two days of the week that the medication is not to be given must be clearly marked on the MAR.


67

68

35



MARMEDICATIONS GIVEN ON ALTERNATING DAYSSome medications may be ordered to give dosages on different days:

• When different doses of the same medication are given on different days or different times, the medication needs to be listed on the MAR each time the dose is different

• In the following example L-thyroxine is given in two different doses on alternating days.


69

70

36



MAR - INSULIN

Insulin orders require additional information on the MAR:• When CBG testing must occur• CBG value (blood sugar results)• Where the injection was given (rotation site)• What to do if blood sugar is too high or too low


71

72

37

MAR – INSULIN


MAR – INSULIN

Some rotation charts do not have numbers or letters listed. If they are blank: • Add letters or numbers• Keep the chart with the

residents MAR• List the corresponding number

or letter on the MAR


73

74

38

MAR – TRANSDERMAL PATCHES

Transdermal patches also require additional information to be written on the MAR:• Where the patch was placed (rotation site)• A time to remove if it is not replaced with a new one at the same time

each day – for example Nitroglycerin transdermal patches can only be left in place for 8 – 10 hours depending on the order

• Failure to remove can create significant negative outcomes for the resident




75

76

39

You may use the provided tracker.Instructions on appropriate placement is found in the product information sheet.This rotation (tracker) document is specific for Exelon.



77

MAR – DOSE CHANGE

If the medication dose is changed, draw a line from the last dose given to the end of the month:

• In a new line, write the new information regarding the medication, dose, route, day and time; draw a line to the start day.


77

78

40

MAR – DOSE CHANGE


MAR - MISSED OR DECLINED MEDICATIONS

If a medication is missed or if the resident declines to take it, the caregiver must document this on the MAR by circling their initials and indicating why the medication was missed or declined. The caregiver must also document in the resident’s record what action was taken (who was notified), as well as any follow-up instructions from the resident’s primary healthcare practitioner.A resident has a right to decline taking a medication. As a caregiver, you should do your best to understand why they are declining the medication. If necessary, talk with the resident’s primary healthcare practitioner for any necessary changes.


79

80

41


MAR - MISSED OR DECLINED MEDICATIONS

Declined, stated they don’t need it right now

81

MAR – SELF-ADMINISTRATION

In the case of those residents with written authorization from their primary healthcare practitioner to self-medicate, you are still responsible for:• Knowing the reason for the medication• What the medication is expected to do; and • If there are any special instructions from the prescribing practitioner

about the medications


81

82

42

MAR – SELF-ADMINISTRATION

It is recommended that you keep an updated MAR so you have current information. Some examples of needing this information include:• In order for you and your caregivers to document in the resident

record that the resident is taking medications as ordered• It is necessary in an emergency when information needs to be shared

with emergency responders• If the resident is unable to take medications


MAR - SELF-ADMINISTRATION


83

84

43

MEDICATION ADMINISTRATION RECORDACTIVITYReina Torres sees Dr. Neil Litts as her general healthcare practitioner. Reina is allergic to sulfa. Dr. Litts has prescribed the following:• Acetaminophen 500 mg; take 1 tablet by mouth every 4 hours as

needed for headache. May take 1 more tablet in 2 hours if no relief after the first dose. Maximum 6 tablets in 24 hours.

• Losartan 50 mg; take 1 tablet by mouth at 9am daily for hypertension.• On the 17th of this month, Dr. Litts changed the Losartan prescription

to Losartan 50 mg; take 2 tablets by mouth at 9am daily for hypertension.

• Are there any interactions to take note of for Losartan?

ODHS Safety, Oversight and Quality Unit January 2021 85

MEDICAL VISITS

When a resident has a medical appointment with her or his primary healthcare practitioner and/or specialist:

• Take a medical visit report, SDS 0341, listing all medications (including over-the-counter) the resident is currently taking; and

• Information regarding any concerns or issues with any medication


85

86

44

EXAMPLE MEDICAL VISIT FORM


PSYCHOTROPIC MEDICATIONS

Psychotropic, also known as psychoactive, medications act primarily upon the central nervous system where they affect the brain, changing an individual’s perception, mood, consciousness, cognition and/or behavior.Psychotropic medications are not intended to be used:

• For the convenience of the caregiver or facility• Instead of implementing non-medication interventions, including

redirection; or• To control individual behaviors that do not pose a risk to the

individual or others


87

88

45


Psychotropic medications are important tools used to treat:• Anxiety• Attention Deficit Hyperactivity Disorder (ADHD)• Bipolar disorder• Depression• Obsessive-compulsive disorders (OCD)• Post Trauma-Stress Disorders (PTSD)• Schizophrenia



Psychotropic medications must be used with an abundance of caution.Research has demonstrated that older adults are more likely to experience serious side effects with the use of these medications.Older adults have side effects not typically experienced among younger individuals.Any psychotropic medication that is not scheduled but prescribed as a PRN medication must have specific written parameters.


89

90

46


It is important to be aware of potential side effects and carefully monitor the resident taking these medications.Sedatives/hypnotics are generally used to aid a resident with sleep. The use of these medications is discouraged for older adults because the sedation effects can create problems such as falls and daytime sedation.


ALERTA psychotropic medication used for the sole purpose of treating a resident’s behavioral symptoms is a form of chemical restraint. The resident’s physician, nurse practitioner, a qualified nurse or mental health practitioner prior to prescribing a psychotropic medications must:

• Complete a behavioral assessment; and

• Try alternative interventions before starting a psychotropic medication


91

92

47


Psychotropic medications may mask an underlying problem:The resident’s healthcare practitioner needs to rule out behavioral problems caused by:

• Medication side effects• Medication interactions• Infections



If the reason for seeking a psychotropic medication is to address behaviors:

• Alternative measures to any medication to control the behaviors must be tried first

• Should include consultation with a behavioral specialist• All attempts to use alternative measures must be documented including any

results; and• The resident’s healthcare practitioner must be notified of all attempts

Alternative measures include such things as lowering noise level and environmental confusion, change of provider interactions with the resident and redirection of the resident.


93

94

48


Psychotropic medications must not be used to:• Discipline the resident; or• For the caregiver’s convenience

Some inappropriate uses include the following:• To decrease the amount of supervision the resident requires• To stop a resident from yelling• To stop the resident from pacing or wandering including trying to

leave the AFH



Use of a psychotropic medication to treat behavioral symptoms requires:• Prescribing practitioner’s orders• A thorough assessment conducted by a qualified health professional;

and• Resident’s or the legal representative’s consent


95

96

49


Normal aging alters medication absorption and elimination, which means the action of many medications in the elderly is less predictable than in younger adults:• Each person reacts differently to medication therapy partly because

of age-related changes• Because of natural decline in kidney function, the body is slower to

eliminate the medication


MEDICATION DECLINE BY RESIDENT

Residents may decline taking medications for a variety of reasons.A resident may not openly object, you must be alert to signs that medication is not being taken. For example, a resident may pretend to swallow a pill, but actually store it in the mouth and spit it out later.If a resident declines to take a medication, ask why and try to understand the resident’s point of view.Remember: a resident has a right to decline to take a medication for any reason.


97

98

50

MEDICATION DECLINE BY RESIDENT

It is important that residents take their medications as ordered and on time. Call the prescribing practitioner or their healthcare provider and document what happened, what you did and what instructions you were given, if a resident:

• Declines to take medication for any reason, including nausea, vomiting or diarrhea

• Vomits medication within 20 minutes of taking the medication• Reports observing (or you observe) parts of coated tablets in stool• Shows sudden changes in mental status or behavior• Shows sudden changes in eating, sleeping or elimination (for example,

constipation or diarrhea) patterns


ALERT

The resident has a right to refuse; you cannot force the resident to take a medication. It is inappropriate and a violation of a resident’s rights to put medication in a resident’s food or beverage in order to trick or bully the resident into taking their medication.


99

100

51

MEDICATION DECLINE BY RESIDENTHere are some common reasons for an individual declining to take medications and suggestions for supporting the individual.

Do not hesitate to contact the resident’s primary care practitioner or the RN consultant when a resident declines or discards needed medications.


Reason/Complaint Suggestion

Unpleasant taste If allowed by the prescribing practitioner, provide crackers, juice or food to help cover up the taste.

Unpleasant side effects Report to the prescribing practitioner. Sometimes changing when or how the medication is given helps with unpleasant side effects.

Lack of understanding Provide reminders of why the resident was prescribed the medication and how it helps or keeps them healthy.

Denial of need for medication Provide reminders or encouragement but do not bully or argue with the resident

101

MEDICATION STORAGE

Medications for each resident must be:• Stored in a separate box with the resident’s name clearly marked• LockedMedications requiring refrigeration must be:• Stored in a separate box and locked; AND• If there are any refrigerated medications for anyone else who lives in

the AFH they must also be lockedA small dorm refrigerator with a lock on the outside is useful for multiple residents with refrigerated medications.


101

102

52

MEDICATION STORAGE

Refrigerated medications require monitoring. To ensure proper temperature use a refrigerator thermometer and keep a daily temperature log.If there is a power outage it will assist the pharmacist determining if the medication is still safe.


MEDICATION DISPOSAL

Medications and associated supplies must be disposed of properly.Sharps Safety – use approved sharps containers:

• Rigid plastic container with a lid that can be secured• Store in a safe secured area• Must replace when full – do not overfill• DO NOT dispose of sharps in the garbage

Contact your local pharmacy or waste disposal company for instructions.


103

104

53

MEDICATION DISPOSAL

Contaminated supplies such as bandages etc.:• Dispose of in a plastic bag within a covered garbage container

Transdermal patches:• Follow manufacturer’s instructions

Outdated or discontinued medication:• Dispose of immediately• Follow local regulations


ALERT

Pill boxes, pill cutters/crushers, CBG monitors, lancet holders, etc. are all personal items and MUST NOT be shared. Personal items must be labeled with the resident’s name.


105

106

54

TRAINING


ADDITIONAL TRAINING

Oregon Administrative Rule 411-049-0125Requires 12 hours of training annually (after the first year) for the:

• Licensee• Administrators• Resident managers, floating resident managers• Shift Caregivers

Requires all providers (licensees, administrators, resident managers, floating resident managers and caregivers) to take a Department-approved Six Rights of Safe Medication Administration within the first 12 months from date of licensure or approval.All caregivers are also required to take dementia training before providing hands-on care to residents.


107

108

55

ALERTDon’t wait to take the mandatory Six Rights training!The information provided in the Six Rights training contains critical information needed once you have admitted residents with medications. It is recommended:

• You take it within the first month of admitting a resident; and

• Substitute caregivers take the course.


RESOURCES


Additional resources on a wide range of medication topics can be found on DHS’s Safe Medication Administration website:https://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/Pages/safe-med-administration.aspx

110

109

110

d ] ] } v u ] v ] ] } v ]

Documents