Download - Qualified Medication Administration Person QMAP · The medication administration program is established in accordance with Section 25-1.5-301, C.R.S et seq. The medication administration

QMAPSyllabusLighthouseAssistedLiving

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Qualified Medication Administration

Person (QMAP) Syllubus Revised 2018�

Liz Littleton, RN, BSN

[email protected]


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Purposeofthiscourse

ThemedicationadministrationprogramisestablishedinaccordancewithSection25-1.5-301,C.R.Setseq.Themedicationadministrationcourseisdesignedtoteachunlicensedstafftosafelyadministermedicationsinsettingsauthorizedbylaw.Staffwhosuccessfullycompletethemedicationadministrationcoursearenotcertifiedorlicensedinanyway,andarenottrainedorauthorizedtomakeanytypeofjudgment,assessmentorevaluationofaclient.StaffwhosuccessfullycompletethecourseareconsideredQualifiedMedicationAdministrationPersons(QMAP).Successfulapplicantswillpasswrittenexamandahands-onpracticalexam.

TheImportanceofSafeAdministrationofMedications

• Theadministrationofmedicationsisaprivilege.• Thisroleisamajorresponsibilitythataffectsthequalityofclients'lives.• Improperorcarelessadministrationofmedicationsmayresultindeath.• Youareresponsibleforwhatyouadminister.Itisbestpracticetoadminister

medicationsthatyouhaveprepared.Youmayadministermedicationsusingmedicationreminderboxes(MRBs)thatothers(client,family,otherfacilitystaff)haveprepared.ThepurposeoftheMedicationStudyGuidealongwiththeQMAPcourseistohelpyoubecomemoreknowledgeablewithadministeringmedicationsandbetterpreparedforthetestaswellastrainingatyourcommunity.

• QMAPmustprovideanIDshowingaminimumageof18yearsold

Courseobjectives

• Safeadministrationofmedicationsaccordingtowrittenphysician'sorders• Maintainingproperdocumentationoftheadministrationofbothprescriptionandnon-

prescriptiondrugs• Useofpropertechniqueswhenadministeringmedicationsbythevariousroutes• Youwillknowanddemonstratemasteryofthefollowing:

A.ComprehensionofimportantguidelinesB.UseandformsofdrugsC.MedicationordersD.DocumentationE.MedicationreminderboxesF.StepsofproceduresG.MedicationerrorsH.Medicationstorage

• Safelyandaccuratelyfillandadministermedicationstoandfrommedicationreminderboxeswithoversightfromalicensedpersonorqualifiedmanager

Atthecompletionofthiscourse,youshouldbeabletodemonstrate:

• Properreading,understandingandtranscribingofphysician’sorders


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• Safeadministrationofmedicationsviamultiple"routes"(ingested,applied,inhaled,inserted)indesignatedsettingsusingwrittenphysicianordersaccordingtothe"7rightsofadministration"

• Documentationofmedicationadministrationaccordingtostateboardofhealthregulations

• SAFEadministrationofmedicationsfromMedicationReminderBoxes(MRB)

AuthorizedSettings

1.AssistedLivingResidences.2.AlternativeCareFacilities.3.Statecertifiedadultdayprograms.4.ResidentialChildCareFacilities5.DevelopmentalDisabledpopulation(Willrequireadditionaltraining)6.AdultFostercareFacilities7.SecureResidentialTreatmentCenters

ThisQMAPcourseisnotappropriateforthefollowingsettings:

1. FacilitiesregulatedbytheDepartmentofCorrectionshaveaqualifiedmedicationadministrationcurriculumspecificallydevelopedfortheadministrationofmedicationsincorrectionalfacilities.

2. Programs/servicesregulatedbytheDepartmentofHumanServiceshaveaqualifiedmedicationadministrationcurriculumdesignedtoaddresschildcarepopulation

3. ChildCarelessthan24-hourcare

Requirements

1. Mustprovidepaymentof$110.00infullpriortoclasstobeconsideredregisteredforclass.PaymentswillbeacceptedonlyviaEventbrite.

2. Youmustpassthewrittentestwithaminimumscoreof75%.3. Youmustscore100%onthepracticumexamtopassthecourse;thisincludeshandson

demonstrationsandfillinganMRB.4. Mustbe18yrsoldandabletoprovidecurrentphotoidentificationandthelastsixdigits

ofyoursocialsecuritynumber.5. Employersmustprovide“onthejobtrainingandmentoring”forallQMAPs.

CAUTIONS

1. Thiscoursedoesnotleadtocertificationoralicense.Uponsuccessfulcompletionofthiscourseyouwillreceiveaprovisionalletterofcompletionauthorizingyoutoadministerprescriptionornonprescriptionmedicationsinvarioussettingsassetforthinthelaw.Youwillbeconsideredqualifiedtoadministermedications,asaQualifiedMedicationAdministrationPerson(QMAP).


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2. Personssuccessfullycompletingthiscoursearenottrainedorauthorizedtomakeanytypeofjudgment,assessmentorevaluationofmedications.

3. FEESpolicy.Yourpaidfeeswillbeforfeitedifyouareregisteredforaclass/testinganddonotattendormissanyportionofwithoutmakingappropriatearrangementswiththeinstructor.

4. Uponsuccessfulcompletionofthecourse,theQMAP’sinformationwillbeforwardedtotheStateofColoradotobeaddedasanactiveQMAPwithinthestateofColorado.Thisinformationwillbesubmittedtothestatewithin3businessdaysofsuccessfulcompletion.Acompletionformwithbegiventoeachstudentuponpassingthecourse.ThisformdoesnotauthorizetheQMAPtoadministermedication.TrainingfortheQMAPmaybeginoncethequalificationisnotedonthestatewebsite.AdditionalinformationcanbefoundontheQMAPwebsitelocatedatwww.healthfacilities.info

INFORMATIONFOREMPLOYERSANDSTUDENTS

1. StudentsshouldnotworktheovernightshiftbeforeattendingtheQMAPclassandshouldnotworkovernightbeforetesting.

2. Studentsmustread,writeandspeakEnglish3. Studentsshouldhavebasicmathskills4. Studentsmustprovidephotoidentificationattheclass5. Employersmustconductacriminalbackgroundcheckpriortoallowingmedication

administrationbytheQMAPemployee.


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Unit1:Communication

InterpersonalSkills:

Whatdoesthismean?

Whoarewetalkingabout?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Benefitsofgoodcommunicationskills:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

HowcanIgetbetteratthis?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Communicationwiththevisuallyimpaired:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Communicationwiththehearingimpaired:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CommunicationwithAlzheimer’sresidents:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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***AllQMAPsmustbefamiliarwiththepopulationthattheyareworkingwith.Forexample,behaviorscommonlyassociatedwithAlzheimer’sanddementia,mentalillness,poststroke,chemicaldependency,etc.Thefollowingarelinkstolearnmoreaboutpersonswithimpairments.

Youcanusetheinternetresourcestofindtheinformationsuchas:• https://changeagents365.org/resources/ways-to-stay-engaged/the-gerontological-

society-of-america/Communicating%20with%20Older%20Adults%20Low_GSA.pdf

• https://www.alz.org/care/dementia-communication-tips.asp

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074568/

• http://www.chadd.org/Understanding-ADHD/For-Adults/Living-with-ADHD-A-Lifespan-Disorder/Relationships-Social-Skills/Social-Skills-in-Adults-with-ADHD.aspx

• http://www.healthyhearing.com/report/51744-Communication-strategies-when-talking-to-individuals-with-hearing-loss


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Unit2:PurposesofDrugs

Objective1:Describesomeofthepurposesfordrugs

• Preventortreatdiseaseorillness• Treatsymptoms• Aidindiagnoses• Restoreormaintainnormalbodyfunctions• Reachdesiredortherapeuticeffect

Objective2:Learnthedifferencebetween(1)monitoring,(2)administeringand(3)clientself-administrationofmedications.

Theauthorizedpractitionermuststate,inwriting,whichoptionispermitted/requiredifmedicationistakeninadesignatedsettingbyaclient.Anauthorizedpractitionerislicensedphysician(MD),physician’sassistant(PA),nursepractitioner(NP)withprescriptiveauthority.

Monitoringmedicationtakenbytheclient:

• Remindingaspecificindividualclienttotakemedicationatthetimeordered• Deliveringacontainerofmedicationlawfullylabeledtoaspecificclient,ifneeded• Observingaspecificindividualclienttomakesures/hetookmedications• Makingawrittenrecordofeachmedication,withthenote"monitored"

Note:RegulationsdonotrequiresuccessfulcompletionofaQMAPcourseifstaffonly"monitors"anddoesnot"administer"medicationstotheclient.(Documentwhatyoudo)

Administeringmedicationtoaclient:

• Assistingaclientintheingestion,application,inhalation,or• Insertionofarectalorvaginalmedicationaccordingtowrittendirectionsofan

authorizedpractitioner• Handingstaff-preparedmedicationstoaclient• Makingawrittenrecordofeachmedicationadministered,includingbothprescription

andoverthecounterdrugs

Self-administrationofmedicationbyaclient:


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• “Self-administration”meanstheabilityofapersontotakemedicationindependentlywithoutanyassistancefromanotherperson.

• Theclientiscompletelyresponsiblefortakinghis/herownmedications.Staffisnotinvolvedotherthantoensuresafetyofotherclientsandencouragenotificationofupdatedinformation.

• Thereisnorequirementfordailydocumentationofself-administeredmedication.• Thereshouldbeanoteontheplanofcareatleastonceyearly,updatedasappropriate,

documentingthefacility'sknowledgeofmedicationsbeingself-administered.

• Ifafacilityadministerssomemedicationsandaclientself-administerssomemedicationsthefacilitymusthavewrittenphysicianapprovalforeachself-administeredmedication

Objective3:Learnthesevenrightsofmedicationadministration.

1. rightclient2. righttime–1⁄2hourbeforescheduleddoseto1⁄2hourafter;ifaspecifictimeisstated

ontheorder.3. rightmedication4. rightdose5. rightroute6. documentation7. righttorefuse

Medicationsthatareorderedtobegiven“am”or“pm”donothaveatimerequirementsetbytheprescribingauthority;however,thefacilitymaydesignateatimeframeintheirpoliciesandproceduresoruse“am”and“pm”formedicationstobegiven.

Objective4:Learnthe4"routes"ofgivingmedications

1. Ingestiona. oraltablets,capsulesorliquidsb. lozenges(inthemouth,notswallowed)c. sublingualtablets(undertongue,notswallowed)Note:QMAPsareallowedto

utilizethebarrelofasyringetoadministeroralmedications.2. Application

a. skinointments,gels,lotions,linimentsb.skinspraysoraerosolsb. throatgarglesc. transdermalskinpatchesd. eyeointmentordropse. eardropsf. nosedropsornasalsprays


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3. Inhalation(respiratory)4. Insertion(rectal/vaginalcreamsorsuppositories)

*EPIPens*Theassistantprocessofhelpingsomeonewithanepinephrineiscoveredunderyourfirstaidtrainingandcanonlybedoneafterbeingdirectedbyemergencyservices(911operatororEMT)andhashadanaphylactictrainingrecognizedbyanationalorganization(AHA;RedCross)

Injections:QMAPsarenotallowedtoinjectanymedicationofanykind.Whenaclientrequiresinjections,theclient,alicensednurse,thefamily/friendoroutsideagencywillneedtoadministertheinjection.

ALWAYS NEVER1.ALWAYSmeasureusingthemetricsystem. 1.NEVERusehouseholdspoons.

2.ALWAYSuseanoralmeasuringsyringeforsmallamountsofliquidmedication

2.NEVERswitchthespecialdroppersthatcomewithsomeliquidmedications.

3.ALWAYSplacecuponasolidsurfaceateyelevel.

----4tsp--------3tsp--------2tsp--------1tsp----

3.NEVERusecupsthatarenotmarkedwiththeamounttheyhold.

4.Ifthelabelsaystomeasureinmls,ALWAYSuseameasuringdevicethatismarkedinmls.

4.NEVERmeasuremlswithameasuringdevicethatismarkedinmgs.

5.Ifthelabelsaystomeasureinmgs,ALWAYSuseameasuringdevicethatismarkedinmgsforthatmedication.

5.NEVERmeasuremgswithmeasuringdevicesthataremarkedinmlsmg=ml

6.ALWAYSconsultyourpharmacistwhenyouhaveaquestionaboutmeasuring

6.NEVERleaveairbubblesmixedwiththeliquidinanoralmeasuringsyringe


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Unit2Review

1. Listtwoexamplesofmonitoringmedications.________________________________________________________________________________________________________________________________________________

2. Listtwoexamplesofadministeringmedications________________________________________________________________________________________________________________________________________________

3. Thiscoursequalifiesyoutodofingersticks___true___false4. Thiscoursequalifiesyoutoadministermedicationsthroughag-tube,IVportand

injectionthroughtheskin.___true___false5. Youwouldnotneedthiscourseto"monitor"aclientinjectinginsulin___true___false6. Listthe4routesforadministeringmedicationsandgiveanexampleofeachroute:

ROUTE

________________________________________________________________________________________________________

7.TheQMAPcandialup&injectinsuliniftheclienthasaninsulinpen.___true___false


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UNIT3:USESANDFORMSOFDRUGS

Definethemeaningof:

Liquid:Solution_______________________________________________________Suspension_____________________________________________________

Solid:

Tablet/caplet____________________________________________________EntericCoated___________________________________________________

Semi-solid:

Capsule_________________________________________________________Spansule_________________________________________________________Suppository________________________________________________________Ointment_________________________________________________________Cream____________________________________________________________

Patches:________________________________________________________________

Sublingual:______________________________________________________________

• LocalandsystemicdrugactionsLocaldrugactions:______________________________________________________

Systemicdrugactions:___________________________________________________

Prescriptionandoverthecounterdrugs(OTC)andtheirlabeling

Thepurposeofprescribedmedications

• PrescriptionPainRelievers-Prescriptionpainrelieversincludetheopioidclassofdrugs,suchashydrocodone(i.e.,Vicodin),oxycodone(i.e.,OxyContin),morphine,fentanylandcodeine.Opioidsworkbymimickingthebody’snaturalpain-relievingchemicals,attachingtoreceptorsinthebraintoblocktheperceptionofpain.

• TranquilizersandSedatives-Tranquilizersandsedativesarecentralnervoussystemdepressants,suchasXanax,Valium,andLibrium,whichareoftenprescribedtotreat


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anxiety,panicattacksandsleepdisorders.Centralnervoussystemdepressants,knownasbarbituratesandbenzodiazepines,slownormalbrainfunctiontoproduceadrowsyorcalmingeffect.

• Stimulants-StimulantssuchasRitalin,AdderallandDexedrineincreasealertness,attentionandenergyandareoftenprescribedforhealthconditionssuchasattention-deficit/hyperactivitydisorder,narcolepsyanddepression.Stimulantsenhancetheeffectsofnorepinephrineanddopamineinthebrain,increasebloodpressureandheartrate,constrictbloodvessels,andopenupthepathwaysoftherespiratorysystem.

PrescriptionDrugsLabelRequirements:

1._________________________2._________________________3._________________________4._________________________5._________________________

DRAWALABELHERE!

Overthecountermedications:Alloverthecountermedicationsmusthaveaprescribers’orderpriortoadministrationandmustbelabeledwiththeclient’sfullname

1.___________________________________________________________________________2.___________________________________________________________________________3.___________________________________________________________________________


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•GenericandtradenamesofmedicationsGeneric:________________________________________________________________Tradenames:_____________________________________________________________

1. Whydoweneedtoknowthis?________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Howdoweknowwhatdrugsarethesame?________________________________________________________________________________________________________________________________________________________________________________________________________________________

Definecontrolledsubstances(narcotics)

• Adrugsubjecttorestrictionswithpotentialforaddiction.• Adrugthatinmoderatedosesdullsthesenses,relievespain,cancausestupor,coma,or

convulsions.• Classifiedinto5"schedules"classI=mostpotentialforaddiction,classV=leastpotential

foraddiction.Thereshouldbeasourceofinformationavailabletodetermineifadrugisonthecontrolledsubstancelist.

• Itisyourresponsibilitytostorecontrolledsubstancesunderdoublelock,count,anddocumentthecountwithanotherQMAPwhenevergivingaccesstoanotherQMAP.

• Ifsomeoneisnotavailabletocount,youdonotleavethekeys.Waituntilsomeoneisavailabletocount.

• Ifthereisanydiscrepancy,itmustbereportedtoasupervisorimmediately

Note:Youwillneedtofollowyourfacility’spolicy&proceduresforcountingliquidmedication.

DrugDiversion

DRUGDIVERSIONISASTATEREPORTABLEOCCURANCEWITHINGALR’S,ADULTFOSTERCAREFACILITIES,ACFS,RESIDENTIALCHILDCAREFACILITIES,SECURERESIDENTIALTREATMENTCENTERS,STATECERTIFIEDADULTDAYPROGRAMSANDFACILITIESFORDEVELOPMENTALDISABILITIES

Asyouremoveanarcotic,youwilldocumenttheremovalonaseparateinventorysheet.Thesesheetsarewhatyouwillbereferencingwhendoingthenarcoticcount.


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Whatdoyoudoifthereisnotasecondpersontocount?

• QMAPshouldalwayshandoffthemedicationkeystoanotherQMAP,however,ifthereisnooneelsetocountknowyourfacilitiespolicies

• QMAPleavingcountsthenarcoticsandsignsforthem• WhenaQMAPcomesintheymustcountthenarcoticstomakesurethey

matchpriortoadministeringanymedications• Ifthereisadiscrepancy,itmustberesolvedimmediatelywith

managementnotified

Explainwhatyoushoulddoifyoususpectthatmedicationsarebeingdivertedatyourfacility.______________________________________________________________________

Drugdiversionawareness:

1.Whodoesit?_____________________________________________________

2.Whydotheydoit?________________________________________________

3.Whattolookfor?_________________________________________________

Sideeffects,Adversereactions&Allergies

• EveryQMAPneedstobeawareofwheretheycanlookupmedications

• Somefacilitiesofferonlineresources(drugs.com,lexicomp),pharmacyinserts,pharmacistsanddrugreferenceguides(drugreferenceguidesexpireandshouldbeupdatedevery4-5years)

• Whennewmedicationsarestarted,whichmedicationsfallunderallergies,whenisthebesttimetoadministermedications,whyarethemedicationsgivenandwhataretheyusedfor

Definitions:

Sideeffects:___________________________________________________________

Commonsideeffects:

Nausea,constipation,diarrhea,sleepiness,weightgain,weightloss,drymouth&Dizziness(thesearesomebutnotallofthecommonsideeffects)


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Adversereactions:___________________________________________________________

Adversereactionstowatchfor:(Thesearenotallinclusive)RashShortnessofbreathVomitingSeverejointpainUncontrolledmovementsofthelimbsSevereheadache

Anaphylaxis:________________________________________________________________

SafetyandEmergencyresponse1.Knowyourcompanypolicyandprocedures

__________________________________________________________________________________________________________________________________________________________

2.Observationandreportingvsassessment____________________________________________________________________________________________________________________________________________________________

3.Whendoyoucall911?____________________________________________________________________________________________________________________________________________________________

4.Whatdoyouhavereadyfortheemergencyteam?____________________________________________________________________________________________________________________________________________________________

5.Whoelsedoyoucall?____________________________________________________________________________________________________________________________________________________________


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Unit3Review

Discussthefollowing

Sourcesofinformation:www.drugs.com;drugreferenceguide;druginsertsfrompharmacy;pharmacist____________________________________________________________________________________________________________________________________________________

Indicationsforuse:____________________________________________________________________________________________________________________________________________________

Whyshouldyouknowbesttimeofdaytoadministerthemedicationstoclients?____________________________________________________________________________________________________________________________________________________

Whyshouldyouknowcommonreactions/sideeffects?____________________________________________________________________________________________________________________________________________________

Provide3examplesofwhatyoushoulddoifyouhavequestionsaboutmedications.______________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. WhyshouldtheQMAPknowtheindicationforuseofeachmedication?

2. Whatisthedifferencebetweenasolutionandasuspension?

3. Whendoyoucall911?

4. Whyarethepossiblereasonsamedicationisentericcoated?

5. Localdrugactionstakeplaceinaspecificareaofthebody.___True___False


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6. Whatisthedifferencebetweenthegenericnameandthetradenameofamedication?

7. Youshouldalwaysreportsuspicionsofdrugdiversiontoyoursupervisor.______True______False

8. Whichofthefollowingpossibleresultsoftakingmedicationsisexpected:adversereactionorsideeffect?

9. Whatisyourresponsibilityregardingcontrolledsubstances?

10.WherecanaQMAPlearnaboutamedicationtheyareunfamiliarwith?

11.Suspicionandconvictionofdrugdiversionstayswithyouonyourrecord.___True

___False


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UNIT4:MEDICATIONORDERS

Objective1:Usingandunderstandingcommonabbreviations.Writeouteachprescribeddrugcompletely,includingallabbreviations:

1.Digoxin0.125mg,ITABpoqd

2.Coumadin2.5mgpohsonM,T,TH,F

3.Coumadin3mgpohsonW,S,Su

4.Tylenol325mg,iitabspoq4-6hprnforkneepainnomorethan6tabletsperday

5.Timoptic0.5%ophthsol,1gttODandIgttOStidx7d

6.Tobramycin250mg,1tabpoq6hx7d

7.Debroxoticgtts,2gttstoeachearqdx3d

8.AdderalXR25mg,give1tabat9amand1tabat3pm

9.Guaifenesin200mg,givepoq4hprnnottoexceed2.4g/day.

10.Docusatesodium50mgcap,give100mgpoqdx7daysthenDC.


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11.Effexor225mgpoqamatthesametimeeachdayac.

12.Prednisone60mgpoBIDX3Dthen40mgpoBIDX3Dthen20mgpoBIDX3Dthen10mgpoX3Dthen10mgpoBIDX2daysthen10mgpoQDthenD/C

13.Carafate1.5gpoTIDwithmeals

14.Lactulose45ccpoQDmixedwithjuiceofchoice

15.Resperidone1mgpoQAMand2mgQHS

Objective2:Thesixpartsofamedicationorder

1. Client’sfirstandlastname2. Medication3. Dose4. Route5. Date6. Physician/ProviderSignature

Apharmacycannotfillanorderunlesseachcomponentispresent.

Objective3:A"dose"has3parts.Explainthemeaningofeach:

Size:____________________________________________________________________Frequency:_______________________________________________________________Duration:_________________________________________________________________

Keflex500mgpoTIDX10D

Objective4:Explain“strengthofpreparation”

____________________________________________________________________________________________________________________________________________________________


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Objective5:Explainwhythemetricsystemusedinmedicineisabettersystemofmeasurementthanthehouseholdsystem.

Metricsystem–adecimalsystemofstandardweightsandmeasuresusingthemilligram(mg),gram(gorgm),kilogram(kg),milliliter(ml)andliter(l),amongothers.Note:acubiccentimeter(cc)isthesameamountasamilliliter(ml)--or--1cc=1ml

Householdsystem–asystembasedoncommon,thoughnotstandard,measuringdevices:teaspoonandtablespooncanbedifferentsizes.

Equivalentsthatmustbelearned:

1tsp.=5cc=5ML

3tsp.=1Tbsp=15cc=15ML=1/2OUNCE

2Tbsp=30cc=30ML=1oz


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MEASURINGDEVICES


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Objective5:Practicedeterminingthedosetobegivenfromthephysician'sorder.

1.Theordersaystogive500mg.ofthedrug.Themedbottlereadseachscoredtabletis250mg.Howmanytab.shouldyougive?______________________________

2.Themedbottlereadseachscoredtabis300mg.Theorderistogive150mg.Howmanytab.willyougive?__________________________________________

3.Aliquidmedicinehas50mg.ofdrugineach5cc.Theordersaystogive100mg.Whatisthestrengthofpreparationofthedrug?___________________________Whatisthedosageordered?_________________________________________Howmuchoftheliquidshouldyougive?_______________________________

4.Themedicinecomesin5mg.scoredtabs.Youaretogive15mg.Howmanytab.shouldyougive?______________________________________

5.YouaretogiveMilkofMagnesia(MOM)1oz.Howmanycc’swillyoupour?_________________________________________

6.Themedicationbottlereadstake1gofmedication.Thescoredtabletsare500mg.Howmanytablet(s)willyougive?______________________________________

7.TheclientneedsMetamucil1Tbsp.Howmanytsp.willyougive?__________________________________________

8.TheorderreadsTagamet300mg.bid.Howoftenwillyougivethisdrug?______________________________________

9.YouarefillingaMRBandyouneed10mg.ofadrugbid.Thelabelonthebottlesays5mg.HowmanytabletswillyouneedtofilltheMRBfor1week?_______________

10.Norvasc5mg.isorderedbythephysician.Thebottlecontains2.5mgscoredtabs.Howmanytabletswillyougiveeachdose?_________________________

11.Accupril20mg.isordered.Thebottlecontains40mgscoredtabsofAccupril.HowmanytabletswillyougiveEACHDOSE?______________________________

12.Youneedtogive15ccofaliquidmedication.Whatistheequivalentamountintbsp?_______intsp?_______inounces?_______

13.YouneedtogivePaxil10mg.dailyinthea.m.YouhavePaxil20mgscoredtablets.Howmanytabswillyougiveeachmorning?_______________________________


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Objective6:PracticeMedicationAdministrationquestions

Forthefollowing,identifytheStrengthofPreparationwithan“S”andtheDosagewitha“D”.Determinehowmuchofthemedicationyouwillgivetoyourclient.

1. ______Tylenol325mg.TAB______Take650mg.q4hprnforbackpainHowmuchwillyougive?__________

2. ______PromethazineHCL25mgtabletevery8hrprnfornausea&vomiting______Take25mg.Q8HprnHowmuchwillyougive?__________

3. ______TakeChlortrimetonq4h4mgprnforhayfever.______Chlortrimeton2mg/5ccHowmuchwillyougive?_______

4. ______Isordil10mg.tabpoforcongestiveheartfailure______Take5mg.q8hforcongestiveheartfailure.Howmuchwillyougive?______

5. ______SodiumCitrate500mg/5cc______Take1.5Gbidforkidneystones.Howmuchwillyougive?________

6. ______Take20meqofKCLqdForlowpotassium______KCL(potassium)40meq/30ccHowmuchwillyougive?________

7. ______Wellbutrinsr(buproprionsustainedrelease)150mgtab______take1tabdailyx4days.Howmuchwillyougive?__________

8. ______TakeGuiafenesin1200mgq12h,forproductivecough______Guiafenesin400mgtab.Howmuchwillyougive?________


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9. ______Propranolol20mgtab______Take40mgpobid.Howmuchwillyougive?________

10. ______TakeMaxalt10mgtabslprnformigraine______Maxalt10mgtab.Howmuchwillyougive?_________

Objective7:TheQMAP’sroleinstarting,changingorstoppingmedicationorders

Inordertostart,changeorstopamedicationorder,youmust:

• Haveawrittenphysician’sorder.VerbalandphoneorderscannotbeacceptedbyaQMAP.

• Facilitiesmayacceptfaxedordersfromaphysician,butmaynotacceptfaxesfromapharmacist,unlessitisacopyofasignedphysicianorder.

• Ifaclientreturnsfromaninpatienthospitalstay,thefacilitymustobtainnewordersfromanauthorizedpractitioner,foreachroutineandPRNmedicationthatwasnotincludedonthedischargeorders.“Resumepreviousorders”isnotacceptable.

• Areadmissionshouldbetreatedthesameasanewadmission• ProperlydocumentthenewinformationontheMAR• Followyourfacility’spoliciesandprocedures

Objective8:Yourrelationshipwiththepharmacy:Keypoints

1.Alwaysrefillwhenyouhaveabouta5-daysupplyremaining.

a.Insuranceissues

b.Mayneedrefillsfromthephysician

Monitorrefills

Mayrequireanadditionalprescription(Narcotics)AnewhardcopyscriptmustbesuppliedtothepharmacyeachtimeyouarerequestingscheduleIInarcotics.

2. Ifyouareunabletogiveamedicationduetounavailability,itisconsideredamedicationerror.Keepcommunicationopenwiththepharmacy.

3. Ifamedicationisbeingmissedduetounavailabilitycontactyoursupervisorandfollowyourcompany’spolicyandprocedures.


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4. Eachcommunityshouldhaveasysteminplaceforreorderingmedications.Ifitiseveryone’sjobthenitisnoone’sjob.


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Unit4:Review

1. Dosageandstrengthofpreparationisthesamething.___True___False

2. YoushouldusehouseholdmeasuringspoonstomeasureoutteaspoonsandTablespoonswhenadministeringmedication.___True___False

3. 3tsp.=________Tbsp.=15cc.

4. 2Tbsp.=________cc.=________oz.

5. Howmanymilligramsarein1gram?

6. Listthesixpartsofamedicationorder.1. ____________________________________2. ____________________________________3. ____________________________________4. ____________________________________5. ____________________________________6. ____________________________________

Forthefollowing,identifytheStrengthofPreparationwithan“S”andtheDosagewitha“D”.Determinehowmuchofthemedicationyouwillgivetoyourclient

7. ______TakeChlortrimeton4MGprnforhayfever

______Chlortrimeton2mg/5cc Howmuchwillyougive?_____

8. ______Tylenol325mg.TAB______Take650mg.q4hprnforpain Howmuchwillyougive?______


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9. ______Amoxicillin250mg/5ml______Take500mg.tid Howmuchwillyougive?______

Physicianorder:Pharmacylabel:

10.DoesthePhysicianOrderandthePharmacylabelabove,correctlymatchforthemedicationLasix?YesorNo_________________________________________

11.ReferringtothePhysicianOrderabove:a.Whatismissingfromthephysicianorder?_________________________

b.Whatinformationontheordermakesupthe“dose”ofthemedication,Lasix?1)______________,2)_______________,

12.ReferringtothePharmacylabelabove:a.Youhaveanorderforlasixandhaveabottlewiththedrugnamefurosemide.youtakebeforegivingthemedication?

13.ReferringtothePhysicianOrderandthePharmacylabelbelow,

a)HowmanyTbspofAmoxicillinwouldyougive?_____________

b)Howmanyounceswouldyougive?_____________

14.Thereareitemsmissingorincompletefromthepharmacylabelbelow?Listthreeofthem?1)______________,2)_______________,3)_______________


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15.Basedonthislabel,whatactionwouldyoutakeastheQMAP?

Physicianorder:Pharmacylabel:


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Unit5:RulesofDocumentation

Objective1:Explaintherulesfordocumentingmedications.

1. TheMedicationAdministrationRecord(MAR)isalegaldocument.Documentationmustbeaccurate.

2. Documentimmediatelyaftergivingormonitoringmedications,notbefore.3. Documenteachadministrationormonitoringatthetime4. Onlydocumentmedicationsthatyouadministerormonitor.5. Initialmedicationsgivenormonitoredintheboxforthecorrespondingdateandtime.6. Alwaysuseblackink,neverusepencil7. Neverusewhiteoutorattempttoeraseanerror8. Notdocumented,notadministered/monitored9. NoblanksontheMAR

Objective2:DocumentingontheMedicationAdministrationRecord(MAR)

1. Discontinuedmeds:WritedateandDClargethendrawalinethroughtherestofthedatesandindicatediscontinued;useatransparentyellowmarkertohighlightthenameofthediscontinuedmedication.

2. Newmeds:transcribenewmedicationsatthebottomoflist;drawalinethroughdatedboxesuptothestartdate.

3. TocreateanewMAR,copyfromthephysicianorders.NEVERcopyfromtheoldMARsheet.

4. Eachmedicationmustbedocumentedatthetimeofadministration.Forexample,ifeight

medicationsareadministeredtheQMAPmustinitialtheMAReighttimesindicatingthateach

medicationhasbeenadministered,refusedorunavailable.

5. Neworder:transcribenewmedicationsontheMAR.Goodpracticeistokeeproutineandprn

medicationsondifferentsectionstheMAR

6. Followyourfacilitypoliciesandproceduresre:notificationofnewmedications.

Objective3:Explainwhattodoif:


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1. Youmakeachartingdocumentationerror:Drawasinglelinethroughthemistakenentryandinitialanddate.ExplainonthebackoftheMAR.

2. Amedicationcannotbeadministeredbecauseitisnotavailableorisrefused:Circlethedateboxwithyourinitials,documenttheexactreasononthereverseside(orotherdesignatedarea)oftheMAR,andcontacttheappropriatepersonaccordingtofacilitypolicy.

3. Lateentrydocumentation:CirclethedateboxwithyourinitialsandyouMUSTdocumentinthenotessectionoftheMAR.

Objective4:ExplainhowdocumentationforPRNmedicationsisdifferent.

1. Initialappropriatebox.Documentonthereverseside(orotherdesignatedarea)ontheMARthetime,dose,andreasonwhyPRNmedicationwasadministered.

2. Checkbackwiththeclientwithin30-60minanddocumentclient'sstatus(betterorworse?)onthereverseside(orotherdesignatedarea)ontheMAR.Contacttheappropriatepersonifnecessary,documentthatyouhavenotifiedsupervisorifclientisnotimproved.

3. PsychotropicmedscannotbegivenPRNexceptinresidentialtreatmentfacilitiesforthementallyilloriftheclientunderstandsthepurposeofmedicationandiscapableofrequestingit.

Objective5:PracticedocumentingontheMAR

MidlandFamilyPractice

RX:HazelGreen____Amoxicillin30ccPOBIDx7daysthenDC

MidlandFamilyPractice

RX:HazelGreen____Furosemide40mgqdpo

Usingthemedicationordersabove,practicedocumentingadministrationormonitoringofmedicationson

J.R.Midland,MD7/1/15J.R.Midland,MD7/1/15theMARbelow.PracticeroutineandPRNmedications,amedicationthatcannotbegivenorisrefused,andhowtohandlevariousdocumentationerrors.FRONTOFEXAMPLEMAR


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Unit5:Review

1. DocumentonlythemedicationsyouadministeronMAR,usingink___True___False

2. Explainwhyyoushouldnotcopyfromlastmonth’sMARsheet.

3. IfyoumakeanerrorwhenchartingontheMAR,shouldyouwhiteitoutandrewriteitcorrectly?Whyorwhynot?

4. Youdon’tneedtochartPRNmedications___True___False

5. Itisacceptabletochartallmedicationsattheendoftheday/shift___True___False

6. TheQMAPwhoadministeredmedstodayforgottodocumentoneclient'smedsontheMAR.Youareconsideringinitialingallofthisclient'smedicationsbecauses/heverifiestheyweregiven.Explainhowthissituationshouldbehandled:

7. Youadministered2tabletsofTylenol325mgtoMrs.Smithatherrequestforaheadacheat4pm.At5pmshetellsyoushefeelsbetter.Areyourequiredtodoanythingelseinthissituation?Pleaseexplain:

8.Mr.SmithrefusedhisZantactoday.Areyourequiredtodoanything?Pleaseexplain:


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9. YouaretheQMAPintheassistedlivingfacilitytoday.Ms.Jonesisarguingwithotherclientsandyellingatthestaffmembers.YouareawareshehasaPRNorderforAtivan0.5mgpoq6hoursPRNforagitation.YouknowthatAtivanisapsychotropicmedication.Canyouadministerthismedication?Whyorwhynot?

10. Givefourexamplesoftherulesfordocumentingmedications________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

11. Define"psychotropic"medicationsandgive3examples:_______________________________________________________________________

________________________________________________________________________

12. YoucanadministeraPRNifthefamilyoryoursupervisoraskyoutoeveniftheresidentdidnotaskforthemedicationT__________F___________


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Unit6:MedicationReminderBoxes

Objective1:DefineMRB.

• MedicationReminderBox(MRB):acontainerthatiscompartmentalizedanddesignedtoholdmedicationsfordistributionaccordingtoatimeelementsuchasday,week,orportionsthereof.

• MRB’scanbefilleduptofourteen(14)daysinadvance.OBJECTIVE2:AdministrationofmedicationsfromMRBs.

SuccessfulcompletionofthiscourseallowsyoutofillMRB’swithsupervisionbyalicensedprofessionalorqualifiedmanager.Regulationsalsoallowmedicationreminderboxesusedindesignatedfacilitiestobefilledbytheclient,thefamilyorafriend.

Objective3:GuidelinesforfillingMRBs

• Theremustbeacompletelabelfirmlyattachedtothebox.Thisrequiresthenameoftheclient,thenameofeachmedication,dosage,quantity,route,andthespecifictimethateachmedistobeadministered.Ifthedesignoftheboxdoesnotpermitfirmattachmentofthecompletelabel,theMRBcannotbeusedbytheQMAP.

• TheremustbeaMARforrecordingalldrugsplacedintheMRBandmonitoredoradministeredbystaff.Aclient"self-administering"medicationsmayfillhis/herownMRBandutilizethismethodforstoringmedicationpriortotakinghis/hermedication.Medicationsthatare"self-administered"fromaMRBmustbeproperlylabeledbutdonotneedtobedocumentedonaMAR.

• Ifthereisaphysicianorderedchangeintheclient'smedications,thefacilitymuststoptheuseoftheMRBuntilthedesignatedQMAP,nurseorfamilymember/friendhascorrectedtheMRBaccordingtotheneworder.

• CertainmedicationsmaynotbeplacedinaMRB:•Controlledsubstances•PRNmedications•liquidmedications

• medicationswithspecialinstructions,suchas“30minutespriortolunch"•powders,inhalers,ointmentsandcreams

QMAP’s"shallbefamiliarwiththetypeandquantityofmedicationineachcompartmentofthebox."IftheQMAPsuspectsthatthetabs/capsintheMRBarenotconsistentwiththelabelontheMRB,theQMAPadministeringmedicationsmustnotproceedwithadministrationofmedicationsfromtheMRBuntiltheproblemisresolved.TheQMAPshouldnotcorrectthediscrepancy;alicensedperson,qualifiedmanagerortheQMAPwhofilledtheMRBshouldresolvedifference(s).


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AqualifiedmedicationmanagermustoverseeaQMAPfillingaMRB.ThequalifiedmanagershouldcheckthefillingoftheMRB’sweeklyduringatleastthefirsttwo(2)timestheMRBsarefilledbyanewQMAP,orbyaQMAPwhoisanewemployeeandperiodicallythereafter.AqualifiedmanagermustbeavailableforconsultationwheneveraMRBisbeingfilled.

OBJECTIVE4:IdentifythestepsneededtofilltheMRBaccuratelyandsafelyaccordingtowrittenphysicianorders.

Itisbestpracticeto:Weargloveswhenhandlingmedications,especiallyifyoutouchpillsorclients.

1. FilltheMRBinasafe,quiet,securedarea,freefrominterruptionsfromstaff,clientsandtelephonecalls.Thisavoidserrorscausedbydistractions.

2. CheckallMRBspriortofillingforcleanlinessandgoodrepair.3. FilltheMRBforonlyoneclientatatime.ThisavoidsfillingtheMRBwithwrongclients

medications.4. Steps:

Step1:Cross-checktheMRBlabelwiththephysicianorder,theMARandthepharmacist-preparedmedicationbottle.

ThelabelontheMRBshouldreflecttheexactnumber(s)ofeachtablet/capsuleofmedicationtobeplacedintheMRB.

IfthelabelontheMRBdoesnotmatchtheinformationoneitherthephysicianorder,theMARorthemedicationbottle,youmustresolvethediscrepancybeforefillingtheMRB.Thisincludesverifyingthattradeandgenericnamesusedarethesamedrug.

Alwaysaskforassistancewhenunsureofanorder,amedication,alabelortheprocedureusedinfillingMRB’s.YouareresponsibletoknowyourfacilitiespoliciesandproceduresforfillingandforadministeringormonitoringmedicationsfromMRB’s.

Step2:Washhandsimmediatelybeforeopeningmedicationbottles.Applygloves.

a.TransfermedicationsfrombottlelidtoMRBortransfermedicationwearinggloves.Nevertouchpillswithbarehands.

b.Ifdesired,youmayusecleantweezersintransferringmedicationsfrombottlelidtoMRB;alcoholwipesareacceptableforcleaningtweezers.

Step3:Usinganorganizedsystem,eachmedicationontheMRBlabelisfilled,oneatatime,untilallmedicationsfortheclienthavebeencompleted.CountthenumberofmedicationsintheMRBandcomparetotheMRB’slabel.


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Step4:Afterfillingiscompleted,countorestimatethenumberofpillsremaininginthebottle.Enoughmedicationsshouldbeinthebottleforatleastfive(5)daysifpossibleorasinsuranceallows.Findoutfromyourfacilityyourresponsibilityregardingthereorderingofmedications.

IfthereisnolabelontheMRBitmustnotbeuseduntilthepersonwhofilleditcomesandcreatesalabel,orthemedicationsmustbedestroyed.

Ifmedicationsareexpiredordiscontinued,theymustbedestroyedperfacilitiespolicies.Allmedsarethepropertyoftheresidentortheresponsibleparty,soconsentmustbeobtainedbytheresidentorresponsiblepart.Thebestwaytodestroymedicationsistoplacetheminkittylitter.Theremustbedocumentationofallmedsthataredestroyedmustbesignedandaccountedfor.


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Unit6:Review

1. ItisoktofilltheMRBwithPRNmedications.___True___False

2. Listthreeguidelinesfortheuseofmedicationreminderboxes.

MedicationReminderSystemlabel:

ReferringtotheMRBlabelabove:

1. ThereareerrorsontheMRBlabel.Listtwoofthemedicationsinvolved:

1)_____________________________,2)____________________________

2. WhyisCoumadinlistedtwice?_______________________________________

3. IfyoufindanerrorintheMRB,isitoktocontinueusingit?Whyorwhynot?

4. WhatisthemaximumlengthoftimeindaysthatMRBscanbefilled?

5. WhatarethesupervisionrequirementsforaQMAPfillingaMRB?


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Unit7:MedicationAdministration

Objective1:InfectionControl

• Universalprecautionsweredevelopedinthe1980'sasameansofavoidingcontactwithblood-borne(carriedintheblood)"pathogens"orinfections.Themethodusedwaswearingnon-porousglovestoavoidcontactwithanyandallblood;allpatientswereassumedtobeinfected.

• Sincethattime,"universal"hasbeenexpandedto"standard"precautionscoveringmorebodyfluidsandmorebodysites:blood,secretions(eyes,nose,ears,mouth),excretions(vomit,urineandfeces),non-intactskin,mucousmembranes.Standardprecautionsmustnowbeobservedforallclientsatalltimesinallcontacts.

• Becausetheadministrationofmedicationbysomerouteswillinvolvephysicalcontactwithbodysites,itisimportantforQMAP’storoutinelyfollowstandardprecautionswithclientsduringtheadministrationofmedications.

• Usedglovesareremovedandturnedinsideoutinonemotion.• Usedglovescontaminatedwithbodyfluidsshouldbedisposedofin

containerswithplasticbagsthatareknottedpriortodisposal,toprotectjanitorialstaff.Youmustbefamiliarwithyourfacility'spoliciesandproceduresaboutdisposalofglovesandothermaterials(incontinencebriefs,wipes,etc)contaminatedwithbodyfluidsindesignatedtrashcans.

• Tipsforgoodhandwashing:

_________________________________________________________________________________________________________________________________________________________________________________________________________

Objective2:Reviewthesevenrightsofmedicationadministrationlearnedinunit1,giveexamplesofgoodpracticetoimplementeachoftheserights.

1. RightClient2. RightTime–1⁄2hourbeforescheduleddoseto1⁄2hourafterifatimeisstatedonDr.

order3. RightMedicine4. RightDose5. RightRoute6. Documentation7. Righttorefuse


38

Pleasenote:Fornon-timespecificmedicationsthefacilitymaydesignateatimeframeoruse“am”and“pm”(forthetimeslotsontheMAR)aslongastheinformationisincludedwithinintheirpoliciesandprocedures

Nopre-pouringObjective3:Additionalpreparationandalteringmedicationsbeforeadministrationofmedications:

1. Gathertheclient'smedicationfromstorageandverifythatthemedicationhasnotexpired.

2. Gathertheclient'sMARandthecopyofthephysicianorder.

3.Cross-checkthelabelonthemedicationcontainerwiththeMARandthephysicianorderthreetimes.Onceasthemedicationistakenoffoftheshelf,onceasthemedicationisbeingpouredandagainwhenthemedicationisreturnedtothestoragearea

4. Someclientsrequesttheirmedicationsbeplacedinamediumtoassisttheminswallowingthemedications.Thisisacceptableaslongasthemediumofchoiceisinlinewiththeclient’sdiet.Physician’sorderishowevernecessarytocrushmedicationtoassistisswallowing.Itisimportanttorememberthatyoumaynotcrushextendedreleasetablets.

5. Manycapsulescanbepulledapartwiththecontentplacedinamediumtoassistinswallowing.Thisactionalsorequiresaphysician’sorder.Pleaserefertothemanufacturerecommendationstolearnifacapsulecanbealtered.Youmayalsocontactthepharmacyregardingmedicationsthatmaybealteredforswallowing.

6. Gatherotherequipmentneededforthetypeofmedicationtobeadministered:• Oralmedications(tabs,caps):gloves(ifneeded),pillcutter(ifneeded),

tweezers,papermedicinecup• Oralmedications(liquids):gloves(ifneeded),medicinecup,plasticorglass

measuringcup• Eardrops,eyedropsorointment,nosedropsornasalspray:gloves,cotton

balls,warmwetwashclothortissues• Suppositories:gloves,medicinecup,lubricantsuchasK-Yjelly• Transdermalskinpatches:gloves.

7. Takethemedicationandyourothersuppliestotheclient,orhavetheclientcometoyouradministrationarea.Besureanyareausedtoadministermedicationisneatandclean.

8. Identifytheclient.Youmayasktheclienttheirnameandcomparewithaphotograph,oraskastaffpersontoassistinverifying.Neveraskanotherclienttoparticipateinidentifyingaclient.Beawareofprivacyanddignityissueswhenselectinganareatoadminister.


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7.Explaintheproceduretotheclienttoobtaincooperation.8.Washhandsorusehandsanitizer,putongloves(ifneeded).

Somemedicationsrequireadditionalmixing:

Breathingtreatments:_________________________________________________________Liquidmedications:___________________________________________________________Crushedmedications:_________________________________________________________Powderedmedications:________________________________________________________

Objective4:Hands-onstepsandproceduresforthedifferentroutesofmedicationadministration

Ingestion:oraltablets/capsules:

1. Whenpouringtablets/capsules,putonglovesorusethelidofthecontainertopourthemedication,thendropthemedicationintoamedicinecup.Avoidhandlingmedicationswithfingersasyoumayaccidentallydamageordroppills,usetweezersifnecessarytomovemedicationsintothemedicinecup.Otherpackagingoptionsincludebutarenotlimitedtoblisterpacksandpre-filledreadymedicationpacks.

2. Forclientswhohavedifficultyswallowingmedications,thefollowingtechniquesmaybehelpfultogaincooperation,aswellasassisttheclienttotakeallmedications:

1. Theclientshouldbesittinguporstandingtotakeoralmedications,notlyingdown.

2. Offertablets/capsulesoneatatime.Ifnecessary,placemedicationinthemiddleoftheclient’smouth.

c.Offeradrinkofliquidbeforeandaftereachmedication.Useastrawifnecessary.d.Allowtheclienttorestashorttimeaftereachmed(QUIETSTHECOUGHREFLEX).e.Allowenoughtimefortheclienttotakethemedication.

f.Sometabletsorcapsulesmaybeeasiertoswallowifgiveninateaspoonofjellyorapplesauce,ifpermittedontheclient’sdiet.Besuretotelltheclientthatthereismedicationinjellyorapplesauce.Youmaynottrickclientwithdisguisesformeds.Thephysicianmustbeconsultedandanorderwrittentoaddmedicationstofood.

7. Someclientsrequesttheirmedicationtobecrushed.Donotcrushentericcoatedtablets.Youmaynotcrushoropenanymedicationwithoutaphysicianorderapprovingthisprocedure.

8. Iftheclienthascontinueddifficultytakingoralmedications,reportthistothepersoninchargeofclientcare.Thephysicianmayneedtobeconsulted.Manymedicationsareavailableinanotherform.


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3. Remainwithclienttobecertainalloralmedicationshavebeenswallowed.Thisalsoensuresthatthemedicationistakenontime.Insomeinstances,checkingtheclient’smouthmaybeindicatedtoverifyswallowingthemedication.

4. Lozengesarenottobeswallowed.Instructtheclienttoallowthemedicationtodissolveinthemouth.Drinkingliquidsshouldbeavoideduntilthemedicationhascompletelydissolved.Thesemedicationsshouldbegivenlastafterotheroralmedications.

Ingestion:sublingual(sl)tablets:

1.Instructclienttoplacetabletunderthetongueinthefrontpartofthemouth.Ifseveralmedicationsarebeinggiven,givethesublingualtabletlast.

2.Advisetheclientnottoswallowuntilthetabletisentirelydissolved.

3.NitroglycerinSLtablets:

1. Instructtheclienttositdown(NOTtolaydown)uponthefirstindicationofangina

(chestpain),administernitroSLandimmediatelynotifyyoursupervisorofthesituation.

• Notifysupervisor.• Followphysician’sorders• RecordtheexactminuteofadministrationontheMAR.• Consulttheclient'srecordtoseeifthereisaphysicianorderforaspirintobe

givenwhenchestpainoccurs.2. AfteronedoseofnitroSLisgivenandchestpainisnotrelieved,youoryoursupervisor

mustfollowfacilityprocedurestoprovidepromptmedicalattention.

•Call911forparamedicsandtransporttoanemergencyroom.

• Ifchestpainresolveswithin5minutes,adviseclienttositforanadditional15-20minutestopreventdizzinessorfainting.Headachesareacommonsideeffectofthedrugandshouldlastnolongerthan20minutes.Ifheadachespersist,notifysupervisor.

• BesuretotightlyrecapthenitroSLbottle•Replacethemedicationsupplyevery6months.

• Staywiththeclientuntilchestpainisresolved.

Otheremergencyproceduresareasfollows:

SomeoftheSafetyandEmergencyProceduresformedicationadministrationare:• Residentemergenciesrequiringimmediateaction.

• Seizures.


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• Choking/Knowuniversalsignofchoking–butbeawarethatresidentsmayormaynotbeabletogivetheuniversalsignofchoking.

TheQMAPRoleinanEmergency.

• RemainCalm.

• Callorsendforhelp.

• Knowyourlimitation.

• Don’tmoveaninjuredresident.

• Reassuretheresident.

• Takedirectionfromnurseordoctor.

Additionalsublingualmedicationmayinclude:

•Antianxiety•Anti-nausea•Antipsychotic

Ingestion:oralliquidsandgargles:

1. Checktoseethatthecapofthebottleisonsecurely.2. Readinstructionstodetermineifcontentsaretobeshakenaswithsuspensions.A

rotatingwristmovementwillensureamorethoroughmixture.3. Removethecapandplaceitwiththeopensideup(topofcapdown).4. Holdthebottlewiththelabeltowardthepalmofthehandtoavoidsoilingthelabel.5. Locatethemarkingonthemedicationcupfortheamountofmedicationtobepoured.6. Pourthemedicationateyelevelonaflatsurface.Takecaretonotpourmorethanis

needed.Pourimmediatelypriortoadministering,liquidmedicationmaynotsitforanylengthoftime.

7. Cleanthelipofthebottle,ifnecessary,withamoistpapertowel/tissuebeforerecapping.

8. Garglesaresolutionsthatarebubbledinthethroatbykeepingthesolutionintheupperthroat,tiltingtheheadbackandexhalingairtocreatebubbling.Checkdirectionswithgarglestoknowwhetherthemedicationshouldbedilutedpriortoadministration.

Application:ointments,lotions,liniments,andaerosols:

1. Glovesshouldbewornwhenevercomingintodirectcontactwithmedicationoraclient’sskin.Neveruseyourbarefingerstoapplyointments,lotionsorliniments.

2. Directionsforapplicationofthemedicationshouldbeapartofthephysician’sorderorincludedwiththeinstructionsaccompanyingthemedication.


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3. Ointmentsareapplieddirectlytotheskinorplacedonadressingthatisthenappliedtotheskin.Atongueblademaybeusedtoremoveointmentsfromajarorcontainer.Youmayalsousethetonguebladeasanapplicator.

4. Lotionsareapplied/swabbedontheskinfortheirantisepticand/orastringenteffects.5. Linimentsarevigorouslyrubbedintotheskintorelievesorenessofthemusclesand

joints.6. Aerosolsaresprayedontotheskin.Sprayingislesspainfulifskinisirritatedorburned.

Haveclientturnheadawayfromaerosolspray.

Application:Transdermalpatches:

1. Atransdermalskinpatchisimpregnatedwithmedicationwhich,whenappliedtotheskin,releasesacontinuousandcontrolleddosageoveraspecifiedtimeperiod.

2. Glovesshouldbeworntoapply/removetransdermalpatchestoavoidcontactwiththepatch.

3. Washclient’sskinwithsoapandwater(bothnewsiteandremovalsite).4. Rotateapplicationsitestoavoidskinirritation.Ifprevioussitesareblistered,notifyyour

supervisor.(Somepatchesareorderedtobeplacedonaspecificpartofthebody.)5. Writeyourinitials,dateandtimeonthepatchbeforeapplied.6. Peelbackingoffthepatch,pressonskinandapplypressuretoassureskinadherence.7. IncludethesiteofapplicationwithdocumentationontheMAR.

Application:eyedrops/eyeointments:

1. Instructclientaboutprocedure.Assisttheclienttositorliedownwithheadtiltedback.Washhandsandapplygloves.

2. Cleansetheeye(s)withacleantissue,clean,wetwashclothorcottonball.Alwayscleansefromtheinsideoftheeye,nearthenose,totheoutside.Useacleantissueorcottonballforeachwipe.Bestpracticeistocleaneacheyewiththreewipes.

3. Removecoverofcontainer,placelidwithopensideup.(orinacleanmedicinecup)4. Procedurefordrops:instructclienttolookuptowardtopofhead.Retractlowerlid

(makeapocket).Holdingthebottlenomorethanoneinchfromthelowerlid,instillonedropinthecenterofthelowerlid.Repeatprocedureforseconddrop,ifordered.Wait3-5minutesifmultipleeyedropsareordered,toallowtimeforabsorption.

5. Afterapplication,instructclienttolookdownward,thencloseeye(s)forashorttime.6. Giveclientacleantissueorcottonballtowipetheexcess.7. Procedureforointment:instructclienttolookup.Retractthelowerlid(makeapocket).

Withcaretoavoidtouchingtheeyewiththetipofthetube,layathinstripalongthelowerlid.

Application:eardrops:

1. Positiontheclient:Washhands,applygloves.• Iflyinginbed,havebedflatandturnheadtooppositeside


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• Ifsittingup,tiltheadsidewaysuntilearisashorizontalaspossible.2. Cleanexternalearcanalwithacleantissueorcottonball.3. Holdearlobeinsuchamannertoallowvisualizationoftheearcanal.4. Instillorderednumberofdropswithouttouchingdroppertotheclient’sexternalear.5. Placeasmallwadofcottonintheexternalportionofthefirstear.Ifitisnecessaryto

instilldropsinbothears,youshouldwaitatleastfiveminutesbeforeinstillingdropsintheotherearandplacewadofcotton.

6. Suggesttotheclienttheylayquietlyashorttimetoallowthemedicationtoreachtheeardrum.

7. Returntotheclientin10minutestoremovecottonwads;forgottencottonwadscanbecomedifficulttoremove.

Application:nosedrops/nasalsprays:

1. Washhands,applygloves.Avoidtouchingthedropperorspraynozzletotheclient’snose.Ifithappenswipetipoftheapplicatorwithanalcoholswab.

2. Fornosedrops:instructtheclienttotilttheirheadbackorliedownwiththeirheadextendedoverapillow.Theclientmaysitupfornasalsprays.

3. Fornosedrops,placethenosedropperjustinsidethenostril.Instructtheclientto“sniff”onthecountofthreeandinstillthecorrectnumberofdrops.Instructtheclienttoremainwithheadbackforashorttime.

4. Fornasalsprays,instructtheclienttosniffonthecountofthreeasyousqueezethenasalspray.Thiswillhelptocoordinatetheclient’ssniffingwiththeapplicationofthemedication.Optional:Closeonenostrilwhilesprayisappliedtotheothernostril.

Inhalation:inhalers

1. Theclientshouldbeinasittingposition.Washhands,applygloves.2. Graspthemedicationdispenserandremovethemouthpiececover.3. Readinstructionsoninhalertodetermineifmedicationistobeshaken.4. Holdthedispenser’smouthpieceaccordingtopackagedirections.5. Instructtheclienttoexhale,and,onthecountofthree,tobreatheindeeplyasyou

administerthemedication,thenholdtheirbreathforaslongaspossible,beforeexhaling.

6. Itisbesttohaveclientsrinsetheirmouthafteradministeringinhalants.Manytimesinhalantstastebitterorcancausethrush.

7. Usinganalcoholswab,cleanthemouthpieceorspacerbeforereplacingthemouthpiececover.

Insertion:rectal/vaginalsuppositoriesorcreams

1.Removeprotectivecoveringofsuppositoriesandplaceinamedicinecup.2.Obtainlubricantforsuppositoriestoapplybeforeinsertion.3.Vaginalcreamsaredrawnintoavaginalapplicatoraccordingtopackageinstructions.


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4.Provideprivacyfortheclient.5.Glovesmustbewornfortheadministrationofsuppositoriesandvaginalcreams.6.Procedureforinsertingrectalsuppositories:

• Assisttheclienttoliedown,preferablyontheirleftside.ThecolonisontheleftsideofthebodyandthesuppositorywillenterthelowerGItractmoreeasily.

• Visualizetheanalopening,lubricateandinsertthesuppositoryapproximately3inches.Thesuppositoryshouldbeinsertedbeyondtheinternalsphinctermuscleoftherectumtopreventthesuppositoryfrombeingexpelled.•Instructtheclienttonotto"beardown,"andtoholdinthesuppositoryforaslongaspossible.

7.Procedureforinsertingvaginalcreamsorvaginalsuppositories:

• Instructtheclienttolieonherbackina“frogleg”positionorontheirsidewithtoplegslightlybent.

• Vaginalsuppositoriesareinserted2-3inchesintothevaginalorifice.Bodytemperaturewillmeltthesuppositorytoaidintheabsorptionofthemedication.

• Toinsertavaginalcream,graspthebarreloftheapplicator.Placethethumbontheplunger.Pointingtheapplicatorslightlydownward,inserttheapplicatorintothevaginaasfarasitwillcomfortablygo.Pushtheplungerwiththethumbastheapplicatorisslowlyremovedfromthevagina.

• Instructtheclienttoremainlyingdownfor15-30minutesforabsorptionofthemedication.Vaginalcreams/suppositoriesarebestadministeredatbedtime.

Objective6:Describestepsneededaftermedicationadministrationiscompleted

1. Properlydisposeofallusedmedicationcupsandusedgloveswhichhavecomeintocontactwithbodyfluids.Youmustwashyourhandsorusesanitizerbeforeyoumoveontothenextclient.

2. Youmustaccuratelydocumenteachmedicationgivenontheclient'sMARimmediatelyafteradministrationormonitoring.ForPRNmedications,remembertodocumenttheclient’srequestandthereasonforgivingthemedicationaswellasthefollow-upresults.

3. Medicationcontainersshouldbereturnedtotheappropriatestoragelocationbeforeadministration.

4. Ifmedicationshavebeenremovedfromtheoriginalcontainer-theyshouldnotbereturnedtotheoriginalcontainers.Theyshouldbedestroyedaccordingtofacilitypolicy.


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Unit7:Review

1. Whatarethe7rightsofmedicationadministration?1. ________________________________2. __________________________________3. __________________________________4. __________________________________5. __________________________________6. __________________________________7. __________________________________

2. Youaretoadministermedicationsto4clientsseatedatthelunchtable.Whatproceduresmustyoufollow?Why?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Isitacceptabletoleavethemedicationcabinetorcartunlockedwhileyouadministermedicationsbecauseyouwillberightback?Whyorwhynot?________________________________________________________________________________________________________________________________________________

4. Tosavetimeduringyourmedpass,youshouldplacemedicationsonthediningroomtablesneartheclienttowhomtheybelong.___True___False

5. Youalwayswashyourhandsbeforeamedpass,soitisoktotouchthemedicationswithyourbarehandsduringsetupofmedications.___True___False


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Unit8:MedicationErrors

Objective1:Defineamedicationerror:

Medicationadministeredcontrarytoaphysician’sorderthateithercausesorhasthepotentialtocauseharmtotherecipient.

Objective2:ExamplesofmedicationerrorsandImproperpracticethatmayleadtoamedicationerror

• Failuretocomplywithphysicianorders• Failuretoadministeronlyuponcurrentorders• Failuretofollowhands-onprocedurestaughtinclass• Failuretofollowthe6rights• FailuretoaccuratelytranscribeaMAR• FailuretoaccuratelylabelaMRB• ImproperdocumentationonMAR• Impropermedicationstorage• Runningoutofmedications

Note:Theseareexamplesonly.

Objective3:Preventingandreportingmedicationoccurrences(reportableinallfacilitieswhereQMAP’sareapprovedtopractice

• NOSHORTCUTS• NEVERPREPOUR• ALWAYSREVIEWTHEPHARMACYLABELANDCOMPAREITTOTHEMAR• CLARIFYANYDISCREPANCIESPRIORTOGIVINGTHEMEDICAITON• NEVERSITPILLSDOWNANDWALKAWAY• MINIMIZEDESTRACTIONS• FOLLOWTHETECHNIQUESTAUGHTINCLASS• ASKQUESTIONS

Ifitdoeshappen....

1.Immediatelynotifysupervisorandphysician

2.Knowandfollowyourfacility’spolicyformedicationerrors3.Reviewyourmistakeandfindthepointoferror.....learnfromit


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Unit8:Review

1. Whatshouldyoudoifamedicationerroroccurs?Whoshouldyoureporttoifamedicationerroroccurs?__________________________________________________________________________

2. Give3examplesofamedicationerror.

3. Mrs.ChasanordertotakeGuaifenesinAC500mg4timesadayfor7days.Youmisreadtheorderandadministered2gin4hours.Whatdoyoudo?

___________________________________________________________________________

4. Mrs.Hansenhadmedicationsre-orderedonMonday.OnThursdayMrs.Hansenranoutofpills,asofSaturdaythepharmacystillhasnotdeliveredhermedications.Isthisamedicationerror?Why?

5. Listthingsyoucandotominimizedistractionswhilepassingoutmedication?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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Unit9:MedicationStorage

Objective1:Learnstoragerequirementsaswellasappropriatedisposaltechniquesformedicationskeptinlabeledcontainersormedicationreminderboxes.

1.Prescriptionandnon-prescriptionmedications:A.Store"inamannerthatensuresthesafety"ofclients

•Clientsshallnothaveaccesstomedicationwhichiskeptinalockedcentrallocation.

B.Alternativesareacceptablefordaytripsoroutings:

• Closedbackpack,purseoronthepersonofclientofsoundmindinadultdayfacility• Closedwheelchairbagofnon-ambulatorypersoninadultdayfacility• Narcoticsmustbecounteduponleavingthecommunityaswellaswhenreturningto

thecommunity.Itisacceptabletocountwiththefamilymemberorresponsibleparty• Anyprescribedmedicationcanbesentwiththeclientorresponsiblepartyforanouting.• Refertoyourcompanypolicyandprocedureregardinghowmuchmedicationtosend

foreachouting.

C.Medicationsrequiringrefrigeration

• Shallbestoredseparatelyinlockedcontainersorcompartmentalizedpackages,containers,orshelvesforeachclientinordertopreventinterminglingofmedication.

• Ifthereisadesignatedmedicationrefrigeratorandtherefrigeratorisinalockedroom,thenthemedicationsdonotneedtobestoredinlockedcontainers

2.Controlledsubstances: A.Mustbedoubled-locked,countedandsignedforusingasecondpersonforverification.

Example:Lockedportablemedicationboxstoredinsidelockedcabinet.QMAPcountsnumberofpills,secondQMAPorqualifiedmanagerwatchesandagreesthecountiscorrect.Shifttoshiftcountforaccuracyshouldincludethedate,time,quantityremaining,andsignaturesofbothstaff.

B.Anydiscrepancy,reportimmediatelytosupervisorforsuspicion/investigationofdrugdiversionD.Counthowoften?

•Anytimeaccesstonarcoticsisgiventoadifferentparty

3.Medicationshouldnotbestoredwithotheritems,mustneverbeinareaswith:

• Disinfectants


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• Insecticides• Bleaches• Householdcleaners• Poisons

4.Disposalofmedicationisregulatedbythestateandeachcommunitywillhavepoliciesandproceduressurroundingthedisposalofdiscontinuedandexpiredmedication.Somemedications,duetotheirhighlevelofpotentialharmtotheenvironment,mustbedisposedofwithveryspecificdirections.Pleaseseeyourcompanypolicyandprocedureregardingmedicationdestruction.Alldisposalsmustbedocumentedandconsentedtobytheresidentorresponsibleparty.Thesafestwaytodisposemedicationsisincoffeegroundsorkittylittler

Objective2:Learnthedifferencebetweentheexpirationdateandtherefillonorafterdate.

• Expirationdate-thedateontheactualcontainer,oroneyearafteramedication,wasfilled.

• Refillonorafterdate:Thisdatesignifiesthedatetheinsurancewillapprovearefillbasedonthesupplybeingapproximately85%gone

Objective3:MandatoryReportingandsafetyofresidentsandtheirproperty(includingmedications)

It is a state regulation that all suspected abuse, neglect, and misappropriation of resident property and funds be reported. All ALF homes have a zero-tolerance policy surrounding any sort of mistreatment. Should you suspect any form of abuse is occurring, you should follow the steps below: • First, document all pertinent information such as who, when, where, what happened, etc. • Call your direct supervisor and inform them of what you suspect may be happening. • Your manager should investigate to ascertain the validity of the suspected abuse. If it is found that abuse may have occurred, the resident’s family, the police, the Dept. of Social Services, Adult Protection Services, and the Colorado Dept. of Health and Environment should be contacted. • If you bring these findings to your manager and feel that they have done nothing with this information, you are still responsible to bring them to the next level and make sure someone investigates the situation.

• Should you still not get results after bringing the findings to your supervisor’s boss, you are required to contact any of the individuals from above (DSS, Police, APS, etc.)

Mandatory Reporting Procedures


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• Prevent & Report Abuse, Neglect, Misappropriation Property • First, document all pertinent information such as who, when, where, what

happened, etc. • Call your direct supervisor and inform them of what you suspect may be

happening. • Your manager should investigate to ascertain the validity of the suspected abuse.

If it is found that abuse may have occurred, the resident’s family, the police, the Dept. of

• Social Services, Adult Protection Services, and the Colorado Dept. of Health and Environment should be contacted.

• If you bring these findings to your manager and feel that they have done nothing with this information, you are still responsible to bring them to the next level and make sure someone investigates the situation.

• Should you still not get results after bringing the findings to your supervisor’s boss, you are required to contact any of the individuals from above (DSS, Police, APS, etc.)


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Definitions

Knowingthefollowingtermswillhelpyou.

ControlledSubstance:Medicationsthathavethepotentialtobeaddictiveandusedinawayotherthanhowthemedicationwasprescribed;asystemmustbeinplacetoaccountforreceipt,administrationanddispositionofeachmedication.

Document:Torecordorwrite;Documentationoftheadministrationofmedicationsisrequiredonthemedicationadministrationrecord(MAR).

Label:Informationonthemedicationpackage;referredtoalsoasmedicationlabelorprescriptionlabel.

MedicationAdministrationRecord(MAR):Arecordthatlistsallofthemedicationsorderedfortheclient,includingroutineorregularlyscheduledmedicationsandPRNmedications;Itisusedtodocumentorrecordtheadministrationofmedications.

Medication/Drug:Anotherwordusedfordrug;asubstanceormixtureofsubstancesusedinthediagnosis,cure,treatment,orpreventionofdisease.

OTCMedications:Over-the-counterornon-prescriptionmedications;medicationswhichcanbepurchasedorobtainedwithoutaprescription;however,youneedaphysician’sordertoadministerthem.

PrescriptionMedications:Medicationsthatcanonlybeobtainedorpurchasedthroughanorderorprescriptionwrittenbyaphysicianorprescribingpractitioner.

PRN–asneededorifnecessary;PRNmedicationsarenotscheduledtobeadministeredatspecifictimes,orroutinely.ClientsshouldbeabletoaskforPRNmedications,iftheycannotanassessmentoftheclientmustbemadebysomeonedesignatedbythefacilityandmustnotbeaQMAP.AdministrationofPRNmedicationsneedstobedocumentedontheMAR.

PrescribingPractitioner–Referstoalicensedhealthcareprofessionalwhoisauthorizedtoprescribeororderamedication;theprescribingpractitionerpeoplearethemostfamiliarwithisaphysicianordoctor.Otherprescribingpractitionersincludephysicianassistants,familynursepractitionersanddentists.

PoliciesandProcedures:EachfacilityisresponsibleforcreatingPoliciesandproceduresrelatedtoQMAP’sandmedicationadministration.

QualifiedManager:isdesignatedbytheownerofthefacilityandisamanagerorsupervisorofQMAP’s,hassuccessfullypassedtheQMAPcompetencytesting,whooverseesthefillingandadministrationfromMRB’s


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Regulations:anofficialruleorlawthatsayshowsomethingshouldbedone.Report:Tomakeknown,togiveinformationaboutsomething.

Sideeffects:Anyeffectotherthanthedesiredeffect;unwantedeffectsoradversereactionsfromamedication.Topical:applieddirectlytotheskin

Transcribe:Totransferwritteninformationfromoneplacetoanother;informationonthephysician’sordermustbetranscribedtothemedicationadministrationrecord(MAR).

CDPHE–ColoradoDepartmentofPublicHealthandEnvironmentHFEMSD–HealthFacilitiesandEmergencyMedicalServicesDivision

DHS–DOC–IDD–ALR–ADP–ACF-QMAP–QM–DR–PA–NP-

RN–LPN–CNA–MRB–MAR–PRN–MOM–KCL–GI-MA-

DepartmentofHealth&HumanServicesDepartmentofCorrectionsIntellectuallyDevelopmentallyDisabledAssistedLivingResidence

AdultDayProgramAlternativecarefacilitiesQualifiedMedicationAdministrationPersonQualifiedManagerDoctor/PhysicianPhysicianAssistantNursePractitionerRegisteredNurseLicensedPracticalNurseCertifiedNursingAssistantMedicationReminderBoxMedicationAdministrationRecordasneededMilkofmagnesiapotassiumchlorideGastrointestinalMedicalAssistant

Revised 6-15

The SIX Rights of Medication Administration

x The right client x The right time x The right medication x The right dose x The right route x Documentation

The Six Components of a Physician Order

x The client’s full name x The date of the order x Name of the medication x Dosage and administration

information x Route of administration x Physician’s signature

EQUIVALENTS:

METRIC - decimal system of weights and measures using the gram, meter and liter. LIQUID: cubic centimeter (cc) = milliliter (ml) SOLID: 1 gram (gm) = 1000 milligrams (mg) HOUSEHOLD - system based on common, though not standard, measuring devices.

tsp. = teaspoon Tbsp. = tablespoon oz. = ounce

1 tsp. = 5 cc 3 tsp. = 1 Tbsp = 15 cc 2 Tbsp = 30 cc = 1 oz

Common Abbreviations

ac before meals pc after meals

bid twice a day tid three times a day qid four times a day HS hour of sleep po by mouth q every qd every day qh every hour q6h every 6 hours qod every other day DC discontinue mg milligram cc cubic centimeter ml milliliter Gm gram kg kilogram tsp teaspoon Tbsp tablespoon oz ounce mEq milliequivalent ophth ophthalmic otic ear OU both eyes OS left eye OD right eye prn as needed tab tablet cap capsule SL sublingual Buccal: between cheek & gum EC enteric coated oint or ung ointment supp suppository sol solution c with s without x times gtts drops (R) right (L) left XL/XR extended release

Medication Administration Advance Study Sheet

Important facts you must have memorized by the end of the course

20

MEASURING DEVICES

A. Medication Cup B. Spoon

C. Oral Syringe D. Oral Dropper

Revised 4-08

Worksheet Physician order: Pharmacy label: Medication Reminder System label: Please answer the following: 1. Do the Physician Order, Pharmacy label, and MRB label correctly match for the medication, Lasix? Yes or No: _______ 2. Referring to the Physician Order: a. What is missing from the physician order? ________________________________ b. What information on the order makes up the “dose” of the medication, Lasix? i ______________, ii _______________, iii ________________ c. According to the physician order, is the medication, Lasix, correctly listed on the

MRB label? Yes or No: ________ 3. Referring to the Pharmacy label: a. Is Furosemide the same as Lasix? Yes or No: ________ b. What action/s would you take to check this information before giving the

medication? _______________________________________________________ _________________________________________________________________

c. What is the expiration date of the medication, Lasix? _______________________ d. May you administer the medication, Furosemide, from the bottle supplied by the

pharmacy? Yes or No: _______ Please explain: __________________________ _________________________________________________________________

4. Referring to the MRB label: a. There are four errors on the MRB label. List two of the medications involved: i _______________________________, ii _______________________________ b. What action would you take based on the incorrect MRB label and administering

medications from the MRB? __________________________________________________________________

Midland Family Practice RX: Hazel Greene____

Lasix 40 mg PO QD in a.m.

J.R. Midland, MD Date: _____

Goodpills Pharmacy RX: Hazel Greene Furosemide 20 mg Give 2 tablets (40 mg) daily. MD: Midland 12/24/04 exp: 6/13 #:30

Hazel Greene A.M. Noon P.M HS Lasix 40 mg, 2 tabs PO QD in a.m. X Tobramycin 250 mg PO every 6 hours X X X X X X Coumadin 0.1 mg PO odd days Coumadin 0.2 mg PO even days Tagamet 300 mg PO BID X X Tylenol 325 mg, 2 tabs every 4 hrs as needed for headache X

Label the following medication effects as A=Adverse Effect or S= Side Effect

_____ Nausea _____ Vomiting _____ Dry mouth _____ Constipation _____ Respiratory Failure _____ Rash

_____ Cardiac Arrest _____ Diarrhea _____ Death

Match the route of medication with its definition _____ Oral _____ Rectal _____ Ophthalmic _____ Nasal _____ Otic _____Sublingual _____ Inhaled _____ Topical _____ Vaginal _____ Transdermal

A. In the Vagina B. In the nose

C. In the ears D. In the rectum E. Under the tongue F. Patch n the skin G. In the eyes H. On the surface of the skin

I. In the mouth and swallowed

J. In the lungs

Match the abbreviations with the correct definition _____ PRN _____ EC A. Times H. As needed _____ BID _____ oz B. By mouth I. Left eye _____ QD _____ SL C. Enteric coated J. Four times daily _____ HS _____ OS D. Every day K. Ounce _____ PO _____ gtts E. Discontinue L. Drops _____ QID _____ DC F. Two times daily M. Sublingual _____ TBSP _____ x G. Tablespoon N. At bed time

QMAP Homework

To ensure you are administering the right medication you must: A. Compare the Physicians written order to the Client B. Compare the Medication record to the Client C. Compare the Pharmacy label to the Client D. All of the above

Match the situation with the appropriate category. _____ Glenn told Bill his name was Rich.

Bill gave Glenn Rich’s 5 pm medications _____ Ben put his nose drops in his eyes _____ Sue gave 3 TBSP Maylanta to Bob.

The order reads give 30cc/mg _____ Jill gave Thorazine to Sam. The order was to give Thioridazine. _____ Kyle gave Bill his 5pm meds at 7pm when he ate dinner because the label said to give with food. If the medication cannot be given or a person refuses the medication then the QMAP should?

A. Initial the appropriate box B. Circle the initials C. Provide an explanation on the back of the MAR D. All of the above

Using the pharmacy label below answer the following questions

A. Wrong medication B. Wrong dosage C. Wrong route D. Wrong person E. Wrong time

ABC Pharmacy April Jones, MD 1234 Main Street Anytown, CO 12345 Kay Evans Date filled: 2/1/09 303-555-5555 Take 10mg po tid Expiration date: 2/1/10 BuSpar 5 mg RX# 25834 Refills: 2 Qty: 90

What is the dose of the medication? _______________________________________________ What is the name of the medication? ______________________________________________ What is the strength of the medication? ____________________________________________ How often do you give this medication? ___________________________________________

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Objective 5: Practice documenting on the MAR

Using the medication orders above, practice documenting administration or monitoring of medications on the MAR below. Practice routine and PRN medications, a medication that cannot be given or is refused, and how to handle various documentation errors.

FRONT OF EXAMPLE MAR MEDICATION ADMINISTRATION RECORD

Client Name: Month/Year:

Medication info Time 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

BACK OF EXAMPLE MAR QMAP name: Identifying initials

Date Time Notes (REMINDER: SIGN EACH NOTE WITH FULL NAME AND QMAP TITLE)

Midland Family Practice RX: Hazel Green____

Amoxicillin 30cc PO BID x 7 days then DC J.R. Midland, MD 7/1/15

Midland Family Practice RX: Hazel Green____

Furosemide 40mg qd po J.R. Midland, MD 7/1/15

Download - Qualified Medication Administration Person QMAP · The medication administration program is established in accordance with Section 25-1.5-301, C.R.S et seq. The medication administration

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