eqc chapter 11 september - oregon€¦ · title: microsoft powerpoint - eqc chapter 11 september...

ENSURING QUALITY CARE

MEDICATION ADMINISTRATION

• Medication administration basics

• Medical orders and medication administration record (MAR)

• Dispensing and delivering medication

• Special considerations

September 2019 Safety, Oversight and Quality Unit 2

PURPOSE AND KEY TERMS

The purpose of this section is to help learners understand the basics of medication administration and their responsibility in implementing a safe medication administration system.

• Medication errors• Prescription drugs• Over-the-counter (OTC) drugs• Medication routes• Food and drug interactions• Side effects


OBJECTIVES

The learner will be able to:Describe the types of medication errorsList the medication routesDemonstrate how to read a prescription labelDemonstrate how to read an OTC drug labelUnderstand how foods can interact with drugsGive examples of types of side effects that can occur with medications


INTRODUCTION

Implementing safe medication administration system is an essential responsibility of the AFH licensee:

• Administering medication involves more than giving residents their medications – it also includes:

• Obtaining and managing medical orders• Understanding each residents medications• Proper medication storage• Proper medication disposal


INTRODUCTION CONTINUED

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:

• Significant injury to major organs such as the kidneys or liver• Death


INTRODUCTION CONTINUED

The AFH rules require that AFH owners and their 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


ALERT

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


AGE-RELATED CHANGES CONTINUED

Decline in gastrointestinal function. Result:• Medication absorption is delayed

More body fat than muscle. Result:• Because fatty tissue stores some medications, unpredictable and delayed

medication action may occur

Lower body weight in older adults. Result:• Normal adult dosage may cause overdose – fewer medications are required

with low body weight


AGE-RELATED CHANGES CONTINUED

Age-related changes affecting the action of medications include:Decrease in volume of blood and water in the body. Result:

• Medication is distributed throughout the body in a more concentrated form

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


MEDICATION ADMINISTRATION SYSTEMA 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• Disposing of discontinued, unused, contaminated or expired medication• Re-ordering medications


MEDICATION ADMINISTRATION SYSTEM CONTINUED

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 appropriate administering:

• Topical medications• CBG testing• Subcutaneous injections


MEDICAL ORDERS

The resident’s healthcare provider or specialist (prescriber) is responsible for approving all medications and treatments:

• A written order or prescription for all medications• Treatments, therapies and any special diet requirements• Written approval for over-the-counter (OTC), supplements and herbal

treatments requested by the resident


WHO CAN PRESCRIBE?

Prescribing authority in Oregon includes:• Medical doctor (M.D.)• Doctor of osteopathic medicine (D.O.)• Doctor of podiatric medicine (D.P.M.)• Physician’s assistant (P.A.)• Nurse practitioner (N.P.)• Clinical nurse specialist (C.N.S.)• Dentist (D.M.D. or D.D.S.)


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


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


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 cause: Constipation Interference with the effectiveness of other medications


SIDE EFFECTS CONTINUED

Side effects may be:• Minor and may not interfere with

the individual’s quality of life; or• Can be enough of a problem that

it interferes with the person’s quality of life

• The AFH provider is expected to document all side effects and work with the resident’s healthcare provider if side effects negatively impact the resident


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 MEDICATION (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 medicationr it can take weeks or

months to appear.


ADR CONTINUED

ADR must be:• Reported to the prescriber immediately; and• Documented in the resident’s record

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


ADR CONTINUED

• Movement disorders• Memory loss• Rash• Agitation, anxiety• Seizures• Stomach ulcers or bleeding• Incontinence• Hallucinations


SIDE EFFECTS AND ADRs

Side effects and adverse medication 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


SIDE EFFECTS AND ADRs CONTINUED

Side effects and ADRs often go unnoticed or are misdiagnosed in seniors:

• 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

• 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.


MEDICATION INTERACTIONS

A medication interaction is when one medication changes or alters the function of another medication. This includes:

• Pharmacy-dispensed medications• Medications purchased over-the-counter• Alternative medications and supplements• Home remedies• Foods and beverages can also interact with medications


MEDICATION INTERACTIONS CONTINUED

Medication interactions include:Medication to medication:• Calcium supplement 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



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

ingredient for certain medications leading to increased adverse medication reactions

Medication to disease:• 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:

• Taking several medications increases the 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 body


ACCESS TO INFORMATION

Caregivers must have immediate availability to medication references, such as:

• Online resources:• medications.com

• Current medication reference:• Updated medication reference books are generally available annually in

October/November• Current product inserts or medication summary

• Must replace each time a refill 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


MEDICATION ERRORS CONTINUED

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 CONTINUED

• 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:

HOW TO READ LABELS - PRESCRIPTIONS


HOW TO READ LABELS - OTC

September 2019Safety, Oversight and Quality Unit 37

HOW TO READ LABELS -SUPPLEMENTS


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:

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


MEDICATION ROUTES

Medications can be introduced into the body through many routes. The prescribing practitioner will write what route the medication must be given:

If medications are not given as ordered it may result in:• Medication not working properly; or• Harm to the resident


MEDICATION ROUTES CONTINUED

• 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


MEDICATION ROUTES CONTINUED

**Intramuscular (IM) injections cannot be delegated. Arrangements must be made with a licensed practitioner to administer. Options available:

• 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


ALERT - 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


ALERT – DELEGATIONS CONTINUED

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

residents• The delegated caregiver cannot teach other caregivers to do the task


ALERT – DELEGATIONS CONTINUED

For additional information on your responsibility for delegated tasks take the self-study course: RN Delegation for Lay Caregivers at – http://tinyurl.com/DHS-AFHTraining


ALERT – INTRAMUSCULAR INJECTIONSIntramuscular (IM) injections are allowed for anticipatory emergency medications. Giving IM injections is taught and cannot be delegated:

Epinephrine:• Allergic reaction emergencies

Glucagon:• Severe low blood sugar

emergencies


ALERT – INTRAMUSCULAR INJECTIONS CONTINUED

Caregivers must be trained by an approved trainer following the training curriculum outlined by the Health Division’s Anticipatory Emergency rules.


MEDICAL ABBREVIATIONS

While gathering information and medical orders you may encounter medical abbreviations. If you do not understand, ask for clarification from an appropriate medical professional:

• The abbreviations listed on the following tables identified with an asterisk (* ) should not be used – this recommendation is based on high frequency of errors. The abbreviations were included since some individuals may still be using them.


MEDICAL ABBREVIATIONS CONTINUED


MEDICAL ORDERS


PURPOSE AND KEY TERMS

The purpose of this section is to assist the learner in understanding medical orders and how to document medications, treatments and therapies on the medication administration record (MAR).

• Medical order• Medication administration

record (MAR)• PRN medications• Parameters• Self-medicate


OBJECTIVES

The learner will be able to:Describe what requires a medical order by the resident’s primary healthcare

practitionerDemonstrate the ability to record medications on the MARDescribe how to document a missed/refused medicationDefine a PRN medication and how to record on the MARDescribe parameters and the importance of having parameters written for

PRN medicationsDescribe what must be documented when a resident has written approval

from his or her primary healthcare practitioner to self-medicate


MEDICAL ORDERS

The AFH provider is responsible for obtaining all necessary 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

The AFH provider is responsible for carrying out the written orders.


MEDICAL ORDERS CONTINUED

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



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.


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.



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 refuses:

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



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



Changes 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


MEDICATION ADMINISTRATION RECORD (MAR)


MAR

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.


MAR CONTINUED

The MAR must identify all medication, treatments or therapies you or your staff administer including, but not limited to:

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


MAR CONTINUED

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


MAR CONTINUED

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


MAR CONTINUED

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


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 CONTINUED

• 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


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


MAR - PRN MEDICATIONS CONTINUED

It is best if the prescribing practitioner writes 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.


MAR - PRN MEDICATIONS CONTINUED

The parameters should be recorded on the medication administration record (MAR);

• Any caregiver dispensing medications for that specific resident must follow the written instructions

• If you or one of your caregivers does not have a clear understanding of the instructions, ask the RN, pharmacist or prescribing practitioner to explain to them using more details


MAR - PRN MEDICATION CONTINUED

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

• With up to five residents in your home, it can be challenging, but it is critical that you keep all this information – it must be written on the MAR so all caregivers know when the PRN medication was given




Documentation example for a verbal resident:



Documentation example for a non-verbal resident:


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.


MAR - MEDICATIONS GIVEN ALTERNATING DAYSMost 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.


MAR - MEDICATIONS GIVEN ALTERNATING DAYS


MAR - MEDICATIONS GIVEN 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.


MAR - MEDICATIONS GIVEN ALTERNATING DAYS


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


MAR – INSULIN CONTINUED


MAR – INSULIN CONTINUED

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


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


MAR – TRANSDERMAL PATCHES CONTINUED


MAR – TRANSDERMAL PATCHES CONTINUED

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.


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.


MAR – DOSE CHANGE CONTINUED


MAR - MISSED OR REFUSED MEDICATIONS

If a medication is missed or if the resident refuses to take it, the caregiver must document this on the MAR circling the caregiver’s initials, and indicate why the medication was missed or refused. The caregiver also documents in the resident’s record what action was taken (who was notified), as well as any follow-up instructions from the residents primary healthcare practitioner.


MAR - MISSED OR REFUSED MEDICATION


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


MAR – SELF-ADMINISTRATION CONTINUED

It is recommended that you keep an updated MAR because: 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 CONTINUED


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


EXAMPLE MEDICAL VISIT FORM


PSYCHOTROPIC MEDICATIONS CONTINUED

A psychotropic medication used for the purpose of treating a resident’s behavioral symptoms is a form of chemical restraint. The resident’s physician, nurse practitioner or a qualified nurse or mental health practitioner should be asked to do a complete assessment prior to the use of medications as a treatment for behavioral problems.



Psychotropic, also known as psychoactive, medications act primarily upon the central nervous system where it affects 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



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 in the elderly:

• Research has demonstrated that the elderly are more likely to experience serious side effects with the use of these medications; and

• 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



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 the elderly. The sedation effects can create problems such as:

• Falls• 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



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.



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

leaving 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



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


REFUSING MEDICATIONS


MEDICATION REFUSAL

Residents may resist 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 in the mouth and spit it out later

If a resident refuses to take a medication, ask why and try to understand the resident’s point of view.


MEDICATION REFUSAL CONTINUED

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:

• Refuses to take medication• Vomits medication within 20 minutes of taking the medication• Does not want to or avoids taking medications due to nausea, vomiting or

diarrhea• 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.



Common reasons for a person refusing to take medications and suggestions for responding are presented in the next slide.Do not hesitate to contact the resident’s primary care practitioner or the RN consultant when a resident refuses or discards needed medications.


MEDICATION STORAGE AND DISPOSAL


MEDICATION STORAGE

Medications for each resident must be:• Stored in a separate box with the residents name clearly marked• Locked

Medications requiring refrigeration must be:• Stored in a separate box and locked; AND• If there are any refrigerated medications for the AFH family they also must be

lockedA small dorm refrigerator with a lock on the outside is useful for multiple residents with refrigerated medications.


MEDICATION STORAGE CONTINUED

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

Medication 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


MEDICATION DISPOSAL CONTINUED

Contaminated supplies such as bandages etc.:

• Dispose of in a plastic bag within a covered garbage container

Transdermal patches:• Follow manufacturer’s

instructionsOutdated or discontinued medication:

• Dispose of immediately• Follow local regulations


INFECTION CONTROL


INFECTION CONTROL

Wash hands:• Before setting up a resident’s medication; and• After administering the medications• If no sink, place hand sanitizer in every room resident care is given AND in the

area where medications are set-up• Use gloves when appropriate -SQ injections, gels etc.

You must wash your hands before putting gloves on and wash again after removing gloves.


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.


TRAINING


ADDITIONAL TRAINING

Oregon Administrative RuleRequires 12 hours of training annually for the:

• Licensee• Caregivers• Resident managers, floating resident managers

Requires all providers (licensees, resident managers, floating resident managers and shift caregivers) to take a Department-approved Six Rights of Safe Medications 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.


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

• Your caregivers take the course too.


RESOURCES


Additional resources on a wide range of medication topics can be found on DHS’s Safe Medication Administration website:

www.tinyurl.com/DHS-SafeMeds

DISCUSSION/QUESTIONS

September 2019Safety, Oversight and Quality Unit

eqc chapter 11 september - oregon€¦ · title: microsoft powerpoint - eqc chapter 11 september...

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