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Medication Administration

10/15-Hour Training Course for

Adult Care Homes

Instructor Manual

North Carolina Department of Health and Human Services

Division of Health Service Regulation

Center for Aide Regulation and Education

Adult Care Licensure Section

Medication Administration – September 2013

10/15-Hour Training Course for Adult Care Homes i

The Medication Administration: 10-Hour/15-Hour Training Course for Adult Care Homes was

developed as a joint effort by the Center for Nurse Aide Education and Regulation and the Adult

Care Licensure Section of the Division of Health Service Regulation, N.C. Department of Health

and Human Services.

The curriculums for the 10-hour and 15-hour training courses were adapted from the

Medication Administration: A Medication Aide Training Course developed by the North

Carolina Department of Health and Human Services and the North Carolina Board of Nursing.

CURRICULUM DEVELOPMENT

Center of Aide Education and Regulation, Division of Health Service Regulation

Adult Care Licensure Section, Division of Health Service Regulation

North Carolina Department of Health and Human Services

September 2013

Instructor Manual

Table of Contents


10/15-Hour Training Course for Adult Care Homes ii

TABLE OF CONTENTS

Section Title Page

Title Page i

Table of Contents ii

Medication Aide in Adult Care Homes v

Introduction vi

Prerequisite for Students vi

Medication Aide Course Training Requirements and Directions

for Use vii

Student Manual ix

Course Objectives x

Course Schedule xiii

Definitions xv

Section A Prerequisite Skills Review and Validation A-1

Teaching Guide A-2

Course Content A-3

Section B Medication Aide in Adult Care Homes B-1

Teaching Guide B-2

Course Content B-3

Section C Legal and Ethical Responsibilities C-1

Teaching Guide C-2

Course Content C-3

Section D Overview of Medication Administration D-1

Teaching Guide D-2

Course Content D-3

Activity: Medication Orders D-6

Activity: Medication Label D-8

Activity: Decimal and Zeros D-12

Section E Medication Orders and Medication Administration Record (MAR) E-1

Teaching Guide E-2

Course Content E-3

Activity: Medication Order and Transcription E-6

Section F Using the Medication Administration Record (MAR) F-1

Teaching Guide F-2

Course Content F-3

Activity: Medication Administration Record (MAR) F-7

Instructor Manual

Table of Contents


10/15-Hour Training Course for Adult Care Homes iii

Section G Infection Control G-1

Teaching Guide G-2

Course Content G-3

Activity: WHO’s How to Hand Rub? How to Hand Wash G-4

Activity: Instructions for Glove Sizing G-7

Activity: Instructions for Gloves, Gloves, Gloves G-7

Section H Medication Administration Supplies H-1

Teaching Guide H-1

Course Content H-3

Section I Administering Medications I-1

Teaching Guide I-1

Course Content I-3

Section J Medication Administration Checklist J-1

Student Medication Administration Checklist J-2

Instructor Medication Administration Checklist J-3

Instructor Medication Administration Skill Slips J-4

Skill #1: Handwashing J-8

Skill #2: Alcohol-based Hand Rub J-9

Skill #3: Putting On (Donning) and Removing Gloves Check-off J-10

Skill #4A: General Medication Administration Preparation Steps J-11

Skill #4B: General Medication Administration Subsequent Steps J-12

Skill #5: Oral Medication Administration J-13

Skill #6: Sublingual Medication Administration J-14

Skill #7: Oral Inhalant Medication Administration J-15

Skill #8: Eye Medication Administration J-16

Skill #9: Ear Medication Administration J-18

Skill #10: Nasal Medication Administration J-19

Skill #11: Transdermal Medication Administration J-20

Skill #12: Topical Medication Administration J-21

Skill #13: Drawing and Injecting One Insulin J-22

Skill #14: Instructions for Preparing and Injecting with Insulin Pen J-24

Preparing and Injecting with a Insulin Pen J-25

Section K Ordering, Storage and Disposal of Medications K-1

Teaching Guide K-2

Course Content K-3

Instructor Manual

Table of Contents


10/15-Hour Training Course for Adult Care Homes iv

Section L Handouts

C-1 Medication Errors L-1

C-2 Good Medication Administration Practice Habits L-2

C-3 Resident’s Refusal to Take Medications L-3

D-1 Medication Orders L-5

D-2 Medication Label L-7

D-3 Abbreviations L-8

D-4 Six Rights of Medication Administration L-9

D-5 Decimal Point and Zeros L-10

D-6 Common Routes of Medication Administration L-11

D-7 Common Dosage Forms of Medication L-12

E-1 Blank Sample FL-2 L-13

E-2 Blank MAR Sample L-14

E-3 Sample FL-2 for Transcription Activity (Garrett Clayton) L-16

F-1 MAR for Jo Burns L-17

F-2 MAR Worksheet for each student L-19

G-1 WHO’s How to Hand Rub? How to Hand Wash L-21

G-2 Instructions for Glove Sizing L-22

G-3 Gloves, Gloves, Gloves L-23

G-4 Injection Safety Diabetes and Viral Hepatitis L-24

I-1 Review of Measuring Devices L-25

I-2 Always and Never Measuring Tips L-26

I-3 Measuring Tips L-27

I-4 Technique and Use of Meter Dose Inhalers L-28

Answers to Activities/Worksheets

D-1A Medication Orders Answers L-29

D-5A Decimal Point and Zeros Answers L-30

E-4 Medication Orders and Transcription Answers L-31

F-3 Medication Administration Record Answers L-33

Additional Resources

10 Tips to Administer Medications to a Cognitively

Impaired Resident L-35

General Guidelines for Transcription L-37

Appendix

10/15 Test (Optional) 1

10/15 Test Answers 4

Certificate 7

References 8


10/15-Hour Training Course for Adult Care Homes v

Medication Aide in Adult Care Homes

1. A Medication Aide in adult care homes is an individual who has successfully completed the

required Medication Aide course(s) approved by the N.C. Department of Health and Human

Services, passed the state written medication exam for unlicensed staff in adult care homes

and has competency skills validation at the employing facility.

Any individual employed as a Medication Aide prior to 10/01/2013 must be able to verify

employment as a medication aide within the previous 24 months and completed

competency skills validation and passed the state written exam for Medication Aides in adult

care homes.

All Medication Aides in adult care homes must have competency validation at the employing

facility and maintain the 6 hours of continuing education requirements annually.

2. The laws and regulations governing Medication Aides in adult care homes in N.C. include:

GS § 131D-4.5, GS § 131D-4.5A, GS § 131D-4.5B, 10A NCAC 13F/G .0403; 10A NCAC 13F/G

.0503; 10A NCAC 13F/G .0505; 10A NCAC 13F/G .0506, 10A NCAC 13F/G .0903 and 10A

NCAC 13F/G .1000.

3. The routes of medication administration in this course include the following: oral, eye, ear,

nasal, inhalant, transdermal and topical. General information and skills check off for

subcutaneous injections, is included in the curriculum but is only required if the task will be

performed by Medication Aide.

4. Allegations of fraud against a facility or resident, resident abuse or neglect, misappropriation

of property belonging to a resident or facility, or diversion of medication belonging to a

resident or facility by the Medication Aide must be reported to the N.C. Health Care

Personnel Registry. Substantiated findings by the Heath Care Personnel Registry are posted

on the Health Care Personnel Registry.

5. It is the responsibility of the Medication Aide to notify the Adult Care Licensure Section of

name and address changes.

6. Information on registration for the state written exam for unlicensed staff in adult care

homes may be obtained at www.ncdhhs.gov/dhsr/acls/medtech.html or via email to

[email protected]. Results or verification may be obtained via website at

N.C. Adult Care Medication Testing.


10/15-Hour Training Course for Adult Care Homes vi

Introduction

In 2011, the North Carolina Legislature mandated training in addition to competency evaluation requirements

for adult care home medication aides. As a response to the legislation, the North Carolina Department of

Health and Human Services, Division of Health Service Regulation, has developed the required 5-hour and 10-

hour training courses that include instruction in the key principles of medication administration and infection

prevention.

The department developed a 5-hour, 10-hour and 15-hour standardized training course to assist qualified

instructors to train unlicensed staff who will administer medications to residents in Adult Care Homes. Each

training course includes an instructor manual, materials for a student manual and a certificate template

required for participants who successfully complete the course(s).

Course Description

• The 5-hour training course is built around the current skills checklist required for medication staff in adult

care homes. The majority of the 5-hour course schedule centers around time spent for instruction and

validation of skills required for medication administration. Individuals are expected to pass the clinical

skills tasks with 100% competency demonstrated. The design of the course is for a small class of

employees or 1:1 training for a specific facility.

• The 10-hour training course builds upon content in the initial 5-hour training course and developed as a

refresher for the employee. The 10-hour training course includes random competency validation of skills

required for medication administration. A prerequisite for the 10-hour training course is successful

completion of the 5-hour training course. The design of the course is for a larger class than the 5-hour

training course but still limited in size to allow for interactive activities and practice of safe medication

administration skills.

• The 15-hour training course was developed as another option to meet the requirements of the 5-hour and

10-hour training mandated by legislation. The course provides 10 hours of classroom instruction and 5-

hours of clinical skills validation. Successful completion of this course meets the requirements for the 5-

hour and 10-hour training courses. Individuals are expected to pass the clinical skills tasks with 100%

competency demonstrated. The design of the course is for a larger class than the 5-hour training course

but limited in size to allow for lots of practice and integration of safe medication administration skills.

The 5-hour, 10-hour and 15-hour training courses were adapted from the “Medication Administration: A

Medication Aide Training Course” curriculum developed in 2006 by the North Carolina Department of Health

and Human Services and the North Carolina Board of Nursing.

The 5-hour, 10-hour, and 15-hour competency-based curriculums provide unlicensed staff with basic

knowledge and skills needed to ensure that medication administration is performed in a safe and effective

manner. Successful completion of the 5-hour plus 10-hour training courses or the 15-hour training courses

will prepare individuals to take the state written medication exam for adult care home staff.

Pre-requisite for Students

• Must be able to understand, follow and communicate written English instructions.

• Successfully complete the Pre-requisite Skills Review and Validation of the course.


10/15-Hour Training Course for Adult Care Homes vii

Medication Aide Course Training Requirements

and Directions for Instructor Manual

Minimum Requirements

This course has been prepared for instructors qualified to teach state-mandated content in medication

administration to unlicensed staff employed in adult care homes.

Course Content

Each course has been divided into sections. Each of the sections includes core content considered to be

foundations of medication administration knowledge that medication aides must know to safely and correctly

administer medications in adult care homes. Curriculum pages are provided in a portrait layout with

instructional content.

Medication Administration: 10/15-hour course for adult care homes:

Section A: Prerequisite: Prerequisite Skills Review

and Validation

Section G: Infection Control

Section B: Medication Aide in Adult Care Homes Section H: Medication Administration Supplies

Section C: Legal and Ethical Responsibilities Section I: Administering Medications

Section D: Overview of Medication Administration Section J: Medication Administration Skills Checklists

Section E: Medication Orders and the Medication

Administration Record(MAR)

Section K: Ordering, Storage and Disposal of

Medications

Section F: Using the Medication Administration

Record

Classroom Instruction

Teaching Guide is at the beginning of each section and serves as a resource to prepare the instructor to teach

the section. It lists the objectives to cover, handouts and activity sheets to duplicate, and supplies needed.

Blocks of content are included within the confines of borders or boxes and specify what is to be taught to the

students during classroom instruction.

Teaching tips are included that complement the content and provide the instructor with ideas and suggestions

to clarify information, involve students in discussion, and engage students with varied learning strategies. It is

an expectation that the instructor will consistently incorporate teaching tips during the teaching of the

content. Each teaching tip is preceded by a symbol, �� followed by a brief title of the teaching tip. Each

instructor will incorporate the material with her/his presentation style but the content is to be covered

throughout the course presentation.

Suggested activities promote student-centered learning and actively engage the students in the learning

process. Activities provide the students with opportunities to practice what they have learned in class. The use

of activities energizes the classroom, breaks-up the monotony of passive receipt of information through lecture

and provides a deeper understanding of content by the students. Some activities involve the duplication of

activity sheets.


10/15-Hour Training Course for Adult Care Homes viii

Skills Requirements

The skills portion of the training courses consists of skills critical to correct medication administration practice.

First, demonstration of skills must be performed by a qualified instructor. As the instructor demonstrates each

skill, the students should have an unobstructed view of the process and have skill check sheets available to

refer to and follow along as the instructor proceeds through the steps of the skill.

Guided student practice is a vital component of skill acquisition. Guided student practice is best done right

after skills demonstration. During this type of student practice, the instructor observes the practice sessions

and provides descriptive feedback. The instructor must be astute and correct errors during guided practice to

prevent the repetition of errors. If a student continually practices a skill incorrectly, there is a great risk that the

student will continue to perform the skill incorrectly during the skill check-off and while providing care to

residents.

Skill check-offs are performed after demonstration and student practice have taken place. Skills check-offs for

infection prevention and administration of oral, sublingual, ophthalmic, optic, nasal, inhalant, and topical

medications are considered basic medication administration skills to which the unlicensed person must

demonstrate competency validation. Optional Skills check-off for subcutaneous injections is included. Any

unlicensed staff who will perform the “optional” task must be competency validated by a Registered Nurse.

Documentation

The adult care home must maintain documentation of successful completion of the medication administration

training courses for each unlicensed staff who performs medication aide duties and successfully completes

training. Documentation maintained in the employee’s file includes the certificate of successful completion of

required training courses. For 5-hour and 15-hour training courses performed specifically for staff of an adult

care home, the skills check-offs completed during the training course may be used to meet the documentation

of competency validation for the medication administration skills. The Medication Clinical Skills Checklist for

the employing facility must also be maintained on file for each Medication Aide.

Requirements for Instructors

Instructors of the Medication Administration: 5-hour and 10/15-hour Aide Training Courses for Adult Care

Homes should be a Registered Nurse or licensed pharmacist in good standing with their North Carolina

occupational boards and knowledgeable in teaching current standards of practice of medication administration

and infection prevention and regulations related to adult care homes. Skills check-off for the basic medication

administration skills listed above must completed or validated by the Registered Nurse or licensed pharmacist.

Any other skills for routes of administration, including the “optional” administration routes listed above must

be validated by a Registered Nurse.


10/15-Hour Training Course for Adult Care Homes ix

Student Manual

A student manual may be created using the handout and activities. The student may benefit from review of

the materials prior to the training. The student should receive a copy of the skills checklist. The information will

help the student understand and perform the basic competencies required to safely administer medications by

the following routes: oral, sublingual (under the tongue), otic (ear), ophthalmic (eye), nasal (nose), topical (on

the skin), and inhalant (breathed into the lungs).

Course Objectives


10/15-Hour Training Course for Adult Care Homes x

Course Objectives

Section A - Prerequisite Skills Review and Validation

At the completion of this section, the student should:

1. Demonstrate correct technique in obtaining and recording a blood pressure.

2. Demonstrate correct technique in obtaining and recording a radial and apical

pulse.

3. Demonstrate correct technique in obtaining and recording a respiratory rate.

4. Demonstrate correct technique in obtaining a temperature.

5. Demonstrate correct technique with assisted glucose monitoring.

Section B - Medication Aide in Adult Care Homes


1. Identify the general role of a Medication Aide.

2. Explain the expectations of the role of a Medication Aide.

Section C - Legal and Ethical Responsibilities


1. Recognize legal implications of negligence, fraud and diversion.

2. Recognize issues around medication administration errors.

3. Explain the resident’s rights to privacy, confidentiality and refusal.

Section D - Overview of Medication Administration


1. Demonstrate proficiency and safety in preparation of medications.

2. Recognize commonly used abbreviations and terminology related to medication

administration.

3. Demonstrate proficiency in reading a medication label.

4. Identify the Six Rights to administer medications.

Course Objectives


10/15-Hour Training Course for Adult Care Homes xi

Section E - Medication Orders & Medication Administration Record (MAR)


1. Transcribe orders onto the Medication Administration Record (MAR) correctly –

use proper abbreviations, calculate stop dates correctly, transcribe PRN orders

appropriately, copy orders completely and legibly and/or check computer sheets

against orders and apply to the MAR, and discontinue orders.

2. Describe the responsibility of the Medication Aide in relation to FL-2, physician’s

orders and medication administration record (MAR).

Section F - Using the Medication Administration Record (MAR)


1. Compare and contrast the documentation of routine medication administration

and PRN medication administration.

2. Demonstrate the use of the Medication Administration Record (MAR).

3. Identity the three checks between medication label and MAR when

administering medications.

4. Describe the action to take when a medication is not administered due to refusal

or omission.

Section G - Infection Control

At the completion of this section, the student should be able to:

1. Understand the importance of hand hygiene, demonstrate hand washing

techniques, demonstrate alcohol-based hand rub technique, and demonstrate

the proper way of putting on and taking off clean gloves.

2. If applicable, the student should be able to understand the importance of

standard precautions for assisted glucose monitoring and administering

injections.

Section H - Medication Administration Supplies


Demonstrate understanding in preparing a clean, well lit and well supplied work

area from which to safely administer medications.

Course Objectives


10/15-Hour Training Course for Adult Care Homes xii

Section I – Administering Medications


1. Use the Six Rights to administer oral, topical, eye, ear, inhalant, and nasal

medications – right resident, right medication, right dose, right route, right time,

and right documentation.

2. Identify proper action to take when crushing or cutting medications in relation to

medication administration.

Section J - Skills Checklists


1. Complete the Skills Checklists without comments or instructions from your

instructor/evaluator.

2. Achieve the goal of “Pass” by demonstrating the skills as outline on the checklist

and completing them in the time allowed.

Section K – Ordering, Storage and Disposal of Medications


1. Describe procedures for reordering medications and ensuring medications

ordered are available for administration.

2. Describe correct storage and securing of medications.

3. Maintain an accurate inventory of controlled substances.

4. Identify the procedures for disposal of medications.

Section L – Handouts

Course Schedule


10/15-Hour Training Course for Adult Care Homes xiii

Course Schedule

Section

10-Hour*

Estimated Allotted

Time in Minutes

15-Hour

Estimated Allotted

Time in Minutes

Section A

Prerequisite Skills Review and

Validation

0 minutes 30 minutes

Section B

Medication Aide in Adult Care

Homes


Section C

Legal/Ethical Responsibilities


Section D

Overview of Medication

Administration


Section E

Medication Orders and


Record (MAR)


Section F

Using the Medication

Administration Record (MAR)


Section G

Infection Control


Course Schedule


10/15-Hour Training Course for Adult Care Homes xiv

Section

10 Hour*

Estimated Allotted

Time in Minutes

15 Hour

Estimated Allotted

Time in Minutes

Section H


Supplies


Section I

Administering Medications


Section J


Skills Checklist


Section K

Ordering, Storage and Disposal

of Medications


Additional time for breaks and

additional questions or training

time for sections

45 minutes** 75 minutes**

Total 600 minutes 900 minutes

* 10-hour training course – For a student to complete the 10-hour training course, successful completion of

the 5-hour training course is required. Estimated time for the completion of sections in the 10-hour training

program varies from the 15-hour, due to the information or validation in the 10-hour training course was

included in the 5-hour training course. The time needed for discussion of handouts and activities should be

less than the 15-hour training course, since these were included as a part of the 5-hour training course and

will be a review.

** Additional time allows for instructor to add time necessary for sections that students need additional

instruction. Additional time allows for review of the definitions, course objectives, course schedule and

breaks. The written exam is optional and not included in the allotted time.

Definitions


10/15-Hour Training Course for Adult Care Homes xv

Definitions

administer – to give or direct application of a medication to the resident’s body whether by

injection, inhalation, ingestion or any other means

administration route – how the medication is administered or given, i.e., orally, topically,

subcutaneous injection, inhalation, nasal, rectally, vaginally, etc.

adult care home – an assisted living residence in which scheduled and unscheduled personal

care services are provided to two or more residents; licensed under 131D; includes family care

homes

aseptic – free of disease-causing organism

cognitive impairment – altered ability to think, to reason and/or remember which interferes

with the ability to function normally

controlled substances – potentially dangerous or habit-forming medications whose sale and

use are strictly regulated by law; retrievable records for the receipt, administration and

disposition are required

disinfect – to render free from disease-causing organism

expiration date – date after which a medication should not be used

external medications – medications administered on the outside of the body such as creams,

ointments or transdermal patches

facility – an adult care home, includes family care homes

frequency – how often a medication is administered, e.g., once daily, twice daily before meals,

every four hours as needed for cough, etc.

generic medication – an often lesser expensive medication that may be deemed therapeutically

equivalent by U.S. Food and Drug Administration to a trade name drug, because it has the same

active ingredient(s) and identical in strength, dosage form and route of administration

medication administration record (MAR) – a legal record of the medications administered to a

resident; provides instructions on what, how, and when to administer medications to a resident

based on orders written by the health professional responsible for prescribing medications; a

document that provides a location to document the act of administering or not administering a

medication or medications to a resident

Definitions


10/15-Hour Training Course for Adult Care Homes xvi

medication error - when a medication is administered in any way other than how it was

prescribed

medication order - written or oral directions that a physician or other prescribing practitioner

provides about a resident’s medication or medications; required to administer, change or

discontinue any medication to a resident

ophthalmic – related to the eye, usually refers to eye drops or eye ointment with medication

administration

otic – related to the ear, usually refers to the administration of eardrops

OSHA – abbreviations for Occupational Safety and Health Administration

over-the-counter medication – medication available without a prescription; common

abbreviation is OTC; require an order for administration in an adult care home

prescribing practitioner – licensed health professional with the authority by law to diagnose

and treat illnesses and prescribe medications

prescription medication – any medication required by federal law or regulation to be dispensed

only pursuant to a prescription

PRN order – a medication order for a medication to be administered as needed within a

particular time parameter prescribed by the physician or prescribing practitioner

Standard Precautions – established by OSHA to prevent contamination by blood borne

pathogens; wearing gloves when handling body fluids, wearing protective equipment and

disposing of biohazardous waste

routine order – medication order for a medication to be administered over a period of time

until discontinued

trade name – licensed name under which a medication prepared by a specific manufacturer is

sold; also known as proprietary or brand name

Section A


10/15-Hour Training Course for Adult Care Homes A-1

Section A

Prerequisite Skills Review and Validation

Section A



Section A Prerequisite Skills Review and Validation

Objectives:

At the completion of this section of study, the student should:

1. Demonstrate correct technique in obtaining and recording a blood pressure.

2. Demonstrate correct technique in obtaining and recording a radial and apical pulse.

3. Demonstrate correct technique in obtaining and recording a respiratory rate.

4. Demonstrate correct technique in obtaining a temperature.

5. Demonstrate correct technique with assisted glucose monitoring.

Supplies:

• Equipment or devices for obtaining or demonstrating:

o Blood Pressure

o Temperature

o Finger sticks (if applicable)

• Alcohol and other disinfecting and cleaning agents as recommended by manufacturer of

the equipment and devices

Note: Medication Administration will require the Medication Aide to measure the vital signs of

residents who are taking particular medications. The instructions should be a review since

measuring vital signs is included in both the nurse aide training and the personal care aide

training curricula.

This section is not required in the 10-hour training course since it is in the 5-hour training

course.

Section A



Section A: Prerequisite Skills Review and Validation Content

�� TEACHING TIP: Prerequisite Skills Review and Validation

Tell students:

• Before taking the 5-hour or 15-hour Medication Aide Course, you must be able to

demonstrate how to obtain and record the following: temperature, pulse, respirations, and

blood pressure.

• If the student already has competency validation for obtaining vital signs at the facility, the

student is not required to demonstrate competency in measuring and recording vital signs.

Documentation will be needed to reflect competency has already been demonstrated.

Discuss devices for measuring vital signs that will vary. It is important students understand

what measurements are within range and when to report the measurements.

Blood Pressure (B/P)

• For electronic machines, check device for accuracy according to manufacturer’s

recommendations

• Choose correct size of cuff; blood pressure cuffs that are too small or large for the resident’s

arm might result in an inaccurate reading

• Report high and low blood pressures based on facility’s policy or physician’s order

Pulse

• Count number of heartbeats in one full minute

• For radial pulse, heart rate measured at the thumb side of the inner wrist

• For apical pulse, heart rate measured directly over the heart using a stethoscope

• May be obtained by using an electronic device

• Normal range is 60 beats/minute to 100 beats/minute

Respirations

• Number of breaths a person takes per minute

• One full breath is counted after resident has inhaled and exhaled

Section A



Section A: Prerequisite Skills Review and Validation • Most accurate rate is taken when resident is not aware that respirations are being

monitored

• Normal range is 10 to 24 breaths per minute

Temperature

• Activity, food, beverages and smoking all affect body temperature

• Temperature is measured using either the Fahrenheit or Celsius scale

• Normal oral temperature is 36.5 – 37.5 degrees Celsius or 96.7 – 99.6 degrees Fahrenheit

�� TEACHING TIP: Glucose Monitoring [ONLY REQUIRED IF MEDICATION AIDE WILL BE

PERFORMING TASK]

Prerequisite Skills Review and Validation

Tell students:

• Before taking the 10/15-hour Medication Aide Course, you must be knowledgeable about

standard precautions with glucose monitoring.

• If the student has NOT already completed the Infection Control Course for Adult Care

Homes, the student should complete at least Section 3: Bloodborne Pathogens of the

Infection Control Course.

Review procedures for the following activities related to glucose monitoring at adult care homes

and teach/demonstrate: calibrating and cleaning the machine; range of glucose levels for the

machine; interventions and policies when blood sugar values are too low or too high.

Fingersticks/Glucose Monitoring [ONLY REQUIRED IF MEDICATION AIDE WILL BE PERFORMING

TASK]

• Know correct procedures for using (including manufacturer’s instructions on cleaning and

disinfecting) glucose monitoring machine and know where to locate information, if needed

• Wearing gloves when performing fingersticks and when using the glucose monitoring

machine

• Lancets and lancing devices are used for only one resident and never shared

• Correctly dispose of lancets in sharps container

• Proper storage and identification of residents’ supplies for assisted glucose monitoring

Section A



Section A: Prerequisite Skills Review and Validation • Glucose monitoring devices vary greatly in how to clean and/or disinfect. It is critical to

follow the manufacturer’s instructions

• For lancing devices that are NOT single use devices, the device is to be labeled with the

resident’s name and the device is NEVER shared with another individual.

Proceed to Section B

Section B

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes B-1

Section B

Medication Aide in Adult Care Homes

Section B


Section B Medication Aide in Adult Care Homes

Objectives:

At the completion of this section of study, the student should: 1. Identify the general role of a Medication Aide. 2. Explain the expectations of the role of a Medication Aide.

Advance Preparation – In General

Review curriculum

Add examples or comments

Make copies of student manual for each student

NOTE: The Medication Aide’s role and responsibilities will vary in facilities. It is important the Medication Aides know their role and responsibilities in the facility they are employed in and the expectations and limitations of a Medication Aide. Refer to the content for Section B for general discussion of the medication aide’s role, limitations and expectations.

Section B


Section B – The Medication Aide in the Adult Care Homes

Content

Role of the Medication Aide

Based on the need to provide safe care to the public, statewide uniform standards were developed for the training and competency testing for all Medication Aides involved in medication administration in adult care home settings in North Carolina.

The training for administration of medications provided in this course will prepare you at the basic level of medication administration. If you have completed the 5-hour medication training course for adult care homes, the 10-hour training course will help strengthen your skills with medication administration.

Each adult care home has policies to follow and some may have broader and more stringent policies that must be followed. Licensed capacity for adult care homes range from 2 to over 200, therefore, the medication aide’s responsibilities vary greatly.

Expectations of the Medication Aide

Administer medications to residents as ordered by their physician, under the direction of the facility supervisor and administrator

Administer medications in accordance with o Established medication administration standards o Policies, procedures, and practices of the facility, based on specific licensure o Requirements of the state of North Carolina

Respect resident’s right to confidentiality and privacy regarding o Health status o Diagnosis of illness o Medications

Only shares protected health information (PHI) confidentially with health care team members who need information to provide care to a resident

Follow the facility’s standards in hand hygiene and infection control o Hand hygiene is important part of infection prevention and performed in order to prevent

spread of germs o Understanding standard precautions with injections and blood glucose monitoring is

important to prevent spread of blood borne diseases

Section B



Must follow the SIX Rights of medication administration o Identify the Right RESIDENT o Select the Right MEDICATION o Give the Right DOSE o Give by the Right ROUTE o Give at the Right TIME o Perform the Right DOCUMENTATION

Follow clear, complete, specific instructions about medication administration documented on the medication administration record (MAR)

Seek advice from supervisor or licensed healthcare professional before giving medication to the resident anytime something unusual occurs o Example – if resident is too drowsy to take medications, is vomiting, or cannot swallow well

After medications are administered, correctly document that medications were taken

Maintain security of medication cabinet or cart at all times; keep the cabinet or cart locked at all times when not in use

Whenever you leave the work area, lock the cabinet or cart

Respect decisions of residents who are able to make informed decisions about medications

Follow specific facility policies/procedures and regulations regarding handling, storage, and disposal of medications o If the resident did not take medications, document a clear explanation of why it was not

administered o Recognize when a medication should not be given, such as when the medication is expired, is

not labeled or the label is not readable o Recognize that the “unsafe conditions” described above must be reported to supervisor

immediately

REMEMBER –The Medication Aide is the last checkpoint before the resident takes the medication and is an important safeguard for the residents to whom they are administering medications.

Limitations of the Medication Aide

Medication Aide must be able to identify exactly what tasks the facility allows them to perform and what tasks they are not allowed to do legally

Section B



If the resident asks questions about the medication, it is best for the Medication Aide to refer the question to the supervisor, primary physician, registered nurse, or pharmacist

If there is something different about the resident or the medications they are taking, talk to the supervisor or primary physician prior to giving the medication

If the resident seems to be having difficulty because of a medication, alert supervisor or primary physician immediately

Report any errors in the administration of medications immediately to their supervisor or primary physician

Consequences of Exceeding Tasks

If a Medication Aide exceeds those tasks and/or specific job duties outlined in this course and specific facility policy, it may result in legal or disciplinary action taken by the facility and state regulatory agencies. The Medication Aide may lose eligibility to work in certain health care areas

Adult Care Home Responsibilities for the Medication Aide

The adult care home will have a thorough understanding and specific policies and procedures regarding your role as a Medication Aide that you must follow. Responsibilities of Medication Aide vary in adult care homes.

As a Medication Aide, you can expect o Validation of your skills by employing facility o Orientation to facility policies and procedures regarding medication management and

medication administration

Roles of Other Health Care Providers

A healthcare provider such as a physician or nurse practitioner will diagnose disease and decide on treatments, which may include prescribing medications according to the needs of the resident

Registered Nurse (RN) is involved with assessment, development and coordination of a resident’s plan of care. Registered nurses are licensed to administer medications by all routes

Pharmacists will dispense the medications prescribed for the resident and are a resource for questions with medications such as mixing of medications, dosing precautions

Section B



Medication Aide should know whom to contact:

If a resident needs an assessment/evaluation prior to administering a medication

If any questions or concerns related to medication administration

If a resident refuses medications or medications not available for administration

Proceed to Section C

Section C

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes C-1

Section C

Legal and Ethical Responsibilities

Section C


Section C Legal and Ethical Responsibilities

Objectives: At the completion of this section of study, the student should: 1. Recognize legal implications of negligence, fraud and diversion. 2. Recognize issues around medication administration errors. 3. Explain the resident’s rights to privacy, confidentiality and refusal. Advance Preparation – In General

Review curriculum


Make copies of student manual for each student Supplies

Handouts o C-1 Medication Errors o C-2 Good Medication Administration Practice Habits o C-3 Resident’s Refusal to Take Medications

NOTE: Medication aides may be faced with making decisions about the consequences of an action or behavior. Some decisions involve the moral right or wrong of an action. Others involve the legality of the action. At times decisions may have both ethical and legal implications. Medication Aides should have the knowledge to make sound decisions about a particular action or behavior. Refer to the handouts and the content for Section C for discussion of definitions, medication errors, resident’s rights and legal implications.

Section C


Section C – Legal and Ethical

Content

Legal and Ethical Standards

Ethical standards are guides to moral behavior o An example would be every person deserves respect and every person has her/his own

beliefs

Legal Standards are guides to legal behavior o An example is performing her/his job according to the facility policy and state regulations

Legal Implications

Negligence

When a person does not provide the standard of care that a person trained in the same way would do in a certain situation

Example – failing to give medications that have been ordered and transcribed onto the MAR

Remember o We, as citizens of the United States, have certain rights o Additionally, there are resident rights, which include being free from neglect

Fraud

When a person is dishonest or cheats the system

Misrepresentation of any aspect of the job

Possible disciplinary action by the facility and may involve legal charges

Example – if a medication is charted as having been administered, but was not administered

Diversion

Knowingly giving a medication to someone other than the resident the medication was prescribed for, but documenting that the medication was given to the right resident

Stealing medications

Never give medications to people whom the medications are not intended for, even when it seems harmless

Section C



Subject to disciplinary action and may involve legal charges

Examples o If the Medication Aide takes medication intended for a resident and uses it for any other

reason o Giving a resident’s pain medication to a co-worker who has shoulder pain

HANDOUT: C-1 Medication Errors Distribute the handout or locate in the Student Manual. Discuss the information on the handout and below and the importance of reporting when a medication error is discovered.

Medication Errors

Definition: when a medication is administered in any way other than how it was prescribed

When the Medication Aide does not transcribe a physician’s orders correctly, does not compare the instructions on the medication administration record (MAR), and the directions on the bottle, or the approved ways to administer the medication an error may occur

Medication errors often have serious outcomes

Administering medications carries a great responsibility including a need for being extremely careful and methodical

Mistakes in giving medications are one of the most common causes of harm to residents under the care of others

Giving the medication to the wrong resident can be a dangerous error

Potentially serious types of errors that can occur and cause harm to the resident or residents include o Giving a medication to the wrong resident o Giving a medication at the incorrect time o Omitting a dose o Giving the wrong dosage o Giving an extra dose o Giving a medication by the wrong route o Giving the wrong medication o Or giving an expired medication

Section C



Medication Aide is to report errors immediately to supervisor and/or resident’s physician

Medication Aide is to document medication errors after notifying supervisor of error

Ways to prevent medication errors o Always use the SIX Rights of medication administration o If the you cannot read or understand any part of the instructions on the MAR or what needs

to be done to give a medication, ask supervisor before giving the medication o Wait to give any medication that has raised any questions or concerns until talking with

supervisor or health care professional or resident’s physicians; it is better to be safe than sorry

Remember that once medication is swallowed or administered, it is too late to get it back

REMEMBER if in DOUBT – DON’T

TEACHING TIP: HANDOUT C-2 Develop Good Medication Administration Practices Distribute the handout or refer to student manual and discuss the information in the handout on good medication administration practices. Discuss how these practices can prevent medication errors and legal issues.

Borrowing Medications

Do not borrow medication from unit stock or another resident’s medication supply, unless an emergency and your supervisor and a health care professional have been notified and directed you to borrow a medication o For a new medication, it would bypass the checks and balances needed, such as having the

pharmacist check a new medication against what the resident is already taking to see if the new medication reacts with the medications the resident is already taking, if the medication is in the right dosage form or if there are allergies; these checks are done prior to the ordered medication being placed in the resident’s medication supply

o Your efforts to speed up the process by borrowing a medication from another resident may indeed cause costly negative effects for the resident, the facility, and yourself

o Additionally, the resident you borrow from may not have the medications they need at the time they need them

HANDOUT: C-3 Resident’s Refusal to Take Medications Distribute the handout or locate in the Student Manual and discuss reasons a resident may refuse medications, resident’s right to refuse medications or treatments, what to report, involvement of the resident’s designee, responsible party or legal guardian when a resident with cognitive impairment refuses a medication.

Section C



Independence and Refusal

Encourage all residents to be as independent and participate in their medication and treatment administration, as much as can safely be done

Occasionally, a resident will not or cannot take a medication o If a medication is not administered as ordered, whether refused or not given, report to

supervisor and follow facility’s policy o If a resident chooses to refuse medications, Medication Aide documents the medication was

not taken o There will be a place to document the missed dose – either on the back of the MAR or some

other designated place o It is important that the Medication Aide documents why the medication was not

administered as ordered

Some Medication Aides will be administering medications to residents who are mentally impaired o If a resident is mentally impaired, they may not understand the benefits of their medications

and may refuse them o If a resident is not capable of making informed decisions about their medications and they

refuse to take medications, seek advice from supervisor about strategies for encouraging the resident to take medications

o Never do anything that would be considered forcing a resident to take medication o For residents who are not able to give consent for medication, such as an incompetent

resident, the legal guardian will provide consent o For residents with cognitive impairment, it is important to involve the family or resident’s

designee when the resident refuses a medication

Medication Administration and Resident’s Rights

Respect – how the resident is addressed o Do not interrupt a resident while eating for the administration of medications, such as oral

inhalers and eye drops o Do not awaken resident to administer a medication that could be scheduled or administered

at other times o Inform resident about the procedure that is about to be performed o Answer resident’s question about medication and refer to supervisor, nurse or other health

care provider when you do not know

Section C



Refusal – resident has the right to refuse medications o Never force a resident to take a medication o Follow the facility’s policy and procedure when a resident refuses medications (policy and

procedure ensures that physician is notified in a timely manner based on resident’s physical and mental condition and the medication)

Privacy – being away from the public o Knock on closed doors before entering o Do not administer medications when resident is receiving personal care or in bathroom o Do not administer an injection outside resident’s room if the resident receiving the injection

or other residents present are offended by this o Do not administer medications outside the resident’s room that require privacy and removal

of clothing, such as vaginal and rectal administrations, dressing changes and treatments

Chemical restraints –means a drug that is used for discipline or convenience and not used to treat a medical symptom o Do not administer medications for staff convenience

Proceed to Section D

Section D

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes D-1

Section D

Overview of Medication Administration

Section D


Section D Overview of Medication Administration

Objectives:

At the completion of this section of study, the student should: 1. Demonstrate proficiency and safety in preparation of medications. 2. Recognize commonly used abbreviations and terminology related to medication administration. 3. Demonstrate proficiency in reading a medication label. 4. Identify the Six Rights to administer medications.


Review curriculum


Make copies of handouts or student manual for each student

Supplies

Handout o D-1 Medication Orders o D-2 Medication Label o D-3 Abbreviations o D-4 Six Rights of Medication Administration o D-5 Decimal Point and Zeros o D-6 Common Routes of Medication Administration o D-7 Common Dosage Forms

Examples of medication labels, MARs, OTC containers, photos used for MARs

Advance Preparation - Activities

o Medication Orders o Medication Label o Decimal Point and Zeros

NOTE:

Use visual aids to show common dosage forms of medications, MARs and other forms used for medication administration.

If training is for a specific facility, use MARs, medication labels and other documents used for medication administration in the adult care home during the training.

Section D


Section D: Overview of Medication Administration Preparing to Administer Medications

Often the words drug and medication are used interchangeablY

Medications more commonly is used when talking about drugs used for therapeutic or helpful effects

In this course, the word medication will be used when talking about drugs or medications used to treat residents

Administering medications is an important responsibility and must be taken with great care. It is never an easy task and thus cannot be undertaken when you are trying to do several things at once

In order to prevent errors and possible harm to a resident taking the medications, you must focus on this task solely o Do not talk to others while you or they are preparing and giving medications o Do not stop this task unless there is an emergency o Stopping and starting can cause medication errors

Give medication to one resident at a time o Focus on giving all the medications for one resident before moving to another resident o This will help prevent getting one resident’s medications mixed up with another

resident’s medications o Before taking the medications to the resident’s room, mark your place in the MAR

Remember to pour a cup (8 oz.) of water for the resident to drink with their medications. o When all the medications have been swallowed, encourage the resident to drink another

cup of water to make sure all the medications were swallowed and moved into the stomach

o Encouraging the resident to drink water also helps them stay hydrated o Oftentimes residents do not drink enough water and encouraging drinking of water at

the time of medication administration will assist them in getting the amount of water they need each day

o Giving the resident a sip of water beforehand may make it easier to swallow the medication

Some residents take multiple pills at once o Ask them how they like to take their pills, one at a time or several at a time o If they prefer only a few at a time, assist them to take 1-2 pills at a time

Section D


Section D: Overview of Medication Administration It may be helpful to give medications to residents who do not need assistance first, leaving

those needing assistance last

This allows you to take the time you need to help those who need extra assistance take their medications

Before you begin administering medications, check for any specific information needed prior to giving certain medications, such as pulse, blood pressure (BP), or blood sugar readings o This information is needed prior to giving certain medications to some residents o It is important this information be gathered as close to the time the medication is to be

given as possible

Another factor to consider when administering oral medications is how the resident is presently feeling o If resident is vomiting or has a change in behavior, contact your supervisor or resident’s

physician before administering any medication

Resident may have various side effects from taking certain medications

Side effects include but are not limited to the following o Change in behavior o Change in alertness o Change in eating or swallowing o Change in mobility o Skin rashes

When there is a change in the resident, follow the facility’s policy on what to do and who to notify, which may include o Notifying the supervisor, health care professional and/or physician o NOT administering a medication without first having contact with the resident’s

physician

Observation of the resident is an important step in the cycle of medication administration o Resident’s physician and health care providers often depend on the observations of

direct care staff when evaluating residents o Also depend on Medication Aides to observe residents for both desired and undesired

effect of medication

To ensure safe care, the Medication Aide must know how to observe and report changes in the resident’s physical and/or mental status. The Medication Aide must know what to report, to whom it should be reported, and when and how to report observations

Section D


Section D: Overview of Medication Administration Medication Allergy

A reaction occurring as the result of an unusual sensitivity to a medication or other substance o May be mild or life-threatening situation o May include rashes, swelling, itching, significant discomfort or an undesirable change in

mental status, which should be reported to physician

Role of Medication Aide o Should understand that information on allergies should be reported to the pharmacy and

physician and this information is recorded in the resident’s record o Upon admission, important to document any known allergies or if there are no known

allergies should also be documented o Provide immediate emergency care if severe rash or life-threatening breathing

difficulties occur

Medication Orders Definition:

The written or oral directions that a physician or other prescribing practitioner provides about a resident’s medication or medications

Components of a Complete Order

Medication name

Strength of medication (if required)

Dosage of medication to be administered

Route of administration

Specific directions for use, including frequency of administration

Reason for administration if the medication is ordered PRN or as needed

HANDOUT D-1: Medication Orders Distribute a copy of the handout D-1 to each student or locate handout in Student Manual

Section D


Section D: Overview of Medication Administration TEACHING TIP: Medication Orders Refer to the Medication Orders handout and tell students

An order is required to administer, change or discontinue any medication or treatment

It is important to know the components of a medication order

Contact the prescribing health care provider if the order is not legible – DON’T GUESS!

If an order is not complete or clear on how to administer, the medication aide must contact supervisor or physician – DON’T GUESS!

Discuss the different types of medication orders, examples and the difference between a routine medication order and a PRN medication order ACTIVITY: Medication Orders Refer the students to the lower section of the Medication Orders handout and require them to complete the activity. Discuss answers with students upon completion.

REMEMBER:

An order is required to administer, change or discontinue any medication or treatment

Contact the prescribing health care provider if the order is not legible-DON’T GUESS!

If an order is not complete or clear on how to administer, the medication aide must contact the supervisor or physician – DON’T GUESS!

Types of Medication Orders

Four types of medication orders – routine orders, PRN orders, one time orders, and STAT orders

It should be clear on the MAR what type of order the Medication Aide is being asked to follow

Type of order depends on the desired effect of the medication

Section D


Section D: Overview of Medication Administration Medication Aide is allowed to accept verbal orders or orders over the telephone, but

obtaining a written order from the prescribing practitioner is the best and safest practice to obtain an order

The medication orders are transferred to the MAR from the document(s) with the written orders when the orders are received. It is important the order is transferred to the MAR when the order is received. Do not wait until that medication is received.

Medication Labels

Information required on medication labels of medications dispensed by the pharmacy: o Medication name o Medication strength o Quantity dispensed o Dispensing date o Directions for use o Pharmacy that dispensed the medication o Prescription number o Expiration date o Equivalency statement (when the brand or medication name dispensed is different than

the brand or medication name prescribed)

Labeling requirements for over-the-counter (OTC) medications include o In the original manufacturer’s bottle with the resident’s name, OR o Labeled by the pharmacy

TEACHING TIP: Medication Label Locate a medication label or a copy of a medication label or copy of a medication label provided by a pharmacy provider and discuss the location of information on the label. Show students example of OTC containers and discuss labeling requirements. OTC medications administered to resident require prescription and at least the resident’s name on the container. HANDOUT D-2: Medication Label Distribute a copy of the handout to each student or locate handout in Student Manual

Section D


Section D: Overview of Medication Administration TEACHING TIP: Medication Label Refer to the Medication Label handout and tell students

Directions on medication label from pharmacy are checked against the order entry on the MAR

If there is a discrepancy between the information on the MAR and the medication label, check the order in the resident’s record

If a medication is received and there is no entry or information on the MAR for the medication, check the resident’s record for an order and contact your supervisor. ACTIVITY: Medication Label Refer the students to the lower section of the Medication Label handout and require them to complete the activity. Discuss answers with students upon completion.

Common Abbreviations

Abbreviation – a shortened form of a word or phrases

Abbreviations are being used less often for medication administration but you still may see abbreviations

Medication Aides need to learn abbreviations for terms common to medication administration

On the MAR, abbreviations should be spelled out

Be aware that abbreviations can lead to mistakes if they are not legible

Always check with the supervisor if you have questions about abbreviations

HANDOUT D-3: Abbreviations Distribute a copy of the handout to each student or locate handout in Student Manual

Section D


Section D: Overview of Medication Administration TEACHING TIP: Abbreviations Tell students:

These are abbreviations that you may see when you give medications to your residents

HANDOUT D-4: SIX RIGHTS of Medication Administration Distribute a copy of the handout on Six Rights to each student or locate handout in Student Manual Referring to the handout and the content below, discuss the Six Rights of Medication Administration

SIX RIGHTS of Administering Medications Importance

Safety and accuracy are important to welfare of the resident

During a normal workday, Medication Aide may give many medications to large number of residents

Chance of making a mistake each time a medication is given

Anyone giving medications needs to stay focused, be organized, and careful

Follow each and every time when administering medications; never skip them or become careless during administration

To safeguard the resident always ask self these six questions when administering medications, which are often called SIX Rights of medication administration

Questions to Ask Self

Am I giving the medication to the right resident?

Am I giving the right medication?

Am I giving the right dose?

Section D


Section D: Overview of Medication Administration Is this the right route (method of administration)?

Is this the right time?

Have I done the right documentation?

TEACHING TIP: Identifying Residents Before Administering Medications

Review procedures for identifying residents before administering medications at adult care homes and teach/demonstrate the procedure.

Right RESIDENT?

Each time Medication Aide gives medications, the resident must be identified

Giving medications to the wrong resident can cause serious harm

Identify the resident who is to receive the medication by using methods outlined by facility; some facilities require identifying resident two to three different ways

While Medication Aide may know the resident, this part of routine allows for completion of three checks in a careful manner, so do not skip it

This habit will prevent carelessness and possibility of making a mistake now and later

Most adult care homes have the Medication Aide perform identifying steps o A photo of the resident on the MAR to determine the right resident is about to take the

right medicine by matching the picture with the resident o Require that the resident states first and last name o Do not ask the resident, “Are you James Jackson?” because it is too easy for the resident

to say “yes” when he may not be James Jackson; particularly if the resident is confused or hard of hearing

o Some residents are not able to state their names because they cannot talk, they may be confused or have speech impairments due to illness. In those situations, individual responses may not be realistic or accurate

Even when Medication Aide administers medications to the same resident every day, safety measures for identifying the residents have to be in place

If the facility has residents who are receiving medications with similar names, be certain to have an alert on the MAR; date of birth could be a better identifier, such as Leigh Chan and Lee Chang

Section D


Section D: Overview of Medication Administration

Do not use room numbers as an identifier because o There may be more than one resident in the room o A confused resident could have wandered into the wrong room and crawled in bed o Administration may have moved resident into a different room o Resident could have been discharged and Medication Aide not aware prior to

administering medications

Some people may answer yes to another resident’s name trying to get additional medications or trying to jump ahead of other people; particularly true if residents do not understand that medications can be different for different people or if the residents are confused

If Medication Aide prepares medications away from the resident taking them, it is important to keep the MAR with the medications until the medications are taken, so that the wrong medicines are not accidentally given to wrong resident

Important that Medication Aide keeps identifying information with the medications from the point of preparation to the point of giving medication to the resident

Right MEDICATION?

Medication Aide must always refer to MAR when giving medications; never give medications from memory

Three medication checks should always be done when giving medications to make sure Medication Aide has the right medication

During the three medication checks, Medication Aide will not only make sure a particular medication is labeled for a particular resident, but during process Medication Aide also makes sure that medication name, dose, time, and route on the medication label matches information on the MAR o Check the medication name, dose, time and route on the package against the MAR when

container is removed from shelf, drawer, or other storage place o Check medication name, dose, time, and route on the actual drug package or unit dose

label against the MAR as medication is poured, package is opened, or before the medication is placed in the medicine cup

o Check the medication name, dose, time, and route on package when medication container is returned to the shelf, drawer or storage place or before it is opened and place in the medicine cup, just prior to giving the medication to the resident

May feel like you are overdoing the checking, but it is this careful practice that will prevent medication errors

Section D


Section D: Overview of Medication Administration Do not be lulled into poor and unsafe practices because medication administration is done

day in and day out

Many adult care homes use medication packaging that helps to reduce errors such as unit dose, punch cards of medications, etc.

Be alert for similar sounding names for medications while making right medication choices

Never give a medication that you cannot identify by a written medication label or that is found at the resident’s beside

Best and safe practice is to never give a medication prepared by someone else

Right DOSE?

Medication Aide must make sure the right dose is about to be administered by comparing medication label to the MAR; MAR will state exactly how much medication is to be given o For example, if digoxin 0.25 mg is to be given and the supply is digoxin 0.125 mg., two

tablets must be given to equal the right dose o It is best for the MAR to state to give two tablets of digoxin 0.125 mg

(0.125 mg + 0.125 mg = 0.25mg) o If instructions are not clear, ask for them to be made as clear and complete as possible to

help prevent medication errors

To help prevent medication dosing errors, a zero (0) should always precede a decimal but should not follow a decimal o For example, if the 0 is not present in the example above, the decimal might be missed

and instead of giving 0.125 mg. of digoxin it might incorrectly be read as 125 mg of digoxin which would be deadly

o If a medication is ordered at 1 mg and the order is written on the MAR as giving 1.0, the decimal might again be overlooked and the MAR might read to give 10 mg of the medication, which would mean that the resident would be getting 10 times the ordered dose

Another common right dose error is for people to mix up the abbreviations of ml (or mL) for milliliter and the abbreviation of mg for milligram o For example, a 1 ml dose does not equal 1 mg o Mixing up those abbreviations can result in dosage error

ACTIVITY: HANDOUT D-5 Decimal Point and Zeros Refer the students to the Decimal Point and Zeros Activity handout and require them to complete the activity. Discuss answers with students upon completion.

Section D


Section D: Overview of Medication Administration HANDOUTS: D-6 Common Routes of Medication Administration

D-7 Common Dosage Forms Distribute a copy of the handouts on Common Routes of Medication Administration and Common Dosage Forms to each student or locate handouts in Student Manual

TEACHING TIP: Common Routes of Medication Administration and Common Dosage Forms Referring to the handouts and the content below, discuss the common routes of medication administration and common dosage forms. Use visual aids if available.

Right ROUTE?

Right method of administration, such as whether a medication is given by mouth, in the ear, or eye, or if it is to be applied to the skin

The route of medication administration will be noted on the MAR; if it is not, stop and ask supervisor

Do not make assumptions about how to give a medication

Oral Routes o Referred to as oral or PO - meaning by mouth o Medication is placed in mouth and swallowed o Certain people cannot take oral medications; people who cannot swallow well, such as

residents who do not have a gag reflex and choke easily, are confused, refuse to take medications by mouth, or are not to have anything by mouth

o NPO - meaning nothing by mouth

Sublingual o Placed under the tongue and allowed to dissolve and be absorbed under the tongue o Dissolves quickly and gets into blood stream quickly o Resident not to swallow tablet, nor to smoke, drink or eat while this tablet is under

tongue

Topical Route o Delivers medication directly to the area needing treatment or may allow medication to

be absorbed to affect the entire body o These medications can be a variety of preparations including drops or ointment into the

eye, drops into the ear, sprays in the nose or throat, suppositories in the rectum or vagina, and creams or ointment on the skin

o Areas for topical medications are skin, eyes, ears, nose, throat, vagina, and rectum o Some topical medications affect the entire body, such as patches applied to the skin

Section D


Section D: Overview of Medication Administration Inhalation Route

o Delivers medication to lungs through an inhaler or aerosol o One way this medication is taken in is with an inhaler and a tube that is called a “spacer”

or a disc device that allows the powdered form of the medication to be pushed toward the back of the mouth and inhaled

o Many different types of devices for inhalants o Become familiar with device before assisting someone with their inhaled medications

Subcutaneous o Delivers medication to the subcutaneous (fat) layer of the body using a syringe and

needle

Right TIME?

Make sure you give the medication at the Right TIME

The time to give a medication is stated on the MAR

Individual adult care homes will have set standard times for administration of medications o If a medication is to be given BID, meaning twice a day, then the facility may set those

times to be 10 am and 10 pm o When a medication is ordered before (a.c.) or after (p.c.) meals, it should be given 30

min. before or after meals

Medications that are given once a day should be given at the same time each day to keep the right amount of medicine in the resident’s system

Set times within a facility helps to prevent missed or doubled doses, which can be harmful to the resident receiving the medications

The Medication Aide should not give the medication too early because it could be too much medication in the resident’s system at one time

Medication needs to be given within a set amount of time to provide the resident with the correct dose of medication at the right time that allows the medication to work as it should o For example, if a medication is fighting an infection and doses are given at time spans

between doses too far apart, the infection may get worse, making it harder to treat

The window of time for the medication to be given is one hour before or one hour after the time stated on the MAR; medications should be administered within this designated time frame

Section D



If Medication Aide is unsure about giving the medication because it is outside the designated time frame, i.e., a medication was missed, a medication just arrived from pharmacy or a resident has returned to the facility after medications were administered, always check with supervisor, nurse, pharmacist or the resident’s physician to determine if the medication should be administered or not administered; never omit a medication without contacting your supervisor, nurse, pharmacist or resident’s physician because a resident was out of the facility when medications were administered

Timing of medications in relation to meals o Before meals – medication administered about 30 minutes prior to the resident eating

meals o With meals – medication administered while the resident is eating meals o After meals – medication administered directly after the resident has finished eating

meals up to 30 minutes afterwards

Always check the time the last dose of a PRN medication was given before giving the new dose; if ordered time has passed since the last dose, the medication can be given

Right DOCUMENTATION?

May have heard people say, “If it is not documented, it is not done.”

Documentation is important o If documentation is not completed there is no way to know that a medication has been

given o Without correct documentation, there is a danger the resident will get the medication

twice, possibly causing them great harm or to miss receiving an ordered medication

Medication Aide must document medications immediately on the MAR after each resident’s medications are administered and prior to administering another resident’s medications

Do not chart or document medication before the resident actually takes it (called pre-charting) o Many things can happen between the time preparation area is left and when the

resident actually swallows the medication o Always chart or document after the resident takes the medication

After administering a PRN medication to a resident, the Medication Aide must document the date and time the medication was given on the MAR

Section D



Immediate, clear, and accurate documentation shows that the Right DOSE of the Right MEDICATION was given to the Right RESIDENT at the Right TIME on the Right DATE by the Right ROUTE

Proceed to Section E

Section E

Medication Administration - September 2013 10/15-Hour Training Course for Adult Care Homes E-1

Section E

Medication Orders and Medication Administration Record (MAR)

Section E


Section E

Medication Orders and Medication Administration Record (MAR)

Objectives:


1. Transcribe orders onto the Medication Administration Record (MAR) correctly – use proper abbreviations, calculate stop dates correctly, transcribe PRN orders appropriately, copy orders completely and legibly and/or check computer sheets against orders and apply to the MAR, and discontinue orders.

2. Describe the responsibility of the Medication Aide in relation to FL-2, physician’s orders and medication administration record (MAR).


Review curriculum


Make copies of handouts or student manual for each student

Supplies

Handouts o E-1 FL-2 Blank sample o E-2 Blank MAR sample o E-3 Sample FL-2 for Transcription Activity o E-4 MAR Answers for Transcription Activity

Documents used by adult care homes for medication orders and medication administration Advance Preparation - Activity

Medication Orders and Transcription

Section E


Section E Medication Orders and the Medication Administration Record (MAR)

Content

Review the definition of a medication order

The written or oral directions that a physician or other prescribing practitioner provides about a resident’s medication or medications

HANDOUT E-1: FL-2 Distribute a copy of the handout to each student or locate handout in Student Manual HANDOUT E-2: Medication Administration Record (MAR) Distribute a copy of the handout to each student or locate handout in Student Manual TEACHING TIP: Documentation Locate examples of an FL-2, physician’s order sheet and other forms of documentation used by adult care homes regarding orders and medication administration. Review the examples with the students. Tell students

Documentation is an important part of medication management

Forms used to document can be quite confusing to unlicensed persons who are unfamiliar with the process

Medication aides must know how to use the MAR and other forms to ensure safe medication management and compliance with laws and regulations

Forms Commonly Used to Document Medication Orders

Forms commonly used to document medication orders and medication administration can be confusing to unlicensed people who are unfamiliar with the process

Examples of main forms used in most adult care homes o FL-2 o Physician’s Order Forms

Section E



Medication Aides must know how to use these forms to ensure safe medication management and compliance with laws and regulations

Forms Commonly Used to Document Medication Orders– FL-2

FL-2 form is required for new admissions in adult care homes

Important: all information on FL-2, and any admission documents with orders is reviewed for accuracy

If any clarification is needed, contact prescribing practitioner

If FL-2 has not been signed within 24 hours of admission o Verify orders with prescribing practitioner by fax or telephone o Document verification in resident’s record, for example a note in the progress notes or

orders may be rewritten as telephone orders and signed by prescribing practitioner; orders could also be faxed to prescribing practitioner for review, signature and date

Form Commonly Used to Document Medication Orders – Physician’s Order Forms

Used to record prescribed medication and treatment orders

Any form used for physician’s orders and medication orders must be retained in the resident’s record.

Forms Commonly Used to Document Medication Orders and Medication Administration – Medication Administration Record (MAR)

Form onto which medication and treatment orders are transferred

Record of all medications and treatments ordered to be administered

Record of staff who administered medications

Record of medication not administered and the reason

Medication Orders and the MAR

A licensed person prescribes or writes a medication order in the resident’s record or medical record

The medication order is then copied or transcribed onto the MAR The MAR provides the instructions to the Medication Aide for administering medications.

Section E



Transcription of Orders Onto MAR

Transcribe means to write down or to copy o In medication administration it means to copy medication or treatment orders onto the

MAR

Orders are copied onto the MAR when the order is obtained or written o Initial or sign and date orders written on the MAR o Transcribe using proper abbreviations or written out completely; include all components

of a medication order o Count number of dosages to be administered instead of number of days when

calculating stop dates for medication orders that have been prescribed for a specific time period, such as antibiotics

o Do not schedule PRN orders for administration at specific times; they are administered when resident “needs” the medication for a certain circumstance

A discontinue order must be obtained for an order to be discontinued, unless prescribing practitioner has specified the number of days or dosages to be administered or indicates that dosage is to be changed

Information on the MAR

All the information needed for medication administration must be clearly written on the MAR

MARs should include: o Resident’s name (right resident) o Room or bed number (if applicable) o Facility number (if applicable) o Medication name (right medication) o Strength of dose or amount of medications to give (right dose) o Date and time to be given (right time) o Route to be given (right route) o Date the order was written o Date the order expires o Resident’s allergies (if they have any) o Special instructions o Reason why PRN medication is being given (for example PRN medication for headache) o Initials of the personnel transcribing the physician’s order to the MAR

The MAR is kept current and accurate

Section E



Electronic MAR

Some adult care homes may use an electronic MAR (eMAR) that requires staff to document information and administer medication administration on the computerized MAR. The information on an eMAR for administration is the same information that would be found on a paper MAR.

ACTIVITY: Medication Orders and Transcription Activity Distribute a blank MAR (Handout E-2). Choose several drugs listed on the FL-2 for Garrett Clayton (Handout E-3) and have students to transcribe or transfer orders onto the blank MAR. Walk around area and assist students as needed. Discuss answers with students upon completion. NOTE: Initials of individual transferring the information or medication order to the MAR should be identified with the entry. Scheduled administration time is based on the facility’s administration time policy and the first dose is identified when to begin based on the scheduled administration time and the time of admission of the resident and facility policy.

The MAR and the SIX Rights of Medication Administration

It should be clear to the Medication Aide from the MAR o What is to be given (Right Medication) o How much is to be given (Right Dose) o Who is to get the medication (Right Resident) o When it is to be given (Right Time) o How it is to be given (Right Route) o After administering the medication(s) where to document on the MAR that the

medication was given (Right Documentation)

Proceed to Section F

Section F

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes F-1

Section F

Using the Medication Administration Record

Section F


Section F Using the Medication Administration Record (MAR)

Objectives:


1. Compare and contrast the documentation of routine medication administration and PRN medication administration.

2. Demonstrate the use of the Medication Administration Record (MAR). 3. Identity the three checks between medication label and MAR when administering medications. 4. Describe the action to take when a medication is not administered due to refusal or omission.


Review curriculum


Make copies of student manual for each student or handouts

Make copies of the materials for the Medication Administration Record Activity

Supplies

Handouts o F-1 – MAR for Jo Burns o F-2 – Worksheet for each student o F-3 – MAR Worksheet Answers

Sample or copies of MARs and sample or copies of auxiliary labels from pharmacy Advance Preparation - Activity:

Medication Administration Record

Section F


Section F – Using the MAR During Medication Administration

Content

TEACHING TIP: Use of the MAR Tell Students

The MAR used during the training is a sample MAR

There are differences in the MAR forms between facilities but the documentation required for medication administration is the same

Orientation for the Medication Aide at a facility should include documentation of medication administration on the facility’s MAR

Demonstrate the use of a MAR and performing the three medication checks with administering medications

The MAR and Medication Administration

Always refer to the MAR when administering medications to make sure the right medication is given to the right resident at the right time

Do NOT Ever Give Medications From Memory!!!

The medication aide uses the MAR when preparing and administering medications. Compare the label on the medication container to the order on the MAR three times o The first check is when selecting or removing the medication from the storage area o The second check is before or after opening the medication and pouring the medication o The third check is after pouring the medication and before returning the medication

container to the storage area or before you give the medications to the resident

Always double check that the medication prepared is the one that should be given at the designated time as listed on the MAR

The MAR is designed to promote safe and accurate medication administration.

The Medication Aide should always ask the supervisor about anything on the MAR that is not clear, to keep from making medication errors

Remember, If in doubt, ASK

Section F



Whenever medications are given, the Medication Aide will need to initial the MAR under the Right TIME and DATE, which is known as Right DOCUMENTATION

The MAR and Special Instructions

Many medications have special instructions in addition to the dose, time and route

These instructions are listed on the medication label and may also be on the MAR

If the instructions are unclear, ask supervisor prior to preparing the resident’s medications

Plan accordingly if there are certain things that need to be done before or during medication administration o Shake the medication well o Keep the medication refrigerated o Have the resident drink a full glass of water with this medication o Have the resident take the medication on an empty stomach or before eating o Have the resident take the medication with food o Have the resident take the medication after eating o Do not take the medication after eating o Do not take the medication with certain foods o Instruct the resident not to eat or drink 30 minutes after taking the medication o Have the resident sit up for ½ hour (30 minutes) after taking the medication o Crush the medication and mix it with a food product, such as applesauce or pudding

Some labels include auxiliary labels that include instructions such as do not crush

TEACHING TIP: Documentation of Medication Administration on the MAR

Demonstrate and review documentation of routine and PRN medications, refusal or omission of medications using the correct forms and process.

General Information for Documenting Administration of Medication on the MAR

Sign the MAR only after observing the resident take the medications o Pre-charting is not permitted and this includes signing the MAR any time prior to the

medications being administered o The MAR is signed immediately after observing the resident take the medication and

prior to the administration of another resident’s medication

Section F



The MAR has a space where the Medication Aide initials that a dose is given under the correct day and time o Place your initials in the box that corresponds with the date and time for the medication

given o If the medication is given more than once daily, initial in the appropriate box each time

Resident’s refusals and any omission of a medication must be documented on the MAR o Documentation on the MAR is to include the date and time the medication was to be

administered, the reason the medication was refused or omitted and the initials of the Medication Aide

o Often, initials are placed and circled in the appropriate box that corresponds with the date and time for the medication and the other information is provided on the back of the MAR

o Remember to always follow-up with the supervisor for any refusals or omissions

Each entry must be clearly recorded accurately and completely

Use the ink color approved by the facility

Do not erase or cover errors

If an error is made in the recording that a medication has been given, follow facility’s policy to correct documentation

The facility will have a policy for documentation on the MAR, including for refusals and omissions

Documentation of PRN Medications

Depending upon the adult care home, PRN medications may be recorded on the same MAR or a separate MAR

A reason must be documented when a PRN medication is administered o Record symptoms that resident reports and signs that are seen, such as temperature

101⁰ F o For example, write 101⁰ F if Tylenol is given for an elevated temperature

Follow the facility’s policy regarding documentation of PRN medications o Include the amount administered, the time of administration and the reason for

administration o The reason a PRN medication is to be administered is to be indicated in the order

Section F



Document the effectiveness of the medication when determined o The resident will need to be checked on after the PRN is administered to determine the

effectiveness of a PRN medication o If the PRN medication is reported as not effective, the Medication Aide will need to

notify the supervisor and information documented

If a resident is requesting or requiring administration of a PRN medication on a frequent or routine basis, report this to the supervisor or the physician

Administer PRN medications when resident needs the medication but they may not be administered more frequently than the physician has ordered

The need for medication may be based upon resident’s request for the medication or observation by staff, i.e., resident exhibiting pain but does not request medications or may not be able to request the medication

Initials and Signatures

Always initial and sign the signature sheet or the part of the MAR sheets on which initials are to be identified o This signature associates the Medication Aide’s name to the initials used on the MAR o Allows for clear tracking of who gave what medications o Important that the Medication Aide initials each sheet of the MAR and writes name on

the MAR in the space provided

Location of the initial/signature is different on different forms, but signature blocks are usually located at the top or bottom of the MAR o Some facilities have a signature sheet that is kept in a special place such as the front of

the MAR notebook

Key point here is that all adult care homes will have some form for documentation of medications administered and a place for the Medication Aide to identify initials

The Medication Aide must sign the designated page with initials on it once per sheet, per month, depending upon facility policy o For example, if Medication Aide is giving medications to the same set of residents day in

and day out and has already signed the MAR, does not have to sign the sheet again o When a new sheet is put in the MAR and the Medication Aide is giving medications from

it, it must be signed and initialed

Section F



Recheck MAR

When the medication pass is complete, recheck the MAR to make sure all medications have been administered and documented appropriately

ACTIVITY: Medication Administration Record (MAR) Distribute copies of Handout F-1 (Jo Burns’ MAR) and Handout F-2 (the MAR Worksheet) for each student. Walk around room and determine if anyone is having difficulties. Require each student to answer questions on the worksheet and review answers with class upon completion of activity. It should be clear to the student from the MAR:

o What is to be administered (Right MEDICATION), o How much is to be administered (Right DOSE), o Who is to get the medication (Right RESIDENT), o When the medication is to be administered (Right TIME), o How the medication is to be administered (Right ROUTE) and lastly, after the medication

is administered/held/refused, o How to document on the MAR (Right DOCUMENTATION)

Proceed to Section G

Section G


10/15-Hour Training Course for Adult Care Homes G-1

Section G

Infection Control

Section G



Section G

Infection Control

Objectives:


1. Understand the importance of hand hygiene, demonstrate hand washing techniques,

demonstrate alcohol-based hand rub technique, and demonstrate the proper way of

putting on and taking off clean gloves.

2. If applicable, the student should be able to understand the importance of standard

precautions for assisted glucose monitoring and administering injections.

Advance Preparation - In General

• Review curriculum and presentation materials and activity

• Add examples or comments

• If no student manual used, prepare copies of handouts for section for each student

Supplies

• Handouts

o G-1 – WHO’s How to Hand Rub? How to Hand Wash?

o G-4 – Injection Safety Diabetes and Viral Hepatitis

• Supplies for Hand Hygiene Activity

o Alcohol – based hand rub product

o Soap, Paper Towels and Accessibility to Sink

• Gloves (Different sizes) – for Activity

• Sharps Container, Syringes, Single use Lancets, Reusable Lancing Device, Glucose

Monitoring Device and any agents for cleaning and/or disinfecting per manufacturer (if

student will be performing assisted glucose monitoring and injections)

Advanced Preparation - Activities

• Hand Hygiene

• Glove Sizing and Gloves, Gloves, Gloves

Section G



Section G – Infection Prevention Practices

Content

�� TEACHING TIP: Infection Control Course

Determine whether students have had the Infection Control Course required for adult care

home staff. If not, the student should complete the training as soon as possible. Information on

infection control in this course is minimal.

Ask if students know what Standard Precautions are. Explain.

Important Infection Control Concepts During Administration of Medication

• Use sanitary technique when pouring or preparing medications into appropriate container

• Do not touch or handle medications, but pour medication from the original medication

container into a new, appropriate medication container; give the new container to resident

• Never use your own hands to administer medications and never require resident to have to

use his/her own hands to receive medications

Standard Precautions

• Observe Standard Precautions

• Wear gloves when there may be exposure to bodily fluids or mucus membranes, such as the

vagina, rectum, inside of the nose, and the eyes

• Wash hands with soap and water; or with an alcohol-based hand rub if hands are not visibly

soiled or if there has been no contact with bodily fluids

• Wash hands before and after removal of gloves

• Wash hands before and after using shared medical equipment

• Gloves should be worn and hand hygiene must be performed when transdermal products,

i.e., Nitroglycerin or Durgesic patches, are applied or removed

Syringes, Needles and Vials

• Cleanse the tops of medication vials with 70% alcohol before inserting a needle into the vial

Section G




• Never administer medications from the same syringe to multiple patients, even if the needle

is changed

• Do not reuse a syringe to enter a medication vial or solution

• Do not administer medications from single-dose or single-use vials, ampules, bags or bottles

to more than one resident

• Multi-dose vials should be used for a single resident, whenever possible

• Dispose of used syringes and needles at the point of use in a sharps container that is

closable, puncture-resistant, and leak-proof

• Never recap, bend or break needles

�� TEACHING TIP: Alcohol-based Hand Rub

Locate alcohol-based hand rub product used in the adult care home. Read manufacturer’s

directions to determine amount of product needed. Show alcohol-based hand rub product to

students, pointing out the amount of product required.

�� ACTIVITY: Hand Positions During Hand Hygiene (Optional)

Distribute WHO’s How to Hand Rub? How to Hand Wash? Handout to students.

While referring to the WHO’s Hand Rub/Hand Wash Handout, talk through and demonstrate

each hand motion during hand hygiene and notice to make sure the students are following

along and copying what is being demonstrated:

• Rub hands, palm to palm

• Rub right palm over left back of hand with interlaced fingers; and then switch

• Rub palm to palm with interlaced fingers

• Rub backs of fingers to opposite palm with fingers interlocked

• In a rotational motion, rub left thumb while clasping in right palm; and then switch

Section G




• In a rotational backwards and forwards motion, rub left palm with clasped right fingers; and

then switch

• Grasp right wrist with left hand; and then switch

Your Hands – Other Important Points

• There are other things you can do to prevent the spread of infection

• Fingernails

o Keep nails short and clean

o Do not wear fake nails, gel nails or nail extensions, because they can hide harmful germs

• Jewelry

o Leave at home because harmful germs can stick to jewelry

The student will have to demonstrate competency with Hand Wash and Hand Rub

Gloves

• Most common type of Personal Protective Equipment worn with medication administration

• Description

o Non-sterile (clean) gloves made using different materials, such as vinyl or latex; if allergic

to latex, wear non-latex gloves

o Come in different sizes

Gloves – Rules

• Should be worn once and then thrown away

• When wearing gloves, always work from (or touch) a clean area, before touching

contaminated (or dirty) area

• Change gloves if hands are going to move from a body part that is contaminated (dirty) to a

body part that is not contaminated (clean)

• Change gloves right away if dirty or torn

• Take gloves off carefully and do not touch skin or clothes with dirty sides of gloves

Section G




• Do not touch anything with dirty gloves that anyone may touch without gloves, like a

doorknob

• Should be comfortable – not too loose or not too tight

Gloves – When to Wear

• Wear gloves any time you will or think you will come into contact with blood or body fluids

(urine, stool, spit, mucus coughed up)

• Wear gloves any time you will or think you will come into contact with non-intact skin

(opened up skin, such as sores or cuts)

• Wear gloves any time you will or think you will come into contact with mucus membranes

(linings of natural body openings)

o Inside or outside of the rectum

o Inside of the mouth

o Inside of the nose

• Examples of when to always wear gloves:

o When you might touch blood, body fluids, non-intact skin, or mucus membranes

o Providing or assisting with mouth care

o Wiping a nose that is draining

o Providing perineal care (the genitals and the buttocks)

o Caring for a resident with cuts and sores

o Performing a finger-stick blood sugar

o Touching a surface or equipment that is contaminated or may be contaminated

o If staff has open sores or cuts on own hands

Gloves – How to Put On (Don)

• Select correct size and type

• Insert hands into gloves

• Interlace fingers and smooth out folds creating a comfortable fit; and

• Carefully look for tears, holes, or discolored spots

• Special notice: when gloves and gown must be worn, ensure that each glove is extended

over the gown cuff

Section G




Gloves – How to Remove

• Grasp outside edge of one glove near wrist

• Peel glove away from hand turning glove inside-out, with contaminated side on the inside

• Discard

• Wash hands

• Being careful not to touch outside of the glove, peel off second glove from inside, creating a

bag for both gloves

• Hold the removed glove in the opposite gloved hand

• With ungloved hand, slide one or two fingers under the wrist of the other glove

�� ACTIVITIES: Gloves (Optional- if students has completed 5-Hour training program)

Follow instructions for Activity: Glove Sizing

Follow Instructions for Activity: Gloves, Gloves, Gloves

The student will have to demonstrate competency with putting on and removing gloves

�� TEACHING TIP: Handout G-4: Injection Safety Diabetes and Viral Hepatitis

Distribute the handout to each student and review infection prevention for assisted glucose

monitoring and insulin injections

Proceed to Section H

Section H


10/15-Hour Training Course for Adult Care Homes H-1

Section H

Medication Administration Supplies

Section H



Section H


Objectives:


Demonstrate understanding in preparing a clean, well lit and well supplied work area from

which to safely administer medications.


• Review curriculum

• Add examples or comments

• Make copies of student manual for each student

Supplies

• Gather as many of the Medication Administration Supplies as possible to show students

as you discuss the different supplies

Note:

Demonstrate use of devices you have to show.

If training is facility specific: Locate and familiarize self with equipment used during medication

administration in the adult care home, such as medication cart/cabinet and supplies.

Be sure that the students understand the key point is that they prepare their work area to be

clean and well lit. They should be certain that they have all the supplies they need prior to

starting to administer medications to avoid stopping and starting which increases the chances

of errors.

Emphasize security of medications and keeping the medication keys on their person at all

times.

Section H



Section H: Medication Administration Supplies

Content

Prepare and maintain the work area for medication administration

• Prior to beginning to give medications, you must prepare the work area whether that is a

medication cart, medication room or medication counter

• Gather all the supplies you will need

• Supplies vary from facility to facility

• Start with a clean area or cart

• Giving medication requires clean technique

• Wash your hands

• Make sure the area is as well lit as possible


The medication cart or work area should be stocked with supplies, such as:

• Alcohol wipes – little squares of material saturated with alcohol that come in handy for

cleaning off skin before performing an injection, the mouthpiece of inhalers, stethoscopes,

and other small areas

• Alcohol-based hand rub or hand wipes – to cleanse hands and to protect you and resident

from transferring germs

• Clean Gloves in your size – to use when needed and to protect you and the resident from

transferring germs

• Surgilube – lubrication that is used for administration of vaginal or rectal medications

• Band-Aids – small covering for puncture sites after performing an injection or used on other

small areas of the skin and held in place with adhesive

• Tape and gauze – small squares of fabric used to cover topical medications and held in place

with surgical tape

Section H




• Pill cutter – device used to cut a pill

• Pill crusher or Mortar and pestle – device used to crush a pill

• Tissues – thin squares of paper used for dabbing or wiping off topical medication

• Tongue blades – thin wooden structures used to apply topical medication to sterile gauze

• Spoons – plastic device used to stir medications or scoop out food products and never used

to measure medication

• Disposable drinking cups – used for drinking water and also for mixing powder medications

• Straws – thin tubes used by some residents to assist with drinking water or other fluids after

taking medications by mouth

• Soufflé cups – small paper disposable medication cup with pleated sides and often used to

hold tablets or capsules after removal from containers

• Metered or measured plastic cup – small plastic disposable medication cup used for liquids

or pills

• Other devices for measuring liquid medications such as oral syringes or metered/measured

medication droppers or spoons (used for amounts less than 5 ml or when dispensed with a

liquid medication)

• Medication Administration Record (MAR) – review prior to starting and used during

medication administration for accurate medication administration and documentation

• Medication cart/cabinet – centralized location of medications in a facility

• Water pitcher filled with fresh water

• Juices and any food products used in giving medications

Security of Medication Storage Areas

• While you are working as a Medication Aide, you are responsible for all the medications

• You must keep the medication storage area or cart locked at all times when you are not

using it

Section H




• You will keep the keys with you for your entire work period, unlocking and locking each and

every time you step away from the area or cart

• If you are called away in an emergency, remember to lock the cart or area prior to leaving it

• Do not give the medication keys to residents or other facility personnel

• Follow your facility’s policy regarding maintaining security of medications

Key Points

• When in doubt – ASK!

• Whenever you leave the work area, lock the cart or area

• Do not leave medications unattended on top of the cart or counter! Keeping the medication

storage area locked prevents unauthorized access to medications by residents or other staff

• Throw away trash according to your agency’s policy. Keeping your work area free from trash

will help to prevent the spread of germs

• Cleanse hands often

• Keep all medication keys issued to you on your person at all times

Proceed to Section I

Section I

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes I-1

Section I

Administering Medications

Section I


Section I Administering Medications

Objectives:


1. Use the Six Rights to administer oral, sublingual, topical, transdermal, eye, ear, inhalant, and nasal medications – right resident, right medication, right dose, right route, right time, and right documentation.

2. Identify proper action to take when crushing or cutting medications in relation to medication administration.


Review curriculum


Make copies of student manual for each student or handouts

Make copies of each skills checklist for each student

Supplies

Handouts o I-1 – Review of Measuring Devices o I-2 – Always and Never Measuring Tips o I-3 – Measuring Tips o I-4 – Technique and Use of Meter Dose Inhalers

Supplies for cutting or crushing medications

Supplies for cleaning equipment used for cutting and crushing medications

Supplies for demonstrating medication administration skills of each route in section

Section I



Content

Administering Oral (Solid) Medications Overview and Concepts

Some residents take multiple oral medications at once o Ask them how they like to take their pills, one at a time or several at a time o If they prefer only a few at a time, assist them to take 1-2 pills at a time

Remember to pour a cup (8 oz.) of water for the resident to drink with medications o When all the medications have been swallowed, encourage resident to drink another cup

of water to make sure all the medications were swallowed and moved into the stomach o Encouraging the resident to drink water also helps them stay hydrated o Oftentimes residents do not drink enough water and encouraging resident to drink

water at the time of medication administration will assist them in getting the amount of water they need each day

o Giving the resident a sip of water beforehand may make it easier to swallow the medication

Types of Oral (Solid) Medications

Tablet o Hard, compressed medication in round, oval, or square shape o Some have enteric coating or other types of coatings, which delay release of the drug

and cannot be crushed or chewed

Capsule o In a gelatin container that may be hard or soft o Dissolves quickly in stomach

Absorption Rates

When administering oral medications, it is important to administer at the time prescribed or scheduled

Oral medications are absorbed (used by the body) at different rates depending on various factors such as if the contents of the resident’s stomach (empty or full)

Section I



TEACHING TIP: Cutting Medications

Review the procedure for cutting medications and teach/demonstrate the procedure using appropriate equipment.

Cutting Medications

Sometimes medications have to be cut in half to get the correct dose

This should be clear on the MAR

Use a pill cutter to divide a pill into half for the dose

If the pill cuts unevenly, then the pill is to be thrown away and a new pill is cut (a replacement pill will need to be ordered)

Always clean the pill cutter with an alcohol wipe after using it so that the next Medication Aide using it will not be mixing medications

Be careful not to cut self on the razor sharp blade

Discuss with supervisor if medication needs to halved

When the prescribed dose is for only half a pill

Follow the facility’s policy on disposal of the other half of medication

TEACHING TIP: Crushing Medications and Mixing in Food Locate the device used for crushing medications, review the procedures with crushing medications and mixing medications in food, and discuss various policies at adult care homes for crushing medications. Demonstrate one of more methods for crushing a medication. If the device for crushing medication is used for more than one resident, demonstrate cleaning procedure and prevention of cross-contamination of residents’ medications.

Section I



TEACHING TIP: Current List of Medication that Should not be Crushed The facility should have a current list of medications that should not be crushed. Show students what a list may look like. A DO NOT CRUSH list is available from the Institute for Safe Medication Practice at: www.ismp.org/tools/DoNotCrush.pdf.

Crushing Medications

Medication may need to be crushed if no liquid form of a medication is available and resident cannot swallow an oral solid medication

MAR should state if a medication is to be crushed; Medication Aide will not make the decision whether to crush a tablet or not

If it is not clear on the MAR, ask supervisor to provide clear instructions

Several methods to crush a pill o Mortar and pestle or a pill-crushing device o Crushed in its package if only one pill is in the package o Placed between two clean small paper medication soufflé cups and crushed with a pestle

or other crushing device

After crushing medication, clean tools that come in contact with the medication with alcohol or soap and water, being sure to dry them before returning them to storage

When a medication is crushed it will taste bitter and is common to mix medication with small amount of food to help the resident tolerate the taste as they take the now bitter medication o Example, applesauce or pudding o Mix the crushed medication with as little applesauce or pudding as possible because if

too much applesauce or pudding is used, the resident may not be able to eat it all or refuse to eat it all and thus not get all the medication

o Never leave medication in food unattended, because another resident may come by and eat the food, accidentally taking the medication, which will be a medication error and can be very dangerous

Offer resident sufficient fluids following the administration of oral medications even if the medication is administered in a food substance

Observe the resident taking the medication to assure the medication is swallowed before documenting the administration of the medications

http://www.ismp.org/tools/DoNotCrush.pdf

Section I



Not all medications can be cut or crushed; do not ever cut or crush a pill that has an enteric (hard shell) coating, a capsule, or a pill that is sustained release or time released o Enteric-coated pill has a protective hard shell coating that allows it to pass through the

stomach, without dissolving, to be absorbed in the small intestines o Enteric-coated medications designed to be swallowed whole and if cut or crushed, could

burn a hole in the esophagus, stain the teeth, or not be absorbed because the stomach destroys the medication before it begins working

o Capsules and sustained release medications are made to be absorbed over time and if cut open, lose that feature.

o Cutting or crushing time-released medications can result in the resident getting an overdose of the medication because it is absorbed all at once instead of being released over a longer period of time

o There is an extensive list of medications that cannot be crushed; however, Medication Aides are not to have to make a decision about cutting or crushing a medication because instructions should be clear on the MAR

Administering Liquid Medications

Overview and Concepts

A common way to administer medications

Come in many forms – solutions, suspensions, syrups and elixirs

Need to be aware extra care needs to be taken when measuring liquids and that Medication Aide should plan on taking more time

Liquids may have administration requirements such as Shake Well or Requires Dilution prior to administration o Examples of these liquids are Dilantin Suspension, which must be shaken thoroughly

because the medication settles and gives inconsistent dosing; liquid Potassium and bulk laxatives must be mixed with sufficient fluids to decrease side effects

Types of Liquid Medications

Solution – a liquid containing dissolved medication

Suspension – a liquid holding un-dissolved particles of medication and must be shaken before measuring and administering to resident

Syrup – a liquid medication dissolved in a sugar water to disguise its taste

Elixir – a sweet alcohol based solution in which medications are dissolved

Section I



HANDOUT I-1: Review of Measuring Devices; I-2 Always and Never; I-3 Measuring Tips

Distribute a copy of the handouts to each student or locate handouts in Student Manual TEACHING TIP: Common Measuring Devices Referring to the handouts, compare and contrast the different measuring devices used to administer oral, liquid medications. Pay special attention to ml versus mg. Use visual aids if available. Referring to the handouts, discuss/demonstrate if applicable the concepts included.

TEACHING TIP: Metered Medication Cup Obtain enough metered medication cups for each student and distribute; and a bottle of water with the label on half of the bottle. Demonstrate the following as you teach the content: measurements on the side of the medication cup, viewing eye level on a flat surface, and pouring water from the bottle while covering the label with the palm.

Administering Liquid Medication Using a Medication Cup

Do not mix liquid medications together

Never approximate the amount of medication to be administered, such as liquids o Always use the correct measuring device when measuring liquid medications o Never use household measurements or spoons such as a teaspoon or tablespoon to

measure medication doses because of inaccuracy o To administer liquid medications, use a small, clear, graduated medicine cup with

measurements on the side o Use a calibrated syringe for measuring liquids in amounts less than 5 mL and unequal

amounts

Measure liquid medications on a flat, level surface at eye level to make sure that amount is correct

When pouring liquid medications, hold the label under the hand so that the medication flows from the side opposite the label preventing the liquid from running down the container and stain or obscure label

Liquids are prepared in separate cups from pills and tablets

To prevent contaminating the remaining medication, never pour excess medication back into the bottle

Section I



Dispose of the excess medication per facility policy

Ensure resident is sitting upright before administering liquid medication to a resident

Administering Liquid Medication Using a Medication Dropper

Some medications come packaged with a medication dropper with measurements on the side

If a medication comes with a special dropper, use that dropper only when giving that medication

Keep dropper with the medication

Some manufacturers have you replace the cap with the dropper/cap so that it is always ready for use to prepare the correct dose of medication.

Liquid medications may have an oral dropper/syringe specifically for measurement of dose; the name of the medication and the strength of the medication will be printed on the dropper / syringe and should be used to only measure the medication identified on the dropper/syringe

Be careful and note measurements on dropper are in mg or ml and prepare resident’s dose appropriately

Increase chances of making a dosing error if a different measuring device is used

When using a special dropper to administer liquid medicine o Draw up the accurate dose of medication and put it into a medication cup to deliver it to

the resident o Do not use the dropper to give the resident the oral medication because that will

contaminate the dropper and in turn contaminate the remaining liquid medication

TEACHING TIP: Administering Oral (Solid and Liquid) Medications

Refer to the skill sheet on how to administer oral (solid and liquid) medications as you review the process of administering oral medications with the students.

Section I



TEACHING TIP: Administering Sublingual Medications Refer to the skill sheet on how to administer a sublingual medication as you review the process of administering sublingual medications with the students.

Sublingual Medications

Place the medication under the resident’s tongue

Instruct resident not to chew or swallow the medication

Do not follow with liquid, which might cause the tablet to be swallowed

TEACHING TIP: Administering Medication Using an Oral Inhaler

Refer to the skill sheet on how to administer medication using an oral inhaler as you review the process of administering medication using an oral inhaler with the students.

Oral Inhalers

Spacing and proper sequence of the different inhalers is important for maximal drug effectiveness

The prescribing practitioner may specifically order the sequence of administration if multiple inhalers are prescribed or the pharmacy may provide instruction on the medication label or MAR

Wait at least one minute between puffs for multiple inhalations

HANDOUT 3-E: Oral Inhalers Distribute copies of the handout, Technique and Use of Meter Dose Inhalers. Review with students.

TEACHING TIP: Administering Eye Drops and Ointment

Refer to the skill sheet on how to administer eye drops and ointment as you review the process of administering eye drops and ointment with the students.

Section I



Eye Drops and Ointments

Wash hands prior to and after administration of eye drops and ointments

Follow standard precautions

Wear gloves as indicated

Always wear gloves when there is redness, drainage or possibility of infection

Wait a 3- to 5- minute period between medication when two or more different eye drops must be administered at the same time

Do not touch eyes with dropper or medication container

TEACHING TIP: Administering Ear Drops

Refer to the skill sheet on how to administer ear drops as you review the process of administering ear drops with the students.

Ear Drops

Wash hands before and after administration of medication

Gloves are to be worn as indicated

By gently pulling on the ear, straighten the ear canal (Adult)

Request the resident to remain in same position for 5 minutes to allow medication to penetrate

Gently plug the ear with cotton to prevent excessive leakage if necessary

TEACHING TIP: Administering Nose Drops and Nasal Sprays/Inhalants

Refer to the skill sheet on how to administer nose drops and nasal sprays/inhalants as you review the process of administering nose drops and nasal sprays/inhalants with the students.

Section I



Nose Drops and Nasal Sprays/Inhalers

Wash hands before and after

Gloves are to be worn as indicated

For drops o Resident should lie down on his/her back with head tilted o Request the resident to remain in the position for about 2 minutes to allow sufficient

contact of medication with nasal tissue

For Sprays o Hold head erect and spray quickly and forcefully while resident “sniffs” quickly o Have the resident tilt head back to aid penetration of the medication into the nasal

cavity, if necessary

Wipe dropper or sprayer with a tissue before replacing the cap

TEACHING TIP: Administering Nasal Inhalants Remind students to check manufacturer instructions before using inhalers because some require priming prior to administration.

TEACHING TIP: Administering Medications Using Transdermal Products/Patches

Refer to the skill sheet on how to administer medications using transdermal products/patches as you review the process of administering medications using transdermal products/patches with the students.

Transdermal Products/Patches

Rotate application sites for transdermal patches to prevent irritation

Document application sites on the MAR

If the patch is ordered to be worn for less than 24 hours, document on the medication administration record that the patch was removed and the time it was removed

Section I



Wear gloves and wash hands after patch is applied or removed

When a patch is removed, clean the area to remove residual medication on the skin

TEACHING TIP: Administering Topical Medications

Refer to the skill sheet on how to administer topical medications as you review the process of administering topical medications with the students.

Topical Medications

Wear gloves and use tongue blade, gauze or cotton tipped applicator to apply medication

Use a new applicator each time medication is removed from container to prevent contamination

Provide privacy.

Place the lid or cap of the container to prevent contamination of the inside surface

Do not discard gloves and supplies in areas accessible to residents

STOP

TEACHING TIP: Administering Insulin Injections Demonstrate/allow for students to practice/perform skill check-off only if injections will be administered by Medication Aides at the adult care home. If administering injections will be taught/practiced/checked-off during class, a Registered Nurse must validate skills competency of injections.

Refer to the skill sheet on how to administer insulin injections as you review the process of administering injections with the students.

Injections

Never recap syringes

Dispose of syringes in appropriate sharps containers

Wash hands before and after

Wear gloves

Proceed to Section J

Section J

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes J-1

Section J

Medication Administration Skills Checklists


Section J - For Student

Medication Administration Skills Checklists

During the Medication Administration – 10/15-hour Training Course, you will be tested on skills

listed below. You will be expected to do the skills without comments or instruction from your

instructor/evaluator.

The goal is achieve a “Pass” by demonstrating the skill as outlined on the checklist and

completing the skills in the time allowed. Errors that affect the safety of the resident receiving

the medication or the Medication Aide will require a Redo. An example of such an error is not

performing the SIX RIGHTS of Medication Administration.

SKILL SETS:

1. Handwashing

2. Alcohol-based Hand Rub

3. Putting On and Removing Gloves

4a. General Medication Administration Preparation Step

4b. General Medication Administration Subsequent Steps

5. Oral Medication Administration

6. Sublingual medication Administration

7. Oral Inhalant Medication Administration

8. Eye Medication Administration

9. Ear Medication Administration

10. Nasal Medication Administration

11. Transdermal Medication Administration

12. Topical Medication Administration

Optional (if employee will perform skill)

13. & 14. Injections-Insulin Administration


Section J - Instructor

Instructions for Completing the Medication Administration Skills Checklists

1. You will need to print a set of checklists for each student to use during the training session. Walk around and observe students and provide instruction for skill steps not performed at an acceptable level. The training session is to prepare the student for the skills check off.

2. Review instructions for preparation of the medication administration

skills slips for check off or validation of skill performance. MARs will be needed for final check-off of skills. Your pharmacy may be able to provide sample MARs for each skill or the sample blank MAR or MARs in the training courses may be used.

3. All documentation on the checklist for the final check off is to be in ink. 4. The date, name of student, and name and credentials of the evaluator

are to be written on each page of the checklist. 5. As the student performs the skills, place a check beside skills steps

performed at an acceptable level (Yes) and an X by skill steps not performed at an acceptable level (No)

6. Indicate if the student Passes or needs to ReDo by checking the block

provided. 7. Instructor keeps all the checklists for your record, unless the skills

validation of a student/employee is for a specific adult care home. The student will receive a certificate upon successful completion of the training course but the student does not receive the skills checklist.



Medication Administration Skills Slips

The checklists are designed for use as a total group or individually throughout your class. You

will need to have a medication administration record for each checklist for students to use for

the General Administration Checklists.

Make a copy of the two pages of the Skills Slips. Use colorful paper to make it more interesting.

Cut on the dotted lines.

Clip together the skills you want a student to perform. Refer to the table below for

recommended groupings of skills and general instructions for the appropriate course.

Have the student draw out a set of skills to demonstrate as you designate throughout the

check-off day. The other students are to watch so that everyone continues to learn and be

involved. If a student does not perform the skill at a satisfactory level and needs a Redo, you

must have them do ANOTHER set, not the same one.

Remember to always give feedback in a constructive and respectful manner.

10-hour Training Course (Each student will perform at least one set of skills.)

Each skill set is to include general medication administration, hand hygiene, administering an

oral solid and a liquid medication. Skill sets for liquid medications are to include measurement

with metered cup, measurement of volume less than 5 ml or amount not on the metered cup

and requiring a calibrated syringe or dropper and measurement of liquid by mg requiring a

special dropper or syringe. Skill sets for solid oral medications should include cutting, crushing,

powder such as bulk laxatives, administration of a controlled drug and administration of

medications requiring more than one strength or more than one tablet for dosage. The other

two skills* for each set may be selected by the instructor.

Recommended groupings of skill slips for 10-hour training

Set 1 Set 2 Set 3 Set 4 Set 5

Gen. Med Adm Gen. Med Adm Gen. Med Adm Gen. Med Adm Gen. Med Adm

Hand Hygiene Hand Hygiene Hand Hygiene Hand Hygiene Hand Hygiene

Oral Meds (liquid) Oral Meds (liquid) Oral Meds (liquid) Oral Meds (liquid) Oral Meds (liquid)

Oral Meds (cut) Oral Meds (crushing)

Oral meds (powder)

Oral meds

Oral med

Topical* Transdermal* Eye * Nasal* Eye *

Inhalant* Ear* Sublingual* Topical* Transdermal*



15-hour Training Course (Each student will need demonstrate each of the skills or all of the

skill sets.)

Each skill set is to include general medication administration, hand hygiene and administering

an oral solid or liquid medication. Skill sets for liquid medications are to include measurement

with metered cup, measurement of volume less than 5 ml or amount not on the metered cup

and requiring a calibrated syringe or dropper and measurement of liquid by mg requiring a

special dropper or syringe. Skill sets for solid oral medications should include cutting, crushing,

powder such as bulk laxatives, administration of a controlled drug and administration of

medications requiring more than one strength or more than one tablet for dosage.

Recommended groupings of skill slips for 15-hour training

Set 1 Set 2 Set 3 Set 4 Set 5

Gen. Med Adm Gen. Med Adm Gen. Med Adm Gen. Med Adm Gen. Med Adm

Hand Hygiene Hand Hygiene Hand Hygiene Hand Hygiene Hand Hygiene

Oral Meds (liquid)

Oral Meds (liquid.)

Oral Meds (liquid)

Oral Meds (cut)

Oral Meds (crushing)

Oral Meds (powder)

Oral Meds (controlled drug)

Oral Inhalant

Nasal Oral med (more than one strength or more than one tablet)

Topical Transdermal Eye Ear Sublingual



Medication Administration Skills Slips

General Medication Administration

&

Oral Medications


& Ear

Drops


& Eye

Drops


& Eye

Ointment


& Oral

Liquids


& Topical Cream or Ointment

Hand Washing

Clean

Gloving

Alcohol-Rub

Hand Cleaning

General Medication Administration &

Subcutaneous Injection with syringe (Insulin)

(if included in course)




& Subcutaneous

Injection with pen (Insulin) (if included in course)


& Transdermal Medications


& Sublingual

Medications


& Nose

Drops/Sprays


& Oral Inhalant Medication

Note: Multiple copies of skill slips for Oral Liquids, Oral Medications and Hand Hygiene will be needed.

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Section K

Medication Administration – September 2013 K-1 10/15-Hour Training Course for Adult Care Homes

Section K

Ordering, Storage and Disposal of Medications

Section K


Section K Ordering, Storage and Disposal of Medications

Objectives:


1. Describe procedures for reordering medications and ensuring medications ordered are available for administration.

2. Describe correct storage and securing of medications. 3. Maintain an accurate inventory of controlled substances. 4. Identify the procedures for disposal of medications.


Review curriculum and presentation materials and activity


Supplies

Controlled Substance Logs or forms used at adult care homes to keep accurate accountability of controlled substances

Forms used for Destruction or Return of Medications

Policies and Procedures for Ordering, Storage, Controlled Substances and Disposal

Section K


Section K – Ordering, Storage and Disposal of Medications TEACHING TIP: Ordering Medications

Review general information on procedures for the following activities related to ordering medications at adult care homes.

Discuss how medication systems in adult care homes are different but medications have to be ordered timely to ensure medications are available for administration as prescribed.

Discuss the facility is to have back-up pharmaceutical services in order to prevent medications not being available for administration.

Each adult care home will provide orientation to medication aide on how to order and obtain medications for residents

To avoid a medication error resulting from medication availability, there must be a system for ensuring reordering and delivery of resident medications

Medication supplies must be monitored regularly and reordered

If a medication is not available, an effort to obtain the medication must be made and documented

Notify the pharmacy, supervisor, physician and family as needed and in accordance with facility policy

TEACHING TIP: Storage of Medications

Review the regulations for storage of medications and discuss how proper storage reduces medication errors.

Storage of Medications

Medication storage areas, i.e., medication cart and medication room, need to be orderly so medication may be found easily

Store medications in a locked area, unless medications are under the direct supervision of staff; direct supervision means the cart is in sight and the staff person can get to the cart quickly, if necessary

Lock medication room/cart/cabinet when not in use. Unless the medication storage area is under the direct supervision of staff lock the medication area including carts

Section K


Section K – Ordering, Storage and Disposal of Medications

Store external and internal medications in separate designated areas

Store refrigerated medications in the medication refrigerator or locked container if stored in refrigerator accessible to other staff

Store medications requiring refrigeration at 36 degrees F to 46 degrees F (2 degrees C to 8 degrees C)

TEACHING TIP: Controlled Substances

Review the regulations for storage of controlled substances, correctly signing out for controlled substances, and reporting of any discrepancies discovered and teach/demonstrate the procedures.

Controlled Substances

Controlled substances or controlled medications are medications that are kept locked most often in a special location or drawer in the medication cart or medication room o Medication Aide must make sure the number or amount of medication listed on the

controlled substance log or form is correct before removing any medications for the resident. This is called the “count”

o When a controlled medication is removed, the amount removed must be documented and the number of remaining medications must be counted and that number recorded

o The facility must have a readily retrievable record of controlled substances by documenting the receipt, administration and disposition of controlled substances

For each controlled substance there is a facility system in place to track o How much was delivered from pharmacy o How much was on hand when shift started o How much was used (given to the resident) o Who (resident) it was given to o Who gave the medication o How much was left o Reason a resident received a PRN controlled medication, such as pain

Some facilities have a sheet for each drug, other facilities have a notebook for controlled substances

Section K


Section K – Ordering, Storage and Disposal of Medications Periodically, the controlled substances are counted, usually by two people at shift change, and

Medication Aide may be held responsible for missing medications on shift

Controlled substances may be stored in one location in the medication cart or medication room o When Schedule II medications are stored in one location together or with other controlled

substances, the controlled substances are to be under double lock o When controlled substances, including Schedule II, are stored with the resident’s other

medications, only a single lock is required o There must be a readily retrievable record of controlled substances by documenting the

receipt, administration and disposition of controlled substances

TEACHING TIP: Disposal of Medications

Review procedures for disposal of medications when opened and prepared, but not given and teach the procedure

Disposal of Medications

Reasons for disposal of medications include o Resident refused after medication was prepared o Medication was dropped on the floor or contaminated o Medication has expired o Medication has been discontinued by the resident’s physician or prescribing practitioner

Dispose of dosages of medication that have been opened and prepared for administration and not administered for any reason promptly

Medications discontinued or expired are destroyed or return to pharmacy in accordance with facility policy

Regulations require records be maintained for medications destroyed or returned to pharmacy

Regulations and procedures for destruction or disposal of controlled substances will be different from other medications

If training is facility specific, discuss the facility’s procedures for disposal of medications

The END

Section L


10/15-Hour Training Course for Adult Care Homes

Section L

Handouts

Medication Administration – September 2013 10/15-Hour Training Course for Adult Care Homes L-1

HANDOUT C-1

Examples

o Omissions o Administration of a medication not prescribed by the prescribing practitioner o Wrong dosage, wrong time, or wrong route o Crushing a medication that shouldn’t be crushed o Documentation errors

Role of the Medication Aide o Understands the facility’s medication error policy and procedure or knows where to locate it o Recognizes when a medication error is made o Understands importance of acting quickly to report and correct medication errors to help prevent more serious problems

The quicker the error is noted and reported, the better for the resident

Reporting all the details around the error can help facility identify issues that may have contributed to the error and the facility may be able to make changes based on the information provided that can help to decrease medication errors in the future

Medication Error - when a medication is administered in any way other than

how it was prescribed

Medication Errors


10/15 Hour Training Course for Adult Care Homes L-2

HANDOUT C-2

• Always read the medication labels and compare the label to the medication

administration record (MAR).

• Perform the SIX Rights each and every time you give medications for each medication,

for each resident. Sometimes it is tempting to think the SIX Rights are so basic and

simple that you do not need to follow them anymore. Do NOT skip these important

checks; they help you to avoid medication errors.

• Be sure to question unusual orders, for example, if more than 3 tablets or capsules are

needed for one dose of a medication, there is a good chance that you are preparing to

give too much medication.

• A “red flag” should be raised in your mind if the resident says they do not normally take

this medication, such as a “blue tablet” Don’t give the medication until you have re-

checked to be sure you have the:

Right RESIDENT

Right MEDICATION

Right DOSE

Right ROUTE and the

Right TIME!

It is possible you have the correct medication and the pharmacy supplier has changed.

However it is more likely that there is a medication error getting ready to happen. So you

need to carefully recheck the MAR prior to giving the medications. If you continue to have

doubts, contact your supervisor for clarification prior to giving the medication.

Remember if in DOUBT – DON’T!

Be Careful to Develop Good

Medication Administration Practice Habits!


HANDOUT C-3

A. When the resident refuses medication:

1. The resident always has the right to refuse medications.

2. Residents refuse to take medications for many reasons. Some of the reasons are:

a. The effects and/or side effects are unpleasant or unwanted.

b. The medication tastes bad.

c. The resident has difficulty swallowing.

d. Religious, cultural, or ethnic beliefs.

e. Depression or loss of will to live.

f. Delusional belief that staff is intending to harm (“poison”) him/her.

B. Types of refusal

1. Actual refusal is when a person directly refuses to take the medication.

2. Passive refusal is less direct and requires closer observation. Examples are:

The resident takes the medication but later spits the medication out; he/she may or may not attempt to hide the medication.

C. Questions to ask to try to determine the reason for refusal: 1. Does the resident experience any unpleasant effect from the medication?

2. Does the resident have difficulty swallowing?

3. Is the resident afraid for some reason?

4. Is the resident refusing other medical treatment?

(continued next page)

Resident’s Refusal to Take Medications


HANDOUT C-3

D. Examples of Strategies for dealing with resident’s refusal:

1. If the resident refuses and gives no reason, wait a few minutes and then offer the medication again. If the resident refuses again, try again in another few minutes before considering a final refusal. This is particularly important with residents who have a diagnosis of dementia.

NOTE For residents with cognitive impairment such as dementia, it is important to know

when the resident designee, such as responsible party or guardian, wants to be notified if the resident refuses medication. The resident designee may be able to encourage the resident to take the medication.

2. Notify the prescribing practitioner or supervisor when a resident refuses medication. 3. Document refusal. 4. Observe the resident and report any effect which may result from refusal. 5. If there is swallowing difficulty, report to your supervisor and/or resident’s

physician. 6. Consider changing the time of administration if taking the drug interferes with an

activity or with sleep. (Example: diuretics may limit a resident’s ability to participate in an outing because of the need to go to the bathroom frequently.)

7. If there is a suspicion of passive refusal such as “cheeking” medication or vomiting

after administration, follow the recommendations for action on the resident’s Individualized Care Plan.

8. If the refusals continue, explore other options with the resident’s physician. NOTE: Passive refusal is not uncommon in residents with diagnoses of mental illness. It is

important that the resident or resident designee, facility staff, nurse, pharmacist and physician collaborate to develop and follow a plan to assist the resident with adherence to his/her drug regimen.

HANDOUT D-1


Medication Orders

Components of a Complete Order

Medication name

Strength of medication (if required)

Dosage of medication to be administered

Route of administration

Specific directions for use, including frequency of administration

Reason for administration if the medication is ordered PRN (as needed) Examples: Lasix 40 mg. – 1 tablet by mouth once a day in the morning Tylenol 325 mg. 1 tablet by mouth every 4 hours as needed for pain

Do not accept medication orders that state “continue previous medications” or “same medications” because they are not complete medication orders

Types of Medication Orders

There are four types of medication orders

Routine orders

PRN orders

One time orders

STAT orders Routine Medication Orders

Detailed order for a medication given on a routine or regularly scheduled basis such as every morning at 10 AM

The reason the medication is being administered is usually in the resident’s history and physical information or the prescribing practitioner’s progress or notes

PRN Medication (as needed) Orders

PRN means as needed or necessary

A medication which is ordered to be given “when necessary” or “as needed” within a designated number of hours

Are for medications that are needed periodically, such as pain medications, cough syrup, or laxatives

Time interval will be listed on the MAR o A medication that is to be given every 4 hours (q4h) as needed cannot be given unless 4 hours have

passed since the last time the resident has taken the medication o For example, a medication is listed on the MAR for pain to be given by mouth every 4 hours PRN o The Medication Aide is giving the resident their medications and the resident asks for a pain medication o Medication Aide looks at the last time the medication was given and it was only 3 hours ago o Medication Aide cannot give the medication because enough time has not passed since the last

medication o Medication Aide can return and give the medication in 1 hour if it is still needed o Medication Aide should report the pain to supervisor to be evaluated further to see if a different

medication or dosing time is needed (continued next page)

HANDOUT D-1


Medication Orders

One Time Orders

Some medications to be given only once and are ordered to be given at a specific time and then discontinued.

STAT Orders

These medications need to be given immediately or NOW. The STAT orders must be clearly written on the MAR that tell you the resident, medication, dose, route, and time. Do not give medications that do not have clear written instructions.

Activity:

Identify the information missing for each medication order below:

Risperdal 2 mg. Give 1 tablet by mouth

Riopan Liquid 15 ml. by mouth every hours as needed

Aricept 1 tablet by mouth at bedtime

Tylenol 2 tablets by mouth every 4 hours as needed for shoulder pain

Ativan 0.5 mg. 1 tablet by mouth as needed

HANDOUT D-2


10/15-Hour Training Course for Adult Care Homes L-7

Medication Label

Individually labeled medication bottles have the following information on the label:

• Resident’s full name (Right RESIDENT)

• Name of Medication (Right MEDICATION)

• Strength of medication and amount to be given (Right DOSE)

• Directions on how to take the medication (Right ROUTE)

• Direction about when to take the medication, including how often to take the

medication (Right TIME)

• Name of person who prescribed the medication (usually a physician)

• Issue (dispensed) date

• Expiration or discard date

• Pharmacy prescription serial number

• Name, address and phone number of issuing pharmacy

• Name of person who dispensed the medication (usually a pharmacist)

• Quantity of medication dispensed

• Auxiliary labels may provide important information such as “shake well”

• Warning Labels

• Equivalency statement when the name of the medication dispensed differs from

the name of the medication ordered

ACTIVITY: Find each of the above components of a label on the label below.

Your Center Pharmacy

123 Brookshire Lane, Friendly, NC 27856 919-123-4567 DEA# AMB165664

Rx# 4003706 Dr. Sullivan

Jack C. Wallboard ID# 123456

Give 1 tablet (5 MG) by mouth once

daily at 6 PM.

Coumadin 5 MG QTY: # 30

Used for Warfarin Sodium

1/13/2015 0 Refills DISCARD: 1/12/2016

Dispensed By Marie O’Wow, RPh

HANDOUT D-3


10/15-Hour Medication Course for Adult Care Homes L-8

DOSES ROUTES OF ADMINISTRATION

gm = gram po = by mouth mg = milligram pr = per rectum mcg = microgram OD = right eye cc = cubic centimeter OS = left eye ml = milliliter OU = both eyes tsp = teaspoonful AD = right ear tbsp = tablespoonful AS = left ear gtt = drop AU = both ears oz = ounce SL = sublingual(under the tongue) mEq = milliequivalent SQ = subcutaneous (under the skin) per GT = through gastrostomy tube

TIMES OTHER QD = every day MAR = medication administration record BID = twice a day OTC = over the counter TID = three times a day QID = four times a day q_h = every __ hours qhs = at bedtime ac = before meals pc = after meals PRN = as needed QOD = every other day ac/hs = before meals and at bedtime pc/hs = after meals and at bedtime STAT = immediately

ABBREVIATIONS


HANDOUT D-4

A method used during medication administration to safeguard the residents; before administering the medication the Medication Aide must ask self six questions – Am I giving the medication to the right resident? Am I giving the right medication? Am I giving the right dose? Is this the right route? Is this the right time? Have I completed the right documentation?

o Right RESIDENT – identify resident to assure you are giving the medication to

the resident who is supposed to receive the medication and using procedure required by the facility, such as photo on the MAR, asking a resident his/her name, etc.

o Right MEDICATION – the name of the medication ordered by the physician;

always use the three checks

o Right DOSE – the amount of medication ordered

o Right ROUTE – the method of medication administration

o Right TIME – when the resident is ordered to receive the medication

o Right DOCUMENTATION – the process of writing down that a medication was administered to the resident on the MAR OR if a medication was not administered and the reason it was omitted

Six Rights of Medication Administration



HANDOUT D-5

Decimal Points and ZerosDecimal Points and ZerosDecimal Points and ZerosDecimal Points and Zeros Draw a line to match the following dose with the correct statement about the use of decimals and zeros:

DoseDoseDoseDose StatemenStatemenStatemenStatementttt

.45 mg Zero not needed, makes dose confusing

0.45 mg ZERO needed in front of decimal

04.5 mg Zero not needed, could be confused with higher dose if decimal overlooked

8.0 mg Correct use of decimal and zero



HANDOUT D-6

• Oral – taken by the mouth and swallowed

• Buccal – placed between cheek and gum

• Sublingual – placed under the tongue

• Eye – placed in the pocket of the eye created when the lower

eyelid is gently pulled down

• Ear – placed in the ear canal created when the external ear is

pulled up and back

• Nasal – placed in the nostril

• Inhalant – inhaled into the lungs

• Transdermal – placed and affixed to the skin

• Topical – applied to the skin or hair

• Vaginal – inserted into the vagina

• Rectal – inserted into the rectum

• Subcutaneous– injected into the fat with a syringe

Common Routes of Medication Administration

Medication Administration –September 2013


HANDOUT D-7

on Routes of ommon Routes of

• Tablet

o Hard, compressed medication in round, oval, or square shape

o Some have enteric coating or other types of coatings, which delay release of the

drug and can not be crushed or chewed

• Capsule

o In a gelatin container that may be hard or soft

o Dissolves quickly in stomach

• Liquid – different types of liquid medications

o Solution – a liquid containing dissolved medication

o Suspension – a liquid holding undissolved particles of medication that must be

shaken before measuring and administering to resident

o Syrup – a liquid medication dissolved in a sugar water to disguise its taste

o Elixir – a sweet alcohol based solution in which medications are dissolved

• Suppository

o Small solid medicated substance, usually cone-shaped

o Melts at body temperature

o May be administered by rectum or vagina

o Refrigerate as directed by manufacturer

• Inhalant

o Medication carried into the respiratory tract using air, oxygen or steam

o Inhalants may be used orally or nasally

• Topical – applied directly to the skin surface. Topical medications include the following:

o Ointment – a semisolid substance for application of medication to the skin or eye

o Lotion – a medication dissolved in liquid for applying to the skin

o Paste – a semisolid substance thicker and stiffer than an ointment containing

medications

o Cream – semisolid preparation holding medication so it can be applied to skin

o Shampoo – liquid containing medication that is applied to the scalp and hair

o Patches (transdermal) – medication encased in a round, square, or oval disc that is

affixed to the skin

o Powder – fine, ground form of medication that may be used to be swallowed, or

may be used as on the skin for rashes

o Aerosol sprays – solution that holds the medication suspended until it is dispensed

in the form of a mist to spray on the skin

Common Dosage Forms of Medications

FL-2 (86) NORTH CAROLINA MEDICAID PROGRAM HANDOUT E-1 INSTRUCTIONS ON REVERSE SIDE LONG TERM CARE SERVICES PRIOR APPROVAL UTILIZATION REVIEW ON-SITE REVIEW

IDENTIFICATION 1. PATIENT’S LAST NAME FIRS T MIDDLE 2. BIRTHDATE (M/D/Y) 3. SEX 4. ADMISSION DATE (CURRENT LOCATION)

5. COUNTY AND MEDICAID NUMBER 6. FACILITY ADDRESS 7. PROVIDER NUMBER

8. ATTENDING PHYSICIAN NAME AND ADDRESS 9. RELATIVE NAME AND ADDRESS

10. CURRENT LEVEL OF CARE _____ HOME ______ DOMICILIARY _____ SNF (REST HOME) _____ ICF ______ OTHER _____ HOSPITAL ________________

11. RECOMMENDED LEVEL OF CARE _____ HOME ______ DOMICILIARY _____ SNF (REST HOME) _____ ICF ______ OTHER ________________

12. PRIOR APPROVAL NUMBER 14. DISCHARGE PLAN _____ SNF ______ HOME _____ ICF _____ DOMICILIARY (REST HOME) _____ OTHER ________________

13. DATE APPROVED/DENIED

15. ADMITTING DIAGNOSES – PRIMARY, SECONDARY, DATES OF ONSET 1.

5.

2.

6.

3.

7.

4.

8.

16. PATIENT INFORMATION DISORIENTED AMBULATORY STATUS BLADDER BOWEL CONSTANTLY AMBULATORY CONTINENT CONTINENT INTERMITTENTLY SEMI-AMBULATORY INCONTINENT INCONTINENT INAPPROPRIATE BEHAVIOR NON-AMBULATORY INDWELLING CATHETER COLOSTOMY WANDERER FUNCTIONAL LIMITATIONS EXTERNAL CATHETER RESPIRATION VERBALLY ABUSIVE SIGHT COMMUNICATION OF NEEDS NORMAL INJURIOUS TO SELF HEARING VERBALLY TRACHEOSTOMY INJURIOUS TO OTHERS SPEECH NON-VERBALLY OTHER: INJURIOUS TO PROPERTY CONTRACTURES DOES NOT COMMUNICATE O2 PRN CONT. OTHER: ACTIVITIES/SOCIAL SKIN NUTRITION STATUS PERSONAL CARE ASSISTANCE PASSIVE NORMAL DIET BATHING ACTIVE OTHER: SUPPLEMENTAL FEEDING GROUP PARTICIPATION DECUBITI – DESCRIBE: SPOON DRESSING RE-SOCIALIZATION PARENTERAL TOTAL CARE FAMILY SUPPORTIVE NASOGASTRIC PHYSICIAN VISITS NEUROLOGICAL GASTROSTOMY 30 DAYS CONVULSIONS/SEIZURES INTAKE AND OUTPUT 60 DAYS GRAND MAL DRESSINGS: FORCE FLUIDS OVER 180 DAYS PETIT MAL WEIGHT FREQUENCY HEIGHT

17. SPECIAL CARE FACTORS FREQUENCY SPECIAL CARE FACTORS FREQUENCY

BLOOD PRESSURE

BOWEL AND BLADDER PROGRAM

DIABETIC URINE TESTING

RESTORATIVE FEEDING PROGRAM

PT (BY LICENSED PT)

SPEECH THERAPY

RANGE OF MOTION EXERCISES

RESTRAINTS

18. MEDICATIONS / NAME & STRENGTHS, DOSAGE & ROUTE

1.

7.

2.

8.

3.

9.

4.

10.

5.

11.

6.

12.

19. X-RAY AND LABORATORY FINDINGS / DATE:

20. ADDITIONAL INFORMATION:

21. PHYSICIAN’S SIGNATURE 22. DATE

372-124 (12-92) EDS – DMA COPY L-13

HANDOUT E-2 MEDICATION ADMINISTRATION RECORD

Medications Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Charting for the month of: through Physician: Telephone # Medical Record #: Alt. Physician: Alt. Physician Telephone #: Allergies:

Rehabilitation Potential:

Diagnosis:

Admission Date:

Resident’s Name:

Room and bed #:

Medication Administration – September 2013, 10/15-Hour Training Course for Adult Care Homes L-14

Instructions : Result Codes : Injection/Patch Site Codes : A. Put initials in appropriate box when medication given. 1. Effective 1-Right dorsal gluteus 7-Right deltoid B. Circle initials when medication refused. 2. Ineffective 2-Left dorsal gluteus 8-Left deltoid C. State reason for refusal on Nurse’s Notes. 3. Slightly Effective 3-Right upper chest 9-Right upper arm D. PRN medication: Reason given should be noted on Nurse’s Notes. 4. No Effect Observed 4-Left upper chest 10-Left upper arm E. Indicate injection site(code). 5-Right lateral thigh 11-Upper back left

6-Left lateral thigh 12-Upper back right NURSE’S MEDICATION NOTES

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Temperature Respiration Pulse Blood Pressure

Initials Nurse’s Signature Initials Nurse’s Signature Charting Codes: A . chart error B. drug unavailable C. resident refused D. drug held E. dose contaminated F. out of facility G. see notes H. drug holiday

Date/Hour Medication/Dosage Route Reason Initials Results/Response Initials

Medication Administration – September 2013, 10/15-Hour Training Course for Adult Care Homes L-15

FL-2 (86) NORTH CAROLINA MEDICAID PROGRAM HANDOUT E-3 INSTRUCTIONS ON REVERSE SIDE LONG TERM CARE SERVICES PRIOR APPROVAL UTILIZATION REVIEW ON-SITE REVIEW

IDENTIFICATION 1. PATIENT’S LA ST NAME FIRST MIDDLE

Clayton Garrett 2. BIRTHDATE (M/D/Y)

10-17-50 3. SEX

M 4. ADMISSION DATE (CURRENT LOCATION)

09/04/13 5. COUNTY AND MEDICAID NUMBER

Johnston 021-13-1415 6. FACILITY ADDRESS

Adult Care Assisted Living 7. PROVIDER NUMBER

8. ATTENDING PHYSICIAN NAME AND ADDRESS

Dr. Bruton Adams Building City, N.C. 9. RELATIVE NAME AND AD DRESS

Ben Clayton (brother) 10. CURRENT LEVEL OF CARE _____ HOME ______ DOMICILIARY _____ SNF (REST HOME) _____ ICF ______ OTHER X HOSPITAL ________________

11. RECOMMENDED LEVEL OF CARE _____ HOME X DOMICILIARY _____ SNF (REST HOME) _____ ICF ______ OTHER ________________

12. PRIOR APPROVAL NUMBER 14. DISCHARGE PLAN _____ SNF ______ HOME _____ ICF _____ DOMICILIARY (REST HOME) _____ OTHER ________________

13. DATE APPROVED/DENIED

15. ADMITTING DIAGNOSES – PRIMARY, SECONDARY, DATES OF ONSET

1. seizure disorder 5. CHF

2. hypertension 6.

3. insulin-dependent diabetes (IDDM) 7.

4. Asthma 8.

16. PATIENT INFORMATION DISORIENTED AMBULATORY STATUS BLADDER BOWEL

CONSTANTLY x AMBULATORY x CONTINENT x CONTINENT

INTERMITTENTLY SEMI-AMBULATORY INCONTINENT INCONTINENT INAPPROPRIATE BEHAVIOR NON-AMBULATORY INDWELLING CATHETER COLOSTOMY WANDERER FUNCTIONAL LIMITATIONS EXTERNAL CATHETER RESPIRATION VERBALLY ABUSIVE SIGHT COMMUNICATION OF NEEDS NORMAL

INJURIOUS TO SELF HEARING x VERBALLY TRACHEOSTOMY

INJURIOUS TO OTHERS SPEECH NON-VERBALLY OTHER: INJURIOUS TO PROPERTY CONTRACTURES DOES NOT COMMUNICATE O2 PRN CONT. OTHER: ACTIVITIES/SOCIAL SKIN NUTRITION STATUS

PERSONAL CARE ASSISTANCE PASSIVE x NORMAL x DIET NCS

x BATHING x ACTIVE OTHER: SUPPLEMENTAL

FEEDING GROUP PARTICIPATION DECUBITI – DESCRIBE: SPOON

x DRESSING RE-SOCIALIZATION PARENTERAL

TOTAL CARE FAMILY SUPPORTIVE NASOGASTRIC PHYSICIAN VISITS NEUROLOGICAL GASTROSTOMY 30 DAYS CONVULSIONS/SEIZURES INTAKE AND OUTPUT

x 60 DAYS GRAND MAL DRESSINGS: FORCE FLUIDS

OVER 180 DAYS PETIT MAL WEIGHT FREQUENCY HEIGHT

17. SPECIAL CARE FACTORS FREQUENCY SPECIAL CARE FACTORS FREQUENCY

BLOOD PRESSURE BOWEL AND BLADDER PROGRAM

DIABETIC URINE TESTING FSBS ac breakfast & supper RESTORATIVE FEEDING PROGRAM

PT (BY LICENSED PT) SPEECH THERAPY

RANGE OF MOTION EXERCISES RESTRAINTS

18. MEDICATIONS / NAME & STRENGTHS, DOSAGE & ROUTE

1. Dilantin 125mg/5ml - 4ml po every day 7. Accupril 10 mg. 1 tablet once daily

2. Lasix 40mg po twice daily 8. Zithromax 250 mg. 1 daily X 4 days

3. Tylenol 325mg 2 tabs po q6hr prn pain 9. 4. or temp greater than 100°°°°F 10. 5. Humulin 70/30 – 10 units sq. ac breakfast 11. 6.

12.

19. X-RAY AND LABORATORY FINDINGS / DATE:

20. ADDITIONAL INFORMATION: PPD 8/28/03 0mm

PPD 2nd 9/15/03 0mm ∗∗∗∗ allergies - codeine 21. PHYSICIAN’S SIGNATURE

22. DATE 9/04/2013

372-124 (12-92) EDS – DMA COPY 10/15-Hour Training Course for Adult Care Homes – September 2013 L-16

HANDOUT F-1 MEDICATION ADMINISTRATION RECORD

Medications Hour Hydrocodone 10/325

Take 1 tablet by mouth

every 4 hours as

needed for pain.

P

R

N

LASIX 40mg.


once every day.

8AM

COUMADIN 5mg.


every other day.

2/08/00

6PM

Lanoxin 0.125 mg.


daily. Check pulse

before giving and hold

if pulse is less than 60

beats/min

8AM H

Pulse

AMOXICILLIN 250mg

Take 1 capsule by

mouth 3 times daily

for 10 days. 2/03/00

8AM

2PM

8PM

NITRO-DUR 0.4mg/hr

PATCH ----Apply 1

patch every morning

and remove at bedtime

8AM Site

8PM

CAPOTEN 25mg


3 times daily.

8AM

2PM

8PM

CAPOTEN 50mg


3 times daily .

(Give 2-25mg tablets)

2/08/00

8AM

2PM

8PM

LASIX 40mg


twice daily.

2/09/00

8AM

4PM

Charting for the month of: 1/1/13 through 1/31/13 Physician: Dr. Moses Telephone # 919-555-1212 Medical Record #:

Alt. Physician: Alt. Physician Telephone #:

Allergies: NKA Rehabilitation Potential:

Diagnosis: Congestive Heart Failure, H ypertension

Admission Date: 5/03/09

Resident: Jo Burns Date of Birth: 10/17/30 Room / bed #: 123-2



64 68 72 74 80 84 80 64 60 66 64 72 83 83 88 72 80 80 72 76 60 64 66 68 68 72 80 82 84 54

Instructions: Result Codes: Injection/Patch S ite Codes: A. Put initials in appropriate box when medication given. 1. Effective 1-Right dorsal gluteus 7-Right deltoid B. Circle initials when medication refused. 2. Ineffective 2-Left dorsal gluteus 8-Left deltoid C. State reason for refusal on Nurse’s Notes. 3. Slightly Effective 3-Right upper chest 9-Right upper arm D. PRN medication: Reason given should be noted on Nurse’s Notes. 4. No Effect Observed 4-Left upper chest 10-Left upper arm E. Indicate injection site (code). 5-Right lateral thigh 11-Upper back left

6-Left lateral thigh 12-Upper back right NURSE’S MEDICATION NOTES

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Initials Nurse’s Signature Initials Nurse’s Signature TK RB = Right side of back

CJ RC = Right side of chest

DB LB = Left side of back

JU LC = Left side of chest

Charting Codes: A. chart error B. drug unavailable C. resident refused D. drug held E. dose contaminated F. out of facility G. see notes


1-3-13 10AM

Hydrocodone 10/325

1 tablet po Pain in right leg T Effective at 12pm T

1-7-13 6PM Coumadin 5mg po Not available - C C

Pharmacy called

1-9-13 10PM

Hydrocodone 10/325

1 tablet po Pain in right leg C Effective as of 11pm C

1-30-13 8 AM

Lanoxin 0.125 mg

1 tablet po Pulse 54 J



HANDOUT F-2



Medication Administration Record (MAR) Worksheet

1. Turn to page 2 or back of MAR and print your initial to your first name and

initial to your last name on page 2 of the Medication Administration Record

(MAR).

2. On page 2 of the MAR write your first and last name in the blank block in the

Nurse’s Signature area.

3. Mrs. Burns’ MAR includes medications administered during what month?

4. Why did Mrs. Burns receive a dose of Hydrocodone 10/325 on the 3rd

of

January?

5. Why didn’t Mrs. Burns receive three doses of Amoxicillin on the 22nd

of

January?

6. What times did Mrs. Burns receive 25 mg of Capoten on January 2nd

?

7. Why was Mrs. Burns’ Coumadin dose circled on January 7th

?

8. Where was Mrs. Burns’ Nitro-dur patch placed on January 10th

?

9. What time does Mrs. Burns have her Nitro-dur patch removed?

10. Who is Mrs. Burns’ physician?

11. It is 11 PM on January 9th

. Mrs. Burns has asked for something for pain. Can

Mrs. Burns receive something for pain?

12. Does Mrs. Burns have allergies?

(continued)



Handout F-2 Continued

Medication Administration Record (MAR) Worksheet

13. How much Lasix did Mrs. Burns receive at 4 PM on January 18th

?

14. It is 8 AM on January 30th

. You have just administered one tablet of Lasix 40

mg to Mrs. Burns. Document that you gave the Lasix on Mrs. Burns’ MAR.

15. It is 4 PM on January 31st

. Mrs. Burns would like something for pain in her

right leg. Can Mrs. Burns receive something for pain? If so, administer the

appropriate medication and document on Mrs. Burns’ MAR. [

16. It is 8 AM and time for Mrs. Burns to receive her Lanoxin. What must you do

prior to administering the Lanoxin?

17. What are Mrs. Burns’ diagnoses?

18. What are the 6 Rights of medication administration?

a.

b.

c.

d.

e.

f.

19. How many days was Mrs. Burns supposed to receive Amoxicillin?

20. Why is there a zero in front of the decimal on Lanoxin 0.125 mg?

How to handrub? WITH ALCOHOL-BASED FORMULATION

How to handwash? WITH SOAP AND WATER

11

10

Apply a palmful of the product in a cupped hand and cover all surfaces.

Rub hands palm to palm right palm over left dorsum with interlaced fi ngers and vice versa

palm to palm with fi ngers interlaced

backs of fi ngers to opposing palms with fi ngers interlocked

rotational rubbing of left thumb clasped in right palm and vice versa

rotational rubbing, backwards and forwards with clasped fi ngers of right

hand in left palm and vice versa

…and your hands are safe.

Wet hands with waterapply enough soap to

cover all hand surfaces.

rinse hands with water dry thoroughly with a single use towel

use towel to turn off faucet

…once dry, your hands are safe.

40-60 sec20-30 sec

Des

ign:

mon

dofr

agili

s ne

twor

k

WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.

October 2006, version 1.

HANDOUT G-2



Instructions for Glove Sizing

Preparation

Before class, get three pairs of gloves – small ones, average ones, large ones. Notice the

size of your students’ hands. Choose three students – one with large hands, one with

tiny hands, and one with average hands. Ask the students if they will be willing to

participate in an activity.

Tell Students

“We are going to do a fun demonstration. I have asked a few students to assist me with

this activity.”

Explanation of Activity

Ask the three students to come to the front of the room. Have the remaining students

observe the demonstrations. First, have the student with large hands put on small

gloves. Second, have the student with tiny hands put on large gloves. Third, have an

average student put on the right size of gloves.

Wrap-up

Ask students to explain about the importance of choosing the correct size of gloves

when caring for residents. Proceed to the next activity, Gloves, Gloves, Gloves.

HANDOUT G-3



Instructions for Gloves, Gloves, Gloves

Preparation

Before class begins, gather boxes of sizes of gloves.

Instructions to Students

“Now that you understand the importance of choosing gloves that are the correct size, I

would like for each of you to choose the correct size of gloves that you would wear and

put them on.”

Explanation of Activity

Ask students to determine which size gloves they need. Ask each student to put on a

pair of gloves in the appropriate size. After they have put on their gloves, drop a dollop

of chocolate pudding on one glove of each student with a small plastic spoon.

Instructions to Students

“Rub your gloved hands together so you can spread pudding on both gloves – top and

bottom. The pudding represents stool. Now, I want you to remove the gloves without

getting the stool on your skin or clothes and throw away in the trashcan.”

Wrap-up

Ask everyone if they can explain the importance of proper removal of dirty gloves. Ask

if anyone got the fake stool on their hands and if so, how did they feel?

HANDOUT G-4


10/15-Hour Training Course for Adult Care L- 24

Diabetes and Viral Hepatitis:

Important Information on Safe Diabetes Care

Blood glucose testing and insulin administration can expose people to bloodborne viruses

(hepatitis B virus, hepatitis C virus, and HIV) when supplies are shared between people.

Outbreaks of hepatitis B virus infection associated with unsafe diabetes care have been

identified with increasing regularity particularly in long-term care settings such as nursing

homes and assisted living facilities where residents often require assistance with monitoring

of blood glucose levels or insulin administration.

In order to prevent infections, the North Carolina Division of Public Health urges all health

care providers to follow these simple rules for safe diabetes care:

Three Simple Rules for

Assisted Blood Glucose Monitoring and Insulin Administration

1. FINGERSTICK DEVICES

SHOULD NEVER BE USED FOR

MORE THAN ONE PERSON

� Restrict use of fingerstick

devices to a single person.

They should never be

used for more than one

person.

� Select single-use lancets

that permanently retract

upon puncture. This adds

an extra layer of safety for

the patient and the

provider.

� Dispose of used lancets at

the point of use in an

approved sharps

container. Never reuse

lancets.

2. BLOOD GLUCOSE METERS

SHOULD BE ASSIGNED TO

ONLY ONE PERSON AND NOT

SHARED

� Whenever possible, assign

blood glucose meters to a

single person.

� If blood glucose meters

must be shared, they

should be cleaned and

disinfected after every

use, per manufacturer’s

instructions, to prevent

carry-over of blood and

infectious agents.

� If the manufacturer does

not specify how the

device should be cleaned

and disinfected then it

should not be shared.

3. INJECTION EQUIPMENT

SHOULD NEVER BE USED FOR

MORE THAN ONE PERSON

� Insulin pens should be

assigned to only one person

and labeled appropriately.

They should never be used

for more than one person.

� Multiple-dose vials of insulin

should be dedicated to a

single person whenever

possible.

� Medication vials should

always be entered with a

new needle and new syringe.

Never reuse needles or

syringes.

� For information and materials

about safe insulin pen use,

visit www.ONEandONLY

campaign.org

Always practice proper hand hygiene and change gloves between each person.

Adapted from the Diabetes and Viral Hepatitis Important Information on Safe Diabetic Care, N.C.

DHHS Division of Public Health

HANDOUT I-1

Medication Administration - September 2013


Review of Measuring Devices

Medication Cup Use on a level surface

when measuring

Oral Dropper/Syringe

Use when measuring

amounts less than 5 ml.

Household Utensil

Do NOT use for measuring

medications

Special Oral Measuring Device

This measuring device has

measurements of mg instead of ml.

The oral syringe above would be used

for measuring Lasix Solution.

HANDOUT I-2



ALWAYS 1. ALWAYS measure using the

metric system. 2. ALWAYS use an oral

measuring syringe for small amounts of liquid medication.

3. ALWAYS hold cups at eye level when measuring.

4. If the label says to measure in

mls, ALWAYS use a measuring device that is marked in mls.

5. If the label says to measure in

mgs, ALWAYS use a measuring device that is marked in mgs for that medication.

6. ALWAYS consult your

pharmacist when you have a question about measuring.

NEVER 1. NEVER use household spoons.

2. NEVER use cups that are not marked with the amount they hold.

3. NEVER switch the special

droppers that come with some liquid medications.

4. NEVER measure mls with a

measuring device that is marked in mgs.

5. NEVER measure mgs with

measuring devices that are marked in mls.

mg ≠≠≠≠ ml 6. NEVER leave air bubbles

mixed with the liquid in an oral measuring syringe.

HANDOUT I-3 L-27

MEASURING TIPS

10cc = 10ml

20cc = 20ml

30cc = 30ml

Reminder: 1cc = 1ml

A cubic centimeter is the same as a milliliter.

mg. ≠≠≠≠ ml. A mg is NOT the same as a ml ! ! !

TIP: Always read the label carefully to be sure you are measuring the right thing.

If the strength of a medication is 20mg/5ml, this 15ml cup contains 60mg of medication.

�15ml�

YOU CAN'T TELL THE DIFFERENCE BY LOOKING

1 TSP. = 5ml.

TIP: Don't use household teaspoons. They are not accurate!

TIP: To be accurate, use the correct measuring tool. Ask your pharmacist. Some liquid medicines have special measuring tools.

= 1 tbsp. = 3 tsp

= 3 tsp. = 15ml

TIP: When measuring liquids, hold the cup at eye level.

TIP: use an oral syringe for amounts less than 5ml

If the strength of a medication is 40mg/5ml, this 15ml cup contains 120mg of medication.

HANDOUT I-4

10/15-Hour Training Course for Adult Care Homes – September 2013 L-28

All Meter Dose Inhalers must be shaken! Ask the resident to tilt the head back slightly and breathe out. Position the inhaler in one of the following ways:

• Open mouth with inhaler one to two inches away. • Use spacer with inhaler; place spacer in mouth (Spacers are

particularly beneficial for older adults). • Position inhaler in mouth, close lips around inhaler.

Press down on inhaler to release medication as the resident starts to breathe in slowly. Encourage the resident to breathe in slowly (over 3 to 5 seconds). Ask the resident to hold breath for 10 seconds to allow medication to reach deeply into the lungs. If a resident is prescribed multiple inhalers, the physician may order a certain sequence to administer the inhalers or special instructions may be on the MAR. Proper spacing of puffs and different inhalers is important for the maximal effectiveness of the medication.

o Wait one minute between “puffs” for multiple inhalations of the same medication.

o Wait a few minutes between administering another type of inhaler.

If a medication aide provides the resident with the inhalers to administer, the medication aide is responsible for instructing the resident of the proper technique and dose ordered.

TECHNIQUE AND USE OF METER DOSE INHALERS

HANDOUT D-1A



Medication Orders - Answers

Identify the information missing for each medication order below:

Risperdal 2 mg. Give 1 tablet by mouth

[specific direction on how often to give the Risperdal or frequency of administration]

Riopan Liquid 15 ml. by mouth every hours as needed

[specific direction on how often to give the Riopan or frequency of administration

AND the reason for administration]

Aricept 1 tablet by mouth at bedtime

[Strength of Aricept to give]

Tylenol 2 tablets by mouth every 4 hours as needed for shoulder pain

[Strength of Tylenol to administer]

Ativan 0.5 mg. 1 tablet by mouth as needed

[specific direction on how often to give the Ativan or frequency of administration

AND the specific reason for administration]



HANDOUT D-5A - Answers

Decimal Points and ZerosDecimal Points and ZerosDecimal Points and ZerosDecimal Points and Zeros Draw a line to match the following dose with the correct statement about the use of decimals and zeros:

DoseDoseDoseDose StatemenStatemenStatemenStatementttt

.45 mg Zero not needed, makes dose confusing

0.45 mg ZERO needed in front of decimal

04.5 mg Zero not needed, could be confused with higher dose if decimal overlooked

8.0 mg Correct use of decimal and zero

HANDOUT E-4 MEDICATION ADMINISTRATION RECORD ACTIVITY ANSWERS Medications HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Dilantin 125mg/5ml 4ml by mouth every day 09/04/13 9PM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8AM

4PM

Furosemide 40mg for Lasix 40mg 1 tablet by mouth twice daily. 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

P

R

N

Tylenol 325mg 2 tablets every 6 hours as needed for pain or T > 100ºF 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

7AM

site

Humulin 70/30 insulin Inject 10 units subcutaneously before breakfast each day. 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

7AM

4PM

Fingerstick blood sugars Check twice daily before breakfast and supper 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8AM

Zithromax 250 mg. 1 tablet once daily for 4 days 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8AM

Accupril 10 mg. 1 tablet by mouth once daily. 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

9PM

Ambien 5mg tablets 1 tablet by mouth at bedtime. 09/04/13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Initials of individual(s) transcribing entries are also needed.

Charting for the month of: 09/04/13 through 09/30/13

Physician: Dr. Bruton Telephone # 919-555-1212 Medical Record #:

Alt. Physician: Alt. Physician Telephone #:

Allergies: CODEINE Rehabilitation Potential:

Diagnosis: SEIZURE DISORDER, HTN, IDDM, ASTHMA, CHF Admission Date:

Resident’s Name: Garrett Clayton Date of Birth: 10/17/50 Room / bed #: BW999


STOP only 4 STOP only 4 STOP only 4 STOP only 4 dosesdosesdosesdoses

Instructions: Result Codes: Injection/Patch Site Codes: A. Put initials in appropriate box when medication given. 1. Effective 1- Right dorsal gluteus 7- Right deltoid B. Circle initials when medication refused. 2. Ineffective 2- Left dorsal gluteus 8- Left deltoid C. State reason for refusal on Nurse’s Notes. 3. Slightly Effective 3- Right upper chest 9- Right upper arm D. PRN medication: Reason given should be noted on Nurse’s Notes. 4. No Effect Observed 4- Left upper chest 10- Left upper arm E. Indicate injection site(code). 5- Right lateral thigh 11- Upper back left

6- -Left lateral thigh 12- Upper back right

NURSE’S MEDICATION NOTES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Initials Nurse’s Signature Initials Nurse’s Signature

Charting Codes: A . chart error B. drug unavailable C. resident refused D. drug held E. dose contaminated F. out of facility G. see notes



HANDOUT F-3



Medication Administration Record (MAR) Worksheet Answers

1. Turn to page 2 or back of MAR and print your initial to your first name and

initial to your last name on page 2 of the Medication Administration Record

(MAR). [Check individual documentation]

2. On page 2 of the MAR write your first and last name in the blank block in the

Nurse’s Signature area. [Check individual documentation]

3. Mrs. Burns’ MAR includes medications administered during what month?

[January]

4. Why did Mrs. Burns receive a dose of Hydrocodone 10/325 on the 3rd

of

January? [Mrs. Burns had pain in her right leg.]

5. Why didn’t Mrs. Burns receive three doses of Amoxicillin on the 22nd

of

January? [She was only supposed to receive Amoxicillin for ten days and the

ten days had passed; the Amoxicillin had been discontinued.]

6. What times did Mrs. Burns receive 25 mg of Capoten on January 2nd

? [8 AM,

2 PM, and 8 PM]

7. Why was Mrs. Burns’ Coumadin dose circled on January 7th

? [The dose of

Coumadin was not available to administer.]

8. Where was Mrs. Burns’ Nitro-dur patch placed on January 10th

? [On the left

side of Mrs. Burns’ chest.]

9. What time does Mrs. Burns have her Nitro-dur patch removed? [8 PM]

10. Who is Mrs. Burns’ physician? [Dr. Moses]

11. It is 11 PM on January 9th. Mrs. Burns has asked for something for pain. Can

Mrs. Burns receive something for pain? [No, because Mrs. Burns had a dose

of Hydrocodone 10/325 at 10 PM and can only have it every 4 hours.] If so,

administer the appropriate medication and document on Mrs. Burns’ MAR.

[No documentation should occur.]

(continued)



Handout F-3 Continued

Medication Administration Record (MAR) Worksheet Answers

12. Does Mrs. Burns have allergies? [No]

13. How much Lasix did Mrs. Burns receive at 4 PM on January 18th

? [40 mg.]

14. It is 8 AM on January 30th

. You have just administered one tablet of Lasix 40

mg to Mrs. Burns. Document that you gave the Lasix on Mrs. Burns’ MAR.

[Check individual documentation]

15. It is 4 PM on January 31st

. Mrs. Burns would like something for pain in her

right leg. Can Mrs. Burns receive something for pain? [Yes] If so,

administer the appropriate medication and document on Mrs. Burns’ MAR.

[Check individual documentation]

16. It is 8 AM and time for Mrs. Burns to receive her Lanoxin. What must you do

prior to administering the Lanoxin? [Check Mrs. Burns’ pulse rate.]

17. What are Mrs. Burns’ diagnoses? [Congestive heart failure and hypertension]

18. What are the 6 Rights of medication administration?

a. Right resident

b. Right medication

c. Right dose

d. Right route

e. Right time

f. Right documentation]

19. How many days was Mrs. Burns supposed to receive Amoxicillin? [10]

20. Why is there a zero in front of the decimal on Lanoxin 0.125 mg? [To help

prevent medication dosing errors, a zero (0) should always precede a decimal

but should not follow a decimal. For example, if the 0 is not present in the

Lanoxin 0.125 mg., the decimal might be missed and instead of giving

0.125 mg. of Lanoxin it might incorrectly be read as 125 mg of Lanoxin which

would be deadly.]

HANDOUT – Additional Resources



10 Tips for Administering Medication to the

Cognitively Impaired Resident

INTRODUCTION: Accurate, safe medication administration means giving the right drug to

the right resident in the right dose by the right route and at the right time, and documenting

correctly. Achieving these goals can be a challenge with the cognitively impaired resident.

Because they have difficulty with thinking, reasoning and remembering, these residents

may, at times, be resistant, suspicious, or even aggressive. These problems may be

compounded if the resident has difficulty chewing or swallowing. Caregivers must fine-tune

skills to meet these unique challenges. The following will help caregivers to achieve

medication administration:

1. Respect A diagnosis of cognitive impairment is no different than any other diagnosis

when it comes to respect. Knock before entering the resident’s room. A cheery “good

morning” and a pleasant “please” and “thank you” may be the deciding factors as to

whether the resident chooses to take the medication or not. Regardless of the resident’s

response, show respect in every aspect of your behavior.

2. Explain But keep it simple. Remember that the resident has the right to be informed and

to be involved in his/her treatment. Some residents may understand single words only.

Mirroring is a good technique to use to indicate what you want the resident to do. The

simple action of placing an empty medication cup in your lips might be sufficient to get the

resident to do the same.

3. Encourage Compliance Residents frequently refuse to take medications. Encourage, but

be gentle. A non-confrontational approach and a gentle manner go a long way when it

comes to persuasion. Be persistent. Residents who refuse medications one minute will

often accept the next. Remember, the resident ultimately has the right to refuse. Force is

never acceptable.

4. Make Eye Contact We speak volumes with our eyes. Cognitively impaired residents

often have difficulty with verbal communication. Making eye contact when speaking helps

the resident understand what you are saying. Teach your eyes to say, “I want you to take

this medication because I care about you”.

5, Adequate Fluids Offer fluids before giving the medication. A drink of juice or some

pleasant-tasting beverage not only moistens the mouth, but evokes positive feelings as well.

This will aid swallowing and help to prevent the medication from sticking inside the cheek

or to the tongue. Don’t forget to give plenty of fluids after the medication has been

swallowed. The general rule is 8 oz unless fluid restriction is ordered.

(continued)

HANDOUT– Additional Resources



6. Crush Medications Crushing medications may be done in accordance with facility’s

policy and procedures. A physician’s order is needed to crush medications. There are some

medications that should not be crushed, e.g., enteric coated and delay release, and if there

is no alternative for the medication, there has to be a physician’s order for the medication

to be crushed. When in doubt on whether a medication can be crushed, contact your

supervisor and/or pharmacist.

7. Be Patient Rushing not only agitates. Rushing may also cause choking and errors.

8. Observe & Report Be aware of any changes with a resident. The length of time that a

resident takes a drug may alter the effectiveness of the drug, or have unwanted effects.

Psychoactive drugs, those that affect the brain have long-term negative effects in the

elderly. Report your observations promptly to the health care provider.

9. Document Record the date and time of every medication that you administer, if a drug

is not given, record the reason why. Record the reason for administering, and effectiveness

of all PRN (as needed) drugs.

10. Communicate Opening communication with residents, family and health care providers

is a must. Frequent reviews of the resident’s drug regiment should be done to reduce

dosages or eliminate unnecessary drugs.

Good medication administration procedures combined with individualized care-giving

strategy equals mission accomplished!

Adapted from National Gerontological Nurses Association. 2000 Horizons Christine A. Stacy, MS, RN, BC



HANDOUT – Additional Resources

onto the MAR

• Transcribe - means to write down or to copy from one place to another.

o With medication administration, transcribing orders is when the information

from the order is transferred or copied to the MAR.

o When an order is received from the prescribing practitioner, the information

from the order is transcribed to the current MAR.

o With medication transcription, it is important to follow certain guidelines to

ensure accuracy and compliance.

• If you are responsible to transcribe an order to the MAR, the following are basic

guidelines to follow:

o Transcribe the information from the order onto the MAR only if you are able

to read all the information on the order.

o Transcribe the information on the MAR only if the order is complete for

administering the medication.

o Transcribe all the information onto the MAR as it is written on the order.

Other guidelines for transcription onto MARs:

• Do not use abbreviations

• Record each medication ordered from the order form to include:

o Name and strength of the medication

o Dose, Route and Time(s) the medication is to be given

o Date the medication is to be started

o Date the medication is to be stopped (if provided)

o The date and name of person who transcribed the order should be

documented

• Mark out days the medication is not to be given IF the medication is not

prescribed every day. (continued)

General Guidelines for Transcribing Orders

onto the MAR



• For new orders, include the date and indicate the time to start.

• Count number of dosages to be administered instead of number of days when

calculating stop dates for medication orders that have been prescribed for a

specific time period, such as antibiotics

• Do not schedule PRN orders for administration at specific times; are

administered when resident “needs” the medication for a certain circumstance

• If a medication order is discontinued (stopped or changed) by the prescriber,

Discontinue or D/C (abbreviation for discontinued) should be noted for the

medication. The date discontinued and your initials should be included.

• If the medication is not discontinued BUT the dose is reduced or changed, this

should be transcribed as a NEW medication order. The old order would be

discontinued on the MAR. The new order with the revised dosage would be

transcribed onto the MAR exactly as a new order would be.

NOTE: It is important to follow the facility policy regarding how a discontinued

medication is indicated on the MAR as procedures may vary. When a new medication

is ordered, changed or discontinued, be sure to notify the resident of changes.

Appendix


10/15-Hour Training Course for Adult Care Homes M-1

Appendix

Appendix


10/15-Hour Training Course for Adult Care Homes 1

10/15-Hour Medication Course

Test

Name _________________________________

Facility _________________________________

Part 1: Match the term or phrase on the right with the abbreviation or term on the left by

placing the correct letter on the appropriate line.

_____ 1. PRN a. milligram

_____ 2. ac b. at bedtime

_____ 3. stat c. Medication Administration Record

_____ 4. SL d. over the counter

_____ 5. MAR e. before meals

_____ 6. mg f. tablespoonful

_____ 7. pc g. placed and affixed to the skin

_____ 8. OTC h. teaspoonful

_____ 9. Subcutaneous i. milliliter

_____ 10. po j. immediately

_____ 11. qhs k. sublingual

_____ 12. tbsp l. placed under the tongue

_____ 13. transdermal m. after meals

_____ 14. ml n. by mouth

_____ 15. gm o. gram

_____ 16. QOD p. as needed

_____ 17. tsp q. every other day

_____ 18. sublingual r. inject into the fat with a syringe

Appendix



10/15 - Hour Medication Course

Test - Continued

Part 2: Fill in the blank with the appropriate word or term. You may choose to use the word

bank below.

19. A heart tablet taken by the mouth and swallowed is an example of a medication taken by

the _____________ route.

20. A medication that is inserted into the rectum is given using the ____________ route.

21. A __________________ medication is applied directly to the skin surface.

22. A suspension must be ____________________ before measuring and administering the

medication.

23. A medication ______________ is a reaction that occurs because of an unusual sensitivity to

a medication or other substance.

24. A medication _______________ occurs when a medication is not administered as prescribed

by the doctor or practitioner.

25. A hard, compressed medication in a round, oval, or square shape is called a _____________.

26. When placing an ear drop into the right ear, the medication aide should pull the external

ear ____________ and back.

27. Crushed medications may be placed in food such as applesauce or ___________________.

28. ______________ must be worn when there is a chance of contact with mucus membranes.

29. A fine, ground form of medication that may be used on the skin for rashes is called

___________.

30. A device that is placed and affixed to the skin is given by the _______________ route.

Word Bank:

Powder Gloves Pudding Shaken Error Restraint

Oral Up Tablet Transdermal A lemon Rectal

Down Capsule Refuse Allergy Chemical Topical

Appendix



10/15-Hour Medication Course

Test - Continued

Part 3: Dr. Smith has ordered a STAT dose of oral liquid cough syrup for Mrs. Jackson. Circle

each supply that the Medication Aide will need to have in order to administer the medication.

33. Soufflé cup

34. MAR for Mrs. Jackson

35. Alcohol wipe

36. Calibrated plastic cup

37. Gloves

38. Applesauce

39. Lubricant

Part 4: Dr. Majors has ordered a rectal suppository for Mr. Thompson. Circle each supply that

the Medication Aide will need to have in order to administer the medication.

40. Soufflé cup

41. MAR for Mr. Thompson

42. Alcohol wipe


44. Gloves

45. Applesauce

46. Lubricant

Part 5: List 4 of the 6 rights of medication administration.

47. ________________________________________

48. ________________________________________

49. ________________________________________

50. ________________________________________

Appendix



5-Hour Medication

Test Answers

Name _________________________________

Facility _________________________________

Part 1: Match the term or phrase on the right with the abbreviation or term on the left by

placing the correct letter on the appropriate line.

_____ 1. PRN (p) a. milligram

_____ 2. ac (e) b. at bedtime

_____ 3. stat (j) c. Medication Administration Record

_____ 4. SL (k) d. over the counter

_____ 5. MAR (c) e. before meals

_____ 6. mg (a) f. tablespoonful

_____ 7. pc (m) g. placed and affixed to the skin

_____ 8. OTC (d) h. teaspoonful

_____ 9. Subcutaneous (r) i. milliliter

_____ 10. po (n) j. immediately

_____ 11. qhs (b) k. sublingual

_____ 12. tbsp (f) l. placed under the tongue

_____ 13. transdermal (g) m. after meals

_____ 14. ml (i) n. by mouth

_____ 15. gm (o) o. gram

_____ 16. QOD (q) p. as needed

_____ 17. tsp (h) q. every other day

_____ 18. sublingual (l) r. inject into the fat with a syringe

Appendix



5-Hour Medication

Test Answers – Continued

Part 2: Fill in the blank with the appropriate word or term. You may choose to use the word

bank below.

19. A heart tablet taken by mouth and swallowed is an example of a medication taken by

the oral route.

20. A medication that is inserted into the rectum is given using the rectal route.

21. A topical medication is applied directly to the skin surface.

22. A suspension must be shaken before measuring and administering the medication.

23. A medication allergy is a reaction that occurs because of an unusual sensitivity to a

medication or other substance.

24. A medication error occurs when a medication is not administered as prescribed by the

doctor or practitioner.

25. A hard, compressed medication in a round, oval, or square shape is called a tablet.

26. When placing an ear drop into the right ear, the medication aide should pull the external

ear up and back.

27. Crushed medications may be placed in food such as applesauce or pudding.

28. Gloves must be worn when there is a chance of contact with mucus membranes.

29. A fine, ground form of medication that may be used on the skin for rashes is called refuse.

30. A device that is placed and affixed to the skin is given by the transdermal route.

Word Bank:

Powder Gloves Pudding Shaken Error Restraint

Oral Up Tablet Transdermal A lemon Rectal

Down Capsule Refuse Allergy Chemical Topical

Appendix



5-Hour Medication

Test Answers – Continued

Part 3: Dr. Smith has ordered a STAT dose of oral liquid cough syrup for Mrs. Jackson. Circle

each supply that the Medication Aide will need to have in order to administer the medication.

33. Soufflé cup

34. MAR for Mrs. Jackson

35. Alcohol wipe


37. Gloves

38. Applesauce

39. Lubricant

Part 4: Dr. Majors has ordered a rectal suppository for Mr. Thompson. Circle each supply that

the Medication Aide will need to have in order to administer the medication.

40. Soufflé cup

41. MAR for Mr. Thompson

42. Alcohol wipe


44. Gloves

45. Applesauce

46. Lubricant

Part 5: List 4 of the 6 rights of medication administration.

• Right resident

• Right medication

• Right dose

• Right route

• Right time

• Right documentation

This is to certify that

______________________________ Name of Student

has successfully completed a North Carolina State-approved Medication Administration Training Program

at

____________________________________ Name of Training Location (school, facility, etc.)

on the _____________ day of ___________________, 20____.

Certified by:

_____________________ _____________________ Print Name of Trainer Employed by

_____________________ _____________________ Signature of Trainer Date

Medication Administration: 10-Hour Training Course for Adult Care Homes

This is to certify that

______________________________ Name of Student

has successfully completed a North Carolina State-approved Medication Administration Training Program

at

____________________________________ Name of Training Location (school, facility, etc.)

on the _____________ day of ___________________, 20____.

Certified by:

_____________________ _____________________ Print Name of Trainer Employed by

_____________________ _____________________ Signature of Trainer Date

Medication Administration: 15-Hour Training Course for Adult Care Homes

Appendix



References

N.C. Department of Health and Human Services/N.C. Board of Nursing – Medication Administration: A Medication Aide

Training Course. 2006

Commonwealth of Virginia/Virginia Board of Nursing – Medication Aide Curriculum for Registered Medication Aides. 2007

UNC-Chapel Hill/Center for Health Promotion and Disease Prevention – Medication Administration in Rest Homes. 1991

UNC-Chapel Hill/Center for Health Promotion and Disease Prevention – Measuring Medications Workbook. 1991

CDC – Clinical Reminder: Use of Fingerstick Devices on More than One Person Poses Risk for Transmittig Bloodborne

Pathogens, Retrieved in 2011 from: http://www.cdc.gov/injectionsafety/Fingerstick-DevicesBGM.html

CDC – Diabetes and Viral Hepatitis: Important Information on Glucose Monitoring, Retrieved in 2011 from:

http://www.cdc.gov/hepatitis/Settings/GlucoseMonitoring.htm

CDC – Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, Retrieved in

2011 from: http://www.cdc.gov/hicpac/pdf/norovirus/Norovirus-Guideline-2011.pdf

CDC – Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved in 2011

from: http://www.mt pinnacle.com/ppts/PPE.ppt#520,1,Guidance for the Selection and Use of Personal Protective

Equipment (PPE) in Healthcare Settings or http://www.mtpinnacle.com/ppts/PPE.ppt

CDC - Hand Hygiene Basics, Retrieved in 2011 from: http://www.cdc.gov/handhygiene/Basics.html

CDC – Hand Hygiene in Health Care Settings – Core, Retrieved in 2011 from:

http://www.cdc.gov/handhygiene/download/hand_hygiene_core_minus_notes.pdf

CDC – Hand Hygiene in Health Care Setting – Supplemental, Retrieved in 2011 from:

http://www.cdc.gov/handhygiene/download/hand_hygiene_supplement.ppt

CDC – Healthcare-Associated Infections (HAI). Retrieved in 2011 from: http://www.cdc.gov/hai/

CDC – Healthcare – Associated Infections (HAI) Long-term Care Settings, Retrieved in 2011 from:

http://www.cdc.gov/HAI/settings/ltc_settings.html

CDC – Infection Prevention during Blood Glucose Monitoring and Insulin Administration, Retrieved in 2011:

http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html

CDC – Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved in 2011 from:

http://www.cdc.gov/HAI/prevent/ppe_train.html

CDC – Sharps Safety for Healthcare Settings, Retrieved in 2011 from: http://www.cdc.gov/sharpssafety/

CDC – Use of Fingerstick Devices on More than One Person Poses Risk for Transmitting Bloodborne

Pathogens CDC Clinical Reminder. Retrieved in 2011:

http://www.cdc.gov/injectionsafety/PDF/Clinical_ Reminder_Fingerstick_Devices_RiskBBP.pdf

Durham, Carol Fowler (2006) Medication Administration A Medication Aide Training Course, N.C. Department of Health and

Human Services and N.C. Board of Nursing

Appendix



References

One and Only Campaign, Safe Injection Practices Coalition (SPIC), Retrieved in 2013

http://www.oneandonlycampaign.org/

OSHA - Bloodborne Pathogens and Needlestick Prevention, Retrieved in 2011 from:

http://www.osha.gov/SLTC/bloodbornepathogens/index.html

OSHA – Infection, Retrieved in 2011 from:

www.osha.gov/SLTC/etools/hospital/hazards/infection/infection.html

WHO - Education Session for Trainers, Observers and Health-Care Workers, Retrieved in 2011 from:

http://www.ntuh.gov.tw/ifc/hhc/HandHygiene/Education%20Sessions%20for%20Trainers%20and%20Observers%20and

%20Health-care%20Workers.pdf

WHO – How to Hand Rub, Retrieved in 2011 from:

http://www.who.int/gpsc/5may/How_To_HandRub_Poster.pdf

WHO – How to Handwash, Retrieved in 2011 from: http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf