Supervising Consumer Self Administration of Medication (SAM) Information, Rules, and Laws For IDD Staff and Foster Care Providers New

Class Objectives Understand: Role of Paid Unlicensed (non-nursing) Staff Classifications of Medications Purpose/Intended Effects of Medications Common Side Effects of Medications Medication Rules & Laws

Medication Rules and Laws

Who Makes the Rules? Federal Drug Enforcement Agency (DEA) Texas Legislature per Texas Administrative Code Texas Board of Pharmacy Texas Medical Board Texas Board of Nurse Examiners Texas Department of Public Safety (DPS) Other

Why are the rules for prescription medications so strict? Many medications require a prescription because they are too dangerous without a doctor’s supervision. Most prescriptions fall into this “dangerous drug” category. Other prescription medications have potential to become habit forming or may interfere with breathing. These are called “controlled substances” and are monitored even more strictly.

History of the Psychiatric Patient and Person With Intellectual Developmental Delay Years ago persons with IDD or Mental Illness had very limited treatment options. Their care required 24 hour nursing staff. Medications and treatments have developed that allow persons with IDD or Mental Illness to function more independently and nursing tasks can be delegated to non-nursing staff. Community Mental Health settings and Group Homes allow consumers to Self Administer their own medications with trained staff supervising with an appropriate level of assistance.

Criteria for Non-Delegation Per Texas Board of Nurse Examiners Consumer is in an independent living environment. The RN has determined that delegation is not required because the medication is oral, topical, or metered dose inhaler Consumer has a stable predictable condition (chronic not recuperative). Process An RN must make an assessment of the paid unlicensed staff to determine if they are competent to complete the task An RN must verify the competency of the unlicensed staff to perform the nursing task. RN should be available for consultation and questions.

Staff’s Role Definitions

Definitions: Self Administer Medications (SAM) A consumer taking his own medication out of the container and taking or applying it. Supervising/Assisting with SAM Staff gesturing, prompting, instructing consumer, or offering hand-over-hand help and making sure the “five rights” are correct. Administer Medication Taking a medication out of a container, placing a medication in the mouth, or applying a medication. Dispense Medication To place medication in a container and to label a medication container.

Who May Do These Tasks? Self Administer Consumer

Administer Licensed Nurse or paid unlicensed staff that the following is true: #1 the medication is for a predictable and stable condition

#2 The un-licensed staff have been determined competent to do so by an RN or LVN under the direct supervision of a RN #3 The medication is an oral medication, a topical medication, or a metered dose inhaler

Delegated Medications Ear Drops and Eye Drops must be delegated by the RN RN must train and demonstrate proper administration of ear and eye drops to the paid unlicensed staff Paid unlicensed staff must be individually identified as competent to administer ear and eye drops and then be delegated in writing by the RN to do so

What is Staff’s Role With Medications? Help the Consumer Be Independent Help Keep the Consumer Safe Follow Federal and State Laws

Teaching Consumers About Their Medications

Teach at the level the consumer is able to understand. Higher level functioning consumers may be able to learn all “five rights” of the medication. Lower level functioning consumers may only be able to point to correct medication, or say the color of the pill, etc. Consumers who lack hand strength or coordination may be offered hand-over-hand assistance.

Expected Action of the Medication Sometimes different for IDD population than general population. Example: OCD vs MDD, Racing Thoughts vs Psychosis, Paradoxical Response to Some Medications

Possible Side Effects to the Medication May be temporary Help the consumer track the frequency and severity Teach the consumer and family which side effects should be reported to the nurse or doctor (see handout)

What are the rules for consumer’s medications? There must be a doctor’s order or prescription for the medication. In a group home there must be a Medication Administration Record (MAR) that matches doctors’ orders or prescriptions. The medication container must be labeled by a pharmacist or doctor/practitioner. Only a doctor, pharmacist, or consumer may place the medications in the prescription bottle. A nurse may fill a consumer’s “pill minder”, “pill planner”, or similar container specifically designed for medication storage (or an RN may specifically delegate this function in accordance with the Nurse Practice Act guidelines.) Only the person on the prescription may use the medication. Only a nurse or doctor may call in new medications or changes in medication doses or instructions to a pharmacy. In our DD setting the paid unlicensed staff may administer medication with the authorization of an RN. Only a licensed nurse can determine competency of a paid unlicensed staff. If there is a medication error the nurse or doctor must be notified immediately for instructions.

This should be verified with the MAR. The Medication Label Every medication label should have the following information: Consumer Name Medication Name Medication Dose Time to Take It Way (route) to Take It This should be verified with the MAR.

Teaching Consumers About Their Medications “Five Rights” of Medication Right Person (Correct Consumer Name on the Med Bottle) Right Medication (Correct Name of Medication on the Med Bottle) Right Dose (Correct Amount or Size of Pill) Right Time (Correct Time of Day) Right Route (Correct Way)

Some Consumers May Self-Administer Medications With Staff Supervision (Usually IDD) Process One consumer at a time. Appropriate area. Practice cleanliness. Each consumer has separate medication container. Have consumer do as much as they are able. “Five Rights” “Three Checks” Documentation (See handouts)

Supervising Consumer’s Self Administration of Medication Notify consumer it is time for medication. Have consumer clean area and wash hands. Have consumer gather equipment and meds (glass of water, pill cup). First check: verify “five rights” and pill count before consumer removes pill from container. Review med information with consumer: (Reason for med, name of med, color of med, number of pills he takes, possible side effects, etc.) Second check: as consumer places pill in pill cup verify “five rights”. Third check: as consumer places medication back in med container verify “five rights”. Documentation: staff initial, number of pills remaining.

Medication Administration Record It is a Legal Document Use correct documentation procedures. Use black ink only. No White Out.

PRN Medications “PRN” means “as needed” and there has to be a doctor’s order (Standing Orders). Staff documents consumer’s symptoms or reason for prn medication. Staff monitors consumer for desired effect and documents results. If symptoms persist call the nurse.

PRN Medications used for Behaviors Paid unlicensed staff must notify the RN PRIOR to assisting or administering any medication given for behavioral management.

Cont. PRN Meds The RN must make an assessment and determine based on this assessment that a PRN medication is necessary. Under the determination of the RN and the direction of the RN the paid unlicensed staff may then administer the medication as directed by the RN and physicians orders

Medication Storage Medications must be stored separately from other items. Topicals and drops must be kept separate from oral meds. Medications must be in a locked cabinet. Controlled substances must be in a locked box inside a locked cabinet. A pill count must be maintained for prescription medications. Medications must remain in their original containers.

Transporting Medications Never leave medications in a vehicle -theft risk -heat or cold can damage or alter medications

Medication Errors Can Be Dangerous! Medication Errors Are Strictly Monitored By Local, State, and Federal Oversight TYPES OF MEDICATION ERRORS Documentation Errors Administration and Dosage Errors Omission Errors Missing Pills or Incorrect Pill Counts MOST MEDICATION ERRORS OCCUR WHEN STAFF IS IN A HURRY OR DISTRACTED BY OTHER TASKS

Poison Control 1-800-222-1222

Do not throw away medication! Several agencies regulate how expired and contaminated medication must be disposed of. These medications must be given to the nurse who will follow the appropriate disposal process. NEVER throw away a pill, a liquid, or a container of medication.

Documentation Needs to be legible. Should indicate what was evaluated, monitored, taught, demonstrated, or followed up on, and should state consumer’s understanding or cooperation (or lack of cooperation) as well as action consumer is to take. If consumer reports problem, symptom, concern, question, etc., always document what action was or will be taken and by whom. Should connect with one or more of the outcomes, objectives, or strategies listed in the care plan.

Review & Test