Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide

Unit 1 2 Recertification Review Guide, Unit 1

RIGHTS 5 of Medication Administration 1. Right Child 2. Right Medication 3. Right Dose 4. Right Route 5. Right Time RIGHTS of Medication Administration 3 Recertification Review Guide, Unit 1

Three Documents Necessary for Safe Medication Administration Licensed Practitioner’s Order Pharmacy Label Medication Administration Record (MAR) 4 Recertification Review Guide, Unit 1

The Rule of Three is: Documents Licensed Practitioner’s Order MAR Pharmacy Label 3 Comparing the licensed practitioner’s order, MAR and the pharmacy label for the five rights three times every time you administer the medication Rights Child Medication Dose Route Time 5 Times every time you administer the medication 3 5 Recertification Review Guide, Unit 1

Roles of LP, Pharmacist, Medication Certified Staff and Nurse Licensed Practitioner: may diagnose and prescribe treatment/medications. May dispense medication. Pharmacist: dispenses medications according to a licensed practitioner’s order. Medication Certified Staff: may administer medications according to a licensed practitioner’s order to children in any DCF licensed or operated child-caring facility or extended day program. Nurse (RN, LPN or APRN): provides ongoing supervision of medication administration program/staff. 6 Recertification Review Guide, Unit 1

Responsibilities of the DCF Medication Administration Staff Always follow DCF Med Admin Procedure Always use the Five Rights and the Rule of Three before medication administration Know the desired effects of a medication and report any side effects Adhere to any precautions Follow instructions from the LP Contact the Chain of Command whenever you have a question or concern 7 Recertification Review Guide, Unit 1

When to Contact the Chain of Command When you have a question about a LP’s order, a pharmacy label or MAR There is change in the condition of a child When to Contact the Chain of Command A child does not receive his medications as ordered Any incident where medication is not properly safeguarded Any time you have a question or concern 8 Recertification Review Guide, Unit 1

Unit 1 Quiz 1. What are the Five Rights of Medication Administration? 2. What are the three documents you must have to assure safe medication administration? 3. True or False: You only need to check the Five Rights and the Rule of Three the first time you give the medication. 9 Recertification Review Guide, Unit 1

Answers to Unit 1 Quiz 1. What are the Five Rights of Medication Administration? The right child, right medication, right dose, right route and right time 2. What are the three documents you must have to assure safe medication administration? Licensed practitioner’s order, pharmacy label, MAR 3. True or False: You only need to check the Five Rights and the Rule of Three the first time you give the medication. False – You need to check the Five Rights and the Rule of Three every time you administer a child’s medication. 10 Recertification Review Guide, Unit 1

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 11 Recertification Review Guide, Unit 2

Unit 2 12 Recertification Review Guide, Unit 2

Define the terms trade name and generic name for medications marketing name for example: Tylenol Generic name: chemical name for example: acetaminophen 13 Recertification Review Guide, Unit 2

Define active ingredients and inactive ingredients chemical that actually causes the medication’s desired effect Inactive ingredient: dyes, water and other additives to form a tablet, add flavor or color 14 Recertification Review Guide, Unit 2

Define controlled medication Controlled medications have the potential to be abused or addictive 15 Recertification Review Guide, Unit 2

Define unlabeled (off-labeled) use of medication Unlabeled/Off-labeled use of a medication is the use of a medication for a purpose that has not been approved of by the FDA 16 Recertification Review Guide, Unit 2

Describe the different routes of administration Oral medication Eye drops and ointments Ear drops Nasal sprays Inhaled medication Topical medication 17 Recertification Review Guide, Unit 2

List the steps of the DCF Medication Administration Procedure Approach the task in a calm manner allowing no distractions Wash hands before and after medication administration Assemble appropriate equipment 18 Recertification Review Guide, Unit 2

List the steps of the DCF Medication Administration Procedure (Cont.) Perform the rule of three: Compare the LP’s order with the pharmacy label Compare the pharmacy label with the MAR Compare the MAR with the LP’s order to see if the five rights match 19 Recertification Review Guide, Unit 2

List the steps of the DCF Medication Administration Procedure (Cont.) Pour the correct dose of medication Identify the correct child Administer the medication utilizing the proper techniques Perform a mouth check Document Return the medication to the locked area and clean up 20 Recertification Review Guide, Unit 2

Unit 2 Quiz 1. True or False: Unlabeled use means the medication is being used for a purpose that has not been approved by the FDA. 2. What is the description of controlled medication? 3. List the steps of the DCF Medication Administration Procedure. 21 Recertification Review Guide, Unit 2

Answers to Unit 2 Quiz 1. True or False: Unlabeled use means the medication is being used for a purpose that has not been approved by the FDA. True – Unlabeled/Off-labeled use of a medication is the use of a medication for a purpose that has not been approved by the FDA. 2. What is the description of controlled medication? Controlled medications have the potential to be abused or addictive 22 Recertification Review Guide, Unit 2

Answers to Unit 2 Quiz (Cont.) List the steps of the DCF Medication Administration Procedure. 1. Approach the task in a calm manner allowing no distractions 2. Wash hands before and after medication administration 3. Assemble appropriate equipment 4. Perform the Rule of Three 5. Pour the correct dose of medication 6. Identify the correct child 7. Administer the medication utilizing the proper techniques 8. Perform a mouth check 9. Document 10. Return the medication to the locked area and clean up 23 Recertification Review Guide, Unit 2

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 24 Recertification Review Guide, Unit 3

Unit 3 25 Recertification Review Guide, Unit 3

Identify what you must know about a medication before you administer it Medication’s name Medication’s use Medication's action Controlled or non-controlled Usual dose Precautions and considerations Side effects Recertification Review Guide, Unit 3

Describe the process that must occur in the body for a medication to have an effect Enter Absorb Distribute Metabolize Eliminate Recertification Review Guide, Unit 3

List and describe the effects a child may have to a medication Individual effect Desired/Therapeutic effect No effect Side effect Allergic effect Recertification Review Guide, Unit 3

Define the term “side effects” and give examples A response to a medication that is not the desired effect; may be mild to severe and includes: nausea headache difficulty sleeping fever muscle twitching and tics Recertification Review Guide, Unit 3

Identify the correct steps to take if a child experiences a side effect Hold the medication Contact Chain of Command Document Recertification Review Guide, Unit 3

Describe anaphylaxis and the appropriate steps to follow Severe potentially fatal allergic reaction CALL 911 (Follow your facility’s Policies and Procedures re: medical emergencies) Recertification Review Guide, Unit 3

List factors that affect a child’s response to medication Age Weight Route of Administration Drug and Food Interactions Size Gender General Health Status Genetics Recertification Review Guide, Unit 3

Define drug to drug interaction The effects of one medication are changed by the presence of another medication. May occur whenever there is more than one medication in the child’s system. Recertification Review Guide, Unit 3

Describe drug to food interaction The presence of food in the stomach affects how medication is absorbed Recertification Review Guide, Unit 3

Factors that affect a child’s compliance with taking medication Taste Smell Color Consistency of the medication Parental approval Recertification Review Guide, Unit 3

Define commonly used medical abbreviations Q Day every day BID twice a day TID three times a day HS at bedtime (Hour of Sleep) Q#H every # hours PRN as needed AC before meals PC after meals Recertification Review Guide, Unit 3

Define commonly used medical abbreviations (Cont.) mg milligrams ml milliliters cc Cubic centimeters Tab tablet Cap capsule tsp teaspoon Tbsp tablespoon NTE Not to Exceed Recertification Review Guide, Unit 3

Define commonly used medical abbreviations (Cont.) PO by mouth OU both eyes NKA No Known Allergies NKDA No Known Drug Allergies SR Sustained Release CR Controlled Release DR Delayed Release XL Extra Long Release Recertification Review Guide, Unit 3

Define commonly used medical abbreviations (Cont.) MDI Metered Dose Inhaler NPO Nothing by mouth c with s without One tsp 5ml or 5 cc One Tbsp 15ml or 15cc or 3 tsp Recertification Review Guide, Unit 3

Unit 3 Quiz 1. Translate: Depakote 250mg PO TID 2. Identify the correct steps to take if a child experiences a side effect 3. Describe the process that must occur in the body for a medication to have an effect Recertification Review Guide, Unit 3

Answers to Unit 3 Quiz 1. Translate: Depakote 250mg PO TID Depakote 250 milligrams, by mouth, three times a day 2. Identify the correct steps to take if a child experiences a side effect Hold the medication Contact Chain of Command Document 3. Describe the process that must occur in the body for a medication to have an effect Enter, Absorb, Distribute, Metabolize, Eliminate Recertification Review Guide, Unit 3

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 42 Recertification Review Guide, Unit 4

Unit 4 43 Recertification Review Guide, Unit 4

Identify the components of a licensed practitioner’s order Five Rights Signature Date (within the last 90 days) Special instructions Recertification Review Guide, Unit 4

LP’s order must be renewed … Every 90 days (per DCF regulations) Recertification Review Guide, Unit 4

Documentation necessary for OTC medication CT statutes and regulations require a LP’s order for any medication to be administered to a child. That includes OTC medications. Orders must include the Five Rights, be dated within the last 90 days and signed by a LP. Recertification Review Guide, Unit 4

Define “standing orders” Standing orders are licensed practitioner’s orders that include PRN OTC medications used to help treat or manage routine, minor childhood illnesses or symptoms Recertification Review Guide, Unit 4

General rules of documentation Use permanent ink – no pencils or erasable pens Write legibly Only approved abbreviations No white-out Do not obliterate a documentation error – draw a single line through the mistake, write your initials and date above it Use full, proper names and titles Do not use one child’s full name in another child’s record The time and date should be noted in all documentation Recertification Review Guide, Unit 4

Documenting Non-controlled medications Every child who is prescribed medication must have his own MAR for each medication he is prescribed Recertification Review Guide, Unit 4

Documenting Controlled Medications When you administer a controlled medication you must document how much of that medication remains All controlled medications must be counted and the count documented at the beginning of each shift or whenever responsibility for the controlled medication is transferred from one staff member to another Recertification Review Guide, Unit 4

Documenting PRN medications The time, dose, reason and outcome for the PRN medication must be documented in an objective manner Recertification Review Guide, Unit 4

Unit 4 Quiz 1. Identify the components of a licensed practitioner’s order 2. Define “standing orders” 3. When should controlled medications be counted? Recertification Review Guide, Unit 4

Answers to Unit 4 Quiz 1. Identify the components of a licensed practitioner’s order Five Rights, Signature, Date (within the last 90 days), Special Instructions 2. Define “standing orders” Standing orders are licensed practitioner’s orders that include PRN OTC medications used to help treat or manage routine, minor childhood illnesses or symptoms 3. When should controlled medications be counted? All controlled medications must be counted and the count documented at the beginning of each shift or whenever responsibility for the controlled medication is transferred from one staff member to another. Recertification Review Guide, Unit 4

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 54 Recertification Review Guide, Unit 5

Unit 5 55 Recertification Review Guide, Unit 5

Household vs. metric terms 5ml = 1 tsp 5cc 15ml = 1 Tbsp 15cc 1ml = 1cc “ml” and “cc” are used interchangeably Recertification Review Guide, Unit 5

Identify how weight is measured for medication administration Milligrams (mg) indicate the weight of the medication in a: Pill Capsule Tablet In a certain amount of liquid Recertification Review Guide, Unit 5

Units for measuring liquid medication Liquid medication must be carefully measured using only standardized or calibrated measuring tools Measured in metric (“ml” or “cc”) or household (tsp or Tbsp) units Recertification Review Guide, Unit 5

Using decimals Write a “0” in front of the decimal point for doses less than 1: Correct: 0.25 mg 0.5 mg Incorrect: .25mg .5mg Do not write a “0” after last number: 1 mg 0.250mg 1.0mg Write the decimal point clearly so that it is clearly visible Recertification Review Guide, Unit 5

Verify that the dose on the LP’s order matches the pharmacy label and the MAR What dose is prescribed? 1 To verify that doses all match you will need to ask: What is the concentration? 2 What dose does the MAR or pharmacy label say to give? 3 Is this a liquid medication? Do I need to convert mm/cc to tsp/Tbsp? 4 Recertification Review Guide, Unit 5

Unit 5 Quiz Practice math for medication administration (click on the link below) Unit 5 Quiz Answers to: Unit 5 Quiz Recertification Review Guide, Unit 5

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 62 Recertification Review Guide, Unit 6

Unit 6 63 Recertification Review Guide, Unit 6

The physical changes in the lungs of people with asthma Bronchial constriction Inflammation Increased mucous Recertification Review Guide, Unit 6

Common asthma triggers are: Smoke Dust Pollen Fumes Strong odors Strong emotions Exercise Cold air Recertification Review Guide, Unit 6

Common symptoms of an asthma attack are: Shortness of breath Cough Wheezing Chest tightness Difficulty breathing Chest and neck retractions Recertification Review Guide, Unit 6

Two general types of asthma medications are: Rescue – inhaled bronchodilator – will quickly open constricted airways during an asthma attack Maintenance or Prevention – inhaled steroids, cromolyn sodium, Leukotriene antagonists, oral steroids – taken daily to keep asthma under control and prevent attacks Recertification Review Guide, Unit 6

Know how to administer an MDI Hold the inhaler upright and shake it Exhale completely Hold the inhaler 1 to 2 inches from the mouth or Place the mouth piece of the inhaler in the mouth forming a tight seal Recertification Review Guide, Unit 6

Know how to administer an MDI (Cont.) Depress the canister once while inhaling for 2–5 seconds Hold breath for up to 10 seconds or as long as possible Wait 1 minute and repeat the entire process if a second puff is ordered Recertification Review Guide, Unit 6

Unit 6 Quiz 1. What are the three physical changes that occur in the body during an asthma attack? 2. True or False: Inhaled bronchodilators (rescue medications) are typically used to treat an asthma attack. 3. True or False: Chest and neck retractions and cough are two symptoms of an asthma attack. Recertification Review Guide, Unit 6

Answers to Unit 6 Quiz 1. 2. 3. Bronchial constriction Inflammation What are the three physical changes that occur in the body during an asthma attack? Bronchial constriction Inflammation Increased mucous 2. True or False: Inhaled bronchodilators (rescue medications) are typically used to treat an asthma attack. True 3. True or False: Chest and neck retractions and cough are two symptoms of an asthma attack. Recertification Review Guide, Unit 6

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 72 Recertification Review Guide, Unit 7

Medications for Medical Conditions Unit 7 73 Recertification Review Guide, Unit 7

1 5 2 3 4 Antibiotics Treat Bacterial Infections Watch for allergies May reduce the effectiveness of birth control medications 5 Finish entire prescription 2 Treat Bacterial Infections Do not give double dose to make up for a missed dose 3 Follow specific instructions about administration with food 4 Recertification Review Guide, Unit 7

Anti-viral medications Treat viral infections Reduces symptoms – will not cure viral infection Must start at the earliest sign of viral infection Recertification Review Guide, Unit 7

Scabicides Treat scabies infestation of the skin Follow orders and directions exactly May cause serious adverse effects if overused Potentially toxic to the Central Nervous System LP’s order required for administration Contact the chain of command if child is re- infected Recertification Review Guide, Unit 7

Pediculocides Treat lice infection Follow orders and directions exactly May cause serious adverse effects if overused Potentially toxic to the Central Nervous System LP’s order required for administration Contact the chain of command if child is re-infected Recertification Review Guide, Unit 7

Antifungal medication Treat fungal infection Treatment may take a long time Keep infected area clean and dry Good hygiene prevents spread of infection Report any side effects to chain of command Recertification Review Guide, Unit 7

Analgesics Relieve pain Frequent, unusual, or pain that interferes with child’s usual activity must be reported to the chain of command Recertification Review Guide, Unit 7

Antipyretics Reduce fever Monitor child’s temperature before and 1 hour after administering antipyretic Fever is a change of condition that must be reported to the chain of command Recertification Review Guide, Unit 7

Expectorants Promote coughing up mucous Report any persistent cough to the child’s physician Increased fluid intake will help to loosen secretions Recertification Review Guide, Unit 7

Antitussives Suppress cough May mask signs of infection such as pneumonia or bronchitis May be ordered at night to quiet a cough that interrupts sleep Narcotic antitussives should be used cautiously with clients who have a history of drug or alcohol abuse Recertification Review Guide, Unit 7

Decongestants Reduce congestion in the sinuses and nasal passages May cause excitability and insomnia Avoid administering at bedtime Recertification Review Guide, Unit 7

Antihistamine Reduce symptoms of allergic reactions May cause drowsiness – use with caution May cause decreased ability to urinate Recertification Review Guide, Unit 7

Cardiovascular medications Affect the heart and circulatory system BP and pulse must be checked routinely Do not stop abruptly Doses should not be missed Unlabeled use: Anxiety and ADHD Recertification Review Guide, Unit 7

Anticonvulsants Reduce or prevent seizures Give consistently on time May require periodic blood work Unlabeled use: mood disorders Recertification Review Guide, Unit 7

Laxatives Promote bowel movements; treat constipation Increased fluids, fiber, and activity may reduce the need for laxative medication Recertification Review Guide, Unit 7

Antacids Control or reduce acid in stomach Check with pharmacist or licensed practitioner before administering at the same time as another medication: may interfere with absorption of other meds Frequent complaints of heartburn or stomach upset should be evaluated by a physician Recertification Review Guide, Unit 7

Birth control / contraceptives Prevent pregnancy Must be administered as ordered for maximum effectiveness Follow LP’s order re: missed doses May be prescribed to regulate menstrual cycle Recertification Review Guide, Unit 7

Unit 7 Quiz (click on the link below and print) Medications to treat medical conditions Answers to: Medications to treat medical conditions Recertification Review Guide, Unit 7

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 91 Recertification Review Guide, Unit 8

Medications for Psychiatric Conditions Unit 8 92 Recertification Review Guide, Unit 8

Antipsychotic Treat psychotic conditions/symptoms For suspected side effects: hold the medication, contact the chain of command, and document Difficulty swallowing, drooling, facial tics, twitches, and change in gate may be the first sign of a serious side effect Fever is also a possible side effect Call 911 if appropriate Certified staff must directly consult with a LP before administering any psychotropic PRN Recertification Review Guide, Unit 8

Anticholinergic Treat muscle movement disorders associated with antipsychotic meds Adequate fluid intake is essential, especially in hot weather Contact the chain of command if symptoms don’t improve/get worse Recertification Review Guide, Unit 8

Antidepressant Treat depression Watch for signs of worsening depression or thoughts of suicide Recertification Review Guide, Unit 8

Mood stabilizer – Lithium Treats mood disorders Encourage adequate fluid intake Routine blood test may be ordered Ibuprofen should not be administered to patients treated with Lithium Recertification Review Guide, Unit 8

Mood stabilizer – Anticonvulsant “Off-labeled” use to treat mood disorders Must be given on time as ordered Take as prescribed Routine blood test may be ordered Recertification Review Guide, Unit 8

Anti-anxiety Treats anxiety, tension and nervousness May be controlled medication Med certified staff must directly consult with a LP before administering a PRN anti-anxiety Overdose can be fatal Recertification Review Guide, Unit 8

Stimulants – ADHD medications Treat attention deficit hyperactivity disorder Usually not administered late in the day Monitor weight and food intake May be controlled medication May delay growth Recertification Review Guide, Unit 8

Hypnotics – sleep medication Promotes sleep Offer non-medication interventions first Report insomnia or poor sleeping to the LP Recertification Review Guide, Unit 8

Serious side effects (adverse reactions) Some serious side effects are potentially life-threatening or may become permanent. If you notice or the child complains of any of these side effects, hold the medication, contact your chain of command and document. Recertification Review Guide, Unit 8

Serious side effects (adverse reactions) (Cont.) Fever or complaint of sore throat Drooling or difficulty swallowing Changes in gait (walking) Confusion or increased sedation Muscle stiffness, esp. in the neck or mouth area Eyes rolling back involuntarily Complaint of stomach pain If you notice or the child complains of any of these side effects:  hold the medication  contact your chain of command &  document Recertification Review Guide, Unit 8

Other side effects (Must report to chain of command) Sensitivity to sun Apply sunscreen Sensitivity to heat Encourage increased fluid intake Constipation Encourage fluids, fiber, exercise Appetite changes Monitor food intake, encourage healthy food choices Weight gain Follow nutritional recommendations Sleep disturbances Allow for relaxing bedtime routine Dry mouth Encourage fluids to relieve dry mouth Recertification Review Guide, Unit 8

Unit 8 Quiz (click on the link below and print) Medications to treat psychiatric conditions Answers to: Medications to treat psychiatric conditions Recertification Review Guide, Unit 8

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 105 Recertification Review Guide, Unit 9

Medication Administration Techniques Unit 9 106 Recertification Review Guide, Unit 9

General Information Follow the steps of the Medication Administration Procedure every time you administer any medication to any child. You must perform the Five Rights and the Rule of Three making sure that the five rights match on all three documents Thoroughly wash your hands before and after you administer medication Use Standard Precautions whenever necessary 107 Recertification Review Guide, Unit 9

Standard Precautions (aka: Universal Precautions) A set of practices that prevent the spread of infection including the use of personal protective equipment such as gloves, gowns, masks and goggles Frequent hand washing is the best way to prevent the spread of infection 108 Recertification Review Guide, Unit 9

Forms of oral medication Liquid medications Tablets Capsules Gel caps Chewable tablets Quick dissolving tablets 109 Recertification Review Guide, Unit 9

Forms of oral medication (Cont.) Enteric coated tablets have a special coating so that the tablet will not be absorbed until it reaches the small intestine Sustained Release tablets designed to be absorbed over a long period of time so that the child may not need to take the medication several times daily XR, XL, CR, or SR after the medication name indicate a sustained release medication 110 Recertification Review Guide, Unit 9

Scored tablets Scored tablets – a scored tablet has a groove(s) dividing the pill in equal parts (half, third, etc.) A groove across the center of the tablet indicates that the tablet may be cut exactly in half 111 Recertification Review Guide, Unit 9

General guidelines for administering oral medication Ask the child to remove gum, candy or food from his mouth before you administer medication to him Always give oral medication with fluids; water is usually the best choice A mouth check should be done to make sure that the child swallowed the medications If you must directly touch a tablet, wear gloves 112 Recertification Review Guide, Unit 9

Forms of oral medications that should not be crushed Enteric coated tablets Sustained release tablet Gel caps Other liquid filled capsules 113 Recertification Review Guide, Unit 9

How to crush a tablet Use a clean, dry mortar and pestle, a pill crusher or place the tablet between the bowls of two spoons Wrap the tablet in waxed paper or in a paper med cup to prevent the crushed medication from spilling Mix the crushed medication with a small amount of food (applesauce, yogurt, pudding, etc.) Use no more than a tablespoon or two to mix with the medication Offer glass of water after administering the medication 114 Recertification Review Guide, Unit 9

Liquids Liquid medications are often prescribed for young children or for children who cannot swallow pills Any dose of medication that is less than 5cc/ml must be measured in an oral syringe or calibrated dropper 115 Recertification Review Guide, Unit 9

Measuring liquid medications The medication cup must be placed on a flat surface at eye level While pouring medication from the bottle hold the label facing upward to avoid spilling the medication onto the label 116 Recertification Review Guide, Unit 9

Technique for administering oral medications Follow the medication administration procedure Pour the accurate dose: place the prescribed number of pills or pour the correct amount of liquid into a medication cup Administer the medication to the client with water or juice After administering the medication, perform a mouth check to ensure that the child swallowed the medication 117 Recertification Review Guide, Unit 9

Eye medications Wash hands and wear gloves when administering eye medication Ask the child the following questions: Does the eye feel worse? Does the eye hurt? If the child answers yes to either of these questions: Hold the medication Contact the chain of command Document and follow instructions 118 Recertification Review Guide, Unit 9

Eye medications (Cont.) After administering an eye medication, have the child remain in a safe environment until medication is completely absorbed and the client’s vision is cleared Never bandage an eye unless there is a specific order to do so 119 Recertification Review Guide, Unit 9

How to clean an infected eye Wash hands and wear gloves Moisten a washcloth, gauze, or cotton ball with warm water Wipe the infected eye gently from the inner to outer corner To prevent spreading the infection, never use the same area of the washcloth for more than one wipe AND use separate washcloth for each eye Remove your gloves and wash hands when the eye is clean Put on clean gloves before handling the medication 120 Recertification Review Guide, Unit 9

Technique for administering eye ointment Follow the DCF Med Admin procedure Prepare medication correctly: place the cover of the medication on its side to avoid contamination. Warm the medication to room temperature. Clean the child’s eye if necessary Wear gloves. Squeeze a small amount of medication out of the tube onto a tissue before administering Have the child tilt his head slightly backward, resting it against a hard surface if possible. Ask the child to look up and away 121 Recertification Review Guide, Unit 9

Technique for administering eye ointment (Cont.) Do not touch the eye with the medication container Gently pull down the lower eyelid using the side of a finger. Beginning at the inner corner of the eye, place a thin ribbon of medication into the lower lid Instruct the child to close his eyes for 1-2 minutes so the medication may be absorbed Gently wipe away any excess medication that may have dripped out of the eye. 122 Recertification Review Guide, Unit 9

Technique for administering eye drops Follow the DCF Med Admin procedure Have tissues available; place the cover of the medication on its side to avoid contamination. Warm the medication to room temperature. Clean the child’s eye if necessary 123 Recertification Review Guide, Unit 9

Technique for administering eye drops Wear gloves. Have the child tilt his head slightly backward, resting against a hard surface if possible. Ask the child to look up and away. Do not touch the medication dropper to the eye or eyelashes Gently pull down the lower eyelid using the side of your finger. Form a small pocket and place the prescribed number of drops into pocket. 124 Recertification Review Guide, Unit 9

Technique for administering ear drops Follow the DCF Med Admin procedure Wash hands and wear gloves Remove the cover and place on its side to avoid contamination; warm the medication to room temperature Position the child with the ear to be treated upward 125 Recertification Review Guide, Unit 9

Technique for administering ear drops (Cont.) Straighten the ear canal by the following methods: 3 years old or younger: gently pull ear lobe down and back Over 3 years old: gently pull upper part of the ear up and back Place the prescribed number of drops against the side of the ear near the ear canal opening to allow the medication to roll in Have the child remain with affected ear upward for 3-5 minutes 126 Recertification Review Guide, Unit 9

Technique for administering nasal spray Follow the DCF Med Admin procedure Have the child gently blow his nose. Have tissues available. Wear gloves. While plugging one nostril, place the tip of the sprayer 1cm (3/8 inch) into the other nostril Ask the child to breathe in through his nose as the spray is administered Have the child exhale through his mouth after the spray is administered, repeat the procedure if prescribed Discourage him from blowing his nose for 5 minutes 127 Recertification Review Guide, Unit 9

Types of inhaler devices Metered Dose Inhaler (MDI) use chemical propellants to push out the medication from the inhaler. A spacer or aero-chamber may be prescribed to use with the MDI to make proper use easier and the medication more effective. Dry powder or Rotary Inhalers (Turbuhaler, Discus) dry powder inhalers are activated through breathing; they release the medication through rapid inhalation instead of using propellants Nebulizers convert liquid medication into a fine mist and deliver the mist through a face mask or mouth piece that is connected to the nebulizer machine with plastic tubing. Your program nurse should teach you the correct way to use a particular child’s nebulizer before you use it. 128 Recertification Review Guide, Unit 9

Administering topical medication Allow for client privacy Clean the skin if necessary per LP’s directions Wear disposable gloves The skin should be dry prior to applying topical medication Apply enough medication to cover the area to be treated, unless otherwise directed 129 Recertification Review Guide, Unit 9

Administering topical medication Except for powders, never apply a topical medication directly from the container onto the skin. Place a small amount of medication onto clean gauze then apply to the skin. This prevents contamination of the medication container. Observe the client for any rashes that are new or that get worse 130 Recertification Review Guide, Unit 9

The correct method for applying and removing transdermal medication patches Gloves should be worn to apply or remove transdermal patches The patch should be applied to clean, intact, dry skin that is not infected, scarred, callused or tattooed Wash the skin with soap and water both where the new patch will be placed and where the old patch was removed Remove the old patch before applying the new one. Check the skin under the patch for redness or rash 131 Recertification Review Guide, Unit 9

The correct method for applying and removing transdermal medication patches (Cont.) Change application sites to avoid skin irritation Peel backing off the patch, press onto the skin and apply pressure to assure that it sticks to the skin Document in the child’s record the site where you applied the patch (for example: 6/18/2010, upper right arm) Read package instructions for any further information 132 Recertification Review Guide, Unit 9

The role of DCF Med Admin certified staff in administering rectal and vaginal medication Do not directly administer to any child DCF Med Admin certified personnel are not trained nor certified to administer any rectal or vaginal medications The children who have these types of medication ordered must be able to self administer the medication or have a nurse available to administer the medication 133 Recertification Review Guide, Unit 9

The role of DCF Med Admin certified staff in administering rectal and vaginal medication (Cont.) Medication certified staff may provide the child with instructions on self administration. This information may be found on the package information. Review of instructions may be done by a staff member of the same sex as the child and in the presence of another staff member as witness. This review should be documented. 134 Recertification Review Guide, Unit 9

Unit 9 Quiz 1. True or False: After administering oral medication you must always perform a mouth check. 2. True or False: Hand washing is the most effective way of preventing the spread of infection. 3. True or False: To administer ear drops to a 2year old child you straighten the ear canal by gently pulling the ear lobe down and back. 135 Recertification Review Guide, Unit 9

Answers to Unit 9 Quiz 1. 2. 3. True 136 True or False: After administering oral medication you must always perform a mouth check. True 2. True or False: Hand washing is the most effective way of preventing the spread of infection. 3. True or False: To administer ear drops to a 2year old child you straighten the ear canal by gently pulling the ear lobe down and back. 136 Recertification Review Guide, Unit 9

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 137 Recertification Review Guide, Unit 10

Unit 10 138 Recertification Review Guide, Unit 10

Regulations re: safeguarding the medications and the medication storage keys The medication storage keys must be carried by the medication certified staff person or licensed medical person on duty 139 Recertification Review Guide, Unit 10

Storage requirement for non-controlled medications Non-controlled medications must be stored in a locked, immobile container that is accessible only to med certified or licensed medical staff 140 Recertification Review Guide, Unit 10

Storage requirement for controlled medications Controlled medications must be stored in a locked, immobile container that is inside another locked, immobile container accessible only to medication certified staff or licensed medical staff 141 Recertification Review Guide, Unit 10

Controlled medication count Must be performed at the change of shift or whenever the responsibility for the medications changes 142 Recertification Review Guide, Unit 10

Incorrect Controlled medication count 1 If the controlled medication count is wrong (there is a discrepancy) Contact your chain of command 2 Complete an incident report 3 Forward the incident report to the Dept. of Consumer Protection Drug Control Division and to DCF 143 Recertification Review Guide, Unit 10

Refrigerated medications The medication refrigerator must be kept at 36° - 46°F. Medications stored in the refrigerator must be accessible only to med certified or licensed medical staff 144 Recertification Review Guide, Unit 10

Storage of external, internal and emergency medications Internal medications and external (topical) medications must be stored separately from each other Emergency medications (Epi-pens and rescue asthma inhalers) must be stored where all trained staff may have easy access to them. They should not be locked with other medications. 145 Recertification Review Guide, Unit 10

Guidelines for destroying non-controlled and controlled medications 2 DCF med certified staff may destroy non-controlled medications Contact Drug Control Division of Consumer Protection if controlled medications need to be destroyed Follow your facility’s policy and procedure for destroying medications 146 Recertification Review Guide, Unit 10

Unit 10 Quiz 1. Who may legally dispense medication? 2. licensed practitioners, RN’s, med admin certified staff b) pharmacists, licensed practitioners, RN’s c) pharmacists, licensed practitioners d) pharmacists, med admin certified staff 2. True or False: The controlled medication count must be performed at the change of shift or whenever the responsibility for the medications changes 3. True or False: 2 DCF med certified staff may destroy non-controlled medications 147 Recertification Review Guide, Unit 10

Answers to Unit 10 Quiz 1. Who may legally dispense medication? c) pharmacists, licensed practitioners 2. True or False: The controlled medication count must be performed at the change of shift or whenever the responsibility for the medications changes True 3. True or False: 2 DCF med certified staff may destroy non-controlled medications 148 Recertification Review Guide, Unit 10

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 149 Recertification Review Guide, Unit 11

Unit 11 150 Recertification Review Guide, Unit 11

Types of medication errors Error in communication Error in documentation Error in storage and control Error in ordering or dispensing medications Error in administration 151 Recertification Review Guide, Unit 11

Steps to take if an error occurs Check on the child and follow your facility’s policy and procedures Inform your supervisor and chain of command and follow any directions Document the error; use objective description 152 Recertification Review Guide, Unit 11

Documenting a medication error Note the child’s name, medication, the date and time, staff involved Write an objective description of the error: what happened, action taken, and status of the child Documentation must be completed before the end of the shift by the person who made or discover the error Follow facility policy and procedure on submitting required documentation to DCF Risk Management 153 Recertification Review Guide, Unit 11

Reporting medication error that leads to the child needing medical attention In addition to the documentation already discussed Notify child’s guardian, social worker Call DCF Careline if after hours Send copy of incident report to the DCF Medical Director within one business day 154 Recertification Review Guide, Unit 11

When to contact the Dept. of Consumer Protection Drug Control Division When controlled medications appear to be missing If controlled medications need to be destroyed 155 Recertification Review Guide, Unit 11

Unit 11 Quiz 1. True or False: Documenting a medication error must be completed before the end of the shift by the person who made or discover the error 2. Who must be contacted when controlled medication appears to be missing or needs to be destroyed? 156 Recertification Review Guide, Unit 11

Answers to Unit 11 Quiz 1. 2. True True or False: Documenting a medication error must be completed before the end of the shift by the person who made or discover the error True 2. Who must be contacted when controlled medication appears to be missing or needs to be destroyed? The Department of Consumer Protection, Drug Control Division 157 Recertification Review Guide, Unit 11

Recertification Review Guide STATE OF CONNECTICUT Department of Children and Families Medication Administration Certification Training Based on the Basic Medication Administration Curriculum 2010 Edition Recertification Review Guide 158 Recertification Review Guide, Unit 12

Unit 12 159 Recertification Review Guide, Unit 12

A LP’s order should be questioned when: You do not understand the order Unusual quantities or doses are prescribed The medication is ordered to be given at unusual times 160 Recertification Review Guide, Unit 12

Medication should not be administered when: You have a question about the order A child has a sudden change in physical or mental state The pharmacy label is illegible The child refuses to take medication Any of the five rights is violated If there is no LP’s order or you cannot perform the Rule of Three If storage practices are questionable Medication looks unfamiliar to you or the child 161 Recertification Review Guide, Unit 12

Steps to take when questioning an order or a medication Do not administer the medication (hold the medication) Contact the chain of command and follow directions Document contacts and directions Follow up on directions 162 Recertification Review Guide, Unit 12

Why borrowing medication is not permitted Med admin certification permits you to administer medications only when the Five Rights match on the order, pharmacy label and MAR. If you are borrowing on child’s medication for another child, the Five Rights will not match on all three documents. 163 Recertification Review Guide, Unit 12

Criteria for administering medication at the right time Medications may be administered one hour before until one hour after the scheduled administration time unless the LP has ordered the medication to be given at a specific time. 164 Recertification Review Guide, Unit 12

Dispensing The act of placing a medication into a container, labeling the container and giving the container for someone else to administer Medication certified staff may not dispense Only LP’s and pharmacists may dispense medications 165 Recertification Review Guide, Unit 12

Unit 12 Quiz 1. When would you not administer a medication? a) if there is no change in status of the client b) if the client refuses c) if the medication is stored in a locked and immobile container d) if the licensed practitioner's order is present 166 Recertification Review Guide, Unit 12

Answers to Unit 12 Quiz 1. b) if the client refuses 167 When would you not administer a medication? b) if the client refuses 167 Recertification Review Guide, Unit 12