1. Medication Administration Class

2. Format for Class  Medicines  Giving them  Proving you gave them  Doctors, Nurses and Medicines  Core Competencies  Skills  And (Ahhhh) THE TEST

3. Protocol for Passing Medications Medication Class Pass test with 75% Medication Assignment Shadowing

4. Fatal Four Aspiration Constipation Dehydration Seizures Why do we care?

5. Nursing Outcomes at CCS Aspiration Constipation Dehydration Seizures Skin Care Preventable ER visits

6. Six Rights  Right Medication  Right Dose  Right manner/route  Right time  Right person  Right documentation

7. Right Medication A drug order is written for specific medication Double check that you obtained the right drug Your responsibility: Obtain Prepare Administer the correct medication Check three times the medication container to the MAR Right medication

8. Right Dose Your responsibility it to confirm what dose within the dose range was ordered Make sure that the dose of the medication you are giving matches the MAR order Never assume what dose of drug will be administered You cannot give a different dosage than what is ordered Right dose

9. Right Manner or Route Most drugs have different routes for different needs Never assume what form of the drug will be administered Always confirm the right route with the MAR order Most used: PO = oral SL = sublingual Rectal = by rectum Topical = on skin Right Manner/ Route

10. Right Time Administering doses Too close together or To far apart alter the therapeutic effect of the medication Double check with MAR when to administer med The drug’s Purpose and Pharmacokinetics Determine how often the medication is administered Your responsibility is to administer: Stat meds ASAP Single ordered medications at time ordered Standing ordered meds on time PRN medications when needed

11. Right Person A drug order is written for a specific resident Double check that you have the right resident Your responsibility is to: Obtain Prepare, and Administer the medication to the correct person

12. Right Documentation Right documentation includes correct drug order and a signature Using the correct form to record the administration of the med assures that the resident does not receive another dose, preventing overdosing of the resident Your responsibility is to document the administration of the med immediately.

13. Five Always Physician's order for every med/treatment Wash your hands Pour medication into cup Identify and stay with resident until medication is swallowed Keep med storage area locked, clean and orderly

14. Five Nevers Never leave meds with client or out Never give a med prescribed for one client to another Never give meds prepared by another person. Never use a med that is outdated or from an illegible or unlabeled container Never give meds if you have questions.

15. Five Musts Have correct MAR Read label and compare it with MAR Good position Document Understand the medicine

16. Storage of Medications Locked Clean Refrigeration Separate orals from topicals Separate meds for different clients.

17. Preparing Medications Changing the form Crushing meds Measuring liquids

18. Pharmacy Use Olson’s Pharmacy Not all clients use just one pharmacy Important to know how each house connects with Olson’s Use them as a resource

19. Medication Administration Record Forever after known to you as MAR Preparation of MAR Transcription of orders Signing back Time limited medications Discontinuing medications

20. Documentation If it isn’t written down, it did not happen.

21. Charting Codes Charting CodeWhen do you use it YR (your initial) When you sign for a medication When the medication is not given WWhen the client is at work YR

22. Practice 1.You give a medication. 2.Your HM tells you that Jessie needs to have a Dilantin blood test and not to give the 8 AM Dilantin. 3.Adam went home for the weekend. 4.Johnny spit out the medicine you gave him.

23. PRN Medications  Establish the need for the medication  Ensure there is a current order  Administer the medication  Sign the back of the MAR  Follow up within two hours

24. Practice on PRN Medications Johnny complains that his head hurts. Ronny has a cough Mark has a groin rash Susie has not pooped in two days.

25. Controlled Substances Definition Why they are handled differently Examples Special Tracking and charting

26. Abbreviations

27. Charting You are telling a story with your charting Each house will want you to chart in their way

28. Self Administrated Meds Self determination is determined through ISP process At present we have no residents who self-administer Please see packet for process

29. Different kinds of medications Via the mouth! Topicals Sublinguals Eye drops/ointments Ear drops Rectal meds Vaginal meds Nasal meds

30. PO Medications Do not crush unless you have an order Slower to be absorbed Taste is important Food can impact the medicine Take with full glass of water Do not mix in hot drinks Shake all liquids before pouring out

31. Topicals Usually used for skin conditions Always use gloves Check expiration dates Privacy Be aware of residents tendency to put body parts in their mouths Make sure you note effectiveness

32. Sublinguals Under the tongue Do not offer water right away Use gloves Stay with resident until you are sure the medication has been absorbed

33. Eye Drops/Ointments Used to treat infections, inflammation, irritation and lack of moisture Wash hands Use Gloves Explain to client Drops before Ointments

34. Ear Drops Warm ear drops to body temperature Wash hands Wear gloves Have resident lie on side opposite to the ear being treated Have them stay that way 5-10 minutes

35. Rectal Medications Used to stimulate bowel movements, relieve pain, relieve vomiting, reduce fevers, stop seizures Wash hands Wear gloves Privacy!!!! Usually kept in refrigerator Documentation of this one is important

36. Vaginal Medications Determine if administration will involve 1 or 2 staff Wash hands Wear gloves Explain procedure Privacy!!! Best time to insert is after shower or bath

37. Nasal Medications Wash hands Wear gloves Explain procedure Spray vs. drops Work with client

38. Medication Errors Definition of a medication error Examples –Forgetting to sign –Forgetting a follow up –Not giving a suppository when due What happens Intent

39. Where is the error?

40. Residents, Living and Meds Our residents have lives Some work or have lives outside our homes They need their medication Communication is the key

41. Work site responsibilities Work site needs a copy of doctor’s order Administered by designated staff person Same rules apply: i.e. MAR, 5 rights

42. Home responsibilities Provide work with necessary information Inform worksite of any changes What is the abbreviation for the MAR at home when a resident is at work?

43. When a client goes home Pills in envelopes – one type of medication to an envelope Whole bottles go home Document on MAR Never take medicine back

44. Hospitalized Residents DO NOT TAKE MEDICINES TO HOSPITAL What is the appropriate documentation?

45. Disposal of Non-controlled Medications “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit. Documentation of this! Any two staff can do this

46. Disposal of controlled medications “Medication that is outdated, recalled, or unused shall either be disposed of in a manner that assures that the medication cannot be retrieved or it will be returned to the providing pharmacy for client credit.” Documentation! Of the two staff, one must be an LPN or RN

47. Disposal Documentation Date Client’s name Name of medication and dosage Amount of medication disposed Reason for disposal Method of disposal Two signatures

48. Practice

49. What is a medication “Medication means any drug, chemical, compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.” Any medication for our clients must be prescribed by a MD

50. Adverse reaction Allergy Side effects Your part

51. Kinds of medications Anticonvulsants Antipsychotics Antibiotics Antidepressants Multivitamin/Minerals/Dietary Supplements Antidiabetic Topicals Analgesics Laxatives

52. Timing of Medications Know when to give medicines to gain most benefit No laxatives within 1 hr of any other medication Iron should not be taken with milk GERD meds – ½ hr before meal Use your drug guide As the doctor

53. Nurses at CCS Nurse patient relationships When to call Protocol for paging

54. Doctors and Medicines They have the degree They also do the prescribing They prescribe based on information we provide We know the resident better than they do It is in the resident’s best interest to work closely and respectfully with the physician

55. Doctors Visit Who decides How to prepare What to do afterwards

56. A prescription Written by a doctor Parts of a prescription –Client name – first and last –Name of drug –Dosage of drug –How frequent to take it and how long –What route

57. Telephone orders Who can take them –Nurses – LPNs or RNs –House Managers –Assistant House Managers Getting them on the MAR

58. Rights regarding medications Right to: –know what they are getting –have an explanation –refuse or consent –confidentiality and privacy –appropriate services

59. Medication Resources Policies Drug Books Drug information sheets Pharmacy

60. Handwashing List times to wash hands Use plenty of soap Lots of friction Dry hands with paper towel Turn off faucet with paper towel

61. Blood pressure Why do you have a blood pressure What does it represent What is normal How to take it What to do if it is abnormal

62. Practice

63. Respiration Definition How to count What is normal What to do if it is abnormal.

64. Practice

65. Pulse A pulse is the throbbing of a vessel in response to the heart beating. What is normal How to count What to do if it is abnormal

66. Practice

67. Temperature Just as a motor is warm from working, our body is warm from its metabolism. Normal Temperature – USUALLY 98.6º orally – may be different for different residents A fever is an elevation of the body temperature above normal Differences between oral, axillary, and rectal When should you be concerned?

68. Practice

69. Pain Defined by the resident Will be manifested differently by different residents Can lead to other symptoms/behaviors which are not desirable What to do first if you suspect someone is in pain When should you be concerned