1. Company LOGO Medication Administration Program Residential Program Medication System Overview Spring 2015

2. Objectives  To become familiar with a medication system  Technical Assistance Tool sections  To know how to access MAP resources  Required  Informational  Training

3. MAP Monitoring Tool  Tech Assist Tool  Evaluates a medication system  Sections within the tool  Correspond with MAP Policies

4. MAP Technical Assistance Tool Provider: Address: DPH MCSR: Contact(s): Date of Visit: MAP Coordinator/Reviewer: A. HEALTH CARE PROVIDER (HCP) ORDERS & TRANSCRIPTIONS (SECTIONS 13 & 06) YES NO COMMENTS 1. There is a HCP order for all prescription meds, OTCs and herbal supplements or products 2. HCP orders are valid with HCP signature on the same page as orders and dated within 1 year 3. All HCP orders (including new orders and telephone orders) are posted and verified (includes signature, date and time) below HCP signature 4. Changes in medication orders are handled as new HCP orders 5. Staff are not using outdated HCP orders which have been superseded by newer orders or superseded by hospital discharge orders 6. On HCP order forms listing multiple meds, after med(s) are DC’d; staff indicate in the margin - DC, date, initials and see new order, if applicable 7. PRN orders have the specific reason for use and instructions (including hours apart from any regularly scheduled doses ordered) and guidelines when to notify HCP, if applicable. 8. Prescriptions are not substituted for HCP orders 9. HCP orders, pharmacy labels and medication sheets agree 10. HCP orders are correctly transcribed on the medication sheets 11. Telephone orders for med changes are documented on a HCP telephone order form and cosigned by HCP within 72 hours 12. Monthly med sheet accuracy check by 2 Certified and/or licensed staff 13. There is an internal MAP monitoring system B. VITAL SIGNS (SECTIONS 03 & 08) YES NO COMMENTS 1. Each HCP is consulted to determine if vital signs are required for medication administration

5. MAP Resource

6. mass.gov/dph/map

7. MAP Resource 2

8. Health Care Provider (HCP) Orders  Health Care Provider Orders  Telephone/Fax Orders  Hospital Discharge Orders  PRN Orders MAP Policy Sections 06 & 13 Tech Assist Tool Section A

9. Telephone/Fax Order

10. Hospital Discharge Order

11. MAP Resource 3

12. mass.gov/dph/map 2

13. Transcriptions  Transcriptions Agree with HCP Orders and Pharmacy Labels  Monthly Med Sheet accuracy check  MAP Monitoring System MAP Policy Section 13 Tech Assist Tool Section A

14. Vital Signs  HCP is Consulted  If required, HCP order includes  Specific written parameters  What to do if outside parameters  Documentation  HCP Notification  Staff Training & Competency  At Site and Provider main office MAP Policy Sections 03 & 08 Tech Assist Tool Section B

15. Sample Med Sheet

16. Sample Progress Note DateTimeMedicationReasonResponseSignature 12/5/yr9:30a Notified Dr. Jones that Digoxin was held for the second day in a row. Pulse was 54 yesterday and 52 this morning. Dr. Jones said to continue with the med as ordered. He said if the pulse is less than 56 tomorrow morning to call back. He may change the dose at that time. Don Stevens

17. Medication Documentation  Medication Sheets  Organized  Boxes initialed that meds are given  No blank spaces  Corresponding signature of staff MAP Policy Sections 06; 08 & 13 Tech Assist Tool Section C

18. Sample Med Sheet 2

19. Medication Documentation 2  Progress Note  Examples of when to use  Med is not given as ordered  PRN med given  Leave of absence  Refusal  Held

20. Medication Documentation 3  Allergies  Data  PRN bowel meds  PRN seizure meds  Seizure record

21. Staff Certification  On Site  Current  All Staff Administering Meds  Regular  Relief  Acceptable Proof  Master list  MAP Certification expiration dates  Certification letter  www.hdmaster.com MAP Policy Section 02 Tech Assist Tool Section D

22. Certification Letter

23. www.hdmaster.com

24. Ancillary Practices  Blood Glucose Testing  Certified Staff training  Documentation is on site  HCP Order Requirements  Upper/lower parameters  Steps to take when outside parameters MAP Policy 08 Tech Assist Tool Section E

25. CLIA Waiver  Required if monitoring  Blood Glucose  Urine [dipstick]  Ketones, glucose, blood, etc.  Pregnancy MAP Policy 08 & 17 Tech Assist Tool Section E

26. mass.gov/dph/map 3

27. mass.gov/dph/map 4

28. mass.gov/dph/clp

29. CLIA Waiver 2  Required if monitoring  PT/INR  Licensed staff MAP Policy 08 & 17 Tech Assist Tool Section E

30. High Alert Medication  Warfarin sodium  Clozapine  Buprenorphine/naloxone MAP Policy Section 08 Tech Assist Tool Section E

31. mass.gov/dph/map 5

32. Training Resource

33. Training Resource 2

34. Ancillary Practices 2  G/J Tube med administration  Certified Staff training  Documentation is on site  Training is Individual specific MAP Policy Section 14 Tech Assist Tool Section E

35. Ancillary Practices 3  Injectable Epinephrine  Certified Staff training  Documentation is on site  Training is Individual specific MAP Policy Section 14 Tech Assist Tool Section E

36. Insulin  Administered only by licensed staff  Unless Individual is self-administering  Defined in MAP policy Section 07  “Self-injecting” does not automatically mean self-administering MAP Policy Section 07; 14-1

37. Sample Med Sheet 3

38. Insulin 2  MAP Certified Staff may NOT  Administer Insulin  Dial a dose on an Insulin pen  Double check  A dose dialed by an Individual  The amount of insulin drawn up into a syringe by an Individual

39. “Sharps” Disposal  Disposal  Needle  Syringe  Lancet

40. Ancillary Practices 4  Oxygen Therapy  All methods of delivery including  Oxygen cylinders  Oxygen concentrators  MAP policies apply  Oxygen training guidelines MAP Policy 08-4

41. Countable Substance Packaging  Schedule II-V meds must be  Received from pharmacy  In tamper resistant packaging  Blister pack  OPUS  Opti-Pak MAP Policy Section 10 Tech Assist Tool Section F

42. OPUS Medication System

43. Countable Substance Packaging 2  Schedule II-V meds must be  Received from pharmacy  In tamper resistant packaging

44. Schedule VI  DPH recommends  Two Schedule VI meds  Add to count  Fioricet  Gabapentin (Neurontin) MAP Policy Section 10 Tech Assist Tool Section F

45. Blister Pack Monitoring  Tracking method to determine meds are given as prescribed  Not required  Staff  Initial  Date  Time  Backside of package

46. Blister Pack Monitoring 2

47. Countable Substance Documentation  Count Book  Index  Complete  Accurate  Count Sheets  Countables subtracted as removed  Entries not squeezed in between lines  Shift Count Sheets  Reflect meds are counted  Each time key changes hands MAP Policy Section 10 Tech Assist Tool Section G

48. Countable Substance Documentation 2  Signature Requirements  Two signatures when  Beginning a new count sheet  Adding a refill onto a count sheet  Transferring from  Bottom of old page/top of new  An old count book to a new count book  Disposal MAP Policy Section 10 Tech Assist Tool Section G

49. mass.gov/dph/map 6

50. MAP Resource 4

51. Drug Loss (Schedules II-VI)  Include  All prescription meds  Written prescriptions  Reported to DPH  First business day after discovery  Drug Incident Report form required MAP Policy Section 10 Tech Assist Tool Section G

52. mass.gov/dph/dcp

53. mass.gov/dph/map 7

54. MAP Resource 5

55. Self-Administration  Achieved only when  Medication is under complete control of individual  With no more than minimal assistance from staff MAP Policy Section 07 Tech Assist Tool Section H

56. Transitioning to Self-Administering  Self-administering assessment  ISP reflects status  Pill organizer preparation  Only by  Pharmacist  Individual  Documentation MAP Policy Section 07 Tech Assist Tool Section H

57. mass.gov/dph/map 8

58. Off-Site Medication Administration  Preparation  Documentation  Med sheet  Acceptable Codes  DP-day program  W-work  H-hospital, skilled nursing facility, rehabilitation center  S-school  Med-Release document  Signatures  Releasing/Accepting MAP Policy Section 11 Tech Assist Tool Section I

59. Leave of Absence  Preparation  Documentation  Med sheet  Acceptable code  LOA-leave of absence  Med progress note  LOA form  Signatures  Releasing/Accepting MAP Policy Section 11 Tech Assist Tool Section I

60. Leave of Absence 2  Certified staff may prepare if  Unexpected  Pharmacy is unable  LOA is less than 72hrs MAP Policy Section 11 Tech Assist Tool Section I

61. mass.gov/dph/map 9

62. MAP Resource 6

63. Medication Ordering/Receiving  Prescription Deliveries  Tracking  Pharmacy Receipts  Maintained for 90 days MAP Policy Section 10 Tech Assist Tool Section J

64. Cleanliness and Security  Contains only med administration supplies  Internal/External separated  No more than 37 day supply of prescription meds  Unless prescription plan requires otherwise  Documentation  Locked  Countable meds are double locked MAP Policy Section 10 Tech Assist Tool Section K

65. Medication Disposal  “Expired” or “discontinued”  Disposal completed with  2 Certified staff present  1 must be a Supervisor MAP Policy Section 10 Tech Assist Tool Section L

66. Medication Disposal 2  “Dropped” or “refused”  Disposal is with 2 MAP Certified staff present  If unavailable, a Supervisor is not required to be present  Unless your agency requires it MAP Policy Section 10 Tech Assist Tool Section L

67. DPH Disposal Form

68. mass.gov/dph/map 10

69. MAP Resource 7

70. Policies & Resources  Must be on site  MAP policy manual  Med Info sheets  Drug reference  MAP training manual  Provider policies MAP Policy Sections 01; 06; 08; 10 & 11 Tech Assist Tool Section M & N

71. Policies & Resources 2

72. Staff Education  Training Binder  Ongoing med education  Documentation is on site MAP Policy Section 06 Tech Assist Tool Section O

73. mass.gov/dph/map 11

74. MAP Resource 8

75. MOR System Principles  Opportunity to improve  Procedures or systems  That put people at risk  Focus on “cause”  Rather than “who”  Made the mistake MAP Policy Sections 09 &10 Tech Assist Tool Section P

76. Medication Occurrence Process  Tracks Certified staff only  One of five rights went wrong  Individual  Medication  Dose  Time  Omission  Route MAP Policy Sections 09 &10 Tech Assist Tool Section P

77. MOR Process  Self reporting system  Staff must immediately contact MAP Consultant  Follow recommendation Document recommendation MAP Policy Sections 09 &10 Tech Assist Tool Section P

78. Medication Occurrence Reporting  Emergency numbers include  911  Poison Control  MAP Consultant(s)  Available 24/7 MAP Policy Sections 09 & 10 Tech Assist Tool Section P

79. Reporting Requirements  MORs reported to MAP Coordinator  Within 7 days of discovery  Via HCSIS  “Hotline” MORs reported  Within 24 hours of discovery  DPH Clinical Reviewer  MAP Coordinator MAP Policy Sections 09 & 10 Tech Assist Tool Section P

80. DPH Hotline Form

81. mass.gov/dph/map 12

82. MOR Follow-Up  Retraining (usually)  Should occur  Each time a med occurrence happens  Can be determined jointly  Supervisor  MAP Consultant  Documentation MAP Policy Sections 09 &10 Tech Assist Tool Section P

83. MOR Follow-Up 2  Tech assist visit  Hotline  Multiple MORs  Revocation  Occasionally MAP Policy Sections 09 & 02 Tech Assist Tool Section P

84. DPH Registered Programs  Massachusetts Controlled Substance Registration Number (MCSR)  Issued by DPH  Original or copy stays on site  Where medication is stored MAP Policy Section 01 Tech Assist Tool Section Q

85. MAP Coordinators  Carolyn Whittemore, RN  Central/West  413.205.0914 carolyn.whittemore@state.ma.us  Mary Despres, RN  Metro  781.314.7506 mary.despres@state.ma.us

86. MAP Coordinators 2  Gina Hunt, RN  Northeast  978.774.5000 x354 gina.hunt@state.ma.us  Susan Canuel, RN  Southeast susan.canuel@state.ma.us

87. MAP Resource 9

88. mass.gov/dph/map 13