1. MEDICATION ADMINISTRATION TIPS: MED ERRORS BE GONE!
SLIDE PRESENTATION DEVELOPED BY:
GEORGIA SWANK MS, RN, CDDN

2. IS REQUIRED FOR YOU TO KEEP
SAFE MED PASSING
MED PASSING
IS REQUIRED
FOR YOU
TO DO YOUR JOB
BUT…
SAFE MED PASSING
IS REQUIRED FOR YOU TO KEEP
YOUR JOB!

3. THE 6 RIGHTS OF MED ADMINISTRATION
RIGHT CONSUMER
RIGHT MEDICATION
RIGHT DOSE
RIGHT ROUTE
RIGHT TIME
RIGHT DOCUMENTATION
THE MOST IMPORTANT AND HELPFUL SET OF RULES FOR SAFE MED PASSING ARE
THE 6 RIGHTS LIST.
2.READ LIST, SHORT EXPLANATIONS.

4. The 6 RIGHTS MUST BE IN THE PHYSICIAN ORDER ALSO!
RIGHT TIME
RIGHT ROUTE
RIGHT PERSON
RIGHT DOSE
RIGHT MED
CAKY Henderson
IDENTIFY PARTS OF AN ORDER, TYING IN THE 6 RIGHTS.
DON’T FORGET THE 6TH RIGHT…TO DOCUMENT CORRECTLY

5. SAFE MED PASSING INCLUDES:
IDENTIFYING THE CLIENT
GETTING OUT MAR AND USE IT FOR MED PASS
REVIEWING WHAT MEDS YOU WILL BE GIVING PRIOR TO PREPARING
GATHERING ANY SPECIAL EQUIPMENT
(WATER, CUPS, APPLESAUCE, PILL CRUSHER, GLOVES)

6. OTHER SAFETY TIPS MEDS SHOULD NEVER BE OUT OF YOUR SIGHT
NO INTERRUPTIONS
ALL MEDS LABELED
(Never give a med that does not have a legible label)
YOU MUST READ & COMPARE LABEL TO MAR 3 TIMES
INSURE MEDS ARE SWALLOWED
NEVER GIVE MEDS SOMEONE ELSE MEASURED OUT
IF THE CLIENT QUESTIONS, STOP!! CHECK MED AGAIN.
OBSERVE EFFECTS OF MEDS UP TO SEVERAL HOURS, REPORT ANY ADVERSE REACTIONS OR SIDE EFFECTS
NEVER BORROW MEDS

7. MEDICATION DO’S AND DON’TS
DO KEEP LABELS CLEAN
DON’T GIVE ANY MED IF LABEL IS NOT ABLE TO BE READ
DON’T USE EXPIRED MEDS
DO CHECK IN & COUNT ALL MEDS DELIVERED BY PHARMACY
DON’T ACCEPT ANYTHING YOU CANNOT READ
DO KEEP MED STORAGE AREA LOCKED
1. RE: MED AREA LOCKED…..THIS MEANS KEYS ARE NOT LEFT LYING ON COUNTER OR IN AN AREA WHERE CONSUMERS, VISITORS, CASEMANAGERS, AND OTHERS CAN GET THEM. MED STORAGE KEYS SHOULD BE IN CONTROL OF STAFF AT ALL TIMES, AND HANDED OFF TO THE NEXT STAFFPERSON ON THE NEXT SHIFT WHEN THEY ARRIVE.

8. CORRECT PROCEDURES ARE IMPORTANT
Whether you are giving pills, creams, eye drops, inhalers, or meds through a tube….using the correct procedures are vital!
Making sure your consumers get the medications exactly as prescribed by the physician makes sure that their medical issues are treated properly.

9. Tablets & Capsules Crushing pills Opening capsules
Extended Release, Sustained Release, and all pills that have these actions, should NOT BE CRUSHED!
Pharmacy can tell you if a pill can be crushed
Request a DO NOT CRUSH LIST from Pharmacy for your MAR if you have a need to crush pills for a particular consumer
Opening capsules
Pharmacy can tell you if this is OK
Mixing medications with food
Must have an order from the physician for this
Put order right on MAR at the top so all can see
Can ease swallowing for those with swallowing problems or anxiety about taking meds
Can increase compliance for some

10. Liquid Medications Liquids prep
Check instructions to see if liquid med needs to be shaken or mixed before giving
Use a Med cup with measurement markings or dosing syringe (best if you want to be exact and not waste)
Get your eyes level to the markings to read
Syrups and other liquids can get sticky—KEEP BOTTLES CLEAN & LEGIBLE
Do NOT give any liquid that has spilled down the outside over the label, making it illegible or hard to read—request a new label from Pharmacy
Offer a drink of water after the med is given

11. Powdered Medications
These are meds like fiberlax, Metamucil, some potassiums, etc.
If not pre-packaged in already measured packs, use a med cup and measure like a liquid
Set med cup or measuring cup on counter and get your eyes level to the measuring line
Pour out or level off until top of powder is level
Can mix with liquids according to instructions

12. Lotions, creams, ointments
Wash hands before & after
Wear gloves
Apply ONLY to area prescribed for !
Use applicator like a cotton swab or, in some cases, like applying over large skin areas, you can use your gloved hand to spread lotions etc.
If for infection, rash or other medical problem, can squeeze small amt onto clean gauze pad and use from there (to avoid contaminating tip of tube)
If lotion for non-medical purposes can pour directly into hand or consumer can apply if able

13. Transdermal Patches
Might have for heart problems, pain, smoking cessation, birth control
Wear gloves, wash hands after new patch applied & old patch disposed of
Always remove previous patch before applying new one
Rotating sites will reduce potential for skin irritation (follow directions for which sites are best—for example, may move from chest to upper back)
Date, time, and sign patch with pen
Document location in MAR

14. Eye Meds (Ophthalmic) Wash hands Wear gloves
Avoid touching end of dropper to eye or anything else
Some eye drops may need to be shaken first (read directions)
Have client tilt head back slightly
Place fingers on cheek below eye, and gently pull downward to pull the bottom eyelid down and out to form a pocket
Put drops gently into pocket of lower eyelid and have client close eye
Administer eye ointments exactly the same way—these may cause blurred vision for a few minutes
Putting drops directly on eye may cause stinging, client jerking away and drops consequently would not get in the eye.
Do not miss any doses.
Administer the EXACT amount of drops prescribed by the doctor. If it states give 2 drops in the left eye every morning, do exactly that.
Eye Ointments may cause blurred vision. It is important for staff and clients to know this. Tell your client that their vision is going to be blurry for awhile due to the eye medicine. If possible, have them do an activity like watch morning TV or sit and listen to the radio for 15 minutes before getting up to walk. Avoid falls! Plan ahead!

15. Nasal Meds (in the nose)
Have client blow their nose gently first into a tissue
Wash hands
Avoid touching the dropper to any surface
Best to do with the client lying down or laying back in a recliner with head back as far as possible
With client lying down and head back as far as it will go, put drops into nose
Keep head tilted back for 3-5 minutes if possible so the medicine can get where it needs to go
Monitor client closely as some drops may dribble back into throat and cause them to cough
Wash hands, wipe client’s face if necessary
Rinse dropper under warm water
Do not share droppers between consumers!
It is difficult to give nose drops without touching the dropper to the inside of the nose. But, that is the goal. Rinse afterward to remove any nasal drainage from dropper.

16. Oral Inhalers Shake the inhaler (attached to mouthpiece)
Have client breathe out normally
Holding inhaler directly in front of mouth, as client breathes slowly IN, press the container DOWN into the mouthpiece to release a puff of medication
Encourage the client to keep breathing slowly IN as deeply as they can
Have client hold their breath for 5-10 seconds to keep the medicine in the lungs
Then breathe out slowly
Follow directions for number of puffs!
Monitor and document ongoing breathing of client
Can they talk normally without having to take extra breaths? Or not? Do they get out of breath doing normal activities? Do they complain that they can’t catch their breath? These are all things to document and follow up on!
Some oral inhalers (like Advair) is a powder and only requires the client to suck in like they are sucking on a straw (this is easier for most clients to do and the medication gets where it needs to better also)
Some inhalers require that the client rinse out their mouth after using them. This is because some inhalers have a steroid in them and can cause mouth infections like yeast infections if the mouth is not rinsed.
If you have a client that takes more than 1 inhaler, it MAY be important what ORDER they take their inhalers in. Please ask the doctor and/or pharmacist how this should be done if this situation occurs.

17. Ear Medications Wear gloves Have client tilt head with ear pointing up
If client is over the age of 10, pull ear up as you give ear drops or ointments
If client is a young child, pull ear down to give ear drops or ointments
This straightens the ear canal so medicine will get all the way in where it should go
Have client lay still for 5 minutes if possible after instillation of ear drops

18. Suppositories (rectal & vaginal)
Rectal Suppositories:
Have client lay on left side
Wear gloves
Lubrication of suppository
Insert with 1 finger up high enough to get past internal hemorrhoids (about 1 ½-2 inches)
Medication absorbed very quickly thru mucous membranes
Works well for someone who is vomiting and cannot keep food or medicine down
Some pain and nausea meds can be given this way
Vaginal Suppositories:
Have client lay on back and spread legs
Gloves, lubrication
Insert 1-2 fingers and push suppository in as far as fingertips can go
If suppository is not pushed in far enough, it will come back out as soon as the person stands up.
Have person lie flat on bed for 15 minutes after inserting a suppository. This will help it to start dissolve and not come back out.

19. Meds thru Feeding Tubes
Insure stability of feeding tube before instillation
Flush with water before meds to decrease internal stickiness of tube
Flush tube after meds with sufficient water to completely clean tube and push meds through
This also helps with digestion & metabolism of meds
REMEMBER: Some meds cannot be crushed!
If you do not know which meds, call the pharmacy.
Other forms may be more suitable such as liquids, Soltabs (dissolve instantly in mouth), sprinkles
Look at all options

20. AFTER GIVING MEDS…. DOCUMENT WHAT YOU GAVE AFTER GIVEN
DOUBLE CHECK YOURSELF
LOOK THRU ALL PAGES OF MAR
LOOK AT ALL BOXES, DID YOU INITIAL?
ARE BACKS OF MARS SIGNED?
WERE ALL TREATMENTS DONE?
NEVER DOCUMENT SOMETHING YOU DID NOT DO…THIS IS FALSIFICATION OF RECORDS

21. MED ERROR PROCEDURES * TRUTHFUL REPORTING AS SOON AS POSSIBLE
* OBSERVATION OF CONSUMER FOR UNDESIRABLE EFFECTS
* COMPLETE A MED ERROR REPORT
* PHYSICIAN MAY OR MAY NOT BE CONTACTED depending on medication and circumstances
* DOCUMENT IN CHART, DESCRIBE ERROR, WHEN reported AND INSTRUCTIONS GIVEN & FOLLOWED
* CONSUMER/GUARDIAN INFORMED AS DIRECTED BY DR.

22. BE A SAFE MED PASSER. YOUR CONSUMERS DEPEND ON YOU!
Do Your Part...
BE A SAFE MED PASSER. YOUR CONSUMERS DEPEND ON YOU!