1. Available
Revision 2015
Welcome to the ‘Administering Medications the Right Way’ webinar presentation. I will be reviewing revisions to the student manual and corresponding Trainer manual. By viewing webinars marked as ‘required’ within the specified time period, you’ll meet the MAP Trainer meeting attendance requirement. I’m Gina Hunt, a Department of Developmental Services MAP Coordinator and I’m your webinar presenter.

2.
As of December 1, 2015, the revised student manual will be available for download at the CC&R Healthcare Solutions website by clicking on the ‘Updates’ tab and using your access code to log in.

3. Distribution of MAP Updates
All MAP Trainers will receive the memo posted with this webinar from Sharon Oxx, DDS Director of Health Services via . If you have any questions in regard to your access code, please contact CC&R Healthcare Solutions. Their contact information can be found either on their website, or in the memo.

4. Student Manual
The Student Manual is now version number 5.1.1, all margins are dated 2015 and the table of contents was updated to reflect minor page adjustments. The corresponding Trainer Manual version is 5.2.1

5. Introduction xiii
On this page, the language was modified in the second Massachusetts call out box. The words ‘an authorized prescriber (HCP)’ were substituted for the word ‘physician’.

6. D&S Testing Process
Pages a, b, c labeled at the bottom as ‘D&S testing process’ were updated including specific instructions on page ‘b’ to access the online pretest. References to the ‘sample test’ were removed.

7. Categories of Medications
Holistic herbal compounds were removed as a medication category. The content is covered just after the category. In addition, there is a new call out box on this page. It mentions additional training is required specific to high alert medications.

8. HCP Orders for Tylenol
All HCP orders (as well as any corresponding medication sheets) in which Tylenol was ordered, now indicate the frequency as every 6 hours PRN instead of every 4 hours and a guideline was added to ‘Call the HCP if the headache continues after 24 hours’.

9. Key Terms to Study
On page 55 the definition of a ‘lot number’ was added. The definition corresponds with

10. Pharmacy Label Exercise
the pharmacy label exercise on page 60. Notice above the label, there are now explanations of a medications expiration date and number of refills. The additions are also in Module 7, p. 123 of the curriculum where the exact exercise is repeated.

11. Dose Strength Amount
On page 67, the statement, “You should never have to do the math to figure out the amount” was removed from the content because staff are expected to know the basic concept of the strength of the tablet supplied by the pharmacy and the amount printed in the label directions should equal the dose. The exercise on the same page was modified slightly. The Atenolol dose is now 50mg instead of 25, which changes the answer to 2 tabs to give. The Trainer Manual answer key reflects this revision.

12. New ‘Call Out’ Box
This is page 68. Although the information is not new regarding the need for HCP orders to specify the time of day, daily medications should be given; the Massachusetts call out box is. In addition, the content on this page was modified slightly to reflect the information in the call out box.

13. Count Book Index
The content on this page now reinforces ‘Using the index’ to locate the appropriate count sheet page.

14. Giving Multiple Medications
On pages 78 and 88, the ‘note’ in the box pertaining to giving multiple medications was modified.

15. Standard When Giving Medication
This ‘note’ is not new content, however, based on trends seen in the field the information is now in bold print.

16. Telephone/Fax HCP Order Form
The sample telephone/fax HCP order form on page 125 was revised to reflect the need to be posted and verified twice. In addition

17. Telephone Order Exercise
the corresponding telephone order exercise was modified slightly and moved right after the sample form.

18. Start/Stop Date Definitions
The definitions of a start and stop date were modified. A ‘start’ date is the date the first dose is scheduled to be given. A ‘stop’ date is the date the last dose is scheduled to be given.

19. Medication Sheet Revisions
Page 137 is an example of how all med sheets that include transcriptions, now include the reason the medication is being administered. Also notice the revision to the CODES at the bottom. DP-now represents day program and/or dayhab. S for school, which has been approved for some time, is now on the list.

20. Acceptable Codes
Page 138 is the call out box listing acceptable codes with complete definitions.

21. Count Book Sections
The Count book sample pages 144, 145, and 146 of an index, count sheet and shift count sheet were re-organized in the order typically found in a count book. The sample index was modified to give you the opportunity to explain that when Freddy Connors count sheet page 2 was full, the information had to be transferred to the next available count sheet which was page 6.

22. Single Person Count
Notice the call out box states if conducting a single person count, the words, ‘single person count’ must be written in the unused column; “drawing a single line” through that space is no longer allowed. The shift count sheet example

23. Sample Shift Count Sheet
was updated to reflect this expectation.

24. Back Up Keys
On page 148, the language was modified to indicate access to the back up set of keys must be know only to administrative staff.

25. New ‘Call Out’ Box
In regard to the disposal process, the first call out box on page 149, is new although once again, the information is not. It was added to reflect current MAP policy.

26. LOA Form Relocated
The word ‘sample’ was added to the leave of absence form. It’s now located on page 151, immediately following the LOA content. From this point forward you’ll begin to notice the page numbers are slightly different from the previous version.

27. Medication Occurrences
On p. 152 medication occurrence definitions now include ‘omission’.

28. Medication Occurrences
The procedure to follow in the event of a medication occurrence ‘call out’ box was slightly modified and timeline submissions further clarified.

29. MOR Exercise Revision
This exercise on page 154 is no longer matching MOR definitions; it's now applying the definition to figure out what type of occurrence is described. There are also 2 new scenario based ‘Apply What You’ve Learned’ exercises. One involves pre-pouring. The other one involves running out of medications.

30. Reference Section
In the reference section, the ‘other routes’ content was reformatted to include a skills checklist. In addition, all Massachusetts forms were updated.

31. Adjunct Trainer Materials
Medication Book
Count Book
Certification Training 4 Day Model PowerPoint
Transcription Workbooks
Document Based Questions (DBQs) Exercise
The adjunct Trainer Materials as listed on your screen were also updated. The Medication and Count Books contain minor revisions.

32. Medication Administration Program Certification Training
“Administering Medication the Right Way”
The Four Day MAP Certification Training PowerPoint presentation was modified to include curriculum revisions. Remember you can move the PowerPoint slides in any order to accommodate your training program. For your convenience, each PowerPoint slide includes detailed notes pages to the Trainer.

33. Gina Hunt, RN gina.hunt@state.ma.us 508-572-3489 text 978-739-0425 fax
Please be sure to change slide 8 of the PowerPoint so that your name and Trainer contact information is there

34. Successful Completion
100% Attendance
Pre-Test(s)
Computer Based Pretest
Medication Administration
Transcription
There are several new slides outlining pretest requirements in detail including…

35.
…screenshots of how to access the computer based pretest.

36. Pre-Test Score Report
…and the pretest score report you need from staff and what it looks like.

37. Med Pass Pretest Medication Administration
Each staff will be observed (at least once) apply your knowledge of the 3 checks of the 5 rights
Feedback by Trainer/Peer
80% Accuracy
There is a detailed slide of the med pass pretest component.

38. Transcription Pretest
DC one med
Transcribe one med
15 Minutes
100% Accuracy
And there’s a transcription pretest slide detailing the time limit and passing score.

39. Medication Certification
Meds may be administered in
DDS adult
DMH/DCF adult and youth
funded, operated or licensed programs
Good for 2 years
One of the introductory slides includes the DMH/DCF youth.

40. MAP Consultant Registered Nurse Pharmacist Authorized Prescriber
Health Care Provider (HCP)
Nurse Practitioner
Dentist, etc.
The updates include the language used in MAP policy and the revised curriculum.

41. Medication Book Contents HCP orders Med sheets
HCP visit encounter form (if it includes an order)
Med sheets
Acceptable codes
Med progress notes
Medication information sheets
Some of the slides are a bit more detailed like this one.

42. Medication Administration
I included a slide of the medication administration process in this format that many of you have seen, as well as use.

43. Posted Karen Mason 9-3-yr 2pm Verified Lisa Long 9-3-yr 6:30p
Support Plan PRN Med-Anxiety
Specific behaviors that show us Chip is anxious:
Pacing in a circle for more than 4 minutes.
Head slapping for longer than 30 seconds or more than 5 times in 4 minutes.
Staff will attempt to engage Chip in one on one conversation re: current feelings and difficulty.
Staff will attempt to direct and involve Chip in a familiar activity such as laundry, meal preparation, etc.
If unsuccessful with A or B staff may suggest/offer Chip:
Ativan 0.5mg once daily as needed by mouth. Must give at least 4 hours apart from regularly scheduled Ativan doses.
(Refer to HCP order)
If anxiety continues after the additional dose, notify HCP.
Dr. Smith 9-3-yr
Posted Karen Mason 9-3-yr 2pm Verified Lisa Long 9-3-yr 6:30p
Chip’s support plan is posted and verified.

44. Medication Categories
Prescription
Over the Counter (OTC)
Brand name
Generic name
Countable substances
Herbal holistic compounds were removed as a medication category.

45. Other Substances Holistic/Herbal Compounds Very popular
HCP order required
Administered, documented and stored
As prescription meds
The topic is now covered after the medication categories.

46. Holistic/Herbal Compounds
Label requirement options
Pharmacy
Applies label
Licensed staff verification
Nurses’ initials and date signifies they have compared manufacturer’s label to HCP order
Individual’s name
written by nurse
Chip Brown
MD 9/15/yr
There is a slide reflecting label requirement options per MAP policy

47. Answer
The answer sheets to transcription exercises reflect the reason previously transcribed meds were ordered. The codes at the bottom were updated.

48. Telephone Orders Check your agency policy Remind HCP to call pharmacy
Posted/Verified twice
When med is received and transcribed
After HCP has signed
Must be signed by HCP
Within 72 hours
The details of posting and verifying a Telephone Order are included on this slide. And…

49. Sample Order Form
There is a corresponding slide showing a sample Telephone Order form.

50. Countable Substance Packaging
Schedule II-V meds must be
Received from pharmacy
In tamper resistant packaging
A new slide was added regarding liquid countable medication, reflecting a tamper resistant syringe prepared by a pharmacist as a packaging option.

51. Sample Index Page
There are detailed sample pages of each count book section with extensive Trainer notes, including an index…

52. Sample Count Sheet
Page 11
Count sheet and...
Transferred from p. 10

53. Sample Shift Count Sheet

54. Count Sheet Scenario Transferred from p. 10
Page 11
Transferred from p. 10
There is a slide showing different ways to correct documentation mistakes on a count sheet.
Error LL
Error RN

55. Count Procedure Count must be done Shoulder to shoulder with
Off-going Certified staff and
On-coming Certified staff
There are 3 slides detailing how a count should be conducted. I’ve always had staff conduct a single person count at the beginning of a training. I now also incorporate a 2 person count after reviewing this process with staff.

56. Count Sheet Scenario
Page 11
There is an example for staff to follow of how to document a math mistake when the mistake was made by another staff who has left for the day.
12/20/yr 7am Math on 12/19/yr 8p entry is incorrect. Karen Mason, Supervisor notified. Correct count is 6 left Reggie Newton

57. Medication Security Restricted access Two medication key sets
One in use
Must stay with staff
Responsible for med administration
Second known only to
Administrative staff
This slide outlines the restricted access to medication key sets, especially the second set.

58. Disposal Methods Unless prohibited by local community
Read the med information sheet first
See if there are specific disposal instructions. If not,
Take med out of original container
Crush and/or dissolve in water in a sealable bag
Mix with liquid soap, used coffee grounds or kitty litter
Place sealable bag in non descript container
Place in trash
Following disposal remove all identifying personal information from label
Only flush if the med information sheet provides that as a disposal option
This disposal slide is more detailed than the previous version.

59. Disposal Process If meds are expired or discontinued
Disposal must be completed with two Certified staff present
One must be a Supervisor
This slide and the next cover medication disposal, per MAP policy.

60. Disposal Process If a med is refused or accidentally dropped
Disposal must be completed with two Certified staff present
If unavailable, a supervisor is not required to be present
Unless your agency requires it
This slide covers who can dispose of a single dose of meds, if refused or dropped, if a MAP Certified Supervisor is not available.

61. Medication Occurrence
Wrong
Individual
Medication
Dose
Time
Includes omission
Route
And lastly, the medication occurrence slide now includes ‘omission’.

62. Transcription Workbooks
Transcriptions are same
Scenario time varies
Although answers are same
Previous transcription
Now includes reason
‘Codes’ updated
The Transcription workbooks were also updated. In Workbook 1, you’ll notice the scenario times are no longer always 1pm although even with a few scenario time changes, the answers remain the same.

63. Transcription Workbooks
Inside the workbooks you’ll notice, there is no longer a full medication information sheet. The template used in developing the workbooks is very similar to the ones used by the testing company.

64. DBQ’s Exercise
And finally, the Document Based Question Exercise has a ‘new look’. All of the updated Trainer material can be accessed…

65. mass.gov/dph/map
by using the MAP URL Scroll down…

66. mass.gov/dph/map
Under ‘MAP Topics’ click on “MAP Training Tools’

67. mass.gov/dph/map
Here you’ll see links to all the revised adjunct material.

68. Student Manual Available 12-1-15 Version 5.1.1
Recognizing that many of you have a supply of student manuals on hand; please use those now in your upcoming trainings. The expectation is that Student Manual version will be used in all Certification trainings beginning June 1, If you have any questions on the revisions discussed today, please contact your MAP Coordinator. Thank you for listening.