Medication Administration Training

1
Medication Administration Training
Zumbro House, Inc.
2
Training Requirements

• Before administering medications you must
• Be at least 18 years of age
• Complete an approved Medication Administration
  class
• Complete and pass a written exam
• Complete and pass an on-site observed skill
  demonstration

3
Client Rights

• Each of our clients has the right to
• Expect that the medications they receive are
  exactly what has been prescribed by their doctor.
  
• Expect that anyone who administers medications is
  qualified to do so.
• Expect everyone who administers medications to
  know and respect the client rights.
• Refuse medications or treatments.
• Be informed of any consequences that may occur as
  a result of refusing medication.

4
Staff Responsibilities

• As unlicensed, non-medical, personnel, your
  responsibilities include
• Successfully completing this medication
  administration course before giving any
  medication.
• Following the medication order exactly as
  written.
• Informing your supervisor if you are unsure of
  the correct procedure for a medication
  administration task you have been asked to
  perform.
• Ensure that Zumbro House policies are followed.
• Following any government regulations, including
  those regarding privacy and client rights.

Remember You are responsible for your actions!
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Rights of Administration

• You MUST check for all 7 Rights each time you
  administer any medication to any person.

• Right Person
• Right Date
• Right Time

• Right Medication
• Right Dose
• Right Route

• The 6 Rights above are checked BEFORE you
  administer the medication.
• Check 3 times
• When removing the medication from the cabinet
• Just before dispensing the medication
• After dispensing the medication, before returning
  it to the cabinet
• The 7th Right is observe AFTER you administer the
  medication
• Right Documentation

6
Medication Errors

• If you make a mistake in administering
  medications, or if you find that someone else has
  made a mistake, take the following steps
• Call the nurse immediately.
• Explain the error and follow any instructions.
• Document the error in the clients Health
  Progress Notes.
• Document the error on the medication sheet
  (circle the box).
• Complete a Medication/Treatment Discrepancy form.
• Medication errors will result in specific
  consequences as outlined in to Medication
  Administration Agreement. Failure to follow
  proper procedures in response to a medication
  error may result in additional penalties.
• If a medication or treatment is not initialed on
  the medication sheet, it is your responsibility
  to contact the staff person who worked that shift
  and ask if the medication was given or the
  treatment was done.

7
Standing orders

• Each person must have a Standing Order list
  approved and signed by his physician. The
  physician may individualize the list as
  necessary. No over-the-counter (OTC) medications
  may be used unless they are authorized by the
  clients physician.
• When administering a Standing Orders medication
  administer it
• For exactly the reason(s) stated on the order
• In exactly the way the order states
• No substitutions or alterations are allowed
• After administering a Standing Order medication,
  document
• The medication name
• The dosage given
• The time administered
• The reason used
• What effect the medication caused
• Once the Standing Orders form has been signed, it
  is considered doctors orders. No form of OTC
  medication may be given without written, signed
  orders from the doctor.

8
Medication Information

• Never administer a medication unless you are
  familiar with its use.
• There are many sources of information concerning
  medication available to you.
• You can read the informational leaflets, which
  are typically kept in the clients book near the
  med sheets.
• You can call the nurse with any urgent questions
  or concerns.
• You can call the pharmacy. A pharmacist or nurse
  should be available by phone to answer any
  questions you may have.
• You can call the person who prescribed the
  medication (i.e. doctor, dentist, nurse
  practitioner, etc.) for clarification, questions,
  or concerns.
• If necessary, you can call Poison Control to get
  information about medications.
• When you begin your employment, and whenever a
  client is given a new prescription, it is your
  responsibility to review information about the
  drug before administering it.

9
Documentation

• Medication Sheets
• Documentation on the med sheet is done after the
  medication has been administered.
• Initial the box indicating the medication, date,
  and time for any medication you have
  administered.
• Once a month, you must initial and sign the last
  page of the med sheets.
• If a client refuses a medication, write R in
  the box and then circle it. Document on the last
  page of the med sheet that the client refused the
  medication.
• If you have packaged medications for a client to
  take on a vacation or therapeutic leave, draw a
  horizontal line through the box on the med sheet.
  Write L in the top half of the box and your
  initials in the bottom half.
• If a medication was held (i.e. due to illness or
  medical tests) write H in the box and then
  circle it. Document on the last page of the med
  sheet that the medication was held and the
  reason.

10
Health Progress Notes

• Use the Health Progress Notes to document any of
  the following
• Illness or injury
• Any complaints of illness or injury
• Use of PRN medications
• Refusal of medications
• Medication administration errors
• Medical appointments
• Any other issues or concerns related to the
  clients health.

• Remember to use only objective facts in Health
  Progress Notes
• For example, an appropriate entry might say that
  the client was coughing and sneezing,
  complained of a headache, and had a temperature
  of 101.3. It would not be acceptable to say
  that the client had a cold or that the client
  seemed sick.

11
Receipt of Medications Destruction of
Medications
Receiving and Destroying Medications

• All medications to be destroyed should not be
  flushed. The medication should be dissolved in
  water in a disposable container, such as a
  plastic water bottle. Once the medication is
  dissolved, add in used coffee grounds or cat
  litter to ensure that the dissolved medication
  cannot be consumed. The container should be
  thrown in the trash.
• Two staff members must be involved in any
  medication destruction.
• Destruction of medication must be documented on a
  Medication Destruction form. Both staff members
  must sign the form.

• When medications are received from the pharmacy,
  they must be documented on a Medication Receipt
  form.
• All medications must be properly stored.
• Any new Drug Information leaflets (for new
  medications, not just additional copies) that
  come with the medications are to be added to the
  clients book.

12
Release Of Medications

• Medications that are to be administered by
  someone other than Zumbro House staff must be
  released to another responsible person.
• Individually package each dose in an envelope.
• Write on the envelope
• The name of the medication(s)
• The dose of the medication(s)
• The time the medication is to be given
• Any other instructions

• Two copies of a Release of Medication form are to
  be filled out. One copy is to be signed and
  placed in the clients file, the other is to be
  sent with the medications.
• In order to document medications prepared for a
  therapeutic leave, draw a horizontal line through
  the box on the med sheet. Write L in the top
  half of the box and your initials in the bottom
  half.

13
Special Situations

• Vomiting
• If a client is vomiting, or has been vomiting
  recently, withhold any oral medications (with
  nurse approval).
• Check the clients standing orders to see if any
  medications or procedures have been prescribed
  for vomiting.
• Document in the clients Health Progress Notes.
• Difficulty Swallowing
• If a client has difficulty swallowing
  medications, the medication may be prescribed in
  a liquid form.
• If the medication is not available in a liquid,
  it may be acceptable to crush the tablet or break
  open the capsule and mix the powdered medicati0n
  with applesauce to be given to the client.
• Some medications must not be crushed. These
  include enteric coated and time-released
  medications.
• If you are uncertain about crushing a medication,
  contact the pharmacy or the doctor who prescribed
  the medication.

14
Special Situations, Cont.

• Refusal of Medications
• If a client refuses a medication, it may be
  acceptable to hold the medication for a short
  time and attempt to administer the medication
  again later (within 30 minutes)
• If the client still refuses the medication the
  drug must be destroyed.
• Both the clients refusal of the medication and
  the staffs destruction of it must be properly
  documented.
• Document on the back of the med sheet and in the
  Health Progress Notes that the client refused the
  medication.
• Document destruction of the medication on a
  Medication Destruction form.

15
Psychotropic Medications

• Psychotropic Medications
• Psychotropic medications are prescribed to alter
  mood or behavior.
• They require the informed consent of the clients
  legal guardian.
• They also require regular monitoring of side
  effects.
• Informed Consent
• No psychotropic medication may be given without
  the consent of the clients legal guardian.
• The guardian must be given information about the
  proposed medication, the potential risks and
  benefits of the medication, and the reason the
  medication is being proposed. This information
  must be shared both orally and in writing.
• The guardian must sign an Informed Consent form
  stating that they have been informed about the
  medication and are giving consent for the client
  to receive the medication.

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Psychotropic Medications, Cont.

• Psychotropic Medication Monitoring
• Psychotropic medication use must be reviewed by
  the agency and by the clients physician on a
  regular basis.
• Clients receiving psychotropic medication must be
  assessed regularly for side effects.
• MOSES and DISCUS are two of the scales used to
  monitor side effects of psychotropic medications.
  These assessments must be performed by personnel
  who have been specifically trained to do so.
• PRN Psychotropic Medications
• Occasionally, psychotropic medications are
  prescribed on a PRN, or as needed, basis.
• Before a PRN psychotropic implication can be
  administered, the client must meet specified
  behavioral criteria. These criteria should be
  listed in the clients book.
• The nurse must also be notified.
• After administering a PRN psychotropic, document
  in what way the client met the criteria and
  document that the nurse was notified.