Medication Administration Student Syllabus DRAFT. Revised Nov Colorado Department of Public Health and Environment

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Colorado Department of Public Health and Environment

Revised Nov 2011

Colorado Department of Public Health and Environment Health Facilities and Emergency Medical Services Division

4300 Cherry Creek Drive South Denver CO 80246-1530 (303) 692-2800 phone www.HealthFacilities.info

Medication Administration

Student Syllabus

DRAFT

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TABLE OF CONTENTS

GENERAL INFORMATION Page

CDPHE/HFEMSD mission

Purpose

Course Objectives

Applicable settings

Requirements

UNIT ONE PRINCIPLES OF MEDICATION ADMINISTRATION

Objectives

Introduction to student

Legal/ethical issues

Limitations of authority and responsibility (statutory language re: exemption from nurse practice act and pharmacy practice act)

• Education/qualifications of licensed professionals

UNIT TWO GENERAL MEDICATION INFORMATION

Objectives

Brief introduction to pharmacology

Forms/categories of medications

Routes of administration

Storage and disposal of medications

Use of medication administration references

UNIT THREE MEDICATION ADMINISTRATION (procedure)

Objectives

Approaches to patient centered medication administration

Guidelines for administering medications

Principle aspects of universal precautions

Safety in the skill of administering medication

Measurements

Procedure for administration

• Universal precautions

• Procedures per “route”

UNIT FOUR DOCUMENTATION - THE MEDICATION ADMINISTRATION RECORD (MAR)

Objectives/Introduction

Documentation Rules

Errors in medication administration

Error reporting

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GENERAL INFORMATION

The Colorado Department of Public Health and Environment is committed to protecting and preserving the health and environment of the people of Colorado.

Purpose

The medication administration course is designed to teach unlicensed persons to safely administer medications in settings authorized by law. This course prepares you to administer medications to patients that have stable conditions for which a QMAP does not need to exercise any type of judgment, assessment or evaluation of a client. Persons who successfully complete the course are considered Qualified Medication Administration Persons (QMAP). Successful applicants will pass written exam and a hands-on practical exam.

NOTE: This course does not meet the requirements for certified nurse aides (CNA) to administer medications. A CNA may only administer medications under their scope of practice, after completing a medication course designed for CNAs and under the delegated authority of a nurse.

Course Objectives

This is a competency based medication administration program. Students will need to successfully demonstrate competency in each area prior to receiving proof of completion

At the completion of this course, the successful student will be able to:

• Demonstrate proper reading, understanding and transcribing of physician’s orders

• Demonstrate knowledge of safe administration of medications via multiple "routes" (ingested, applied, inhaled, inserted) in designated settings using written physician orders according to the "5 rights of administration”.

• Demonstrate accurate calculations of drug dosages

• Demonstrate proper documentation of the administration of prescription and non-prescription drugs according to current standards of practice

• Demonstrate safe and accurate dispensing of medications to Medication Reminder Boxes (MRB)

• Demonstrate proper administration of medications from MRBs with oversight from a licensed person or qualified manager.

Facilities regulated by the Department of Corrections (DOC) have a qualified medication administration curriculum specifically developed for the administration of medications in correctional facilities.

Programs/ services regulated by the Department of Human Services (DHS), have a qualified medication administration curriculum designed to address developmentally disabled and childcare population. The qualifications set out by DHS and DOC are not interchangeable with this course. Applicable settings: (for this course only)

1. Assisted living residences. 2. Alternate care facilities.

3. State certified adult day programs

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Requirements to be qualified to administer medication as an unlicensed person 1. Pass the written test with a minimum score of 90%.

2. Score 90% in the practicum exam; this includes hands on demonstration of filling the medication reminder box

3. Provide a copy of the original completion letter and recognition of completion document to employer

4. Employers must provide “on the job training and mentoring” for all QMAPs. “On the job training” includes validation of competency in administering medications.

5. QMAPs must sign a disclosure statement that he or she has never had a professional license to practice nursing, pharmacy, or medicine revoked in ANY state for reasons related to the administration of medications. A copy is required to be provided to employer.

6. You may be required to retake an approved medication course and competency evaluation if the authorized regulatory agency determines the need for such training.

Re-qualification guidelines

1. QMAP’s must re-qualify every five years by successfully passing the written competency exam 2. Qualified medication managers (QM) must re-test every 4 years. A QM is a person who is the

owner or operator of the facility or a supervisor designated by the owner or operator of the facility for the purpose of implementing the medication administration according to the

regulations and who has successfully completed the QMAP training or is a licensed healthcare professional

3. QMAPs who are re-qualifying may take the competency exam only once without attending a training session. If the individual fails the exam the applicant must attend the training prior to retesting

4. Students who have not retested for more than 10 years d must take and pass the competency exam by December 2012., The re-qualifying student must pass the written exam with 90% proficiency, if the student is unsuccessful they must retake the QMAP training prior to retesting 5. All students whose qualifications have not been renewed within the five year time period must

retest

REVOCATION OF QMAP QUALIFICATIONS

“If the Department determines, after investigation, that a QMAP or Qualified Manager (QM) has engaged in a pattern of deficient medication administration practice or has administered

medication contrary to a physician’s order or these rules that either causes or has the potential to cause harm to the client, the Department shall rescind that individual’ authority until the individual undergoes retraining, retesting, and successfully passes the competency examinations.” 6 CCR 1011-1, ChapterXXIV, (9.2)

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UNIT ONE

Principles of Medication Administration

AUTHORITY AND RESPONSIBILITY TO ADMINISTER MEDICATIONS

Objectives

Upon completion of this unit the student will:

• Describe licensed professionals that administer and dispense medications

• Identify the Qualified Administration Person’s (QMAP) scope of practice Introduction to the student

You are about to begin a new course of study that will have a definite impact in your workplace and on you. There is so much to learn regarding medications and their effect on people. Pharmacology is the science of drugs and their uses and actions within the body. Pharmacology is always changing

therefore; the process of learning will also be ongoing. You will learn about your role and its limitations, new terms and definitions, and of course, you will learn a great deal about medications and their effect on the human body and how to accurately administer medications

Legal Authority and Responsibility

Medication is an important part of health care for most people. Each individual expects the medications administered by you are the same as those prescribed by their Primary Care Provider (PCP). They also expect those who administer their medications to them are qualified to perform that function. Unfortunately, medication errors sometimes occur. They usually happen when haste and habit replace caution and care. Whatever the cause, there are legal and ethical obligations that must be fulfilled when a medication error occurs. These obligations will be referred to and explored

throughout the curriculum along with your responsibilities and limitations. . Individuals also have the basic right to refuse medications. However, these refusals must be reported to the ordering physician so that the individual can be informed of the medical consequences of the refusal.

LIMITATION OF AUTHORITY AND RESPONSIBILITY

Under Colorado law, individuals may not dispense or administer medications unless they possess a license authorizing them to do so. The medication administration statute, and rules promulgated by CDPHE that govern the medication administration program allow individuals to administer medications who are not otherwise authorized by law to administer medication…only after passing a competency evaluation. These individuals are then exempt from the licensing requirements of the “Colorado Medical Practice Act”, the Nurse Practice Act, and the laws pertaining to possession of controlled substances in accordance with 25-1.5-302(b) C.R.S.

Medications, when not self-administered, are generally administered by licensed health professionals. Caregivers authorized to administer medications include:

Nurses - Registered Nurses (RN) or Licensed Practical Nurses may administer medications. Each receives a license after successful completion of educational programs from a school or college of

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nursing approved by the Board of Nursing (2-4 years of college education is required) and after passing the nursing licensure examination. Nurses administer medications in many different facilities and situations. Nurses frequently incorporate nursing process into the task of administering medication. Those processes include examination, assessment, evaluation, and using professional judgment to document the next course of action.

Pharmacists and Physicians -

Although you will see it less frequently, pharmacists and physicians may also administer medication. Each administers medication in accordance with their training and experience. A pharmacist is licensed after graduation from a school or college of pharmacy approved the Board of Pharmacy (6 years of education is required) and after passing the pharmacy licensure examination; and a physician is licensed after graduation from a school or college of medicine approved the Medical Board (8 years of education is required) and after passing the pharmacy licensure examination.

Your role as an unlicensed person administering medication is:

1. Administer of medications by mouth, or directly to the skin, eye, ears, nose, vagina or rectum according to the safe standards of practice.

2. Follow medication orders received from a physician, nurse practitioner, or physician assistant 3. Follow regulations and facility policies for administering medications, including controlled

substances.

4. Understand that medication administration by a QMAP does not include judgment, evaluation, or assessment of the individual shows symptoms that are not normal for the them, their primary care provider should be notified.

5. Individuals qualified as medication administration person must practice within the scope of their training. Whether administering medication or providing other care to individuals, you must never attempt to perform tasks for which you have not been trained. If your employer asks you to perform tasks that you have not been trained to do, always ask for training first to ensure you provide the best care for the individuals you serve.

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Unit One Review Questions True/False

1. ____ Pharmacology rarely changes, so ongoing education related to medications and their administration is not an important consideration for a QMAP.

2. ____ QMAPs receive the same medication administration training as registered nurses. 3. A QMAP may: (check all that apply)

____ Administer insulin injections ____ Administer rectal suppositories

____ Fill a medication reminder box with prescription medications ____ Give only over the counter and herbal medications to a person ____ Recommend changes to a person's medication regimen

____ Assess a person to determine if they need to take a particular medication ____ Make a person take a medication if they really need it

____ Increase the amount of a person's pain medication if the person is in a lot of pain Short Answer

1. A QMAP may administer medications. What does it mean to administer medications?

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UNIT TWO

GENERAL MEDICATION INFORMATION

Background

Drugs are mixed with various ingredients to make them suitable for people to take. There are ingredients to make oral drugs taste better. There are different concentrations or strengths of drugs. Other ingredients allow drugs to be applied to the skin or placed into the body such as the eyes, ears, or rectum. These combinations of drugs with various ingredients are called drug preparations or forms of medication.

Objectives

After studying this chapter the student will be able to:

• Identify the sources of drugs

• Identify the purpose of drugs

• Describe the system of naming of drugs

• Describe the forms of drugs

• Describe “routes” that drugs may be administered

• Describe proper storage and disposal of medications

Administering medications is a serious responsibility. There are thousands of medications on the market, and new ones are continually being approved. As unlicensed personnel, you should know the nature of every drug you administer.

Sources

Medications come from varied sources: • Plants; leaves, roots (e.g. Digitalis)

• Animals; hormones from glands (e.g. Insulin) • Minerals; earth (iron)

• Synthetic; man-made (e.g. Aspirin) • Semi-synthetic; combination (e.g. Tylox) Purpose

The term drug refers to a substance or mixture (other than food) that is used to do one or more of the following:

• maintain health; (e.g. vitamins to supplement nutrition) • treat disease; (e.g. antibiotics to treat infection)) • relieve symptoms; (e.g. aspirin for pain)

• prevent disease; (.e.g. vaccines to prevent polio or measles) • alter body processes; (e.g. . insulin to regulate blood sugar) • diagnose disease; (e.g. barium dye to enhance xray image)

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Colorado Department of Public Health and Environment System of Drug Naming

The pharmaceutical industry has many names for drugs. These terms serve many purposes and arise from many legal, regulatory, marketing, and scientific needs of the drug industry.

There are many confusing names that sound the same for drugs and it can be difficult to understand the system of pharmacological drug naming. The same drug may be known by a variety of different names for a variety of different reasons. Drugs generally carry names under the following schemes (the same drug carries the following names):

• Generic name– related to chemical or official name of the drug, i.e. hydrochlorothiazide

• brand name – designated and patented by the manufacturer – HydroDiuril, or Microzide

• trivial acronym – letters used for convenience that describe the name of the drug, i.e. HTCZ for hydrochlorthiazide

Pharmacology - the science of drugs and their uses and actions within the body. Specifically,

pharmacology is the study of drugs: their sources, chemical makeup, preparation, and uses in everyday life. Pharmacology includes the study of how specific chemicals affect the human body. In medicine, we are concerned with drugs that help prevent, diagnose, and treat human disease. Drugs for our use are called therapeutic drugs.

Pharmacology attempts to describe the desired effects and the side effects/adverse reactions of drugs. It focuses, too, on the proper amounts of drugs to be given and how drugs are given. Knowledge of the laws and responsibilities surrounding drug use, along with practical experience in giving medication, will equip you to play a vital role in the health care team.

Drugs are essential elements in the care of the person. However, they can be abused with serious results. The safe administration of medications requires sound and current knowledge of the drugs:

• Mode of action – how the drug works

• Side effects– unintended effects of the drug

• Toxicity – the amount of the drug required to become poisonous

• Dosage – appropriate amount of drug required to treat symptoms

• Rate and route of excretion - ways drugs leave the body and how quickly

• Interactions with other drugs– some drugs will cause increased or decreased effectiveness of other drugs when taken at the same time

You will not be required to have in depth knowledge of medications. However, each person administering medication is responsible for ensuring proper administration knowledge and techniques for the safety of the individuals being cared for.

Medication Forms

Medications are found as three basic forms: solid, liquid, and semi-solid. The method for administering drugs depends on the medication's form, properties, and the desired effects.

If a medication is to be administered orally, it may be in a tablet, liquid, or powder form. The basic forms of medications, liquid, solid, and semi-solid consist of the following:

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Liquid preparations: Those containing a drug, which has been dissolved or suspended in a solvent. Two common solvents are water and alcohol.

A. Elixirs: Preparations of drugs in a sweetened alcohol base. Example: Benadryl Elixir or Nyquil.

B. Emulsions: Mixtures of oil and water. They are milky in appearance and tend to separate upon standing for a period of time. They must be shaken before giving. Example: Mineral Oil Emulsion.

C. Fluid extracts: Concentrated fluid preparations of drugs made by dissolving a crude plant or animal based drug in an appropriate solvent. It may be a liquid or powder depending on the degree of evaporation. Example: Fletcher's Castoria.

D. Inhalers: Particles of drug suspended under pressure; measured dose release for oral inhalation. Example: Albuteral, Proventil.

E. Liniments: Aqueous preparations applied topically. They produce heat with massage. Example: Ben Gay.

F. Lotions: Liquid preparations of suspended ingredients used externally to treat skin conditions such as dryness. Example: Suntan lotion or Keri lotion.

G. Mixtures or suspensions: Result when certain medications are mixed with a liquid. The suspension drugs are in the form of fine particles suspended in the liquid. They must be shaken or stirred vigorously before giving. Example: Milk of Magnesia.

H. Sprays: Drugs prepared for administration by an atomizer. They are used for nose or throat conditions. Example: Neo-Synephrine Nasal Spray.

I. Solutions: When one or more drugs are dissolved in an appropriate solvent. When the solvent is water, it is an "aqueous" solution. Example of an aqueous solution: Hydrogen Peroxide.

J. Syrups: Liquid preparations of drugs in a sweetened water base. They are used to mask a bitter taste. Example: Robitussin-AC, a cough syrup.

K. Tincture: Alcoholic dilution of a drug. Example: Tincture of Iodine.

Solids and Semi-solids preparations: Forms of medication, such as tablets, capsules and suppositories, which may be used internally as well as externally, depending on the drug agent

and the drug form. Drug forms for internal use are capsules and tablets. For external use, the

drug forms include suppositories, lotions, creams and ointments. Each of the solid and semi-solid forms are described below:

Solids:

A. Capsules: Small containers made from gelatin. The medication is placed in the capsule, which dissolves in the stomach. Capsules are either "hard" or "soft".

• Hard Capsules: Are used to dispense powdered drugs.

• Soft Capsules: Are used to dispense oils/liquids. Example: Vitamin E. • Spansules: Are sustained-release (time-release) forms of a drug usually

contained in a capsule. Small particles of the drug are coated with compounds, which require varying amounts of time to dissolve. This provides for immediate as well as a time-released action.

9 A Spansule should not be opened, crushed, or chewed. Example: Contact.

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B. Pills: small, globe-shaped, and easy to swallow. Tablets have largely replaced pills but the term is still widely used in referring to various forms of drugs.

C. Tablets: The most common form of medication used today. They are small discs containing a medication and a cohesive substance, which holds the tablet together. Being pressed into molds of various sizes shapes them. The color of the tablet generally has nothing to do with the medications' content or action. Tablets are usually divided into groups, coated or scored.

9 Coated: Tablets may be coated because they taste bitter, discolor the teeth (example: iron tablets), or irritate the lining of the stomach. THESE TABLETS MAY NOT BE BROKEN, CRUSHED, OR CHEWED.

• Enteric-coated: Tablets, which are designed to dissolve in the small intestine rather than the stomach, prevent an irritating drug from upsetting the stomach (example: Aspirin). Sustained-Release tablets dissolve slowly in the intestine, thus releasing the medication gradually.

9 ENTERIC-COATED TABLETS MAY NOT BE BROKEN, CRUSHED, OR CHEWED.

• Scored: Tablets that are marked with indented lines which divide them into halves/quarters for easy breaking for proper dose. Medications that do not contain scoring lines are not to be divided into a smaller dose (the medication is not evenly distributed within the area of the tablet and under/over dosing can occur).

• Sustained- Release: Tablets dissolve slowly in the intestine; thus releasing the medication gradually.

9 SUSTAINED- RELEASE TABLETS MAY NOT BE BROKEN, CHEWED, OR CRUSHED.

D. Troche/Lozenge: Large flat disc that is held in the mouth until dissolved. These are used for local effect. The person should be told not to chew, swallow or drink water with a lozenge. Example: Cepacol.

9 THE PERSON SHOULD BE TOLD NOT TO CHEW, SWALLOW OR DRINK WATER WITH A LOZENGE IN THE MOUTH.

Semi-solids:

E. Ointments: Preparations of a medicinal substance applied locally to the skin or mucous membrane.

Example: Zovirax, Bacitracin.

F. Suppositories: Mixtures of drugs in a base that melts at body temperature. The base is most commonly glycerin

but can be soap or cocoa butter. They are molded into shapes suited for insertion into the rectum or vagina. Example: Dulcolax. They may need refrigeration. Check the label.

G. Creams: A water-soluble medical substance applied locally to the skin.

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Colorado Department of Public Health and Environment Drug Effects and Actions

Although drugs are given because of the therapeutic effect, they can also be dangerous. Persons licensed to prescribe drugs know the actions of the drugs and how they should be used. Remember there is no harmless medication, and there is no absolute correct dose. Each depends on the result achieved with a particular person at a specific time. Therefore, observation of the person's response to drug therapy is crucial.

The following terminology will define actions, effects, dosage, and reactions encountered in medication administration.

Drug action: Means the way a drug produces changes in body cells and tissues. Drug effect: Are physical or psychological changes that take place as a result of drug administration.

Dose: The amount of drug given at one time. The kinds are: Initial dose: The first dose

Lethal dose: Likely to cause death

Loading dose: A comparatively large dose given at the beginning of treatment to get the individual under the influence of the drug.

Maximum dose: Largest amount of a drug that can be taken safely.

Minimum dose: The smallest amount of a drug that can be given to produce the desired effect.

Optimum dose: The dose that will produce the best clinical effects without undesired effects.

Overdose: Dose too large for a person's weight, age and physical condition that is potentially dangerous. Depending on the drug involved and the amount of overdose, with no intervention can become a lethal dose.

Adverse Reaction: Drugs are given for a specific or desired effect. At times, medications may also give unwanted effects that range from minimal (dry mouth) to life threatening (respiratory distress). An adverse reaction may be a desirable effect; for example, Benadryl (antihistamine) taken for allergies, makes the person sleepy, thus allowing for some much needed rest. However, if the person needs to drive and be mentally alert the sleepiness side effect can become dangerous. Frequently an adverse reaction may occur initially but disappear after repeated dosages. It is extremely important to remember that some of these effects/reactions may be very severe, depending on the drug amount used, and the condition of the person. Observe/monitor closely and report any unusual occurrence in the person's mental or physical condition.

Cumulative Effect: Drugs are normally metabolized (broken down chemically) and excreted from the body, some more rapidly than others. Drugs have varying periods of effectiveness in the body, depending on their rate of metabolism, destruction, and excretion or retention. If the drug is administered continuously but excreted more slowly, it accumulates in the body and may produce one or more reactions. These reactions are called cumulative effect. Codeine and Digitalis are examples of drugs that can accumulate in the body.

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Tolerance: An increased amount of a drug is required to produce the same effect that a lesser amount previously produced. For example, if a person takes Valium for a long period of time, they may notice that the dose has to be

increased to accomplish the desired effect.

Hypersensitivity: An allergic response to a drug. It may be present itself as a simple or severe rash that may or may not progress to wheezing and difficulty breathing. Anaphylaxis, the severest form of hypersensitivity, may occur with impending death if there is no intervention. In a severe reaction, the person must be given medication to counteract the reaction. It is essential that unlicensed personnel administering medication be aware of the person's food and drug allergies to avoid any danger to them. An allergic reaction can occur with the first dose or after several doses.

Drug Interaction: Means that two or more drugs react together to change their intended effects on the body. Often two or more drugs can be given to a person as a part of drug therapy; or, a person may take what they believe to be a

"harmless" over the counter (OTC) drug with other prescription drugs. Whenever more than one drug is taken, the possibility of a drug interaction can occur. An allergic reaction can occur with the first dose of medication or after several doses of medication.

Synergistic/Potentiate: Two drugs given together produce a more powerful effect than either of them could produce alone is called a synergistic effect. Another word used frequently for the same effect is potentiated. Example: .A person on Valium is to avoid alcohol, because alcohol causes this type of drug to have a stronger (even fatal) effect.

Antagonistic/Inhibit: Two drugs, which interact to cause a lessened response than one of them would have been expected to cause, are called antagonistic effect. It is also referred to as an inhibiting effect.

Transdermal Delivery System: A patch method of drug delivery to unbroken skin and then the drug is slowly and continuously absorbed into the blood stream. Example: Nicoderm, Habitrol- Anti-smoking methods, Fentanyl. Major Routes or Channels of Administration

The route or channel of administration is determined by:

• the drug's chemical and physical properties • the site of the desired action

• the desired rapidity of the response to the drug

Topical: Medications applied to a confined area. The effect can be either local or systemic, depending on the drug's properties, action, and absorption. Drugs for topical use are often designed to soothe irritated tissue, prevent or cure local infections, or be absorbed through the skin. Topicals come in the form of cream, lotions, ointments, liquids, powders, aerosols, and "patches". They can be sprayed on, rubbed on, or attached to the skin. They can also be instilled, inserted, or used for irrigation.

• Instillation: dropped into eyes, ears, and/or nose.

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• Irrigation: rinse with a solution containing drugs

Systemic: Medications act on the entire body system. Systemic effects are noted only after the medication has been absorbed in the bloodstream and diffused intothe tissues.

Absorption: The process by which the drug enters the blood stream. Oral Routes of Medication

Oral: Medications are given by mouth, swallowed and then enter the stomach. These

medications are digested in much the same manner as food. After being dissolved, oral drugs are absorbed into the bloodstream. Consequently, most drugs given orally have a systematic effect.

9 WATCH FOR SPECIAL INSTRUCTIONS – SUCH AS TAKE 30 MINUTES PRIOR TO EATING, OR NOT TO TAKE WITH GRAPEFRUIT.

Sublingual: Medications placed under the tongue, where they are held until dissolved by saliva. The medication is absorbed by the rich blood supply within the area. Some medications, spray or liquid form may also be administered sublingually. Examples: Nitroglycerin, used to reduce angina chest pain. Ergostat used to treat migraine headaches.

9 THE PERSON SHOULD BE INFORMED NOT TO DRINK WATER OR SWALLOW UNTIL THE MEDICATION IS DISSOLVED.

Buccal: Medications are placed in the cheek pocket, at the back of the lower jaw. The drug is absorbed through the mucous membranes that line the inside of the cheek.

9 TELL THE PERSON NOT TO EAT OR DRINK UNTIL THE MEDICATION HAS DISSOLVED.

TYPES OF TABLETS AND/OR CAPSULES

Plain: "Untreated' tablets or capsules begin to be absorbed in the stomach; most absorption, however, takes place in the small intestine.

Coated: Tablets may be coated to disguise a bad taste, or to prevent staining of the teeth. Enteric coated tablets, which do not begin the absorption process until they reach the small intestine are used if the medication is irritating to the stomach lining or if the medication is destroyed by stomach acid.

RediTabs: A rapidly disintegrating tablet. The unique formulation enables the tablet to disintegrate almost instantly in the mouth. Taking this type of tablet does not require water. Spansule: Sustained or time-released forms are absorbed slowly, over many hours. These forms contain several doses of medication, each of which is covered by a special coating that dissolves at different rates.

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Scored: Tablet marked with indented lines, dividing the tablet into halves or quarters. This scoring allows the tablet to be easily broken to administer the proper dosage. Medications that do not contain scoring lines are not to be divided into a smaller dose (the medication is not evenly distributed within the area of the tablet and under/overdosing can occur).

Other Routes of Administration

Eye (ophthalmic) Medications: Medications can be instilled

into the eye by means of a dropper (for liquids) or a tube (for semi-solids).

Ear (otic) Medications: Medications can be placed into the ear by means of a dropper. Ear medications are usually administered to moisten impacted wax (cerumen) or to instill

medications to treat infections. Example: Auralgan and Debrox

Dermal Patch: Method of administration of a medication, by absorption through the skin. The patch is placed directly on the skin in the specified area. Area must be clean and free of hair. Gloves must be worn for this administration. The Transdermal patch must be time dated. The patch should not be placed in the same spot each application. The PCP or package insert gives advice on rotating sites. Example: Nitroglycerin

Rectal: Medications that are administered rectally are usually in the form of suppositories. However, creams and ointments may also be prescribed. Absorption is through the mucous membrane (lining) of the rectum. This route is frequently used with drugs to relieve constipation in suppository form. Example: Dulcolax, this may also be the best route when an individual is unable to take medication orally due to nausea/vomiting or one who is unconscious. Various pain relievers, anti-nausea drugs, and drugs to treat fever come in suppository form.

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Inhalation: Medication delivered by spraying or inhaling into the lungs. Medication is absorbed through the tiny sacs (alveoli) of the lungs. This form of medication is widely used for the

treatment of asthma symptoms. . Medications used for this route are in the form of gases or fine droplets, sprays, or mists.

9 Because germs can easily enter the body, through the lining of the lungs, all equipment used for inhalation therapy must be kept exceptionally clean.

Nasal: Medications introduced into the nose by means of drops or sprays. Absorption is through the mucous membrane (lining) of the nose.

Vaginal: Medications can be introduced into the vagina by means of creams, suppositories, tablets, or other special applications. Medication is absorbed into the vaginal mucosa. Topical vaginal applications are used to treat local infections.

Controlled substances (narcotics).

• A drug subject to restrictions with potential for addiction.

• A drug that in moderate doses dulls the senses and relieves pain, it can also cause stupor, coma, or convulsions.

• Classified into 5 "schedules", class I=most potential for addiction, class V= least potential for addiction. There should be a source of information available within the medication storage area to determine if a drug is on the controlled substance list.

• It is your responsibility to ensure controlled substances are stored under double locks and to, count, and document the count with another QMAP or Qualified Manager at the end of each shift.

Additional Precautions

• Medications must not be placed in foods, beverages, or nutritional supplements unless directed by the physician or pharmacist.

• Medications are not to be microwaved unless specified by the physician or pharmacist.

• Medications are not placed in the freezer unless specified by physician or pharmacist.

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• Medications that are expired or no longer needed by the individual are to be destroyed per facility policy and procedure or provided to consumer family members or other persons. They are not to be kept for future use.

9 QMAPs cannot administer medications through a gastronomy tube, prepare, draw or administer medication in a syringe for injection into the blood stream or skin, including insulin pen type devices in the CDPHE QMAP program unless otherwise provided by law and the individual has received special training and ongoing supervision. Nurses cannot delegate these functions to QMAPs that are not employed by Department of Human Services (DHS) or Residential Child Care Facility (RCCF).

Storage and Destruction of Medications

1. Prescription and non-prescription medications:

A. Store "in a manner that ensures the safety" of clients

• Individuals shall not have access to medication belonging to others. All medications that are not self-administered should be kept in a locked central location

B. Locked central location recommended, however, alternatives are acceptable if :

• Closed and locked drawer in client’s room in assisted living residence

• Closed backpack, purse or on the person of client of sound mind in adult day facility

• Closed wheelchair bag of non-ambulatory person in adult day facility

• Closed and locked file drawer in administrative area inaccessible to clients C. Medications requiring refrigeration

• Shall be stored separately in locked containers or compartmentalized packages, containers, or shelves for each resident in order to prevent intermingling of medication. Medications must be stored above any food that is stored in the refrigerator

• If there is a designated medication refrigerator and the refrigerator is in a locked room, then the medications do not need to be stored in locked containers

2. Controlled substances:

A. Must be doubled-locked, counted and signed for, using a second person for verification

Example: Locked portable medication box stored inside locked cabinet. The QMAP counts the number of pills remaining, the, second QMAP or qualified manager watches and agrees the count is correct; both staff members must sign and date the narcotic count sheet for the shift B. Any discrepancy, report immediately to supervisor for suspicion/investigation of drug diversion C. If a second person is not available the QMAP the counts number of pills and signs the form. The

next QMAP on duty shall verify the count and sign the narcotic count sheet prior to administering; any discrepancy in the count must be reported to supervisor immediately. D. Count at the end of each shift. Any time medication is given to a third party to take outside

facility; count the medication before it leaves the facility and count the medications upon returning The count should show the only the appropriate number of doses missing in accordance with the medication order.

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E. Any unaccounted for medications are considered drug diversion drugs are diverted to other than the intended use) and shall be reported to CDPHE as an occurrence or as a medication

administration reportable event (MARE)

3. Medication should not be stored with other items, must never be in areas with:

• Disinfectants

• Insecticides

• Bleaches

• Household cleaners

• Poisons

4. Expired and Unused Medications

The expiration date is one year after medication was filled (generally) or the expiration date on the medication container. Medications remaining past the expiration date are not to be administered. Expired and unused medications should be disposed of in accordance with facility policy. Generally, medications should be made unusable and discarded in the garbage.

¾ Take the medications out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter and a small amount of water to dissolve the medication. This should render the medication unusable. The personal and prescription information on the medication containers should be removed or obscured by using a permanent marker or placing duct tape over the information.

¾ Put the mixture in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.

¾ Medications should not be flushed down the toilet or poured down the drain unless the label or package instructions direct otherwise, this is most often seen with controlled substances. The destruction and disposal of controlled substances must be documented on the count form for each drug and witnessed by two QMAPs or other healthcare staff.

¾ Look for drug take back programs in your area. These programs will incinerate the drugs as biohazardous waste which is more environmentally friendly.

• Refill through date is variable and determined by the prescribing authority

USE OF MEDICATION REFERENCES

Every person who administers medicines should know or have access to information regarding each drug's intended use, side effects, adverse reactions, warnings, and special considerations. Appropriate medication dosage and the route of administration must be known.

It is standard practice for a person who is administering medications to:

• have a current drug reference available. In addition, a medical dictionary would be helpful.

• have knowledge of name(s) - generic, and trade names of drugs administered in the facility

• have knowledge of common adverse reactions - according to the various body systems

• have knowledge of common drug interactions

Expiration date is one year after the medication was filled.

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As a general rule, QMAPs should inform the person as fully as possible what the medication is

9 the sign/symptom or disorder it is prescribed to treat

9 any precautions necessary

9 whom to notify should something not "seem right" Considerations:

¾ Never administer a medication with which you are not familiar

9 refer to information about the medication that was obtained from the prescribing physician and/or the pharmacist who filled the prescription

9 Review the medication information in a current drug reference manual. Unit Two Review Questions

True/False

1. ____ A generic medication may have more than one brand name. 2. ____ A drug overdose is the same thing as a lethal dose of medication. 3. ____ All drug interactions have a negative effect.

4. ____ Narcotic medications are all equally addictive.

5. ____ Medications may be mixed into a food such as pudding or applesauce without physician or pharmacist order.

6. ____ An overdose may not produce an adverse effect.

7. ____ Medications may be used for up to 30 days after the expiration date.

Matching

1. Match each drug with its purpose.

____ Health Maintenance A. Morphine

____ Disease Treatment B. Barium

____ Symptom Relief C. Vitamin C

____ Disease Prevention D. Insulin

____ Disease Diagnosis E. Influenza Vaccine

____ Body Process Alteration F. Amoxicillin

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____ Loading Dose A. An increased amount of drug is needed to produce the same effect in the patient ____ Antagonistic Effect B. A large dose of medication given at the

beginning of treatment

____ Potentiate C. Physical or psychological changes that result from drug administration

____ Drug Action D. The interaction of two or more

medications which produces a decreased response in a person

____ Optimum Dose E. The medication dosage which produces the best clinical effects in a person

____ Drug Effect F. A response which occurs when a

medication accumulates more quickly in the body than it is excreted

____ Tolerance G. The way a medication produces changes in body cells and tissues

____ Cumulative Effect H. The interaction of two or more drugs which produces an increased response in a person

Multiple Choice

1. Which of the following may be broken, crushed, or chewed? Select all that apply. a) Coated tablets

b) Sustained release tablets c) Spansules

d) Scored tablets e) Capsules

2. Which of the following are true about adverse reactions? Select all that apply. a) Adverse reactions may bring about a desired effect on a person.

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b) Adverse reactions could potentially be very harmful, up to and including death.

c) Adverse reactions are always a result of an interaction with food or another drug a person is taking.

d) Adverse reactions will occur each time a person takes a particular drug. e) Adverse reactions are the same as allergic reactions.

3. Oral medications are…

a) swallowed and absorbed into the bloodstream.

b) placed in the cheek and absorbed through the mucous membranes. c) placed under the tongue and absorbed into the bloodstream.

4. Sublingual medications are…

5. Buccal medications are…

6. The pharmacy dispenses a drug. The medication requires no special storage conditions and has the average shelf life. If the medication was dispensed on June 30th_{, 2011, when will it expire?}

a) September 30th_{, 2011} b) December 30th_{, 2011} c) March 30, 2012 d) June 30th_{, 2012} e) September 30th_{, 2012} Short Answer

1. Describe the difference between local and systemic medication effects.

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3. Describe the appropriate process for performing a narcotic count when only one QMAP is present.

4. Describe a hypersensitivity reaction.

5. What are the five sources of medications?

a) ____________________________________________________________________ b) ____________________________________________________________________ c) ____________________________________________________________________ d) ____________________________________________________________________ e) ____________________________________________________________________ 6. List at least seven routes of medication administration for which this course will qualify you.

a) ____________________________________________________________________ b) ____________________________________________________________________ c) ____________________________________________________________________ d) ____________________________________________________________________ e) ____________________________________________________________________ f) ____________________________________________________________________ g) ____________________________________________________________________

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Colorado Department of Public Health and Environment Objectives:

Upon completion of this unit the student will be able to:

• Describe the person-centered approach to medication administration

• Define the “five rights” of medication administration

• Recognize and define appropriate medication abbreviations, symbols and terminology related to medications and abbreviations that are not to be used

• Define medication measurements

• Identify medication forms

• Define the various routes of administration

• Indicate correct storage and disposal mechanisms for medications

• Identify medication and medication administration references

• Generally describe drug classifications

• Identify special considerations that determine approaches to medication administration for a specific population.

• Demonstrate the following drug administration procedures.

• Oral medication administration

• Topical medication administration

• instillation of eye medication

• instillation of ear medication

• rectal medication administration

• vaginal medication administration

• nasal medication administration

• inhalant medication administration

• Describe procedure for filling and administering medications from Medication Reminder Boxes APPROACHES TO MEDICATION ADMINISTRATION

Person-Centered Approach

People receiving care retain their rights as citizens and deserve care that embodies dignity. One of the essential rights is the right to be involved with one’s own medical care and the decisions surrounding that care. Each patient has the right to refuse care or treatment including medications.

One hallmark of a person-centered approach to medication administration is a focus on the needs of the person. This approach considers such things as the person's functional movement, ability to

swallow, and what texture is easiest for the person to manage. In addition, consider the person's ability to reliably identify him or herself verbally. If not, there should be a recent photo with the medication administration record so that the person administering can correctly identify the person receiving medication. The medication system is then tailored to meet the person's needs (Barks, 1994).

UNIT THREE

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The person-centered approach shifts control to the person as much as possible. Medication still may be necessary, but the person with intact oral motor function may exert some control, for instance, choosing whether the medication is presented whole or crushed (if allowed).Further, choosing the vehicle (e.g., applesauce or other food) as long as there is no food-drug interaction also allows the person some control. Any dietary restrictions must also be considered when offering choices. Many medications have an unpleasant taste or aftertaste. Medications may also produce unwanted side effects and the person may refuse the drug to avoid the effects (e.g., blurred vision, nausea, or dizziness). It may be difficult for the person with disabilities to distinguish the sensations that come from the medications, and to correctly interpret whether these are therapeutic or undesired effects.

The developmental level of the person is relevant to the type of control he or she is capable of exercising. For example, if the person functions at the pre-school level, he or she may refuse medications necessary for health. Rather than allowing the person to "choose" whether to take the medication, shift control to the person by offering a choice within the medication regimen (e.g., apple or orange juice; mashed banana or applesauce).

Age specific care

Geriatric individuals are those that are age 65 and above. As people live longer due to advances in health care, nutrition and medication, much of the elderly population will be over age 75. By the middle of the next century the population of people 85 and over will increase five times. More than 80% of the elderly population will suffer from at least one chronic health problem.

Studies show that the elderly account for more than 30% of all hospitalizations and 36% of all health care expenditures.

Physiological Effects of Aging

As we age the body goes through many changes. The older body tends to work less effectively than the younger body. Metabolism (process of breaking down substances such as carbohydrates to yield energy) slows and fewer calories are required. However, protein, mineral, calcium needs remain the same. Organ functions decrease and along with decreased metabolism cause the older body to be at risk for dehydration, and formation of renal calculi (concentration of salts and acids forming in the renal tubules).

There is an increased difficulty in maintaining body temperature. Generalized muscle degeneration leads to overall weakness and respiratory problems. Eyesight degeneration and decreased hearing ability affect the overall treatment of disease and the promotion of health in the elderly population. Gastrointestinal (GI) changes lead to intolerance to spicy foods, decreased sense of taste decreased gag reflex, decreased GI motility and increased constipation and incontinence. The process of eliminating waste from the body, including medications is much slower.

Medication and the elderly

“Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”

J Gurwitz, M Monane, S Monane, Javorn Brown University Long-term Care Quality Letter 1995 28% of hospitalizations of elderly are due to Adverse Drug reactions Arch Intern Med.

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Colorado Department of Public Health and Environment April 1990

A major risk of aging develops around the consumption of numerous medications (polypharmacy). Decreased organ function and metabolism can lead to toxic levels which can mean confusion and disorientation. These issues increase the risk of falls, injury, increased infection, malnutrition, decreased sensory ability, immobility, isolation, and incontinence.

Medications should be consistently reviewed by the Primary Care Provider (PCP). After an absence from the facility for medical treatment or extended absence for other reasons, all medication orders must be individually rewritten by the PCP.NEVER accept “resume previous orders” as a valid medication order. The new medication list should be “reconciled” or compared with the past medication orders to guard against duplication of medications under different names and to ensure accuracy. Request the PCP to clarify any information that is missing or unclear.

Medication Administration to Persons with Oral/Motor Difficulties

Oral and motor difficulties are very significant considerations in medication administration. If the person has poor chewing and/or swallowing ability the QMAP should refer questions to the administrator or the person’s Primary Care Provider (PCP). The individual may need to be examined and a plan

implemented to guard against choking and the accidental breathing in/inhaling food or medications into the lungs (aspiration). Aspiration can cause blockage of the airway, pneumonia, and other

complications that can significantly harm the individual and can even result in death. The health care provider can design instructions concerning administration of medications to decrease the risk of aspiration during medication ingestion, eating and drinking. For persons with difficulty swallowing exact placement of medication within the mouth is crucial.

A person with oral motor difficulties should not be rushed through medication administration. This is an important learning experience for him or her, whether it concerns opportunities to practice oral motor skills or to remember different medications and their side effects. People with severe oral motor problems may have some difficulty in mouth opening. Tonic biting on a utensil, delayed swallowing, or loss of food or fluid from the mouth are also common problems.

Special needs of persons with disabilities must also be considered. If the person cannot take a sufficient amount of fluid for the medication to be swallowed and absorbed, the QMAP should refer concerns or questions to the administrator and/or the person’s Primary Care Physician. Determining "a sufficient amount" may be a collaborative effort of the PCP, nurse, dietitian, oral motor specialist, and pharmacist. Lack of sufficient fluids to ensure the passage of medications into the stomach may result in inflammation and destruction of tissue inside the throat.

Enteric-coated (coated to protect the stomach) tablets should not be crushed, because the

esophagus and stomach will be exposed to irritation. If an enteric-coated tablet cannot be taken intact orally, the QMAP should refer concerns to the administrator and/or the person’s Primary Care

Physician in finding an alternate route or medication.

When mixing crushed or powdered drugs, it is important to include the entire dose; if the drug must be given in a pureed texture substance, be certain to give the entire amount. Liquid antiepileptic drugs, in particular, are difficult to dose accurately.

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Syrups and elixirs can exert local anesthetic effects such as numbness or decreased sensation mouth and throat tissues. If fluid is offered immediately after administration of such compounds, the risk of aspiration may be increased. Considerations in selection of a vehicle for medication administration in addition to individual preference are needed. Avoid using the person's food at mealtime as a vehicle for medication administration, unless the person requests the option. These must be appropriate to the person's eating skills. They should be indicated on the person's mealtime

instructions.

Medication Administration to People with Psychiatric/Psychological Diagnoses

Mental health is the ability to perform the activities of daily life successfully. The manner in which people are able to engage in productive activities, form and enjoy relationships and change or cope with adversity. A mentally healthy person is capable of rational thinking, communication, learning, emotional growth, resilience and self-esteem.

Mental illness is a clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability or loss of freedom. (American Psychiatric Association, [APA] 2000).

The goal of medication therapy for people with psychiatric/psychological diagnoses is to assist the person in attaining and maintaining a quality of life that is satisfying and fulfilling in their activities of daily living. There are mental diagnoses that range from addictions to depression, to the most severe biologically based mental illnesses such as schizophrenia.

QMAPs administering medication to individuals with psychiatric/psychological diagnoses must be aware of the patient’s rights. People with psychiatric/psychological diagnoses retain their rights as citizens and have the right to be treated with dignity and respect. The individual has the right to be involved in their care and the decisions made surrounding the care. They also have the right to refuse care or treatment including medications. The person have the right to the least restrictive means of treatment. Medication should never be used by a QMAP as a chemical restraint or for behavioral modification. Medications should be given as the PCP has ordered them them but never as a means of behavior control. Medications given for psychiatric illnesses are often the ones with the most adverse effects, some of which are not reversible.

9 A QMAP may never force an individual to take a medication even if the medication is "court-ordered".

A medication should never be given to adjust a person's behavior for the convenience of the staff.

Guidelines for Administering Medications

1. Give medicines only upon complete written orders from the PCP. Complete orders must include:

• full name, address, phone number, and license number of the prescribing provider • full name of the individual requiring the medication

• date the order was written • name of the medication

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• prescription strength of the drug (200 milligrams, 5 milligrams per 10 cubic centimeters) • dose (2 tablets, 2 drops, 2 tablespoons, etc)

• frequency (twice daily, at bedtime, before meals) • stop date ( number of refills, 10 days, until gone)

• reason for the medication, signs/symptoms requiring physician notification (blood

pressure - call if greater than 180/90)

• provider signature

2. Generally, QMAPs administer medications that are ordered on a routine scheduled basis. However, sometimes, an individual will need medication to address symptoms that are not always present such as fever, diarrhea, or pain. The medications to address these symptoms are often called PRNs which is a greek acronym for "as needed". QMAPs may administer PRN medications on a restricted basis where the individual does not require a professional assessment to determine the necessity for a medication or to actively evaluate the outcome. In these instances, in addition to the required content of a medication order detailed in paragraph 1 above - a PRN order must contain:

• specific and measurable objective parameters for the PRN medication to be given -

"blood pressure over 140/90," "resident rates pain 5 out of a scale of 10," client has had no substantial bowel movement for 5 days"

• specific directions for physician notification when PRNs are administered - "call if BP

greater than 160/100 or 140/90 for 3 days," "call if pain medication is requested more than twice daily x 3 days," " call if no bowel movement after 2 doses"

• For those individuals with cognitive impairments or that cannot otherwise communicate

their needs, the PRN order cannot contain a variable dosage amount that requires the QMAP to make a judgment as to how much to give or how often to give the drug (decide between 1 or 2 tablets, or every 2-6 hours)

• PRNs may not be administered by QMAPs when there are declines in the individual's

medical or psychological condition that requires the assessment, evaluation or judgment of a health professional. For example an individual on hospice care with increasing pain requiring professional management of symptoms.

• Prescription PRN orders (not over the counter) must be re-evaluated and renewed if

indicated at least every 30 days.

3The person administering the medications has the responsibility to know the medication's intended use, the purpose for which it is being given, any common unfavorable reactions or side effects which might occur, any warnings or directions of a specific nature concerning the medication, and the usual dose.

4 It is the responsibility of the person administering medications to be familiar with the condition of the person (e.g., allergies to certain medications, ability to swallow). Medication orders must be compared to the individual's list of medication allergies prior to administration.

5 The following items are important responsibilities of the unlicensed personnel. They must see that the medications are prepared and delivered according to these "five rights":

• PERSON- have you confirmed you have the right person for the medication order?

• DOSE- did you check the medication strength with the dose? How many tablets are to be taken each day? How many times per day? How long is the medication ordered?

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• MEDICATION- did you compare the medication container with the order? Is this the right medication the practitioner ordered? Is it a generic or brand name? Does it belong to someone else?

• ROUTE- did you review how the medication should be administered? Should it be swallowed whole, crushed or chewed? Given with a sip of water, a whole glass or apple sauce?

• TIME - are you giving the medication at the ordered time of day? What about food - should it be given before a meal, during or after a meal?

5. Medications must be identifiable up to the point of administration. Avoid taking medications out of the original packaging to transfer to medication cups until you are in front of the person you are administering medications to

6. Avoid distractions

7. The person receiving the medication should be told the name and the purpose of the each medication administered- "Mrs. Jones, This is your Tums for your heartburn".

8. Each Medication Administration Record (MAR) must be read carefully. If not clear, refer to the PCP order sheet/prescription label or check with a pharmacist or the PCP. The information (e.g., person's name, name of medication, route of administration, dosage, duration and time ordered) must be the same as the PCP order

9. Read the label of the medication container carefully, checking to see that the label and the MAR read exactly the same. The label on the medication container should be read three times as follows:

• When the container is taken from the person's supply • When the medication is removed from the container • When the container is returned to the person's supply

10. Never take medication from an unmarked container, or container with a label that is not readable 11. Keep all containers tightly closed to prevent any changes to the medication from occurring. Any change in color, consistency, or odor of medication must be reported to the, pharmacist. The medication must not be used unless approved by the pharmacist

12. When administering medication to a person, verify that it is the correct person. Photographs on the person's MAR or other visible identifiers are standard practice

13. Give the medication at the time it is ordered and remain with the person until the medication is taken. NEVER leave medication unattended

14. Provide privacy to the person during medication administration when it is indicated (e.g., rectal medications)

15. Medications that have been prepared and not given to the person for any reason (refusal, absence, etc.) are to be discarded. Never return medications to their container

16. The unlicensed person must be aware of the additional responsibilities regarding administration and control of controlled substances. Controlled substances must be double locked at all times and a two person count and signoff must be conducted with each change of shift.

17. Refused medication must be reported to the designated supervisor and the Primary Care Provider. Refused medication must be recorded on the MAR initialed, circled, and the reason why the medication was refused documented (this documentation is generally on the back of the MAR but should be recorded per facility policy). The documentation of "refused" does not satisfy this

requirement. Example "refused Maxide - stomach upset today". Recurring or absolute medication refusals must be reported to the PCP.

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18. When administering medication the principle aspect of universal precautions must be followed. Glove or do not touch medications with your hands. Cleansing and gloving between individuals is imperative in the prevention of infections

19. Medications must be given at the prescribed time (if a time is prescribed). The window of time is one-half hour before or one-half hour after the prescribed time. Medications ordered without specific time of day for administration may be given in the time frame designated by the facility policy/procedure and do not need to follow the one-half hour before and after rule, however, medications should be given at a consistent time.

PRINCIPAL ASPECTS OF UNIVERSAL PRECAUTIONS

Universal precautions are steps designed to protect one's self and others from infection if there is a possibility of contact with anyone's blood or body fluids. Universal precautions are intended to

supplement rather than replace recommendations for routine infection control, such as hand washing and using gloves to prevent microbial contamination of hands.

Universal Precautions in Practice

1. Protective barriers can prevent or reduce incidence of exposure to blood and other body fluids. The type of protective barrier should be appropriate for the procedure performed and the type of exposure anticipated.

a. Use gloves when contact with blood or other body fluids is anticipated, including the following: • Assisting program participates with bathing

• Giving mouth care (e.g., tooth brushing).

• Handling laundry soiled with blood or body fluids. • Obtaining specimen (e.g., urine, stool, blood). • Changing a bandage or dressing a wound.

• Provide skin care (e.g., shaving, application or topical ointments to skin lesions). • Treating cuts, bites, nose bleeds, burns or bee stings.

• Cleaning emesis.

b. Change gloves and wash hands between individual contacts. c. Do not wash or disinfect gloves for reuse.

d. Replace torn or punctured gloves immediately.

e. Cover cuts, rashes, or other breaks in the skin with bandages and gloves.

f. Use general-purpose utility gloves for cleaning instruments or areas involving blood/body fluid contact.

3. The most effective method to prevent and control the spread of disease is proper hand washing. • remove and secure rings.

• use continuously running water. • wet hands and apply soap.

• scrub vigorously all surfaces of the hands, including back of hands and between fingers, for at least 15 seconds.

• rinse thoroughly.

• dry well with a paper towel.

• use the paper towel to turn off faucet. • discard paper towel in the trash can.

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4. During medication administration, if the QMAPs hands come in contact with other persons, the medication cup after use, surfaces other than the one cleansed for medication preparation, they must cleanse their hands before the next individual interaction. The QMAP must also cleanse their hands if they touch their own body such as rubbing the nose, scratching the head or other areas, coughing or sneezing into their hand.

Alcohol based hand sanitizers may also be used between administering medications to individuals. However, whenever hands get overly soiled or come in contact with blood or body fluids, hands must be washed. Hands must also be washed prior to application of medications to a person's eye(s).

Administering Medication Safely

ACTION RATIONALE

1. Medication, dose, time, route, texture and position, (as indicated) must be ordered by the PCP

1. Prescribing is the function of the PCP. Nothing in the order can be left to interpretation

2. Medication order must be in writing on the MAR which states person's name, drug name,

dosage, route, frequency, duration and time to be given. (Texture

and position, as indicated)

Documentation must be in plain language without the use of abbreviations

2. Written documentation provides for person’s safety

3. Following principle aspects of universal precautions, steps for proper hand washing techniques, before and after administering medications

3. Good aseptic– clean technique – not sterile to prevent the spread of infection Alcohol gels and foams are acceptable except prior to application of medication in the eye and after administration of medication in the vaginal and rectal areas. 5. Read label three (3) times when

preparing medications: • upon taking container from supply (before)

• when preparing (during) • when replacing container to supply (after)

5. Triple check assures accuracy in administering. If using a "unit dose";*

• check upon taking from container

• immediately before giving the medication 6. Never give a medication unless label is present

and clearly readable 6. Prevents medication errors

7. Do not touch pills or capsules 7. Reduces spread of infectious organisms 8. Pour liquids away from label side of bottle 8. Prevents messy unreadable label