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QMAPSyllabusLighthouseAssistedLiving
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Qualified Medication Administration
Person (QMAP) Syllubus Revised 2018�
Liz Littleton, RN, BSN
cdphe_hfemsd_qmap@state.co.us
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Purposeofthiscourse
ThemedicationadministrationprogramisestablishedinaccordancewithSection25-1.5-301,C.R.Setseq.Themedicationadministrationcourseisdesignedtoteachunlicensedstafftosafelyadministermedicationsinsettingsauthorizedbylaw.Staffwhosuccessfullycompletethemedicationadministrationcoursearenotcertifiedorlicensedinanyway,andarenottrainedorauthorizedtomakeanytypeofjudgment,assessmentorevaluationofaclient.StaffwhosuccessfullycompletethecourseareconsideredQualifiedMedicationAdministrationPersons(QMAP).Successfulapplicantswillpasswrittenexamandahands-onpracticalexam.
TheImportanceofSafeAdministrationofMedications
• Theadministrationofmedicationsisaprivilege.• Thisroleisamajorresponsibilitythataffectsthequalityofclients'lives.• Improperorcarelessadministrationofmedicationsmayresultindeath.• Youareresponsibleforwhatyouadminister.Itisbestpracticetoadminister
medicationsthatyouhaveprepared.Youmayadministermedicationsusingmedicationreminderboxes(MRBs)thatothers(client,family,otherfacilitystaff)haveprepared.ThepurposeoftheMedicationStudyGuidealongwiththeQMAPcourseistohelpyoubecomemoreknowledgeablewithadministeringmedicationsandbetterpreparedforthetestaswellastrainingatyourcommunity.
• QMAPmustprovideanIDshowingaminimumageof18yearsold
Courseobjectives
• Safeadministrationofmedicationsaccordingtowrittenphysician'sorders• Maintainingproperdocumentationoftheadministrationofbothprescriptionandnon-
prescriptiondrugs• Useofpropertechniqueswhenadministeringmedicationsbythevariousroutes• Youwillknowanddemonstratemasteryofthefollowing:
A.ComprehensionofimportantguidelinesB.UseandformsofdrugsC.MedicationordersD.DocumentationE.MedicationreminderboxesF.StepsofproceduresG.MedicationerrorsH.Medicationstorage
• Safelyandaccuratelyfillandadministermedicationstoandfrommedicationreminderboxeswithoversightfromalicensedpersonorqualifiedmanager
Atthecompletionofthiscourse,youshouldbeabletodemonstrate:
• Properreading,understandingandtranscribingofphysician’sorders
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• Safeadministrationofmedicationsviamultiple"routes"(ingested,applied,inhaled,inserted)indesignatedsettingsusingwrittenphysicianordersaccordingtothe"7rightsofadministration"
• Documentationofmedicationadministrationaccordingtostateboardofhealthregulations
• SAFEadministrationofmedicationsfromMedicationReminderBoxes(MRB)
AuthorizedSettings
1.AssistedLivingResidences.2.AlternativeCareFacilities.3.Statecertifiedadultdayprograms.4.ResidentialChildCareFacilities5.DevelopmentalDisabledpopulation(Willrequireadditionaltraining)6.AdultFostercareFacilities7.SecureResidentialTreatmentCenters
ThisQMAPcourseisnotappropriateforthefollowingsettings:
1. FacilitiesregulatedbytheDepartmentofCorrectionshaveaqualifiedmedicationadministrationcurriculumspecificallydevelopedfortheadministrationofmedicationsincorrectionalfacilities.
2. Programs/servicesregulatedbytheDepartmentofHumanServiceshaveaqualifiedmedicationadministrationcurriculumdesignedtoaddresschildcarepopulation
3. ChildCarelessthan24-hourcare
Requirements
1. Mustprovidepaymentof$110.00infullpriortoclasstobeconsideredregisteredforclass.PaymentswillbeacceptedonlyviaEventbrite.
2. Youmustpassthewrittentestwithaminimumscoreof75%.3. Youmustscore100%onthepracticumexamtopassthecourse;thisincludeshandson
demonstrationsandfillinganMRB.4. Mustbe18yrsoldandabletoprovidecurrentphotoidentificationandthelastsixdigits
ofyoursocialsecuritynumber.5. Employersmustprovide“onthejobtrainingandmentoring”forallQMAPs.
CAUTIONS
1. Thiscoursedoesnotleadtocertificationoralicense.Uponsuccessfulcompletionofthiscourseyouwillreceiveaprovisionalletterofcompletionauthorizingyoutoadministerprescriptionornonprescriptionmedicationsinvarioussettingsassetforthinthelaw.Youwillbeconsideredqualifiedtoadministermedications,asaQualifiedMedicationAdministrationPerson(QMAP).
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2. Personssuccessfullycompletingthiscoursearenottrainedorauthorizedtomakeanytypeofjudgment,assessmentorevaluationofmedications.
3. FEESpolicy.Yourpaidfeeswillbeforfeitedifyouareregisteredforaclass/testinganddonotattendormissanyportionofwithoutmakingappropriatearrangementswiththeinstructor.
4. Uponsuccessfulcompletionofthecourse,theQMAP’sinformationwillbeforwardedtotheStateofColoradotobeaddedasanactiveQMAPwithinthestateofColorado.Thisinformationwillbesubmittedtothestatewithin3businessdaysofsuccessfulcompletion.Acompletionformwithbegiventoeachstudentuponpassingthecourse.ThisformdoesnotauthorizetheQMAPtoadministermedication.TrainingfortheQMAPmaybeginoncethequalificationisnotedonthestatewebsite.AdditionalinformationcanbefoundontheQMAPwebsitelocatedatwww.healthfacilities.info
INFORMATIONFOREMPLOYERSANDSTUDENTS
1. StudentsshouldnotworktheovernightshiftbeforeattendingtheQMAPclassandshouldnotworkovernightbeforetesting.
2. Studentsmustread,writeandspeakEnglish3. Studentsshouldhavebasicmathskills4. Studentsmustprovidephotoidentificationattheclass5. Employersmustconductacriminalbackgroundcheckpriortoallowingmedication
administrationbytheQMAPemployee.
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Unit1:Communication
InterpersonalSkills:
Whatdoesthismean?
Whoarewetalkingabout?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Benefitsofgoodcommunicationskills:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HowcanIgetbetteratthis?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Communicationwiththevisuallyimpaired:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Communicationwiththehearingimpaired:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
CommunicationwithAlzheimer’sresidents:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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***AllQMAPsmustbefamiliarwiththepopulationthattheyareworkingwith.Forexample,behaviorscommonlyassociatedwithAlzheimer’sanddementia,mentalillness,poststroke,chemicaldependency,etc.Thefollowingarelinkstolearnmoreaboutpersonswithimpairments.
Youcanusetheinternetresourcestofindtheinformationsuchas:• https://changeagents365.org/resources/ways-to-stay-engaged/the-gerontological-
society-of-america/Communicating%20with%20Older%20Adults%20Low_GSA.pdf
• https://www.alz.org/care/dementia-communication-tips.asp
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074568/
• http://www.chadd.org/Understanding-ADHD/For-Adults/Living-with-ADHD-A-Lifespan-Disorder/Relationships-Social-Skills/Social-Skills-in-Adults-with-ADHD.aspx
• http://www.healthyhearing.com/report/51744-Communication-strategies-when-talking-to-individuals-with-hearing-loss
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Unit2:PurposesofDrugs
Objective1:Describesomeofthepurposesfordrugs
• Preventortreatdiseaseorillness• Treatsymptoms• Aidindiagnoses• Restoreormaintainnormalbodyfunctions• Reachdesiredortherapeuticeffect
Objective2:Learnthedifferencebetween(1)monitoring,(2)administeringand(3)clientself-administrationofmedications.
Theauthorizedpractitionermuststate,inwriting,whichoptionispermitted/requiredifmedicationistakeninadesignatedsettingbyaclient.Anauthorizedpractitionerislicensedphysician(MD),physician’sassistant(PA),nursepractitioner(NP)withprescriptiveauthority.
Monitoringmedicationtakenbytheclient:
• Remindingaspecificindividualclienttotakemedicationatthetimeordered• Deliveringacontainerofmedicationlawfullylabeledtoaspecificclient,ifneeded• Observingaspecificindividualclienttomakesures/hetookmedications• Makingawrittenrecordofeachmedication,withthenote"monitored"
Note:RegulationsdonotrequiresuccessfulcompletionofaQMAPcourseifstaffonly"monitors"anddoesnot"administer"medicationstotheclient.(Documentwhatyoudo)
Administeringmedicationtoaclient:
• Assistingaclientintheingestion,application,inhalation,or• Insertionofarectalorvaginalmedicationaccordingtowrittendirectionsofan
authorizedpractitioner• Handingstaff-preparedmedicationstoaclient• Makingawrittenrecordofeachmedicationadministered,includingbothprescription
andoverthecounterdrugs
Self-administrationofmedicationbyaclient:
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• “Self-administration”meanstheabilityofapersontotakemedicationindependentlywithoutanyassistancefromanotherperson.
• Theclientiscompletelyresponsiblefortakinghis/herownmedications.Staffisnotinvolvedotherthantoensuresafetyofotherclientsandencouragenotificationofupdatedinformation.
• Thereisnorequirementfordailydocumentationofself-administeredmedication.• Thereshouldbeanoteontheplanofcareatleastonceyearly,updatedasappropriate,
documentingthefacility'sknowledgeofmedicationsbeingself-administered.
• Ifafacilityadministerssomemedicationsandaclientself-administerssomemedicationsthefacilitymusthavewrittenphysicianapprovalforeachself-administeredmedication
Objective3:Learnthesevenrightsofmedicationadministration.
1. rightclient2. righttime–1⁄2hourbeforescheduleddoseto1⁄2hourafter;ifaspecifictimeisstated
ontheorder.3. rightmedication4. rightdose5. rightroute6. documentation7. righttorefuse
Medicationsthatareorderedtobegiven“am”or“pm”donothaveatimerequirementsetbytheprescribingauthority;however,thefacilitymaydesignateatimeframeintheirpoliciesandproceduresoruse“am”and“pm”formedicationstobegiven.
Objective4:Learnthe4"routes"ofgivingmedications
1. Ingestiona. oraltablets,capsulesorliquidsb. lozenges(inthemouth,notswallowed)c. sublingualtablets(undertongue,notswallowed)Note:QMAPsareallowedto
utilizethebarrelofasyringetoadministeroralmedications.2. Application
a. skinointments,gels,lotions,linimentsb.skinspraysoraerosolsb. throatgarglesc. transdermalskinpatchesd. eyeointmentordropse. eardropsf. nosedropsornasalsprays
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3. Inhalation(respiratory)4. Insertion(rectal/vaginalcreamsorsuppositories)
*EPIPens*Theassistantprocessofhelpingsomeonewithanepinephrineiscoveredunderyourfirstaidtrainingandcanonlybedoneafterbeingdirectedbyemergencyservices(911operatororEMT)andhashadanaphylactictrainingrecognizedbyanationalorganization(AHA;RedCross)
Injections:QMAPsarenotallowedtoinjectanymedicationofanykind.Whenaclientrequiresinjections,theclient,alicensednurse,thefamily/friendoroutsideagencywillneedtoadministertheinjection.
ALWAYS NEVER1.ALWAYSmeasureusingthemetricsystem. 1.NEVERusehouseholdspoons.
2.ALWAYSuseanoralmeasuringsyringeforsmallamountsofliquidmedication
2.NEVERswitchthespecialdroppersthatcomewithsomeliquidmedications.
3.ALWAYSplacecuponasolidsurfaceateyelevel.
----4tsp--------3tsp--------2tsp--------1tsp----
3.NEVERusecupsthatarenotmarkedwiththeamounttheyhold.
4.Ifthelabelsaystomeasureinmls,ALWAYSuseameasuringdevicethatismarkedinmls.
4.NEVERmeasuremlswithameasuringdevicethatismarkedinmgs.
5.Ifthelabelsaystomeasureinmgs,ALWAYSuseameasuringdevicethatismarkedinmgsforthatmedication.
5.NEVERmeasuremgswithmeasuringdevicesthataremarkedinmlsmg=ml
6.ALWAYSconsultyourpharmacistwhenyouhaveaquestionaboutmeasuring
6.NEVERleaveairbubblesmixedwiththeliquidinanoralmeasuringsyringe
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Unit2Review
1. Listtwoexamplesofmonitoringmedications.________________________________________________________________________________________________________________________________________________
2. Listtwoexamplesofadministeringmedications________________________________________________________________________________________________________________________________________________
3. Thiscoursequalifiesyoutodofingersticks___true___false4. Thiscoursequalifiesyoutoadministermedicationsthroughag-tube,IVportand
injectionthroughtheskin.___true___false5. Youwouldnotneedthiscourseto"monitor"aclientinjectinginsulin___true___false6. Listthe4routesforadministeringmedicationsandgiveanexampleofeachroute:
ROUTE
________________________________________________________________________________________________________
7.TheQMAPcandialup&injectinsuliniftheclienthasaninsulinpen.___true___false
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UNIT3:USESANDFORMSOFDRUGS
Definethemeaningof:
Liquid:Solution_______________________________________________________Suspension_____________________________________________________
Solid:
Tablet/caplet____________________________________________________EntericCoated___________________________________________________
Semi-solid:
Capsule_________________________________________________________Spansule_________________________________________________________Suppository________________________________________________________Ointment_________________________________________________________Cream____________________________________________________________
Patches:________________________________________________________________
Sublingual:______________________________________________________________
• LocalandsystemicdrugactionsLocaldrugactions:______________________________________________________
Systemicdrugactions:___________________________________________________
Prescriptionandoverthecounterdrugs(OTC)andtheirlabeling
Thepurposeofprescribedmedications
• PrescriptionPainRelievers-Prescriptionpainrelieversincludetheopioidclassofdrugs,suchashydrocodone(i.e.,Vicodin),oxycodone(i.e.,OxyContin),morphine,fentanylandcodeine.Opioidsworkbymimickingthebody’snaturalpain-relievingchemicals,attachingtoreceptorsinthebraintoblocktheperceptionofpain.
• TranquilizersandSedatives-Tranquilizersandsedativesarecentralnervoussystemdepressants,suchasXanax,Valium,andLibrium,whichareoftenprescribedtotreat
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anxiety,panicattacksandsleepdisorders.Centralnervoussystemdepressants,knownasbarbituratesandbenzodiazepines,slownormalbrainfunctiontoproduceadrowsyorcalmingeffect.
• Stimulants-StimulantssuchasRitalin,AdderallandDexedrineincreasealertness,attentionandenergyandareoftenprescribedforhealthconditionssuchasattention-deficit/hyperactivitydisorder,narcolepsyanddepression.Stimulantsenhancetheeffectsofnorepinephrineanddopamineinthebrain,increasebloodpressureandheartrate,constrictbloodvessels,andopenupthepathwaysoftherespiratorysystem.
PrescriptionDrugsLabelRequirements:
1._________________________2._________________________3._________________________4._________________________5._________________________
DRAWALABELHERE!
Overthecountermedications:Alloverthecountermedicationsmusthaveaprescribers’orderpriortoadministrationandmustbelabeledwiththeclient’sfullname
1.___________________________________________________________________________2.___________________________________________________________________________3.___________________________________________________________________________
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•GenericandtradenamesofmedicationsGeneric:________________________________________________________________Tradenames:_____________________________________________________________
1. Whydoweneedtoknowthis?________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Howdoweknowwhatdrugsarethesame?________________________________________________________________________________________________________________________________________________________________________________________________________________________
Definecontrolledsubstances(narcotics)
• Adrugsubjecttorestrictionswithpotentialforaddiction.• Adrugthatinmoderatedosesdullsthesenses,relievespain,cancausestupor,coma,or
convulsions.• Classifiedinto5"schedules"classI=mostpotentialforaddiction,classV=leastpotential
foraddiction.Thereshouldbeasourceofinformationavailabletodetermineifadrugisonthecontrolledsubstancelist.
• Itisyourresponsibilitytostorecontrolledsubstancesunderdoublelock,count,anddocumentthecountwithanotherQMAPwhenevergivingaccesstoanotherQMAP.
• Ifsomeoneisnotavailabletocount,youdonotleavethekeys.Waituntilsomeoneisavailabletocount.
• Ifthereisanydiscrepancy,itmustbereportedtoasupervisorimmediately
Note:Youwillneedtofollowyourfacility’spolicy&proceduresforcountingliquidmedication.
DrugDiversion
DRUGDIVERSIONISASTATEREPORTABLEOCCURANCEWITHINGALR’S,ADULTFOSTERCAREFACILITIES,ACFS,RESIDENTIALCHILDCAREFACILITIES,SECURERESIDENTIALTREATMENTCENTERS,STATECERTIFIEDADULTDAYPROGRAMSANDFACILITIESFORDEVELOPMENTALDISABILITIES
Asyouremoveanarcotic,youwilldocumenttheremovalonaseparateinventorysheet.Thesesheetsarewhatyouwillbereferencingwhendoingthenarcoticcount.
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Whatdoyoudoifthereisnotasecondpersontocount?
• QMAPshouldalwayshandoffthemedicationkeystoanotherQMAP,however,ifthereisnooneelsetocountknowyourfacilitiespolicies
• QMAPleavingcountsthenarcoticsandsignsforthem• WhenaQMAPcomesintheymustcountthenarcoticstomakesurethey
matchpriortoadministeringanymedications• Ifthereisadiscrepancy,itmustberesolvedimmediatelywith
managementnotified
Explainwhatyoushoulddoifyoususpectthatmedicationsarebeingdivertedatyourfacility.______________________________________________________________________
Drugdiversionawareness:
1.Whodoesit?_____________________________________________________
2.Whydotheydoit?________________________________________________
3.Whattolookfor?_________________________________________________
Sideeffects,Adversereactions&Allergies
• EveryQMAPneedstobeawareofwheretheycanlookupmedications
• Somefacilitiesofferonlineresources(drugs.com,lexicomp),pharmacyinserts,pharmacistsanddrugreferenceguides(drugreferenceguidesexpireandshouldbeupdatedevery4-5years)
• Whennewmedicationsarestarted,whichmedicationsfallunderallergies,whenisthebesttimetoadministermedications,whyarethemedicationsgivenandwhataretheyusedfor
Definitions:
Sideeffects:___________________________________________________________
Commonsideeffects:
Nausea,constipation,diarrhea,sleepiness,weightgain,weightloss,drymouth&Dizziness(thesearesomebutnotallofthecommonsideeffects)
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Adversereactions:___________________________________________________________
Adversereactionstowatchfor:(Thesearenotallinclusive)RashShortnessofbreathVomitingSeverejointpainUncontrolledmovementsofthelimbsSevereheadache
Anaphylaxis:________________________________________________________________
SafetyandEmergencyresponse1.Knowyourcompanypolicyandprocedures
__________________________________________________________________________________________________________________________________________________________
2.Observationandreportingvsassessment____________________________________________________________________________________________________________________________________________________________
3.Whendoyoucall911?____________________________________________________________________________________________________________________________________________________________
4.Whatdoyouhavereadyfortheemergencyteam?____________________________________________________________________________________________________________________________________________________________
5.Whoelsedoyoucall?____________________________________________________________________________________________________________________________________________________________
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Unit3Review
Discussthefollowing
Sourcesofinformation:www.drugs.com;drugreferenceguide;druginsertsfrompharmacy;pharmacist____________________________________________________________________________________________________________________________________________________
Indicationsforuse:____________________________________________________________________________________________________________________________________________________
Whyshouldyouknowbesttimeofdaytoadministerthemedicationstoclients?____________________________________________________________________________________________________________________________________________________
Whyshouldyouknowcommonreactions/sideeffects?____________________________________________________________________________________________________________________________________________________
Provide3examplesofwhatyoushoulddoifyouhavequestionsaboutmedications.______________________________________________________________________________________________________________________________________________________________________________________________________________________________
1. WhyshouldtheQMAPknowtheindicationforuseofeachmedication?
2. Whatisthedifferencebetweenasolutionandasuspension?
3. Whendoyoucall911?
4. Whyarethepossiblereasonsamedicationisentericcoated?
5. Localdrugactionstakeplaceinaspecificareaofthebody.___True___False
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6. Whatisthedifferencebetweenthegenericnameandthetradenameofamedication?
7. Youshouldalwaysreportsuspicionsofdrugdiversiontoyoursupervisor.______True______False
8. Whichofthefollowingpossibleresultsoftakingmedicationsisexpected:adversereactionorsideeffect?
9. Whatisyourresponsibilityregardingcontrolledsubstances?
10.WherecanaQMAPlearnaboutamedicationtheyareunfamiliarwith?
11.Suspicionandconvictionofdrugdiversionstayswithyouonyourrecord.___True
___False
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UNIT4:MEDICATIONORDERS
Objective1:Usingandunderstandingcommonabbreviations.Writeouteachprescribeddrugcompletely,includingallabbreviations:
1.Digoxin0.125mg,ITABpoqd
2.Coumadin2.5mgpohsonM,T,TH,F
3.Coumadin3mgpohsonW,S,Su
4.Tylenol325mg,iitabspoq4-6hprnforkneepainnomorethan6tabletsperday
5.Timoptic0.5%ophthsol,1gttODandIgttOStidx7d
6.Tobramycin250mg,1tabpoq6hx7d
7.Debroxoticgtts,2gttstoeachearqdx3d
8.AdderalXR25mg,give1tabat9amand1tabat3pm
9.Guaifenesin200mg,givepoq4hprnnottoexceed2.4g/day.
10.Docusatesodium50mgcap,give100mgpoqdx7daysthenDC.
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11.Effexor225mgpoqamatthesametimeeachdayac.
12.Prednisone60mgpoBIDX3Dthen40mgpoBIDX3Dthen20mgpoBIDX3Dthen10mgpoX3Dthen10mgpoBIDX2daysthen10mgpoQDthenD/C
13.Carafate1.5gpoTIDwithmeals
14.Lactulose45ccpoQDmixedwithjuiceofchoice
15.Resperidone1mgpoQAMand2mgQHS
Objective2:Thesixpartsofamedicationorder
1. Client’sfirstandlastname2. Medication3. Dose4. Route5. Date6. Physician/ProviderSignature
Apharmacycannotfillanorderunlesseachcomponentispresent.
Objective3:A"dose"has3parts.Explainthemeaningofeach:
Size:____________________________________________________________________Frequency:_______________________________________________________________Duration:_________________________________________________________________
Keflex500mgpoTIDX10D
Objective4:Explain“strengthofpreparation”
____________________________________________________________________________________________________________________________________________________________
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Objective5:Explainwhythemetricsystemusedinmedicineisabettersystemofmeasurementthanthehouseholdsystem.
Metricsystem–adecimalsystemofstandardweightsandmeasuresusingthemilligram(mg),gram(gorgm),kilogram(kg),milliliter(ml)andliter(l),amongothers.Note:acubiccentimeter(cc)isthesameamountasamilliliter(ml)--or--1cc=1ml
Householdsystem–asystembasedoncommon,thoughnotstandard,measuringdevices:teaspoonandtablespooncanbedifferentsizes.
Equivalentsthatmustbelearned:
1tsp.=5cc=5ML
3tsp.=1Tbsp=15cc=15ML=1/2OUNCE
2Tbsp=30cc=30ML=1oz
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Objective5:Practicedeterminingthedosetobegivenfromthephysician'sorder.
1.Theordersaystogive500mg.ofthedrug.Themedbottlereadseachscoredtabletis250mg.Howmanytab.shouldyougive?______________________________
2.Themedbottlereadseachscoredtabis300mg.Theorderistogive150mg.Howmanytab.willyougive?__________________________________________
3.Aliquidmedicinehas50mg.ofdrugineach5cc.Theordersaystogive100mg.Whatisthestrengthofpreparationofthedrug?___________________________Whatisthedosageordered?_________________________________________Howmuchoftheliquidshouldyougive?_______________________________
4.Themedicinecomesin5mg.scoredtabs.Youaretogive15mg.Howmanytab.shouldyougive?______________________________________
5.YouaretogiveMilkofMagnesia(MOM)1oz.Howmanycc’swillyoupour?_________________________________________
6.Themedicationbottlereadstake1gofmedication.Thescoredtabletsare500mg.Howmanytablet(s)willyougive?______________________________________
7.TheclientneedsMetamucil1Tbsp.Howmanytsp.willyougive?__________________________________________
8.TheorderreadsTagamet300mg.bid.Howoftenwillyougivethisdrug?______________________________________
9.YouarefillingaMRBandyouneed10mg.ofadrugbid.Thelabelonthebottlesays5mg.HowmanytabletswillyouneedtofilltheMRBfor1week?_______________
10.Norvasc5mg.isorderedbythephysician.Thebottlecontains2.5mgscoredtabs.Howmanytabletswillyougiveeachdose?_________________________
11.Accupril20mg.isordered.Thebottlecontains40mgscoredtabsofAccupril.HowmanytabletswillyougiveEACHDOSE?______________________________
12.Youneedtogive15ccofaliquidmedication.Whatistheequivalentamountintbsp?_______intsp?_______inounces?_______
13.YouneedtogivePaxil10mg.dailyinthea.m.YouhavePaxil20mgscoredtablets.Howmanytabswillyougiveeachmorning?_______________________________
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Objective6:PracticeMedicationAdministrationquestions
Forthefollowing,identifytheStrengthofPreparationwithan“S”andtheDosagewitha“D”.Determinehowmuchofthemedicationyouwillgivetoyourclient.
1. ______Tylenol325mg.TAB______Take650mg.q4hprnforbackpainHowmuchwillyougive?__________
2. ______PromethazineHCL25mgtabletevery8hrprnfornausea&vomiting______Take25mg.Q8HprnHowmuchwillyougive?__________
3. ______TakeChlortrimetonq4h4mgprnforhayfever.______Chlortrimeton2mg/5ccHowmuchwillyougive?_______
4. ______Isordil10mg.tabpoforcongestiveheartfailure______Take5mg.q8hforcongestiveheartfailure.Howmuchwillyougive?______
5. ______SodiumCitrate500mg/5cc______Take1.5Gbidforkidneystones.Howmuchwillyougive?________
6. ______Take20meqofKCLqdForlowpotassium______KCL(potassium)40meq/30ccHowmuchwillyougive?________
7. ______Wellbutrinsr(buproprionsustainedrelease)150mgtab______take1tabdailyx4days.Howmuchwillyougive?__________
8. ______TakeGuiafenesin1200mgq12h,forproductivecough______Guiafenesin400mgtab.Howmuchwillyougive?________
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9. ______Propranolol20mgtab______Take40mgpobid.Howmuchwillyougive?________
10. ______TakeMaxalt10mgtabslprnformigraine______Maxalt10mgtab.Howmuchwillyougive?_________
Objective7:TheQMAP’sroleinstarting,changingorstoppingmedicationorders
Inordertostart,changeorstopamedicationorder,youmust:
• Haveawrittenphysician’sorder.VerbalandphoneorderscannotbeacceptedbyaQMAP.
• Facilitiesmayacceptfaxedordersfromaphysician,butmaynotacceptfaxesfromapharmacist,unlessitisacopyofasignedphysicianorder.
• Ifaclientreturnsfromaninpatienthospitalstay,thefacilitymustobtainnewordersfromanauthorizedpractitioner,foreachroutineandPRNmedicationthatwasnotincludedonthedischargeorders.“Resumepreviousorders”isnotacceptable.
• Areadmissionshouldbetreatedthesameasanewadmission• ProperlydocumentthenewinformationontheMAR• Followyourfacility’spoliciesandprocedures
Objective8:Yourrelationshipwiththepharmacy:Keypoints
1.Alwaysrefillwhenyouhaveabouta5-daysupplyremaining.
a.Insuranceissues
b.Mayneedrefillsfromthephysician
Monitorrefills
Mayrequireanadditionalprescription(Narcotics)AnewhardcopyscriptmustbesuppliedtothepharmacyeachtimeyouarerequestingscheduleIInarcotics.
2. Ifyouareunabletogiveamedicationduetounavailability,itisconsideredamedicationerror.Keepcommunicationopenwiththepharmacy.
3. Ifamedicationisbeingmissedduetounavailabilitycontactyoursupervisorandfollowyourcompany’spolicyandprocedures.
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4. Eachcommunityshouldhaveasysteminplaceforreorderingmedications.Ifitiseveryone’sjobthenitisnoone’sjob.
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Unit4:Review
1. Dosageandstrengthofpreparationisthesamething.___True___False
2. YoushouldusehouseholdmeasuringspoonstomeasureoutteaspoonsandTablespoonswhenadministeringmedication.___True___False
3. 3tsp.=________Tbsp.=15cc.
4. 2Tbsp.=________cc.=________oz.
5. Howmanymilligramsarein1gram?
6. Listthesixpartsofamedicationorder.1. ____________________________________2. ____________________________________3. ____________________________________4. ____________________________________5. ____________________________________6. ____________________________________
Forthefollowing,identifytheStrengthofPreparationwithan“S”andtheDosagewitha“D”.Determinehowmuchofthemedicationyouwillgivetoyourclient
7. ______TakeChlortrimeton4MGprnforhayfever
______Chlortrimeton2mg/5cc Howmuchwillyougive?_____
8. ______Tylenol325mg.TAB______Take650mg.q4hprnforpain Howmuchwillyougive?______
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9. ______Amoxicillin250mg/5ml______Take500mg.tid Howmuchwillyougive?______
Physicianorder:Pharmacylabel:
10.DoesthePhysicianOrderandthePharmacylabelabove,correctlymatchforthemedicationLasix?YesorNo_________________________________________
11.ReferringtothePhysicianOrderabove:a.Whatismissingfromthephysicianorder?_________________________
b.Whatinformationontheordermakesupthe“dose”ofthemedication,Lasix?1)______________,2)_______________,
12.ReferringtothePharmacylabelabove:a.Youhaveanorderforlasixandhaveabottlewiththedrugnamefurosemide.youtakebeforegivingthemedication?
13.ReferringtothePhysicianOrderandthePharmacylabelbelow,
a)HowmanyTbspofAmoxicillinwouldyougive?_____________
b)Howmanyounceswouldyougive?_____________
14.Thereareitemsmissingorincompletefromthepharmacylabelbelow?Listthreeofthem?1)______________,2)_______________,3)_______________
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15.Basedonthislabel,whatactionwouldyoutakeastheQMAP?
Physicianorder:Pharmacylabel:
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Unit5:RulesofDocumentation
Objective1:Explaintherulesfordocumentingmedications.
1. TheMedicationAdministrationRecord(MAR)isalegaldocument.Documentationmustbeaccurate.
2. Documentimmediatelyaftergivingormonitoringmedications,notbefore.3. Documenteachadministrationormonitoringatthetime4. Onlydocumentmedicationsthatyouadministerormonitor.5. Initialmedicationsgivenormonitoredintheboxforthecorrespondingdateandtime.6. Alwaysuseblackink,neverusepencil7. Neverusewhiteoutorattempttoeraseanerror8. Notdocumented,notadministered/monitored9. NoblanksontheMAR
Objective2:DocumentingontheMedicationAdministrationRecord(MAR)
1. Discontinuedmeds:WritedateandDClargethendrawalinethroughtherestofthedatesandindicatediscontinued;useatransparentyellowmarkertohighlightthenameofthediscontinuedmedication.
2. Newmeds:transcribenewmedicationsatthebottomoflist;drawalinethroughdatedboxesuptothestartdate.
3. TocreateanewMAR,copyfromthephysicianorders.NEVERcopyfromtheoldMARsheet.
4. Eachmedicationmustbedocumentedatthetimeofadministration.Forexample,ifeight
medicationsareadministeredtheQMAPmustinitialtheMAReighttimesindicatingthateach
medicationhasbeenadministered,refusedorunavailable.
5. Neworder:transcribenewmedicationsontheMAR.Goodpracticeistokeeproutineandprn
medicationsondifferentsectionstheMAR
6. Followyourfacilitypoliciesandproceduresre:notificationofnewmedications.
Objective3:Explainwhattodoif:
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1. Youmakeachartingdocumentationerror:Drawasinglelinethroughthemistakenentryandinitialanddate.ExplainonthebackoftheMAR.
2. Amedicationcannotbeadministeredbecauseitisnotavailableorisrefused:Circlethedateboxwithyourinitials,documenttheexactreasononthereverseside(orotherdesignatedarea)oftheMAR,andcontacttheappropriatepersonaccordingtofacilitypolicy.
3. Lateentrydocumentation:CirclethedateboxwithyourinitialsandyouMUSTdocumentinthenotessectionoftheMAR.
Objective4:ExplainhowdocumentationforPRNmedicationsisdifferent.
1. Initialappropriatebox.Documentonthereverseside(orotherdesignatedarea)ontheMARthetime,dose,andreasonwhyPRNmedicationwasadministered.
2. Checkbackwiththeclientwithin30-60minanddocumentclient'sstatus(betterorworse?)onthereverseside(orotherdesignatedarea)ontheMAR.Contacttheappropriatepersonifnecessary,documentthatyouhavenotifiedsupervisorifclientisnotimproved.
3. PsychotropicmedscannotbegivenPRNexceptinresidentialtreatmentfacilitiesforthementallyilloriftheclientunderstandsthepurposeofmedicationandiscapableofrequestingit.
Objective5:PracticedocumentingontheMAR
MidlandFamilyPractice
RX:HazelGreen____Amoxicillin30ccPOBIDx7daysthenDC
MidlandFamilyPractice
RX:HazelGreen____Furosemide40mgqdpo
Usingthemedicationordersabove,practicedocumentingadministrationormonitoringofmedicationson
J.R.Midland,MD7/1/15J.R.Midland,MD7/1/15theMARbelow.PracticeroutineandPRNmedications,amedicationthatcannotbegivenorisrefused,andhowtohandlevariousdocumentationerrors.FRONTOFEXAMPLEMAR
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Unit5:Review
1. DocumentonlythemedicationsyouadministeronMAR,usingink___True___False
2. Explainwhyyoushouldnotcopyfromlastmonth’sMARsheet.
3. IfyoumakeanerrorwhenchartingontheMAR,shouldyouwhiteitoutandrewriteitcorrectly?Whyorwhynot?
4. Youdon’tneedtochartPRNmedications___True___False
5. Itisacceptabletochartallmedicationsattheendoftheday/shift___True___False
6. TheQMAPwhoadministeredmedstodayforgottodocumentoneclient'smedsontheMAR.Youareconsideringinitialingallofthisclient'smedicationsbecauses/heverifiestheyweregiven.Explainhowthissituationshouldbehandled:
7. Youadministered2tabletsofTylenol325mgtoMrs.Smithatherrequestforaheadacheat4pm.At5pmshetellsyoushefeelsbetter.Areyourequiredtodoanythingelseinthissituation?Pleaseexplain:
8.Mr.SmithrefusedhisZantactoday.Areyourequiredtodoanything?Pleaseexplain:
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9. YouaretheQMAPintheassistedlivingfacilitytoday.Ms.Jonesisarguingwithotherclientsandyellingatthestaffmembers.YouareawareshehasaPRNorderforAtivan0.5mgpoq6hoursPRNforagitation.YouknowthatAtivanisapsychotropicmedication.Canyouadministerthismedication?Whyorwhynot?
10. Givefourexamplesoftherulesfordocumentingmedications________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
11. Define"psychotropic"medicationsandgive3examples:_______________________________________________________________________
________________________________________________________________________
12. YoucanadministeraPRNifthefamilyoryoursupervisoraskyoutoeveniftheresidentdidnotaskforthemedicationT__________F___________
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Unit6:MedicationReminderBoxes
Objective1:DefineMRB.
• MedicationReminderBox(MRB):acontainerthatiscompartmentalizedanddesignedtoholdmedicationsfordistributionaccordingtoatimeelementsuchasday,week,orportionsthereof.
• MRB’scanbefilleduptofourteen(14)daysinadvance.OBJECTIVE2:AdministrationofmedicationsfromMRBs.
SuccessfulcompletionofthiscourseallowsyoutofillMRB’swithsupervisionbyalicensedprofessionalorqualifiedmanager.Regulationsalsoallowmedicationreminderboxesusedindesignatedfacilitiestobefilledbytheclient,thefamilyorafriend.
Objective3:GuidelinesforfillingMRBs
• Theremustbeacompletelabelfirmlyattachedtothebox.Thisrequiresthenameoftheclient,thenameofeachmedication,dosage,quantity,route,andthespecifictimethateachmedistobeadministered.Ifthedesignoftheboxdoesnotpermitfirmattachmentofthecompletelabel,theMRBcannotbeusedbytheQMAP.
• TheremustbeaMARforrecordingalldrugsplacedintheMRBandmonitoredoradministeredbystaff.Aclient"self-administering"medicationsmayfillhis/herownMRBandutilizethismethodforstoringmedicationpriortotakinghis/hermedication.Medicationsthatare"self-administered"fromaMRBmustbeproperlylabeledbutdonotneedtobedocumentedonaMAR.
• Ifthereisaphysicianorderedchangeintheclient'smedications,thefacilitymuststoptheuseoftheMRBuntilthedesignatedQMAP,nurseorfamilymember/friendhascorrectedtheMRBaccordingtotheneworder.
• CertainmedicationsmaynotbeplacedinaMRB:•Controlledsubstances•PRNmedications•liquidmedications
• medicationswithspecialinstructions,suchas“30minutespriortolunch"•powders,inhalers,ointmentsandcreams
QMAP’s"shallbefamiliarwiththetypeandquantityofmedicationineachcompartmentofthebox."IftheQMAPsuspectsthatthetabs/capsintheMRBarenotconsistentwiththelabelontheMRB,theQMAPadministeringmedicationsmustnotproceedwithadministrationofmedicationsfromtheMRBuntiltheproblemisresolved.TheQMAPshouldnotcorrectthediscrepancy;alicensedperson,qualifiedmanagerortheQMAPwhofilledtheMRBshouldresolvedifference(s).
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AqualifiedmedicationmanagermustoverseeaQMAPfillingaMRB.ThequalifiedmanagershouldcheckthefillingoftheMRB’sweeklyduringatleastthefirsttwo(2)timestheMRBsarefilledbyanewQMAP,orbyaQMAPwhoisanewemployeeandperiodicallythereafter.AqualifiedmanagermustbeavailableforconsultationwheneveraMRBisbeingfilled.
OBJECTIVE4:IdentifythestepsneededtofilltheMRBaccuratelyandsafelyaccordingtowrittenphysicianorders.
Itisbestpracticeto:Weargloveswhenhandlingmedications,especiallyifyoutouchpillsorclients.
1. FilltheMRBinasafe,quiet,securedarea,freefrominterruptionsfromstaff,clientsandtelephonecalls.Thisavoidserrorscausedbydistractions.
2. CheckallMRBspriortofillingforcleanlinessandgoodrepair.3. FilltheMRBforonlyoneclientatatime.ThisavoidsfillingtheMRBwithwrongclients
medications.4. Steps:
Step1:Cross-checktheMRBlabelwiththephysicianorder,theMARandthepharmacist-preparedmedicationbottle.
ThelabelontheMRBshouldreflecttheexactnumber(s)ofeachtablet/capsuleofmedicationtobeplacedintheMRB.
IfthelabelontheMRBdoesnotmatchtheinformationoneitherthephysicianorder,theMARorthemedicationbottle,youmustresolvethediscrepancybeforefillingtheMRB.Thisincludesverifyingthattradeandgenericnamesusedarethesamedrug.
Alwaysaskforassistancewhenunsureofanorder,amedication,alabelortheprocedureusedinfillingMRB’s.YouareresponsibletoknowyourfacilitiespoliciesandproceduresforfillingandforadministeringormonitoringmedicationsfromMRB’s.
Step2:Washhandsimmediatelybeforeopeningmedicationbottles.Applygloves.
a.TransfermedicationsfrombottlelidtoMRBortransfermedicationwearinggloves.Nevertouchpillswithbarehands.
b.Ifdesired,youmayusecleantweezersintransferringmedicationsfrombottlelidtoMRB;alcoholwipesareacceptableforcleaningtweezers.
Step3:Usinganorganizedsystem,eachmedicationontheMRBlabelisfilled,oneatatime,untilallmedicationsfortheclienthavebeencompleted.CountthenumberofmedicationsintheMRBandcomparetotheMRB’slabel.
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Step4:Afterfillingiscompleted,countorestimatethenumberofpillsremaininginthebottle.Enoughmedicationsshouldbeinthebottleforatleastfive(5)daysifpossibleorasinsuranceallows.Findoutfromyourfacilityyourresponsibilityregardingthereorderingofmedications.
IfthereisnolabelontheMRBitmustnotbeuseduntilthepersonwhofilleditcomesandcreatesalabel,orthemedicationsmustbedestroyed.
Ifmedicationsareexpiredordiscontinued,theymustbedestroyedperfacilitiespolicies.Allmedsarethepropertyoftheresidentortheresponsibleparty,soconsentmustbeobtainedbytheresidentorresponsiblepart.Thebestwaytodestroymedicationsistoplacetheminkittylitter.Theremustbedocumentationofallmedsthataredestroyedmustbesignedandaccountedfor.
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Unit6:Review
1. ItisoktofilltheMRBwithPRNmedications.___True___False
2. Listthreeguidelinesfortheuseofmedicationreminderboxes.
MedicationReminderSystemlabel:
ReferringtotheMRBlabelabove:
1. ThereareerrorsontheMRBlabel.Listtwoofthemedicationsinvolved:
1)_____________________________,2)____________________________
2. WhyisCoumadinlistedtwice?_______________________________________
3. IfyoufindanerrorintheMRB,isitoktocontinueusingit?Whyorwhynot?
4. WhatisthemaximumlengthoftimeindaysthatMRBscanbefilled?
5. WhatarethesupervisionrequirementsforaQMAPfillingaMRB?
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Unit7:MedicationAdministration
Objective1:InfectionControl
• Universalprecautionsweredevelopedinthe1980'sasameansofavoidingcontactwithblood-borne(carriedintheblood)"pathogens"orinfections.Themethodusedwaswearingnon-porousglovestoavoidcontactwithanyandallblood;allpatientswereassumedtobeinfected.
• Sincethattime,"universal"hasbeenexpandedto"standard"precautionscoveringmorebodyfluidsandmorebodysites:blood,secretions(eyes,nose,ears,mouth),excretions(vomit,urineandfeces),non-intactskin,mucousmembranes.Standardprecautionsmustnowbeobservedforallclientsatalltimesinallcontacts.
• Becausetheadministrationofmedicationbysomerouteswillinvolvephysicalcontactwithbodysites,itisimportantforQMAP’storoutinelyfollowstandardprecautionswithclientsduringtheadministrationofmedications.
• Usedglovesareremovedandturnedinsideoutinonemotion.• Usedglovescontaminatedwithbodyfluidsshouldbedisposedofin
containerswithplasticbagsthatareknottedpriortodisposal,toprotectjanitorialstaff.Youmustbefamiliarwithyourfacility'spoliciesandproceduresaboutdisposalofglovesandothermaterials(incontinencebriefs,wipes,etc)contaminatedwithbodyfluidsindesignatedtrashcans.
• Tipsforgoodhandwashing:
_________________________________________________________________________________________________________________________________________________________________________________________________________
Objective2:Reviewthesevenrightsofmedicationadministrationlearnedinunit1,giveexamplesofgoodpracticetoimplementeachoftheserights.
1. RightClient2. RightTime–1⁄2hourbeforescheduleddoseto1⁄2hourafterifatimeisstatedonDr.
order3. RightMedicine4. RightDose5. RightRoute6. Documentation7. Righttorefuse
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Pleasenote:Fornon-timespecificmedicationsthefacilitymaydesignateatimeframeoruse“am”and“pm”(forthetimeslotsontheMAR)aslongastheinformationisincludedwithinintheirpoliciesandprocedures
Nopre-pouringObjective3:Additionalpreparationandalteringmedicationsbeforeadministrationofmedications:
1. Gathertheclient'smedicationfromstorageandverifythatthemedicationhasnotexpired.
2. Gathertheclient'sMARandthecopyofthephysicianorder.
3.Cross-checkthelabelonthemedicationcontainerwiththeMARandthephysicianorderthreetimes.Onceasthemedicationistakenoffoftheshelf,onceasthemedicationisbeingpouredandagainwhenthemedicationisreturnedtothestoragearea
4. Someclientsrequesttheirmedicationsbeplacedinamediumtoassisttheminswallowingthemedications.Thisisacceptableaslongasthemediumofchoiceisinlinewiththeclient’sdiet.Physician’sorderishowevernecessarytocrushmedicationtoassistisswallowing.Itisimportanttorememberthatyoumaynotcrushextendedreleasetablets.
5. Manycapsulescanbepulledapartwiththecontentplacedinamediumtoassistinswallowing.Thisactionalsorequiresaphysician’sorder.Pleaserefertothemanufacturerecommendationstolearnifacapsulecanbealtered.Youmayalsocontactthepharmacyregardingmedicationsthatmaybealteredforswallowing.
6. Gatherotherequipmentneededforthetypeofmedicationtobeadministered:• Oralmedications(tabs,caps):gloves(ifneeded),pillcutter(ifneeded),
tweezers,papermedicinecup• Oralmedications(liquids):gloves(ifneeded),medicinecup,plasticorglass
measuringcup• Eardrops,eyedropsorointment,nosedropsornasalspray:gloves,cotton
balls,warmwetwashclothortissues• Suppositories:gloves,medicinecup,lubricantsuchasK-Yjelly• Transdermalskinpatches:gloves.
7. Takethemedicationandyourothersuppliestotheclient,orhavetheclientcometoyouradministrationarea.Besureanyareausedtoadministermedicationisneatandclean.
8. Identifytheclient.Youmayasktheclienttheirnameandcomparewithaphotograph,oraskastaffpersontoassistinverifying.Neveraskanotherclienttoparticipateinidentifyingaclient.Beawareofprivacyanddignityissueswhenselectinganareatoadminister.
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7.Explaintheproceduretotheclienttoobtaincooperation.8.Washhandsorusehandsanitizer,putongloves(ifneeded).
Somemedicationsrequireadditionalmixing:
Breathingtreatments:_________________________________________________________Liquidmedications:___________________________________________________________Crushedmedications:_________________________________________________________Powderedmedications:________________________________________________________
Objective4:Hands-onstepsandproceduresforthedifferentroutesofmedicationadministration
Ingestion:oraltablets/capsules:
1. Whenpouringtablets/capsules,putonglovesorusethelidofthecontainertopourthemedication,thendropthemedicationintoamedicinecup.Avoidhandlingmedicationswithfingersasyoumayaccidentallydamageordroppills,usetweezersifnecessarytomovemedicationsintothemedicinecup.Otherpackagingoptionsincludebutarenotlimitedtoblisterpacksandpre-filledreadymedicationpacks.
2. Forclientswhohavedifficultyswallowingmedications,thefollowingtechniquesmaybehelpfultogaincooperation,aswellasassisttheclienttotakeallmedications:
1. Theclientshouldbesittinguporstandingtotakeoralmedications,notlyingdown.
2. Offertablets/capsulesoneatatime.Ifnecessary,placemedicationinthemiddleoftheclient’smouth.
c.Offeradrinkofliquidbeforeandaftereachmedication.Useastrawifnecessary.d.Allowtheclienttorestashorttimeaftereachmed(QUIETSTHECOUGHREFLEX).e.Allowenoughtimefortheclienttotakethemedication.
f.Sometabletsorcapsulesmaybeeasiertoswallowifgiveninateaspoonofjellyorapplesauce,ifpermittedontheclient’sdiet.Besuretotelltheclientthatthereismedicationinjellyorapplesauce.Youmaynottrickclientwithdisguisesformeds.Thephysicianmustbeconsultedandanorderwrittentoaddmedicationstofood.
7. Someclientsrequesttheirmedicationtobecrushed.Donotcrushentericcoatedtablets.Youmaynotcrushoropenanymedicationwithoutaphysicianorderapprovingthisprocedure.
8. Iftheclienthascontinueddifficultytakingoralmedications,reportthistothepersoninchargeofclientcare.Thephysicianmayneedtobeconsulted.Manymedicationsareavailableinanotherform.
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3. Remainwithclienttobecertainalloralmedicationshavebeenswallowed.Thisalsoensuresthatthemedicationistakenontime.Insomeinstances,checkingtheclient’smouthmaybeindicatedtoverifyswallowingthemedication.
4. Lozengesarenottobeswallowed.Instructtheclienttoallowthemedicationtodissolveinthemouth.Drinkingliquidsshouldbeavoideduntilthemedicationhascompletelydissolved.Thesemedicationsshouldbegivenlastafterotheroralmedications.
Ingestion:sublingual(sl)tablets:
1.Instructclienttoplacetabletunderthetongueinthefrontpartofthemouth.Ifseveralmedicationsarebeinggiven,givethesublingualtabletlast.
2.Advisetheclientnottoswallowuntilthetabletisentirelydissolved.
3.NitroglycerinSLtablets:
1. Instructtheclienttositdown(NOTtolaydown)uponthefirstindicationofangina
(chestpain),administernitroSLandimmediatelynotifyyoursupervisorofthesituation.
• Notifysupervisor.• Followphysician’sorders• RecordtheexactminuteofadministrationontheMAR.• Consulttheclient'srecordtoseeifthereisaphysicianorderforaspirintobe
givenwhenchestpainoccurs.2. AfteronedoseofnitroSLisgivenandchestpainisnotrelieved,youoryoursupervisor
mustfollowfacilityprocedurestoprovidepromptmedicalattention.
•Call911forparamedicsandtransporttoanemergencyroom.
• Ifchestpainresolveswithin5minutes,adviseclienttositforanadditional15-20minutestopreventdizzinessorfainting.Headachesareacommonsideeffectofthedrugandshouldlastnolongerthan20minutes.Ifheadachespersist,notifysupervisor.
• BesuretotightlyrecapthenitroSLbottle•Replacethemedicationsupplyevery6months.
• Staywiththeclientuntilchestpainisresolved.
Otheremergencyproceduresareasfollows:
SomeoftheSafetyandEmergencyProceduresformedicationadministrationare:• Residentemergenciesrequiringimmediateaction.
• Seizures.
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• Choking/Knowuniversalsignofchoking–butbeawarethatresidentsmayormaynotbeabletogivetheuniversalsignofchoking.
TheQMAPRoleinanEmergency.
• RemainCalm.
• Callorsendforhelp.
• Knowyourlimitation.
• Don’tmoveaninjuredresident.
• Reassuretheresident.
• Takedirectionfromnurseordoctor.
Additionalsublingualmedicationmayinclude:
•Antianxiety•Anti-nausea•Antipsychotic
Ingestion:oralliquidsandgargles:
1. Checktoseethatthecapofthebottleisonsecurely.2. Readinstructionstodetermineifcontentsaretobeshakenaswithsuspensions.A
rotatingwristmovementwillensureamorethoroughmixture.3. Removethecapandplaceitwiththeopensideup(topofcapdown).4. Holdthebottlewiththelabeltowardthepalmofthehandtoavoidsoilingthelabel.5. Locatethemarkingonthemedicationcupfortheamountofmedicationtobepoured.6. Pourthemedicationateyelevelonaflatsurface.Takecaretonotpourmorethanis
needed.Pourimmediatelypriortoadministering,liquidmedicationmaynotsitforanylengthoftime.
7. Cleanthelipofthebottle,ifnecessary,withamoistpapertowel/tissuebeforerecapping.
8. Garglesaresolutionsthatarebubbledinthethroatbykeepingthesolutionintheupperthroat,tiltingtheheadbackandexhalingairtocreatebubbling.Checkdirectionswithgarglestoknowwhetherthemedicationshouldbedilutedpriortoadministration.
Application:ointments,lotions,liniments,andaerosols:
1. Glovesshouldbewornwhenevercomingintodirectcontactwithmedicationoraclient’sskin.Neveruseyourbarefingerstoapplyointments,lotionsorliniments.
2. Directionsforapplicationofthemedicationshouldbeapartofthephysician’sorderorincludedwiththeinstructionsaccompanyingthemedication.
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3. Ointmentsareapplieddirectlytotheskinorplacedonadressingthatisthenappliedtotheskin.Atongueblademaybeusedtoremoveointmentsfromajarorcontainer.Youmayalsousethetonguebladeasanapplicator.
4. Lotionsareapplied/swabbedontheskinfortheirantisepticand/orastringenteffects.5. Linimentsarevigorouslyrubbedintotheskintorelievesorenessofthemusclesand
joints.6. Aerosolsaresprayedontotheskin.Sprayingislesspainfulifskinisirritatedorburned.
Haveclientturnheadawayfromaerosolspray.
Application:Transdermalpatches:
1. Atransdermalskinpatchisimpregnatedwithmedicationwhich,whenappliedtotheskin,releasesacontinuousandcontrolleddosageoveraspecifiedtimeperiod.
2. Glovesshouldbeworntoapply/removetransdermalpatchestoavoidcontactwiththepatch.
3. Washclient’sskinwithsoapandwater(bothnewsiteandremovalsite).4. Rotateapplicationsitestoavoidskinirritation.Ifprevioussitesareblistered,notifyyour
supervisor.(Somepatchesareorderedtobeplacedonaspecificpartofthebody.)5. Writeyourinitials,dateandtimeonthepatchbeforeapplied.6. Peelbackingoffthepatch,pressonskinandapplypressuretoassureskinadherence.7. IncludethesiteofapplicationwithdocumentationontheMAR.
Application:eyedrops/eyeointments:
1. Instructclientaboutprocedure.Assisttheclienttositorliedownwithheadtiltedback.Washhandsandapplygloves.
2. Cleansetheeye(s)withacleantissue,clean,wetwashclothorcottonball.Alwayscleansefromtheinsideoftheeye,nearthenose,totheoutside.Useacleantissueorcottonballforeachwipe.Bestpracticeistocleaneacheyewiththreewipes.
3. Removecoverofcontainer,placelidwithopensideup.(orinacleanmedicinecup)4. Procedurefordrops:instructclienttolookuptowardtopofhead.Retractlowerlid
(makeapocket).Holdingthebottlenomorethanoneinchfromthelowerlid,instillonedropinthecenterofthelowerlid.Repeatprocedureforseconddrop,ifordered.Wait3-5minutesifmultipleeyedropsareordered,toallowtimeforabsorption.
5. Afterapplication,instructclienttolookdownward,thencloseeye(s)forashorttime.6. Giveclientacleantissueorcottonballtowipetheexcess.7. Procedureforointment:instructclienttolookup.Retractthelowerlid(makeapocket).
Withcaretoavoidtouchingtheeyewiththetipofthetube,layathinstripalongthelowerlid.
Application:eardrops:
1. Positiontheclient:Washhands,applygloves.• Iflyinginbed,havebedflatandturnheadtooppositeside
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• Ifsittingup,tiltheadsidewaysuntilearisashorizontalaspossible.2. Cleanexternalearcanalwithacleantissueorcottonball.3. Holdearlobeinsuchamannertoallowvisualizationoftheearcanal.4. Instillorderednumberofdropswithouttouchingdroppertotheclient’sexternalear.5. Placeasmallwadofcottonintheexternalportionofthefirstear.Ifitisnecessaryto
instilldropsinbothears,youshouldwaitatleastfiveminutesbeforeinstillingdropsintheotherearandplacewadofcotton.
6. Suggesttotheclienttheylayquietlyashorttimetoallowthemedicationtoreachtheeardrum.
7. Returntotheclientin10minutestoremovecottonwads;forgottencottonwadscanbecomedifficulttoremove.
Application:nosedrops/nasalsprays:
1. Washhands,applygloves.Avoidtouchingthedropperorspraynozzletotheclient’snose.Ifithappenswipetipoftheapplicatorwithanalcoholswab.
2. Fornosedrops:instructtheclienttotilttheirheadbackorliedownwiththeirheadextendedoverapillow.Theclientmaysitupfornasalsprays.
3. Fornosedrops,placethenosedropperjustinsidethenostril.Instructtheclientto“sniff”onthecountofthreeandinstillthecorrectnumberofdrops.Instructtheclienttoremainwithheadbackforashorttime.
4. Fornasalsprays,instructtheclienttosniffonthecountofthreeasyousqueezethenasalspray.Thiswillhelptocoordinatetheclient’ssniffingwiththeapplicationofthemedication.Optional:Closeonenostrilwhilesprayisappliedtotheothernostril.
Inhalation:inhalers
1. Theclientshouldbeinasittingposition.Washhands,applygloves.2. Graspthemedicationdispenserandremovethemouthpiececover.3. Readinstructionsoninhalertodetermineifmedicationistobeshaken.4. Holdthedispenser’smouthpieceaccordingtopackagedirections.5. Instructtheclienttoexhale,and,onthecountofthree,tobreatheindeeplyasyou
administerthemedication,thenholdtheirbreathforaslongaspossible,beforeexhaling.
6. Itisbesttohaveclientsrinsetheirmouthafteradministeringinhalants.Manytimesinhalantstastebitterorcancausethrush.
7. Usinganalcoholswab,cleanthemouthpieceorspacerbeforereplacingthemouthpiececover.
Insertion:rectal/vaginalsuppositoriesorcreams
1.Removeprotectivecoveringofsuppositoriesandplaceinamedicinecup.2.Obtainlubricantforsuppositoriestoapplybeforeinsertion.3.Vaginalcreamsaredrawnintoavaginalapplicatoraccordingtopackageinstructions.
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4.Provideprivacyfortheclient.5.Glovesmustbewornfortheadministrationofsuppositoriesandvaginalcreams.6.Procedureforinsertingrectalsuppositories:
• Assisttheclienttoliedown,preferablyontheirleftside.ThecolonisontheleftsideofthebodyandthesuppositorywillenterthelowerGItractmoreeasily.
• Visualizetheanalopening,lubricateandinsertthesuppositoryapproximately3inches.Thesuppositoryshouldbeinsertedbeyondtheinternalsphinctermuscleoftherectumtopreventthesuppositoryfrombeingexpelled.•Instructtheclienttonotto"beardown,"andtoholdinthesuppositoryforaslongaspossible.
7.Procedureforinsertingvaginalcreamsorvaginalsuppositories:
• Instructtheclienttolieonherbackina“frogleg”positionorontheirsidewithtoplegslightlybent.
• Vaginalsuppositoriesareinserted2-3inchesintothevaginalorifice.Bodytemperaturewillmeltthesuppositorytoaidintheabsorptionofthemedication.
• Toinsertavaginalcream,graspthebarreloftheapplicator.Placethethumbontheplunger.Pointingtheapplicatorslightlydownward,inserttheapplicatorintothevaginaasfarasitwillcomfortablygo.Pushtheplungerwiththethumbastheapplicatorisslowlyremovedfromthevagina.
• Instructtheclienttoremainlyingdownfor15-30minutesforabsorptionofthemedication.Vaginalcreams/suppositoriesarebestadministeredatbedtime.
Objective6:Describestepsneededaftermedicationadministrationiscompleted
1. Properlydisposeofallusedmedicationcupsandusedgloveswhichhavecomeintocontactwithbodyfluids.Youmustwashyourhandsorusesanitizerbeforeyoumoveontothenextclient.
2. Youmustaccuratelydocumenteachmedicationgivenontheclient'sMARimmediatelyafteradministrationormonitoring.ForPRNmedications,remembertodocumenttheclient’srequestandthereasonforgivingthemedicationaswellasthefollow-upresults.
3. Medicationcontainersshouldbereturnedtotheappropriatestoragelocationbeforeadministration.
4. Ifmedicationshavebeenremovedfromtheoriginalcontainer-theyshouldnotbereturnedtotheoriginalcontainers.Theyshouldbedestroyedaccordingtofacilitypolicy.
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Unit7:Review
1. Whatarethe7rightsofmedicationadministration?1. ________________________________2. __________________________________3. __________________________________4. __________________________________5. __________________________________6. __________________________________7. __________________________________
2. Youaretoadministermedicationsto4clientsseatedatthelunchtable.Whatproceduresmustyoufollow?Why?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Isitacceptabletoleavethemedicationcabinetorcartunlockedwhileyouadministermedicationsbecauseyouwillberightback?Whyorwhynot?________________________________________________________________________________________________________________________________________________
4. Tosavetimeduringyourmedpass,youshouldplacemedicationsonthediningroomtablesneartheclienttowhomtheybelong.___True___False
5. Youalwayswashyourhandsbeforeamedpass,soitisoktotouchthemedicationswithyourbarehandsduringsetupofmedications.___True___False
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Unit8:MedicationErrors
Objective1:Defineamedicationerror:
Medicationadministeredcontrarytoaphysician’sorderthateithercausesorhasthepotentialtocauseharmtotherecipient.
Objective2:ExamplesofmedicationerrorsandImproperpracticethatmayleadtoamedicationerror
• Failuretocomplywithphysicianorders• Failuretoadministeronlyuponcurrentorders• Failuretofollowhands-onprocedurestaughtinclass• Failuretofollowthe6rights• FailuretoaccuratelytranscribeaMAR• FailuretoaccuratelylabelaMRB• ImproperdocumentationonMAR• Impropermedicationstorage• Runningoutofmedications
Note:Theseareexamplesonly.
Objective3:Preventingandreportingmedicationoccurrences(reportableinallfacilitieswhereQMAP’sareapprovedtopractice
• NOSHORTCUTS• NEVERPREPOUR• ALWAYSREVIEWTHEPHARMACYLABELANDCOMPAREITTOTHEMAR• CLARIFYANYDISCREPANCIESPRIORTOGIVINGTHEMEDICAITON• NEVERSITPILLSDOWNANDWALKAWAY• MINIMIZEDESTRACTIONS• FOLLOWTHETECHNIQUESTAUGHTINCLASS• ASKQUESTIONS
Ifitdoeshappen....
1.Immediatelynotifysupervisorandphysician
2.Knowandfollowyourfacility’spolicyformedicationerrors3.Reviewyourmistakeandfindthepointoferror.....learnfromit
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Unit8:Review
1. Whatshouldyoudoifamedicationerroroccurs?Whoshouldyoureporttoifamedicationerroroccurs?__________________________________________________________________________
2. Give3examplesofamedicationerror.
3. Mrs.ChasanordertotakeGuaifenesinAC500mg4timesadayfor7days.Youmisreadtheorderandadministered2gin4hours.Whatdoyoudo?
___________________________________________________________________________
4. Mrs.Hansenhadmedicationsre-orderedonMonday.OnThursdayMrs.Hansenranoutofpills,asofSaturdaythepharmacystillhasnotdeliveredhermedications.Isthisamedicationerror?Why?
5. Listthingsyoucandotominimizedistractionswhilepassingoutmedication?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Unit9:MedicationStorage
Objective1:Learnstoragerequirementsaswellasappropriatedisposaltechniquesformedicationskeptinlabeledcontainersormedicationreminderboxes.
1.Prescriptionandnon-prescriptionmedications:A.Store"inamannerthatensuresthesafety"ofclients
•Clientsshallnothaveaccesstomedicationwhichiskeptinalockedcentrallocation.
B.Alternativesareacceptablefordaytripsoroutings:
• Closedbackpack,purseoronthepersonofclientofsoundmindinadultdayfacility• Closedwheelchairbagofnon-ambulatorypersoninadultdayfacility• Narcoticsmustbecounteduponleavingthecommunityaswellaswhenreturningto
thecommunity.Itisacceptabletocountwiththefamilymemberorresponsibleparty• Anyprescribedmedicationcanbesentwiththeclientorresponsiblepartyforanouting.• Refertoyourcompanypolicyandprocedureregardinghowmuchmedicationtosend
foreachouting.
C.Medicationsrequiringrefrigeration
• Shallbestoredseparatelyinlockedcontainersorcompartmentalizedpackages,containers,orshelvesforeachclientinordertopreventinterminglingofmedication.
• Ifthereisadesignatedmedicationrefrigeratorandtherefrigeratorisinalockedroom,thenthemedicationsdonotneedtobestoredinlockedcontainers
2.Controlledsubstances: A.Mustbedoubled-locked,countedandsignedforusingasecondpersonforverification.
Example:Lockedportablemedicationboxstoredinsidelockedcabinet.QMAPcountsnumberofpills,secondQMAPorqualifiedmanagerwatchesandagreesthecountiscorrect.Shifttoshiftcountforaccuracyshouldincludethedate,time,quantityremaining,andsignaturesofbothstaff.
B.Anydiscrepancy,reportimmediatelytosupervisorforsuspicion/investigationofdrugdiversionD.Counthowoften?
•Anytimeaccesstonarcoticsisgiventoadifferentparty
3.Medicationshouldnotbestoredwithotheritems,mustneverbeinareaswith:
• Disinfectants
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• Insecticides• Bleaches• Householdcleaners• Poisons
4.Disposalofmedicationisregulatedbythestateandeachcommunitywillhavepoliciesandproceduressurroundingthedisposalofdiscontinuedandexpiredmedication.Somemedications,duetotheirhighlevelofpotentialharmtotheenvironment,mustbedisposedofwithveryspecificdirections.Pleaseseeyourcompanypolicyandprocedureregardingmedicationdestruction.Alldisposalsmustbedocumentedandconsentedtobytheresidentorresponsibleparty.Thesafestwaytodisposemedicationsisincoffeegroundsorkittylittler
Objective2:Learnthedifferencebetweentheexpirationdateandtherefillonorafterdate.
• Expirationdate-thedateontheactualcontainer,oroneyearafteramedication,wasfilled.
• Refillonorafterdate:Thisdatesignifiesthedatetheinsurancewillapprovearefillbasedonthesupplybeingapproximately85%gone
Objective3:MandatoryReportingandsafetyofresidentsandtheirproperty(includingmedications)
It is a state regulation that all suspected abuse, neglect, and misappropriation of resident property and funds be reported. All ALF homes have a zero-tolerance policy surrounding any sort of mistreatment. Should you suspect any form of abuse is occurring, you should follow the steps below: • First, document all pertinent information such as who, when, where, what happened, etc. • Call your direct supervisor and inform them of what you suspect may be happening. • Your manager should investigate to ascertain the validity of the suspected abuse. If it is found that abuse may have occurred, the resident’s family, the police, the Dept. of Social Services, Adult Protection Services, and the Colorado Dept. of Health and Environment should be contacted. • If you bring these findings to your manager and feel that they have done nothing with this information, you are still responsible to bring them to the next level and make sure someone investigates the situation.
• Should you still not get results after bringing the findings to your supervisor’s boss, you are required to contact any of the individuals from above (DSS, Police, APS, etc.)
Mandatory Reporting Procedures
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• Prevent & Report Abuse, Neglect, Misappropriation Property • First, document all pertinent information such as who, when, where, what
happened, etc. • Call your direct supervisor and inform them of what you suspect may be
happening. • Your manager should investigate to ascertain the validity of the suspected abuse.
If it is found that abuse may have occurred, the resident’s family, the police, the Dept. of
• Social Services, Adult Protection Services, and the Colorado Dept. of Health and Environment should be contacted.
• If you bring these findings to your manager and feel that they have done nothing with this information, you are still responsible to bring them to the next level and make sure someone investigates the situation.
• Should you still not get results after bringing the findings to your supervisor’s boss, you are required to contact any of the individuals from above (DSS, Police, APS, etc.)
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Definitions
Knowingthefollowingtermswillhelpyou.
ControlledSubstance:Medicationsthathavethepotentialtobeaddictiveandusedinawayotherthanhowthemedicationwasprescribed;asystemmustbeinplacetoaccountforreceipt,administrationanddispositionofeachmedication.
Document:Torecordorwrite;Documentationoftheadministrationofmedicationsisrequiredonthemedicationadministrationrecord(MAR).
Label:Informationonthemedicationpackage;referredtoalsoasmedicationlabelorprescriptionlabel.
MedicationAdministrationRecord(MAR):Arecordthatlistsallofthemedicationsorderedfortheclient,includingroutineorregularlyscheduledmedicationsandPRNmedications;Itisusedtodocumentorrecordtheadministrationofmedications.
Medication/Drug:Anotherwordusedfordrug;asubstanceormixtureofsubstancesusedinthediagnosis,cure,treatment,orpreventionofdisease.
OTCMedications:Over-the-counterornon-prescriptionmedications;medicationswhichcanbepurchasedorobtainedwithoutaprescription;however,youneedaphysician’sordertoadministerthem.
PrescriptionMedications:Medicationsthatcanonlybeobtainedorpurchasedthroughanorderorprescriptionwrittenbyaphysicianorprescribingpractitioner.
PRN–asneededorifnecessary;PRNmedicationsarenotscheduledtobeadministeredatspecifictimes,orroutinely.ClientsshouldbeabletoaskforPRNmedications,iftheycannotanassessmentoftheclientmustbemadebysomeonedesignatedbythefacilityandmustnotbeaQMAP.AdministrationofPRNmedicationsneedstobedocumentedontheMAR.
PrescribingPractitioner–Referstoalicensedhealthcareprofessionalwhoisauthorizedtoprescribeororderamedication;theprescribingpractitionerpeoplearethemostfamiliarwithisaphysicianordoctor.Otherprescribingpractitionersincludephysicianassistants,familynursepractitionersanddentists.
PoliciesandProcedures:EachfacilityisresponsibleforcreatingPoliciesandproceduresrelatedtoQMAP’sandmedicationadministration.
QualifiedManager:isdesignatedbytheownerofthefacilityandisamanagerorsupervisorofQMAP’s,hassuccessfullypassedtheQMAPcompetencytesting,whooverseesthefillingandadministrationfromMRB’s
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Regulations:anofficialruleorlawthatsayshowsomethingshouldbedone.Report:Tomakeknown,togiveinformationaboutsomething.
Sideeffects:Anyeffectotherthanthedesiredeffect;unwantedeffectsoradversereactionsfromamedication.Topical:applieddirectlytotheskin
Transcribe:Totransferwritteninformationfromoneplacetoanother;informationonthephysician’sordermustbetranscribedtothemedicationadministrationrecord(MAR).
CDPHE–ColoradoDepartmentofPublicHealthandEnvironmentHFEMSD–HealthFacilitiesandEmergencyMedicalServicesDivision
DHS–DOC–IDD–ALR–ADP–ACF-QMAP–QM–DR–PA–NP-
RN–LPN–CNA–MRB–MAR–PRN–MOM–KCL–GI-MA-
DepartmentofHealth&HumanServicesDepartmentofCorrectionsIntellectuallyDevelopmentallyDisabledAssistedLivingResidence
AdultDayProgramAlternativecarefacilitiesQualifiedMedicationAdministrationPersonQualifiedManagerDoctor/PhysicianPhysicianAssistantNursePractitionerRegisteredNurseLicensedPracticalNurseCertifiedNursingAssistantMedicationReminderBoxMedicationAdministrationRecordasneededMilkofmagnesiapotassiumchlorideGastrointestinalMedicalAssistant
Revised 6-15
The SIX Rights of Medication Administration
x The right client x The right time x The right medication x The right dose x The right route x Documentation
The Six Components of a Physician Order
x The client’s full name x The date of the order x Name of the medication x Dosage and administration
information x Route of administration x Physician’s signature
EQUIVALENTS:
METRIC - decimal system of weights and measures using the gram, meter and liter. LIQUID: cubic centimeter (cc) = milliliter (ml) SOLID: 1 gram (gm) = 1000 milligrams (mg) HOUSEHOLD - system based on common, though not standard, measuring devices.
tsp. = teaspoon Tbsp. = tablespoon oz. = ounce
1 tsp. = 5 cc 3 tsp. = 1 Tbsp = 15 cc 2 Tbsp = 30 cc = 1 oz
Common Abbreviations
ac before meals pc after meals
bid twice a day tid three times a day qid four times a day HS hour of sleep po by mouth q every qd every day qh every hour q6h every 6 hours qod every other day DC discontinue mg milligram cc cubic centimeter ml milliliter Gm gram kg kilogram tsp teaspoon Tbsp tablespoon oz ounce mEq milliequivalent ophth ophthalmic otic ear OU both eyes OS left eye OD right eye prn as needed tab tablet cap capsule SL sublingual Buccal: between cheek & gum EC enteric coated oint or ung ointment supp suppository sol solution c with s without x times gtts drops (R) right (L) left XL/XR extended release
Medication Administration Advance Study Sheet
Important facts you must have memorized by the end of the course
Revised 4-08
Worksheet Physician order: Pharmacy label: Medication Reminder System label: Please answer the following: 1. Do the Physician Order, Pharmacy label, and MRB label correctly match for the medication, Lasix? Yes or No: _______ 2. Referring to the Physician Order: a. What is missing from the physician order? ________________________________ b. What information on the order makes up the “dose” of the medication, Lasix? i ______________, ii _______________, iii ________________ c. According to the physician order, is the medication, Lasix, correctly listed on the
MRB label? Yes or No: ________ 3. Referring to the Pharmacy label: a. Is Furosemide the same as Lasix? Yes or No: ________ b. What action/s would you take to check this information before giving the
medication? _______________________________________________________ _________________________________________________________________
c. What is the expiration date of the medication, Lasix? _______________________ d. May you administer the medication, Furosemide, from the bottle supplied by the
pharmacy? Yes or No: _______ Please explain: __________________________ _________________________________________________________________
4. Referring to the MRB label: a. There are four errors on the MRB label. List two of the medications involved: i _______________________________, ii _______________________________ b. What action would you take based on the incorrect MRB label and administering
medications from the MRB? __________________________________________________________________
Midland Family Practice RX: Hazel Greene____
Lasix 40 mg PO QD in a.m.
J.R. Midland, MD Date: _____
Goodpills Pharmacy RX: Hazel Greene Furosemide 20 mg Give 2 tablets (40 mg) daily. MD: Midland 12/24/04 exp: 6/13 #:30
Hazel Greene A.M. Noon P.M HS Lasix 40 mg, 2 tabs PO QD in a.m. X Tobramycin 250 mg PO every 6 hours X X X X X X Coumadin 0.1 mg PO odd days Coumadin 0.2 mg PO even days Tagamet 300 mg PO BID X X Tylenol 325 mg, 2 tabs every 4 hrs as needed for headache X
Label the following medication effects as A=Adverse Effect or S= Side Effect
_____ Nausea _____ Vomiting _____ Dry mouth _____ Constipation _____ Respiratory Failure _____ Rash
_____ Cardiac Arrest _____ Diarrhea _____ Death
Match the route of medication with its definition _____ Oral _____ Rectal _____ Ophthalmic _____ Nasal _____ Otic _____Sublingual _____ Inhaled _____ Topical _____ Vaginal _____ Transdermal
A. In the Vagina B. In the nose
C. In the ears D. In the rectum E. Under the tongue F. Patch n the skin G. In the eyes H. On the surface of the skin
I. In the mouth and swallowed
J. In the lungs
Match the abbreviations with the correct definition _____ PRN _____ EC A. Times H. As needed _____ BID _____ oz B. By mouth I. Left eye _____ QD _____ SL C. Enteric coated J. Four times daily _____ HS _____ OS D. Every day K. Ounce _____ PO _____ gtts E. Discontinue L. Drops _____ QID _____ DC F. Two times daily M. Sublingual _____ TBSP _____ x G. Tablespoon N. At bed time
QMAP Homework
To ensure you are administering the right medication you must: A. Compare the Physicians written order to the Client B. Compare the Medication record to the Client C. Compare the Pharmacy label to the Client D. All of the above
Match the situation with the appropriate category. _____ Glenn told Bill his name was Rich.
Bill gave Glenn Rich’s 5 pm medications _____ Ben put his nose drops in his eyes _____ Sue gave 3 TBSP Maylanta to Bob.
The order reads give 30cc/mg _____ Jill gave Thorazine to Sam. The order was to give Thioridazine. _____ Kyle gave Bill his 5pm meds at 7pm when he ate dinner because the label said to give with food. If the medication cannot be given or a person refuses the medication then the QMAP should?
A. Initial the appropriate box B. Circle the initials C. Provide an explanation on the back of the MAR D. All of the above
Using the pharmacy label below answer the following questions
A. Wrong medication B. Wrong dosage C. Wrong route D. Wrong person E. Wrong time
ABC Pharmacy April Jones, MD 1234 Main Street Anytown, CO 12345 Kay Evans Date filled: 2/1/09 303-555-5555 Take 10mg po tid Expiration date: 2/1/10 BuSpar 5 mg RX# 25834 Refills: 2 Qty: 90
What is the dose of the medication? _______________________________________________ What is the name of the medication? ______________________________________________ What is the strength of the medication? ____________________________________________ How often do you give this medication? ___________________________________________
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Objective 5: Practice documenting on the MAR
Using the medication orders above, practice documenting administration or monitoring of medications on the MAR below. Practice routine and PRN medications, a medication that cannot be given or is refused, and how to handle various documentation errors.
FRONT OF EXAMPLE MAR MEDICATION ADMINISTRATION RECORD
Client Name: Month/Year:
Medication info Time 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
BACK OF EXAMPLE MAR QMAP name: Identifying initials
Date Time Notes (REMINDER: SIGN EACH NOTE WITH FULL NAME AND QMAP TITLE)
Midland Family Practice RX: Hazel Green____
Amoxicillin 30cc PO BID x 7 days then DC J.R. Midland, MD 7/1/15
Midland Family Practice RX: Hazel Green____
Furosemide 40mg qd po J.R. Midland, MD 7/1/15