11/7/2014
1
MAP Trainer WebinarOctober 29, 2014
Meeting Objectives
1) Learn about pending Warfarin Sodium MAP policy requirements
2) Receive clarification on required components of MAP trainings
3) Learn of policies and procedures and clinical issues related to medication administration
Agenda
UpdatesTrendsWhat's New?Back to BasicsD&S
11/7/2014
2
Update
Organizational Chart
Update
DDS Technical Assistance Tool Revision
MAP Resource
11/7/2014
MAP Resource
MAP Resource
Update
Student Curriculum“AMRW” Revisions
3
11/7/2014
Update
www.mass.gov/dph/dcp
MAP Resource
MAP Resource
4
11/7/2014
Update
Department of Public Health
Fax # 617.753.8046
Department of Public Health
Drug Control Program
99 Chauncy Street 11th floor
Boston MA 02111
Update
www.mass.gov/dph/map
5
11/7/2014
6
Revised DPH MOR Form
Update
DPH Advisory Ruling 6‐18‐14The Role of Nurses in the Medication Administration
Program
Update
Medical Marijuana
11/7/2014
7
Update
Methadone
Update
Tramadol
Trends
Medication is Ordered
Medication is Not Available
Contact HCPObtain a Later Start Time
11/7/2014
8
Trends
Effect of PRN Medication
Documentation
Trends
Acceptable Codes
DP‐day program P‐packaged by
W‐work individual
LOA‐leave of H‐hospital, nursing
absence home, rehabilitation S‐schoolcenter
Trends
Documentation
Late Entry
11/7/2014
9
Count Sheet Scenario
12/20/yr 7:45p Morning dose not subtracted when removed. K. Mason notified. Lisa Long
12/21/yr 6a Late entry. On 12/20/yr 8a med was given but not subtracted at that time. Reggie Newton
Trends
Medication Occurrence
Site Supervisor Follow UpWhy
What
Minimize Recurrence/Risk
Trends
Health Care Provider Order
Form Design
11/7/2014
10
Trends
Daily in the am Daily in the afternoonDaily in the eveningDaily at bedtime
Trends
Telephone Orders
Post/Verify Twice
Trends
Only MAP Certified staff can receive medication
deliveries
11/7/2014
11
Trends
Medication & Treatment form corrections
What’s New?
MAP Policy Revisions
Warfarin Sodium (Anticoagulant)
Therapy Training
8‐28‐2014
11/7/2014
12
Objectives
1. What is an anticoagulant?
2. Why is anticoagulant therapy necessary?
3. What is a PT/INR?
4. Who can give Warfarin sodium?
Circulatory System
HeartPumps blood through the body
Delivers oxygenated bloodReturns deoxygenated blood to lungs
Blood Clots
11/7/2014
13
Good Blood Clots
Prevents or stops bleedingNormal body functionCutFlossing teethNosebleedAccident
Bad Blood Clots
Stops the normal flow of blood within the body
May cause
Heart attackStrokeDeep Vein Thrombosis (DVT)‐ blood clot in legs
Pulmonary Embolism‐ blood clot in lungs
Stroke
11/7/2014
14
Anticoagulant
Blood thinnerBrandCoumadin
GenericWarfarin sodium
PT/INR Blood Test
PT Prothrombin TimeUsed to measure how long it takes blood to clot
INR International Normalized Ratio A way of standardizing PT results no matter the testing method used
PT/INR Blood Test
PTProthrombin Time
INR International Normalized RatioINRTarget INR Range
11/7/2014
15
PT/INR Blood Test
May be obtained atLabsClinicsHCP visitHome self‐test kitLab home visit
PT/INR Blood Test
If managed in a home settingMust be performed by licensed staff
Certified staff are NOT permitted to perform the test
Warfarin Sodium
Can be affected by Illness InfectionsDiarrhea Indwelling cathetersFeverHigh B/P
11/7/2014
16
Warfarin Sodium
Can be affected byOther medications
Certain foods Herbal preparations
Medication Interactions
Increase effects of Warfarin sodium
Ibuprofen, Aleve, Aspirin
Decrease effects of Warfarin sodium
Certain antibiotics, B/P meds
Food Interactions
Decrease effects of Warfarin sodium
Vitamin K
Leafy green vegetables broccoli, kale, spinach
AvocadosGrapefruits and grapefruit juice
11/7/2014
17
Vitamin K
Important that the amount of Vitamin K eaten remains consistent
Vitamin K
Often used in the treatment of Warfarin sodium overdose
Herbal Interactions
Garlic
Ginger
St John’s wort
Echinacea
Ginkgo biloba
Red clover
Chamomile
11/7/2014
18
Warfarin Sodium
May also be affected by
AlcoholNicotine
Warfarin Sodium
Supplied in differentStrengthsShapesColors
Warfarin Sodium
Administered at the same time each day helps
To maintain a consistent blood level
With accuracy of PT/INR results
11/7/2014
19
Warfarin Sodium
Med sheets must include
Next PT/INR date
Start/Stop dates2 person check Special precautions
Sample Med Sheet
HCP Orders
If received from an Anticoagulation Management Service (Coumadin Clinic)
Must be signed by a HCP
Telephone orders must be signed by the HCP within 72 hrs.
11/7/2014
20
Tracking
Follow agency policyBlister pack monitoring
Add to count Flow Record or Event Sheet
Policy
Warfarin sodium agency policy to include
Training of MAP Certified staff
Emergency procedures
Protocol
Individualized Warfarin sodium protocol to includeDetails of how HCP orders are obtainedProcess for obtaining PT/INR lab draw PT/INR lab results
Target INR range
11/7/2014
21
Adverse Effects
Increased risk for bleedingReport to the HCPUnusual easy bruising Prolonged bleeding from cutsgums
Frequent nosebleeds
Adverse Effects
Increased risk for bleedingReport to the HCPBlack tarry stools Persistent weakness/tiredness
Nausea/vomiting, stomach pain
Safety
Decrease risk of bleeding byUsingan electric razor for shavinga soft‐bristle toothbrushwaxed dental floss
Being cautious with knives or scissors Preventing falls Not missing lab appointments
11/7/2014
22
Training
Must be Certified and/or Licensed to administer Warfarin sodiumCertified staff must receive Warfarin sodium Therapy training
Remember
Safety and PreventionKeep all HCP and lab appointmentsGive Warfarin sodium at same time each day
Report changes when observedMonitor diet
Remember
You are key to safe anticoagulation therapy !
11/7/2014
23
Questions
Back to Basics
Preceptor Survey Results
Preceptor Training Format
Class Makeup
Materials• Required
• Adjunct
Pre Testing
WebETest© Features
11/7/2014
24
Training Day Format
Days per TrainingHours per DayFrequency of Training
Class Makeup
Class SizeAgency Requirement•Before Hire
Required Materials
“Administering Medications the Right Way” Version 4.1.1
Medication Administration Video
CC&R Health Care Solutions www.medicationadminstration.com
11/7/2014
25
CC&R Health Care Solutions
www.hdmaster.com
Adjunct Materials
PowerPointWhite BoardOverheadDBQ Exercise“Making the Connection” video
www.rehabresourcesinc.org
11/7/2014
26
WASHAREA & HANDS
UNLOCK LOOK
FOR MED BOOK
HCP ORDER TO PHARMACY LABEL
PHARMACY LABEL TO MED SHEET
PREPARE
PHARMACY LABEL TO MED SHEET
GIVE
SILENTLOOK AGAIN
DOCUMENTMED SHEET
COUNT SHEET, IF NEEDED
LOCK WASH HANDS
OBSERVE
#2#1
Medication Administration
Liquid Medication
Look at the area circled in red“Guaifenesin Oral Solution USP 100mg/5mL”
That means each 5mL contains 100mg of Guaifenesin
Review Game
11/7/2014
27
Transcription Workbooks
Medication Book
Count Book
Adjunct Materials
www.mass.gov/dph/map
www.mass.gov/dph/map
11/7/2014
28
MAP Training Tools
Pre-Test Components
•Knowledge (CBT)
•Transcription
•Medication Pass
www.hdmaster.com
11/7/2014
29
www.hdmaster.com
Pre-Test Score Report
Not Acceptable
11/7/2014
30
Not Acceptable
Not Acceptable
www.hdmaster.com
11/7/2014
31
Medication Pass Demo
Medication Pass Demo
www.hdmaster.com
11/7/2014
32
www.hdmaster.com
www.hdmaster.com
Pre-Test
11/7/2014
33
WebETest© Features
Class RosterVerification Forms
Scheduling Directions
www.hdmaster.com
www.hdmaster.com
11/7/2014
34
www.hdmaster.com
www.hdmaster.com
www.hdmaster.com
11/7/2014
35
www.hdmaster.com
Roster
11/7/2014
36
Verification Form
Demographic Verification
Scheduling Directions
11/7/2014
37
Scheduling Directions
www.hdmaster.com
www.hdmaster.com
11/7/2014
38
D&S Diversified Technologies
Fall 2014 Update
www.hdmaster.com
www.hdmaster.com
11/7/2014
39
Verification Form
Why Use It?
Pass Rates
First TimeKnowledge
TranscriptionMed Pass
Knowledge
7/1/11 – 6/30/12 7/1/13 – 6/30/14
DDS 71% 72%
DMH79% 79%
ADULT
DMH 0% 77%
YOUTH
11/7/2014
40
Transcription
DDS
7/1/11 – 6/30/12
64%
7/1/13 – 6/30/14
69%
DMHADULT
74% 75%
DMH YOUTH
0% 71%
Med Pass
DDS
7/1/11 – 6/30/12 7/1/13 – 6/30/14
65% 68%
DMHADULT
77% 71%
DMH YOUTH
0% 71%
Common Testing Issues
Prior to TestWhich Test?
ID’s?
11/7/2014
41
Unacceptable ID
Common Testing Issues
Med Pass
What Do I Verbalize?
Remember the NAME!
How Many Do I Pop?
Common Testing Issues
Med Pass
Documentation
Count BookWrong Page
11/7/2014
42
Common Testing Issues
TranscriptionDose and StrengthStart/Stop DateGrid
Incorrect Grid
What Not to Wear
Wrist Watch Cell Phones
11/7/2014
43
TestMaster Universe
Available in 2015
Next Meeting Date
