PharmacologyPharmacology

Information, Rules, and LawsInformation, Rules, and Laws

For MedicationsFor MedicationsPrepared by Scooter Brown, RN, Director of NursingPrepared by Scooter Brown, RN, Director of Nursing

(For use by Mental Health clinic staff as Annual Refresher training.)(For use by Mental Health clinic staff as Annual Refresher training.)

Class ObjectivesClass ObjectivesUnderstand:Understand:

Classifications of Classifications of MedicationsMedications

Purpose/Intended Purpose/Intended Effects of MedicationsEffects of Medications

Common Side Effects of Common Side Effects of MedicationsMedications

TIMA ProgramTIMA Program

Medication Rules & Medication Rules & LawsLaws

What is Our Role With What is Our Role With Medications?Medications?

Help the Help the Consumer Be Consumer Be IndependentIndependent

Help Keep the Help Keep the Consumer SafeConsumer Safe

Follow Federal and Follow Federal and State LawsState Laws

Who Makes the Rules?Who Makes the Rules? Federal Drug Federal Drug

Enforcement Agency Enforcement Agency (DEA)(DEA)

Texas Legislature per Texas Legislature per Texas Administrative Texas Administrative CodeCode

Texas Board of PharmacyTexas Board of Pharmacy Texas Medical BoardTexas Medical Board Texas Board of Nurse Texas Board of Nurse

ExaminersExaminers Texas Department of Texas Department of

Public Safety (DPS)Public Safety (DPS) OtherOther

Is prescribing medication a Is prescribing medication a guessing game?guessing game?

Medical research and studies determine a best Medical research and studies determine a best course of treatment for doctors to follow for course of treatment for doctors to follow for

most major medical conditions.most major medical conditions.These are referred to as “standards of care” or These are referred to as “standards of care” or

“best practices” or “evidence based “best practices” or “evidence based treatment”.treatment”.

““Best Treatment”Best Treatment”TIMATIMA

Texas Implementation of Texas Implementation of Medication AlgorithmsMedication Algorithms

Four Parts to TIMAFour Parts to TIMA

1. Algorithm1. Algorithm2. Training to Staff2. Training to Staff

3. Patient/Consumer Education3. Patient/Consumer Education4. Record Keeping4. Record Keeping

1. Algorithm1. AlgorithmAn algorithm is a tool for solving An algorithm is a tool for solving

problems by going through a problems by going through a series of steps. A medication series of steps. A medication algorithm recommends to the algorithm recommends to the

doctor which medication is best doctor which medication is best to use in a particular situation to use in a particular situation and what steps to follow if the and what steps to follow if the

first treatment does not work at first treatment does not work at all or does not work completely.all or does not work completely.

TIMA MaterialsTIMA Materials

AlgorithmsAlgorithms

2. Training2. TrainingDoctors are trained so Doctors are trained so

they can use the they can use the algorithms in the algorithms in the

most effective way.most effective way.

The goal is to get as The goal is to get as much improvement in much improvement in

symptoms as symptoms as possible.possible.

This may mean trying This may mean trying different medications.different medications.

3. Patient & Family Education3. Patient & Family Education

Information can Information can increase the increase the consumer’s consumer’s

understanding understanding about illness about illness

and treatment so and treatment so consumers can consumers can

be a true partner be a true partner in treatmentin treatment

4. Record Keeping4. Record Keeping1.1. Assisting the consumer Assisting the consumer

to keep a journal of to keep a journal of medications, symptoms, medications, symptoms, side effects, etc., can side effects, etc., can help the doctor visit be help the doctor visit be more productive.more productive.

2.2. Appropriate Appropriate documentation of documentation of consumer’s statements, consumer’s statements, appearance, and actions appearance, and actions verifies the consumer’s verifies the consumer’s status as well as the status as well as the staff member’s actions.staff member’s actions.

3.3. Accurate documentation Accurate documentation insures funding and insures funding and compliance.compliance.

TIMA is for TIMA is for consumers with a consumers with a

diagnosis of:diagnosis of:

DepressionDepression

Bipolar DisorderBipolar Disorder

SchizophreniaSchizophrenia

Teaching Consumers About Teaching Consumers About Their MedicationsTheir Medications

Expected Action Expected Action of the of the

MedicationMedication

Be realisticBe realistic

Help the consumer Help the consumer track their track their progressprogress

TIMA Education Booklet is TIMA Education Booklet is an excellent source for an excellent source for

thisthis

Teaching Consumers About Teaching Consumers About Their MedicationsTheir Medications

Reason for Reason for medicationsmedicationsTeach the Teach the

consumer about consumer about their diagnosis their diagnosis and conditionand condition

Please use approved Please use approved sources, such as TIMA sources, such as TIMA

and approved and approved handouts or approved handouts or approved

websites*websites*

Teaching Consumers About Teaching Consumers About Their MedicationsTheir Medications

Possible Side Possible Side Effects to the Effects to the MedicationMedication

May be temporaryMay be temporaryHelp the consumer Help the consumer

track the track the frequency and frequency and

severityseverityTIMA Education Booklet is TIMA Education Booklet is

an excellent source for an excellent source for thisthis

Why are prescription medications Why are prescription medications different?different?

Many medications require a Many medications require a prescription because prescription because

they are too dangerous they are too dangerous without a doctor’s without a doctor’s supervision. Most supervision. Most

prescriptions fall into this prescriptions fall into this “dangerous drug”“dangerous drug” category. Other category. Other

prescription medications prescription medications have potential to become have potential to become

habit forming or may habit forming or may interfere with breathing. interfere with breathing.

These are called These are called “controlled substances”“controlled substances” and are monitored even and are monitored even

more strictly.more strictly.

What categories of prescription What categories of prescription medications do we use?medications do we use?

AntidepressantsAntidepressantsSeveral CategoriesSeveral Categories

Mood StabilizersMood StabilizersAnti-Manic/Anti-ConvulsantsAnti-Manic/Anti-Convulsants

Antipsychotics/NeurolepticsAntipsychotics/NeurolepticsTypical & AtypicalTypical & Atypical

First Generation/Second Generation orFirst Generation/Second Generation or

New GenerationNew Generation

OtherOtherAnti-Anxiety Anti-Anxiety

(Anxiolytic)/Anti-EPS/Anti-Parkinsonism/Stimulant(Anxiolytic)/Anti-EPS/Anti-Parkinsonism/Stimulant

Sedative/HypnoticSedative/Hypnotic

Teaching Consumers About Teaching Consumers About Their MedicationsTheir Medications

How to TakeHow to TakeMedicationMedication

1.1. As directed by the doctor. As directed by the doctor. (Staff should check the latest (Staff should check the latest doctor’s order. The directions doctor’s order. The directions may have changed since the may have changed since the Rx was filled)Rx was filled)

2.2. With a full glass of water and With a full glass of water and with foodwith food unless instructed unless instructed by doctor, nurse, or by doctor, nurse, or pharmacist to take without pharmacist to take without food.food.

3.3. If dose missed*, don’t double If dose missed*, don’t double up. Don’t run out of meds.*up. Don’t run out of meds.*

*Call the nurse or doctor.*Call the nurse or doctor.

Teaching Consumers About Teaching Consumers About Their MedicationsTheir Medications

TheThe““Five Rights” of Five Rights” of

MedicationMedicationRight PersonRight Person

((Correct Consumer Name on the Med Correct Consumer Name on the Med Bottle)Bottle)

Right MedicationRight Medication(Correct Name of Medication on the Med (Correct Name of Medication on the Med

Bottle)Bottle)

Right DoseRight Dose(Correct Amount or Size of Pill)(Correct Amount or Size of Pill)

Right TimeRight Time(Correct Time of Day)(Correct Time of Day)

Right RouteRight Route(Correct Way)(Correct Way)

For Best Results Encourage For Best Results Encourage Consumers To:Consumers To:

Keep Clinic Keep Clinic AppointmentsAppointments

Take MedicationsTake MedicationsAs PrescribedAs Prescribed

Report Report Symptoms Symptoms oror Side EffectsSide Effects

What are the rules for What are the rules for consumer’s medications?consumer’s medications?

There must be a doctor’s order (prescription) for the There must be a doctor’s order (prescription) for the medication.medication.

The medication container must be labeled by a pharmacist or The medication container must be labeled by a pharmacist or doctor/practitioner.doctor/practitioner.

Only a doctor, pharmacist, or consumer may place the Only a doctor, pharmacist, or consumer may place the medications in the prescription bottle. A nurse may fill a medications in the prescription bottle. A nurse may fill a consumer’s “pill minder”, “pill planner”, or similar container consumer’s “pill minder”, “pill planner”, or similar container specifically designed for medication storage (or an RN may specifically designed for medication storage (or an RN may specifically delegate this function in accordance with the Nurse specifically delegate this function in accordance with the Nurse Practice Act guidelines.)Practice Act guidelines.)

Only the person on the prescription may use the medication or Only the person on the prescription may use the medication or be in possession of the medication unless acting as a be in possession of the medication unless acting as a documented agent of a facility or practitioner.documented agent of a facility or practitioner.

Only a nurse, doctor, or other practitioner may call in Only a nurse, doctor, or other practitioner may call in medication doses or instructions to a pharmacy.medication doses or instructions to a pharmacy.

Medication Medication ProceduresProcedures

Medication Medication Handling Guidelines Handling Guidelines

for Stafffor Staff

DefinitionsDefinitionsDispenseDispense: to prepare, package, compound, : to prepare, package, compound,

or label a dangerous drug. or label a dangerous drug. ONLY A DOCTOR OR PHARMACISTONLY A DOCTOR OR PHARMACIST

AdministerAdminister: removal of a medication from : removal of a medication from a previously dispensed, properly labeled a previously dispensed, properly labeled container. container.

ONLY A LICENSED HEALTH PROFESSIONALONLY A LICENSED HEALTH PROFESSIONAL

UNLESS SPECIFICALLY AUTHORIZED IN ACCORDANCE WITH THE RN DELEGATION RULES OF THE UNLESS SPECIFICALLY AUTHORIZED IN ACCORDANCE WITH THE RN DELEGATION RULES OF THE TEXAS RN NURSE PRACTICE ACTTEXAS RN NURSE PRACTICE ACT

PrescribePrescribe: to authorize a “dangerous drug” : to authorize a “dangerous drug” or controlled substance to be dispensed. or controlled substance to be dispensed.

ONLY A LICENSED PRACTITIONER.ONLY A LICENSED PRACTITIONER.

Transporting Transporting MedicationsMedications

Always verify and Always verify and sign for the sign for the

medications you medications you accept to accept to

transport for any transport for any reason, and reason, and require the require the

receiving person receiving person to do the same.to do the same.

Transporting Transporting MedicationsMedications

Never leave Never leave medications in medications in

a vehiclea vehicle

-theft risk-theft risk

-heat or cold -heat or cold can damage or can damage or alter alter medicationsmedications

Assisting Consumers With Assisting Consumers With Their Pill ContainersTheir Pill Containers

A licensed nurse may A licensed nurse may fill the pill containers fill the pill containers

in instances where in instances where the consumer is the consumer is

unable to do this.unable to do this.

In special In special circumstances an RN circumstances an RN

may delegate a may delegate a specific unlicensed specific unlicensed person to do this as person to do this as

long as all the long as all the criteria for criteria for

delegation is met.delegation is met.

Criteria for RN Delegation to Criteria for RN Delegation to Unlicensed Assistive StaffUnlicensed Assistive Staff

1.1. Consumer is in an Consumer is in an independent living independent living environment.environment.

2.2. Consumer or guardian is Consumer or guardian is willing to participate in willing to participate in consumer’s care.consumer’s care.

3.3. Consumer has a stable Consumer has a stable predictable condition (chronic predictable condition (chronic not recuperative).not recuperative).

ProcessProcessAn RN must make an assessment An RN must make an assessment

of the consumer to determine of the consumer to determine if delegation of the nursing if delegation of the nursing

task is appropriate.task is appropriate.An RN must verify the competency An RN must verify the competency

of the unlicensed staff to of the unlicensed staff to perform the nursing task.perform the nursing task.

RN should be available for RN should be available for consultation and questions.consultation and questions.

If Filling Medication Pill Containers If Filling Medication Pill Containers is Delegated to Youis Delegated to You

1.1. It must be documented with It must be documented with RN signature and staff RN signature and staff signature and consumer or signature and consumer or guardian.guardian.

2.2. Universal precautions must Universal precautions must be observed (gloves and no be observed (gloves and no touching pills).touching pills).

3.3. Use it as a teaching activity.Use it as a teaching activity.

4.4. Information about how to Information about how to call the nurse or clinic prior call the nurse or clinic prior to taking a medication if to taking a medication if there are questions.there are questions.

5.5. Incorporate TIMA materials.Incorporate TIMA materials.

Items on the Prescription BottleItems on the Prescription Bottle

Verify The Following:Verify The Following:

Consumer NameConsumer Name

Medication NameMedication Name

Medication DoseMedication Dose

Medication TimeMedication Time

Medication RouteMedication Route

These are also theThese are also the

““Five Rights”Five Rights”

Poison ControlPoison Control

1-800-222-12221-800-222-1222

DocumentationDocumentation1.1. Needs to be legible.Needs to be legible.2.2. Should indicate purpose of Should indicate purpose of

appointment, what was appointment, what was addressed, and consumer’s addressed, and consumer’s understanding of information, as understanding of information, as well as action consumer is to well as action consumer is to take.take.

3.3. If consumer reports problem, If consumer reports problem, symptom, concern, question, etc., symptom, concern, question, etc., always document what action will always document what action will be taken and by whom.be taken and by whom.

4.4. If consumer indicates suicidal or If consumer indicates suicidal or homicidal thoughts, address homicidal thoughts, address those as appropriate: “Are you those as appropriate: “Are you saying you feel like hurting saying you feel like hurting yourself or someone else?...How yourself or someone else?...How do you think you might do do you think you might do that?...Do you think you might act that?...Do you think you might act on those feelings?” Notify the on those feelings?” Notify the doctor, nurse, LPHA, or Clinic doctor, nurse, LPHA, or Clinic Director if yes to above and Director if yes to above and document that notification or document that notification or follow up to comments.follow up to comments.

Review & TestReview & Test