HELPING CLIENTS WITH SELF-ADMINISTRATION OF MEDICATIONS INTRODUCTION Certified nursing assistants (CNAs) work in hospitals, long-term facilities, and other health care settings. But they also work with clients who live at home but need professional help to maintain their health and independence. One aspect of home care CNAs can be involved with is helping the client with self-administration of medications. Many clients who live at home but need the assistance of a CNA are often taking multiple prescription medications. Some of these medications have serious side effects. Some can be dangerous if the dose is too high or too low, or if an extra dose is taken. And although many people can safely self-administer their medications, if a mistake is made extra doses are taken, outdated drugs or the wrong drugs are taken, etc. there is potential for harm and damage. The practice laws that govern the CNA profession in your area may require CNAs who supervise client s medication self-administration to have special training, pass a test, and obtain certification. This module contains the basic information about how to properly self-administer medications and also the information you need to evaluate whether or not your clients are capable of self-administering their medications and that they are doing so safely and accurately. The module will also discuss medication errors: what they are, how to recognize them, and how to make sure they don t happen. OBJECTIVES When the student has finished this module, he/she will be able to: 1. Correctly identify the definition of a medication error. 2. Identify an important, added aspect of the definition of a medication error. 3. Correctly identify three different medication errors. 4. Identify the five rights of medication administration. 5. Identify the sixth right of medication administration. 6. List four areas used to determine client ability to self-administer medications. 7. List three questions used to assess client ability to self-medicate. 8. List another three questions used to assess client ability to self-medicate. 9. Identify the proper action to take if a client cannot answer these questions. 10. Identify three ways clients can be helped to safely self-administer medications. WHAT IS A MEDICATION ERROR? In order to help clients self-administer medications, you must know proper medication administration techniques in other words, you need to know how to do it right. But you also must be able to recognize when mistakes are being made. You need to be able to recognize a medication error. Medication errors are very, very common, whether they are committed by health care professionals or by members of the public who are self-administering medications. There
are literally millions of these errors that occur every year. Some have no consequence, while others cause harm or even death. But what is a medication error? If a client is scheduled to take his pain medication at 14:00, but takes it at 14:15, is that a medication error? If the client continues by mistake to take a medication after the physician has ordered it to be stopped, but she suffers no immediate harm, is that a medication error? What about the client who takes three tablets of digoxin (a cardiac medication) instead of one and suffers a serious heart arrhythmia? Obviously, in all three instances the client has made a medication error, but the implications and the consequences of each situation are very different. It is very unlikely that taking a medication 15 minutes past the scheduled time will cause problems; the second error may cause harm later on; the third person had to be hospitalized. But although these three medication errors are very different in terms of what happened or could have happened, they are all definitely medication errors. A medication error is not defined by whether or not someone is injured. A medication error is considered to be the use of a medication that has the potential to cause harm. So the definition of a medication error is: A medication error is any use of a drug that deviates from a physician s orders. Medications are prescribed by physicians and the prescription specifies who the drug is for, what drug should be taken, and when, how often, and by what route (oral, rectal, etc.) the drug should be taken. If these instructions are not followed, the client could be harmed and sometimes that can happen in ways that are not obvious. For example, if a medication was scheduled to be administered at 14:00 was taken at 14:15 and no harm was done, why not take it at 14:30, or 14:45? Taking some medications this way may not be a problem. If someone takes ibuprofen three times a day for pain, but takes a dose an hour late, that person might have some discomfort but it is highly unlikely he/she will be harmed. But some drugs must to be taken at tightly scheduled intervals so that blood levels of the drug are maintained. If they are not taken this way, the drugs will not be effective. Learning Break: A medication error does not occur only when a client uses a drug incorrectly and suffers harm. A medication is a deviation from safe medication practices that has the potential to cause harm. TAKING MEDICATIONS PROPERY AND SAFELY Taking medications properly and safely is not difficult to do. The easiest way and the traditional way to make sure medications are being taken correctly is to remember the five rights of medication administration. The right drug should be given to, To the right person, At the right time, By the right route, At the right dose
One other consideration is that the right drug should be given to the right person for the right reason. Someone who does not have diabetes should not be receiving a medication that can lower the blood sugar and unfortunately these types of mistakes do happen. Simply following the five rights is very important, but there is more to safe medication administration than that basic rule. In the five rights it is assumed that if a medication was prescribed by a physician for a specific client and the client takes the medication then proper procedure has been followed. But is the drug is not needed by that client or may be harmful to the client, saying that everything is fine, the right drug was given to the right client because that is what the physician ordered would be a big mistake and a medication error. So remember the five rights but make sure you add a sixth one: medications should be given for the right reason. CLIENT ASSESSMENT Now you know what a medication error is, and you know how to determine if medications are being given properly and safely. The next step is to use this knowledge to assess whether or not your client is capable of self-administering his/her medications. Remembering the five rights and the sixth right will be very helpful. The assessment can be an interview/question and answer session; it can be a printed form the client fills out, a demonstration in which the client shows the CNA he/she knows how to safely selfadminister medications, or a combination of the three. The assessment should cover these areas. Right drug: Does the client know what he/she is currently prescribed? See if the client can write down a complete list of all his/her drugs, or see if the client can correctly identify these drugs from a list of medications. You can also determine if the client can recognize the prescribed medication by color, size, or shape. Pharmacy errors are very uncommon, but they do occur. The label may be correct but the bottle might have been filled with a different medication so clients should make sure the tablets, capsules, etc. they received are the correct ones. Right person: Does the client understand that medications should only be taken if a physician has decided a specific client needs that drug? This means that he/she should never use someone else s medication or borrow or trade medications with another person. Reinforce with the client that different medications that can prescribed for a particular condition are not all the same. Two people might both have hypertension, but the drugs that are used for each person might vary tremendously in the way they work, side effects, etc. Some drugs are dangerous if they are given to someone with a specific medical condition or to children. Drugs dosages are also often based on weight or age. Right time: Make sure the client understands the importance of taking medications at the proper time. This might involve taking a drug before eating, an hour before or after meals, etc. Ask clients why they take their medication when they take them and see if have a good explanation. Ask them what they would do
if they noticed they were late taking a dose, or what they would do if they forgot to take a dose. Right route: It seems very obvious that certain medications are intended to be taken orally, applied to the skin, instilled into the ear, etc., and the prescription labels on the containers/packages will have this information. But is very common for people to put ear drops into their eyes or to take dermal medications orally. Make sure your client can tell you by what route a medication is intended to be used. Also make an assessment to determine if the client is aware that medications should not be altered in any way. For example, medications that are sustainedrelease are manufactured so that the drug is slowly and steadily absorbed. These drugs should be swallowed intact and not cut or opened. If they are tampered with, they may not be effective and they could be dangerous. Right dose: Medication dosages carefully calculated to get the maximum benefit with the least amount of risk. Determine if your client knows the dosages of the medications he/she is taking. See if the clients understand that the doses have been prescribed specifically for them so that the drug is effective but won t cause harm. Medication Safety: One of the most important aspects of medication selfadministration is medication safety. Does the client understand that it is important to read the client information that came with the prescription? Can your clients tell you about the side effects of the medications they are taking? Do they know the signs and symptoms of an allergic reaction and what to do about it? Do they know that they should never stop or start taking a medication, including over-thecounter drugs and supplements, unless a physician has told them to it is all right to do so? Ask them what they would do if they missed a dose, or if they took a medication twice, or if they are not sure if they took their medication. Ask them who they would call or talk to if they had a question about one of their medications. Do they know how to properly store their medications and what to do if the drugs have not been properly stored? Medication administration: All medications must be used in a specific way. Many drugs are simple: swallow the tablet/capsule with a little water. Others are more complicated. They must be taken with food, or on an empty stomach. There might be certain foods that should be avoided: grapefruit juice can decrease the potency of many drugs. Some drugs (nicotine, some pain medications) are applied as patches to the skin and the medication is slowly absorbed; cutting the patch can be dangerous. Medications such as insulin must be injected properly to avoid infection. Nitroglycerin tablets that are used for chest pain must be placed under the tongue and allowed to dissolve; they will not be effective is they are swallowed.
Learning Break: Each medication must be taken in a specific way in order to be effective and safe. Instructions for taking medications should be provided by the physician or will be provided with the prescription when it is dispensed by the pharmacy. Making an assessment that includes all of this information may seem as if it would be complicated and time-consuming, but with a little organization it is easy. A printed sheet with all of the important questions can easily be prepared. Include these questions. 1. What medications are you currently taking? What are the names, and what do they look like? 2. What are the dosages? How often do you take them? 3. When do you take them? 4. Why do you take them? What are they for? 5. How do you take them? What medications and/or foods should you avoid? 6. What are the side effects of these medications? 7. What are the signs/symptoms of an allergic reaction? What would you do if you were having an allergic reaction? 8. Who would you call if you had a question about you medications? 9. What should you do if you miss a dose or take a medication twice? 10. Should you start or stop a medication or change the dose by yourself? If the client seems uncertain or confused about any of these questions or cannot answer them, make sure you carefully document this information. Notify your immediate supervisor, but also try and determine if there is an emotional or physical reason why the client cannot answer the question HELPING YOUR CLIENTS SAFELY TAKE THEIR MEDICATIONS Helping clients to self-administer their medications starts with the assessment. If the client can answer the assessment questions, that s great. But even clients who can answer the assessment questions could need some help, especially if they take many different medications, new medications are prescribed, dosages are changed. Fortunately, there are a lot of resources available. Medication timers: Medications timers are basically alarm clocks that can be set to ring, alarm, etc. at specified times during the day. When the alarm goes off, the client will it is time to take a medication. Medication watches are also available. Medication organizers: These are very popular. The most commonly used ones are week-long organizers. These have seven separate containers labeled Monday through Sunday. The client simply places the day s supply of medications in each container. Medication calendars are another option. The client writes down what he/she needs to take each day and makes a note on the calendar after taking a dose.
Medication cards: These are printed cards that can be placed in a prominent position where the client will easily see them. Organization: Some people find that putting their medication in a specific place will help them remember to take a dose, e.g., place the bottle of tablets that are taken every morning next to the coffee pot to the toaster. Make a list: The client can make a list of all his/her the medications, including names, dosages, reason for use, time to take, how to take them, and side effects. Have a health care professional pharmacist, MD, CNA, RN who can verify the information check it, then place it in a safe and easily accessible place.