This policy replaces NPP 517 dated May 8, 2007 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Medications POLICY NUMBER: 517 Effective Date: July 26, 2007 SUBJECT: MEDICATION ADMINISTRATION ORIENTATION/COMPETENCY VALIDATION 1. GENERAL: Only licensed nursing service staff that has successfully demonstrated their competency in medication administration may give medications without supervision at Coalinga State Hospital. 2. MEDICATION ADMINISTRATION COMPETENCY VALIDATION: A. All licensed nursing services staff that may be required to administer medications at Coalinga State Hospital shall be oriented to the med room and successfully complete the Medication Administration Practicum. The Orientation/Competency validation process will minimally include: 1) Review of nursing procedures regarding medication administration. 2) Assessment of the employee's knowledge of medications and medication procedures including noting physician s orders. 3) Supervision of an employee's demonstrated proficiency in administering medications. The Orientation/Certification Process will also extend to those employees demonstrating a need for retraining. B. The nursing educator will forward the exam to the HSS. (See 3A.) C. The HSS/designee will perform the clinical validation (which includes on site observation and supervision of employee administering medication with procedural review of oral, injectable and topical medications and instillations [including actions and side effects]). If the employee passed the clinical certification review, then the employee is able to administer medications without supervision. The HSS will assure that the Training Department, receives all necessary/required paperwork so a record of competency/validation is maintained. D. Medication Administration competencies are to be completed quarterly. The Unit Supervisor or designee is responsible for two of the four competencies (the first and third quarters) and the HSS will complete the alternating quarterly competencies (the second and forth quarters). The initial staff competency validation is to be completed by the HSS. -1-
3. COMPETENCY REVALIDATION: A. Annually, all licensed nursing service staff, with the exception of Health Services Specialists, who are required to administer medications shall be required to attend an updated class on medication administration taught by a designated instructor from the Training Department and pass a written and/or a proficiency examination (examination is on a pass/fail basis). B. If the employee fails to pass the written Med-Cert. Test the Training Center notifies the Unit Supervisor/designee and the HSS/designee, and then processes the Med Certification failure notice. C. The Unit Supervisor will notify the HSS of anyone who requires clinical validation/revalidation for any other reason prior to assigning him/her to administer medications. The HSS will make recommendations for necessary actions, e.g. recertification, clinical certification, clinical supervision, etc. 4. MINIMUM STANDARDS: Minimum standards relating to medication administration include: A. Knowledge of Coalinga State Hospital Nursing Policies and Procedures as described in the Nursing Policy and Procedure Manual and knowledge of the Pharmacy Formulary and Policy Manual; B. Knowledge of medication administered including action of medication, beneficial effect and adverse effects of medication; C. Proficiency in administering oral, injectable, topical, ophthalmic, otic and nasal medications; D. Knowledge of the Individual, including proper identification, allergies, and history. 5. CORRECTIVE RETRAINING: Corrective retraining will be done at the request of the Program Director/designee and may include: A. Same as described above. B. Pharmacology review. C. Or any designated part of the certification training process based on the nature of the need. -2-
Unit Supervisor or designee Medication Pass Confirmation of Competency Employee Name: Title: I.D. #: Birth Month: Date Observed: Time: Program: Unit: Medication Administration: 1. Identifies patients using two forms of identification. Yes No 2. Leaves Medication in its original Package until given to the Individual. Yes No 3. Uses a 3 Check Process to Medication Preparation: Yes No a. Checked when medication is selected against MAR. b. Checked after med wrapper opened and placed in medication cup. c. Checked empty wrapper / packaging against MAR before administration. 4. There is a second staff member standing by the med pass line actively assisting in the proper identification of the individual in the medication line. Yes No 5. The employee confirms that the individual swallowed all medications. Yes No 6 No more then five individuals are in the Medication Line at a time. Yes No 7. Medication related teaching done in a professional manner as needed to the individual Yes No NA 8. Employee safely and accurately administered medications according to the 7 Rights including; monitoring of laboratory findings, V/S, documentation, and pain assessment. Sufficient fluid for the medications was administered. Yes No Employee: Signature US or designee Evaluator: Printed Name US or designee Evaluator: Signature Note: Send Original to Central Nursing Services and Copy to Nursing Coordinator. Note: Send Original to Central Nursing Services and Copy to Nursing Coordinator. -3-
HSS MEDICATION ADMINISTRATION COMPETENCY Employee Name: Title: Birth Month: ID# Date Observed: Time: Program/Unit: INDICATORS Knowledge Base: 1. Verbalizes generic and trade names of medications administered. 2. Describes therapeutic effects, usual doses, and routes of medications administered. 3. Differentiates expected side effects from adverse reactions. 4. Explains "sliding scale" for regular insulin. 5. Verbalizes symptoms and appropriate interventions of hypo/hyperglycemia. 6. States rationale of unapproved abbreviation list and location. 7. Verbalizes proper procedure for wasting and disposal of medication. Administration (Per Hospital Policy): 8. Applies principles of asepsis to medication administration. 9. Prepares medications no more than 1 hour before administration. 10. Identifies Individual by name and photograph to ensure correct identification. 11. Checks for allergies. 12. Measures, interprets & records B.P. & pulse before administering cardiac & antihypertensive medication. Withholds medication as indicated. 13. Opens/pours medication in front of Individual. 14. Correctly administers crushed and liquid medications. 15. Checks medication with MTR 3 times. 16. Educates the Individual regarding medications. 17. Assesses Individual before administering PRN/Stat medication. 18. Administers: correct medication (including controlled medication) correct dose to correct individual by correct route at correct time/date 19. Ensures that the Individual swallowed all medications. 20. Applies proper technique with use of safety syringes. 21. Ensures Individual's privacy and confidentiality. 22. Properly administers eye/ear drops, inhalers/spray. Documentation (Per Hospital Policy): Met Not Met N/A -4-
23. Documents and signs out controlled medications correctly. 24. Documents meds given on MTR immediately after administering. 25. Documents on MTR when medication is not taken and notifies physician. 26. Documents reasons for administering PRN/Stat medication. 27. Documents effects of PRN/Stat medication within one hour. 28. Documents telephone order, read back, noting, and transcribing orders. 29. Documents Involuntary and/or Emergency Medication administration for PRN/Stat. Environmental: 30. Keeps medication room and cart locked when not in use. 31. Keeps medication room and cart clean and tidy. 32. Properly stores items in clearly marked areas of medication cart. 33. Keeps medication keys under constant surveillance. 34. Does not leave medication unattended. Employee Signature HSS Evaluator (Print Name): HSS Evaluator (Signature): Note: Send original to Central Nursing Services and Copy to Nursing Coordinator. -5-