How to Conduct a Medication Administration Observation Transcript Title Slide (no narration) Welcome Hello. My name is Jill Morrow and I am the Medical Director for the Office of Developmental Programs. I will be your narrator for this webcast. Lesson 12 Lesson 12 is comprised of multiple webcasts. This webcast focuses on how trainers and Practicum Observers conduct medication administration observations. Trainers view this webcast in order to become certified as a trainer and Practicum Observers also view it as part of the Practicum Observer course. Lesson Focus At the end of this webcast, you will be able to do the following skills to complete a medication administration observation: Prepare for the observation, Conduct the observation, Document the observation, And, remediate the observation. Steps of Observation We will now walk through the steps to conduct a medication administration observation including what you will need to do to prepare yourself and the staff administering medication for the observation. For the purposes of the Initial Training and the Annual Practicum, one medication administration observation is considered to be the administration of one medication to a person at a specified time of day regardless of the number of medications the person receives at that time. There are six steps in conducting an observation. Step 1 is to prepare yourself by identifying the person and the medication that will be used for the observation. You should read the person s record and MAR so that you are familiar with them and any special instructions required for administration. You should also assure that you have the Observation Checklist labeled for the staff that you will be observing and the date of the observation. As these checklists are multiuse, you may have one that is blank or one that has other observations on it. Step 2 is to prepare the staff administering medication by telling them to describe each step in administration as they are doing it so that you know what they are doing and are sure that they have completed each step. Let them know that you will be looking over their shoulder at the log and the label to assure that they are doing the task correctly. This will help reduce their anxiety around the process of being observed and tested. 1
Step 3 is to complete the observation. You will need two documents to complete the observation. The Observation Criteria is used to compare the medication administrator s performance on the task to the standard criteria. You then document their performance on the Observation Checklist. There are a few things to remember while observing. Try not to distract the staff while they are completing the task. Do not fill in the answer if they get stuck. Do not interrupt the process unless the staff has made a mistake that would lead to a medication error. In this case, do not allow the staff to administer medication in error. Instead, end this observation with a fail. If an error is discovered after the administration, then you and the staff should initiate the provider process for addressing a medication error, including immediate medical intervention for the person, if needed. Step 4 is to document the results of the observation on the Observation Checklist which includes not only a place to indicate correct completion of the step with a P or incorrect with an F, but also a place to write any comments about the step. All incorrect or failed steps require an explanation in the comment box so that you document why the person failed that step. Step 5 is to identify the need for remediation based on the staff performance on the observation. Step 6 is to complete and document the applicable remediation activities. Documentation Let s now move on to looking at how to conduct the observation. For this, you will need the two documents that we mentioned previously to follow along with the slides. These are the Observation Criteria and the Observation Checklist. Click on the picture of each document to download them or they are also available as a resource where you launched this webcast. You should print them now if you do not already have access to a copy of each as you will need them as we review the criteria. Click [Continue] when you are ready. We will start walking through the standard criteria that must be met to pass a medication administration observation found on the Observation Criteria form. Remember that depending on how your provider conducts medication administration, you may need to alter the order of the steps in Parts 1 or 3 as permitted. Please review the material from the Classroom Presentation to identify which steps are permitted to be done in a different order. You may modify the order of the steps on the Observation Checklist to match those used in your provider. While performing an observation, you will need to document pass or fail on the Observation Checklist as the staff moves through the steps. Before we review the Observation Criteria, let s look at how you will complete the Observation Checklist during the observation. During the observation, either the trainer or Practicum Observer will complete the documentation for each step in the observation as the staff finishes that step. This documentation is put on the Observation Checklist. Instructions for completing the Checklist appear on the Checklist. Assure that the following items are entered on the Checklist either at the beginning or after each step. The name of the staff person observed. The date of the observation. Each step in the observation process should have either a P or an F. There should be comments for each F and where needed for any P. An explanation of what occurred is required for each failed step so that you can use that information to provide feedback as well as providing a record of what the person did that resulted in the failure. 2
Observation Part 1: Preparing Looking at the observation criteria, the first step in Part 1, Preparing, is identifying the person and their medication. In order to pass this step, staff correctly identify the person and the correct medication for the person to receive for this administration. Staff would fail this step if they incorrectly identify the person or medication. Relying on another staff or the person receiving medication to identify the person or the medication would also result in a fail. Once you ve determined whether this step was passed or failed, you would document that in the appropriate area on the Observation Checklist. Don t forget if the step was failed, then you must include a comment describing what happened. Step 2 in Part 1, Preparing, is the preparation of the space. To pass, staff clear and clean a space to work in. A fail results if staff either doesn t clear or doesn t clean the space. Gathering equipment is Step 3 in Part 1, Preparing. In this step to pass, staff gathers all of the needed equipment before moving to the next step. Failure results if the staff moves to the next step, but has to come back and get another piece of equipment. A problem with the equipment would not lead to failure here. Getting the medication is the fourth step in Part 1, Preparing. To pass, staff retrieves the appropriate medication for the administration. Staff fail if they get the wrong medication for the administration or leave the medication unattended, unsecured, or unlocked. Next, we move to Step 5 in Part 1, Preparing, which is wash hands. Here to pass, staff wash their hands using the skills they learned in the lesson about handwashing and gloving. Forgetting to wash their hands before continuing to the next step or not using proper technique would result in a fail. Observation Part 2: Administering Now we move to Part 2 of the observation which is Administering. Step 1 is Check 1. To pass, staff compares the pharmacy label to the medication log or MAR and assures that all 5 Rights, person, medication, dose, route, and time, match. Staff must talk through what they are doing. You should prompt them with tell me what you are doing if they do not. Failure results if staff fails to identify any of the 5 Rights or leaves the medication unattended, unsecured, or unlocked. Check 2 is the second step in Part 2, Administering. Check 2 occurs just prior to pouring the medication. To pass this step, staff compares the pharmacy label to the medication log or MAR and assures that all 5 Rights, person, medication, dose, route, and time, match. Be sure that staff talks this through. Prompt them with tell me what you are doing if they do not. Staff fails this step if any of the following occurs: Fails to identify any of the 5 Rights, Leaves medication unattended, unsecured, or unlocked, Uses a partial tablet when the dose required a whole tablet, Or, alters the medication such as by splitting or crushing without specific instructions to do so. 3
Recapping the bottle is Step 3 in Part 2, Administering. This is Check 3 and like the two previous Checks a pass requires that staff compares the pharmacy label to the medication log or MAR and assures that all 5 Rights match. Don t forget to prompt staff to describe the activities in Check 3. Failure here occurs if staff fails to identify any of the 5 Rights or leaves the medication unattended, unsecured, or unlocked. Step 4 in Part 2, Administering, is to administer the medication. In order to pass, staff must administer the correct medication allowing the person to participate in the process as they are able. As well, staff must follow any special instructions such as doing a pulse or blood pressure or giving medication before a meal. If any of the following occur, staff fails this step. A mistake is made with any of the 5 Rights. At this point, the administration should be stopped. Do not allow staff to proceed. Staff administers medication using an incorrect technique such as administering medication lying down when it should be given sitting up or giving medication without water. Or, staff administers medication without following special instructions. Observation following administration to make sure that the person has taken the medication is Step 5 in Part 2, Administering. In order to pass this step, staff remains with the person assuring that they have swallowed the medication and are not in any acute distress. Failure to observe the person after administering the medication would result in a fail for this step. Observation Part 3: Completing The next part of observation is Part 3, Completing. The first step in this Part is to recheck the rights, look again to make sure that the administration was correct. This is also referred to as Check 4. To pass, staff rechecks the 5 Rights comparing the pharmacy label to the MAR. If staff does not recheck any of the 5 Rights, then this step is failed. Step 2 in Part 3, Completing, is to document the medication administration. A pass here requires that staff documents the medication administration on the MAR using the correct date and time box and correctly indicating any other required documentation for that administration including using the right abbreviations. Failure results if staff fails to document the administration or staff makes an error in the documentation. An example of an error in documentation would be putting their initials in the wrong date and time box. Putting the medication away is Step 3 in Part 3, Completing. To pass, staff returns the medication to the storage area and secures it properly including locking it if required. Staff that does not lock and secure the medication or return it to its storage area fails this step. Washing hands is Step 4 in Part 3, Completing. Here to pass, staff wash their hands using the skills they learned in the lesson about handwashing and gloving. Forgetting to wash their hands before continuing to the next step or not using proper technique would result in a fail. 4
To complete Part 3, Completing, Step 5 is observe for effects. To pass Step 5, staff should tell you that they will be observing for medication effects both now and on an on-going basis. Because this is not a distinct step, you may prompt staff with What will you look for now that you have completed the medication administration? Staff who does not provide information about observing for effects either spontaneously or with prompting fails this step. This is the last step to document on the Observation Checklist. Next we will look at how to complete the documentation for a medication administration observation. Observation Concluding Observation At the end of the observation, the observer, either a trainer or a Practicum Observer, will complete the remainder of the documentation for that observation on the Observation Checklist. In addition to assuring that the name of the staff and the date are present, the final tasks for completing the observation include the following. Check to assure that each step in each part of the administration process has either a P or an F and that there are comments for each F. Remember that an explanation of what occurred is required for each failed step so that you can use that information to provide feedback and there is a record of what the person did that resulted in the failure. Next, indicate at the bottom of that observation a Pass or Fail for the observation. In order to pass, all steps must be passed. Any step with an F indication is failed and results in a failure of the entire observation. After determining whether or not the observation was passed, the trainer or Practicum Observer will provide feedback to the staff regarding their performance and inform the appropriate provider supervisor as relevant. Indicate that the feedback was provided including the date of feedback on the Observation Checklist. Sign the Checklist for that observation where the Pass or Fail indication is. File the Checklist where medication administration documentation is filed in the provider. Trainers or Practicum Observers transfer the pass/fail information from the Observation Checklist onto the Summary and Certification form for either Initial Training or Annual Practicum for that staff. 5
Let s take a look at how the feedback should be provided to staff. The purpose in providing feedback to staff is to reinforce what was done well and identify areas needing improvement. It is recommended to begin with the places that staff did well before looking at areas of need. The failed steps should be reviewed individually providing staff with the description of what was done and what should have been done instead. Be sure to provide constructive feedback and ask staff about how their performance in that step might have been improved. This may reveal systemic issues with medication administration related to the environment or other factors that can result in medication errors. Correcting these at this point will not only correct them for this staff, but also for the other staff in the provider. Be sure to tell staff what to expect regarding the next steps for certification including required remediation and additional observations. Student Testing and Monitoring Initial Training Let s move to talking about how many observations are required for Initial Training and the Annual Practicum. For Initial Training, unlicensed staff must complete four medication administration observations supervised by either a trainer or a Practicum Observer to meet the criteria to be certified to administer medication. Two of the four observations must take place in the workplace and the other two may be done either in the workplace or the classroom. For the observations occurring in the workplace, staff will complete the entire process including documenting the administration with their initials. While they are not yet certified at that point, the documentation of the date of the observation by the certified trainer or Practicum Observer on the Observation Checklist serves as validation that the administration was supervised by a certified person. Classroom observations are mock demonstrations, but they must be done independently and not as part of a classroom teaching or practice activity. Staff that pass all four observations pass the medication administration observation portion of the testing for purposes of certification. Those that do not, need to participate in remediation. Staff that pass a total of four observations are eligible for certification. For each observation that is failed during Initial Training, an additional observation must be successfully completed to pass. Staff may only fail two observations to pass without participating in remediation. Thus, staff have a maximum of six attempts to pass the observation component for Initial Training. For staff who fail more than two observations out of six, remediation is required. These staff must review the online lesson about administration and complete the trainer-led demonstration from the Classroom Presentation. Those staff who failed the documentation step, Part 3, Step 3, must also complete the online documentation lesson. An additional two practice administrations are also required for remediation prior to retesting. The staff then must complete all four observations correctly to become eligible to be certified. Any staff who is unable to complete the four observations without any failures during the second attempt must repeat the entire course. At this point, trainers need to consider whether or not a staff who is unable to correctly administer medication after remediation is capable of performing the task. Student Testing and Monitoring Recertification 6
For annual recertification, unlicensed staff must successfully complete two medication administration observations supervised by either a trainer or a Practicum Observer to meet the criteria to continue to be certified to administer medication. These two observations must take place in the workplace and be spread throughout the year. These observations are identical to those conducted for Initial Training and trainers and Practicum Observers will use the same Observation Criteria and Observation Checklist. Staff that fail an observation for the Annual Practicum must successfully complete two additional observations for each failed observation. Passing two observations after a failure counts for one of the two required observations for that Annual Practicum. The two additional observations must be completed within 30 days of the failed observation. The course leaves the decision of whether or not the staff that failed an observation can continue to administer medication while completing the two additional observations up to the judgment and discretion of the trainer and Practicum Observer. However, consideration should be made for removing a staff from administering medication until the trainer and Practicum Observer are comfortable that this staff can safely administer medication. The trainer and Practicum Observer may also make additional requirements for remediation for that staff to assure that staff is capable of completing the tasks safely and accurately. Remediation is required of any staff that fails to successfully complete one of the two additional observations. For staff who fail one of the two additional observations, remediation is required. These staff must review the online lesson about administration and complete the trainer-led demonstration from the Classroom Presentation. Those staff who failed the documentation step, Part 3, Step 3, must also complete the online documentation lesson. An additional two practice administrations are also required for remediation prior to retesting. Staff then must pass both observations to remain certified. Any staff who is unable to complete the two observations without any failures during the second attempt must have their certification revoked and repeat the entire course. At this point, trainers need to consider whether or not a staff who is unable to correctly administer medication after remediation is capable of performing the task. Next Step Thank you for viewing this webcast about how to conduct a medication administration observation. Now you should view How to Review Medication Administration Records. 7