Module IV Administration of Medications and Treatments

Module IV Administration of Medications and Treatments

Preparing for Medication Administration Good routines and habits can help reduce errors by creating consistent methods of communicating and planning for medication support. Reduce errors by doing the following: When more than one direct support professional (DSP) is present, designate one DSP to provide ALL medication support that is needed during that shift If you are responsible for medication support, check EACH time you work to see if anything has changed. Do this RIGHT AWAY when you come to work. A new medication may have been started or the timing of an old medication may have been changed. Don t wait until after a medication mistake to find out! Plan ahead. Include enough time in the other plans for the day for taking medications. Don t get caught away from home without medications. Avoid being in the middle of another important task at the time when you need to provide medication support. Avoid being interrupted while giving medications Several minutes before giving medications do the following: Look at the Medication Administration Record (MAR) and review which medications need to be given, to whom, how, and when Let the person know it is almost time to take medications Wash your hands Gather necessary supplies, such as gloves or measuring devices Check the medications for the five rights, make sure all medications are there, and check so nothing seems out of place Remember No multitasking during medication support!!!! Things to Remember in Medication Administration Keep your focus on the individual at all times. During medication administration, these are things to remember: Keep the person informed of what you are doing and what will happen next. Do this even when it appears the person cannot understand what you are saying. Many times, even when a person has little capacity for communication and understanding s/he is responsive to voice tone and touch. Be gentle. Make sure your hands are warm before touching someone. Speak calmly, kindly, and professionally. Stay focused on the person. Don t talk to others or complete procedures as if the person was not there

Privacy is important to many people. Some people are uncomfortable with everyone knowing what medications they are taking and when. DSPs are sometimes more focused on their own convenience than ensuring the privacy of individuals during this process. Observe privacy as desired by the person by doing the following: o Do not announce publicly that it is time for the person to take his/her medications o Do not give medications in a public place, even if they are just pills, unless the person has stated that is his or her preference. Remember, preferences can change from day to day o Do not announce to others the medications an individual receives. Don t say to a person in front of others, John, it is time for your Dilantin. o Do not discuss a person medications with others, unless the person has clearly stated this is acceptable. This includes other family members. o Always complete any procedures that require exposed body parts in privacy o If the person cannot communicate clearly, always assume they prefer more privacy, not less Dealing with Interruptions in Medication Administration If you are interrupted during the time for medication administration, take steps to ensure that people are safe and comfortable. You must also figure out ways to secure the medications, and ensure that no errors are made. Here are some tips for handling this situation: If possible, let someone else handle the situation that is interrupting you. Call for help if there is another person in the setting who can help Make sure the medications are secured and inaccessible to anyone who may handle them inappropriately. This can include children and some adults with intellectual disabilities, dementia or other conditions that may impair their judgment with medications. If it would take too long to lock them up, set them out of reach, or carry them with you Take a brief moment to remember what you are doing. Did the person take the medications or not? Make sure the person is comfortable if you are in the middle of a procedure. For example, remove blood pressure cuffs and return clothing to its normal position. Cover the person and help them get into a more comfortable position if needed. Tell them what you are doing. Never make things worse by leaving a person in a situation where s/he may be harmed

Return as quickly as possible to the person. Get focused and calm down before proceeding. If a delay has been so long it breaks the prescribed timing of the medications, seek advice before giving the medications Complete Module IV An Exercise in Medication Administration Quiz Review of the Five Rights of Medication Administration ion Always remember the five rights, and that missing just one of them constitutes a medication error! 1. Right Person 2. Right Medication 3. Right Time 4. Right Dose 5. Right Route Some agencies and some training courses (such as Medication Manager) also consider the sixth right Right Documentation to be a medication error. While MYEP places a high priority on documenting medication administration, we do not consider this to be a medication error, but rather a documentation error. As such documentation errors are followed up on by supervisors directly with the DSP, but not recorded on a Medication Incident Report Form. The Medication Triple Check MYEP requires the staff providing medication support to perform a triple check each time each medication is being administered. What this means is that you must check the medication label 3 times: 1. When removing the medication from the cabinet/storage area, check the label to ensure your are handling the correct medication, for the correct person, at the correct time and dosage 2. When removing the medication from its container, compare the label on the medication to the MAR to ensure they match. If they don t STOP and discover why 3. When returning the medication to the cabinet/storage area, check the dosage that you prepared to ensure it is accurate The triple check is important because many pill containers look similar and are easy to mix up. Labels can be easy to misread. It is easy to think you

remember the dosage correctly, when you don t. The triple check is a method for catching these problems and others. Complete the Triple Check for prescription medications, as well as over-thecounter medications, supplements and remedies. Tips and Tricks For some settings, it is helpful to come up with a system that ensures that you have prepared all of the person s medications for that time of day. This is especially helpful when providing support to a person who takes multiple medications. Some helpful tips for this are: Place a tiny dot on the MAR in the box after each of the medications is prepared but before administering the medication to the person. This will help to ensure that you got all of the proper medications have been prepared. Once you have administered the medications and ensure the person took/swallowed them, return immediately to the MAR and place your initials over each dot for the medications that you personally administered Always keep medications for the same time of the day for the same person together. When using the unit dose system this is especially helpful, as this makes the triple check much easier to perform Administering Oral Medications For each of the medication routes defined below, you will be asked to complete a skills test with your supervisor/trainer if that type of medication is administered by staff in your work- site before course completion can be finalized Capsules and Tablets These are general tips for administering tablets and capsules. In every case, you must know and follow the recommendations provided on the label and by the prescribing health care professional: Do not touch the pills with your hands. Measure the pills into the lid of the medication container or into a medicine cup Do not crush, allow the person to chew, or mix these medications with food unless directed to do so or given clearance to do so from a medical professional Any pill that is swallowed must be given with a full glass or water (4-8 oz). Taking pills with plenty of water makes sure they get into the stomach quickly. This keeps them from irritating the digestive track. It also helps to ensure the medication is being released into the system

as planned. Before using another liquid besides water, check to make sure that the medication is not to be taken on an empty stomach Check for directions regarding food. Some medications need to be taken on an empty stomach. Some need to be taken with food or milk If the person being supported has special needs with positioning, carefully review the proper procedures to be sure you understand how to assist with positioning. A person could choke or be harmed if not in the proper position Because choking is always a concern with oral medications, there is a handout that accompanies this Module that describes the use of the Hiemlich Maneuver. Lozenges,, Sublingual, or Buccal Medications: These are general tips for administering lozenges and sublingual or buccal tablets. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Buccal = dissolved in the back pocket of the mouth between the gums and the cheek Sublingual = dissolved under the tongue Lozenges = are meant to be sucked like hard candy. Do not chew lozenges!! Do not swallow or chew these medications. They are meant to be dissolved in the mouth Do not take with water (unless prescribed to do so). Wait for 10-15 minutes (or per recommendations) before eating or drinking If you need to assist with proper placement of the medication in the person s mouth, wear a clean pair of disposable gloves Liquid Medications: These are general tips for administering liquid medications taken through the mouth. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Check to see if the liquid needs to be shaken prior to measuring. Many do Remove the lid and place it face up to prevent contamination from the counter surface Use only approved measurement devices to ensure proper dosage Sterilize measuring devices between uses. When people live together, consider labeling measuring devices with the person s name and making these personal use items

Check to see if water or food should be avoided for a period of time after taking the medications For spray liquids, check to see if they are meant to be sprayed in certain areas of the mouth or throat, or inhaled (see inhalants later in this module) How to pour and measure liquids: Be careful not to pour or measure more medication than will be taken. Extra medication cannot be returned to the bottle. It must be thrown out. Prevent waste by measuring carefully and slowly While pouring the medication from a bottle, cover the label with the palm of your hand and pour away from the label. This will prevent medication from dripping on the label. Stains from medication dripping can make it difficult to read the label later. Gently wipe off any drips from around the rim or on the bottle with a clean, damp paper towel Measure on a level surface at eye level (bend down if you need to get to eye level). Not doing so could result in dosage errors You can use a graduating measuring cup, a graduated needle-less syringe or a graduated eye dropper to measure liquids Administering Inhalants These are general tips for administering medications with inhalers. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: For as needed (PRN) medications, don't wait until you need the inhaler to figure out how to use it. The steps may seem complicated at first. It can be easy to make mistakes. If there is an urgent need for the medication it can be too late. Some inhalers need to be primed and some do not. Some need to be shaken before and between each puff. Some do not. If there are two puffs prescribed, usually it is required that there is at least a minute interval between puffs. You must know the exact procedure from start to finish. Do not use the removable mouth piece for one type of inhaler on another type, even if it appears to fit. A mouthpiece is very specific to the medication and may not work correctly on another. Know the method used for the specific person. The key to inhalers is getting medications into the lungs. Persons with intellectual or physical disabilities may have difficulty coordinating the steps required. They may need special techniques to assist them with getting enough medication into the lungs.

Inhalers can cause irritation in the mouth and throat. Ask if it is OK to have the person rinse and spit, swab the mouth, or use a device to reduce the exposure to these tissues. Anyone who uses the inhaler should periodically be observed by a qualified medical professional to ensure it is being used it correctly. There is a Handout that accompanies this Module that goes over the GENERAL steps of using two different types of inhalants. While this gives basic guidance on their use, and is helpful information, ensure you follow the specific instructions of the inhalant you will be using. Administering Eye (Opthalmic) Medications These are general tips for administering medications for the eye. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Eye drops and Ointment: If the eye is crusty, it needs to be cleaned before applying medications. Use a cotton ball with warm water and wipe from inside of eye to the outside. Repeat as necessary using a CLEAN cotton ball for EACH WIPE The tip of the applicator and the inner part of the lid to eye medications CANNOT touch any surface including the person s eye The medication must be clearly labeled ophthalmic to indicate it is for the eyes To administer the medication: Remove the cap and place it so the rim does not touch any surface Pull the bottom eyelid down gentle with one finger, creating a pocket Have the person look up Come from below, out of the line of vision of the person, and place the medication in the pocket o For drops, drop the number of recommended drops from no higher than one inch above the eye into the center of the lid o For ointment, place a thin line from the inner eye to the outer Ask the person to close his or her eyes for 1-2 minutes after administration (or for the specific time recommended) If the person has tears or there is too much medication, lightly wipe the eye from the inside to the outside with a clean disposable tissue There is also a Handout that accompanies this Module that goes through these basic steps of Eye medication administration.

Administering Ear (Otic) Medications These are general tips for administering medications for the ear. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Medications may be for one ear, or both. Have the person tilt his or her head with the ear being treated facing up. Check the ear for wax and gently wipe clean if needed with a moist (not wet) cotton ball. Measure the medications. The tip of the applicator cannot touch the person's ear or any surface. For adults, lightly grip the top of the ear and gently pull the ear up and back. Administer the drops. For a child, lightly grip the top of the ear and gently pull the ear down and back. Administer the drops. Have the person remain still with his or her head tilted for five minutes (or as long as recommended with the medication). Wait to do the second ear until the waiting period has passed. Avoid placing cotton in the ear, unless specifically prescribed. If it is necessary, be careful not to pack the cotton in too tightly. There is also a Handout that accompanies this Module that goes through these basic steps of Eye medication administration. Administering Nasal Medications These are general tips for administering nasal medications. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Before administering a nasal medication, the person should gently blow the nose to clear passages. For nasal drops: o Have the person get in a comfortable position with his or her head tilted back. Have him or her breathe through the mouth during the procedure. o Administer the drop into the nose as prescribed. Avoid touching the nose with the dropper if possible. o Have the person remain still with head tilted for 1-2 minutes. o Gently rinse the dispenser in warm water and dry with a clean tissue. For nasal spray: o Prepare the spray as necessary.

o The person sits up during this procedure. o Place the applicator in the nostril and spray briskly. The person needs to sniff briskly and avoid blowing his or her nose for several minutes after the application. o Gently rinse the applicator with warm water. Do not let water enter the medication container. Wipe dry with a clean tissue and place the cap back on the container. Administering Topical Medications These are medications that are applied to the skin, and include patches, sprays, ointments, and lotions. They are applied for different reasons. You must follow the specific directions that accompany the medications. These are general tips for administering topical medications. In every case, you must know and follow the recommendations on the label and by the prescribing health care professional: Usually the area must be clean and dry to apply the medication. Cleanse the area as needed and allow to thoroughly dry before administering the medication. Check for irritation caused by the medication. This is especially likely with patches. Change the spot where the patch is placed if needed or talk to the health care practitioner about other alternatives. Use the amount recommended. Wear a pair of clean disposable gloves during these procedures. There is a Handout that accompanies this Module that goes through the basic steps of applying an ointment or cream Administering Rectal Suppositories or Vaginal Suppositories ies and Creams Some of the individuals you support may have prescribed suppositories or vaginal creams. Suppositories may be prescribed for administration through the rectum or through the vagina. If you are working with an individual for whom a suppository or vaginal cream is to be applied, your supervisor/onsite trainer will provide you will specific training on the administration of these medications. There is a handout that accompanies this Module on the use of suppositories to provide you with general information. This will also be a part of your on-the-job skills test that must be passed prior to finalized course completion.

Administering Injections, IV Medications, and Medications through a Feeding Tube At MYEP our policy is that staff must be trained by a Registered Nurse or Licensed Practical Nurse before doing any skilled care procedures. This includes feeding tubes, diabetic care, colostomy care, etc. This training will be specific to the individual for whom the cares must be provided. NEVER will MYEP staff be involved in administering Intravenous (IV) medications. The use of an Epi-Pen for severe allergic reactions is an exception to this general policy. If you are working with a person who has been prescribed an Epi-Pen, you must know how to use it before an emergency situation were to arise. There is a handout that accompanies this Module on the use of an Epi- Pen, and you will be asked to describe/show your supervisor/on-site trainer how to use this as a part of your skills test. Handling Inappropriate Use of Medications Some reasons a person may not take medications as recommended may include: The person wants to avoid certain experiences of side effects (such as a bitter taste or uncomfortable sensation) or get certain "benefits" from side effects (such as feeling sleepy or high, or enjoying the taste). A conflict between lifestyle choices and medications requirements (such as sleep patterns, eating patterns, alcohol use, having to remember to carry the medications, having others know about medications) Confusion or lack of understanding about medications that may be caused by mental illness or cognitive disabilities. Confusion or lack of understanding due to language differences. Cultural and individual differences in understanding or valuing medications and treatments. Not believing there is a need for the medication. Not being able to afford the medication. Feeling the need for the medication in a dose larger than recommended (for example, taking 4 tablets for headache, rather than 2). Feeling so much better from a long-term medication that the person discontinues the medication (or wants to discontinue) too soon.

People s Rights With Regard to Medications People do have the right to refuse medications. NEVER try to sneak medications into food or drink. NEVER try to force someone to take medications against their will. The first thing to do is to find out why the person is refusing. Responding to Refusal to Take Medications If possible find out why the medication is being refused and see if you can make a change. If the person cannot communicate directly this may require observation and trial and error. (For example, trying a different voice tone or touch during the procedure). If possible, ask for ideas from someone who knows the person well. Do not give a second dose of medications that have been spit out. It is impossible to tell what amount was swallowed or absorbed. Giving more of the medication may overdose the person. Contact a medical professional about next steps. If the person will not take the medication as recommended, follow procedures that are appropriate for the medication. For example, in some cases documenting the refusal may be enough. In other cases, a medical professional must be contacted immediately. You must know the medication, the person and the consequences of missing the medication. If in doubt, seek advice from a supervisor, health professional or pharmacist. In most cases, it will be important that you document exactly what happened. The details may be important in discovering why the person is refusing the medication. You will learn more about documentation in a later module. Teaching People About Their Own Medications Some people that you support will be working on goals to learn to take their own medications, and others may just want to be more involved in this process. In order to teach effectively do the following: Find out what the person already knows and build on those skills Find out what is most important to the person. Focus on what s/he wants to know Be creative. Think of alternatives that might work for the person. If a person cannot tell time, can s/he learn to take medications when the 5 o clock news comes on? Make it fun and pleasant, not a chore

If the learning is formal (i.e. a goal), track, document and reinforce successes and challenges Remember! If a part of your job responsibility with a person is to provide medication support, the person does need some assistance and supervision. Do not forget that you are still responsible for ensuring that a person gets his or her medications correctly each time. Review The MAR serves as a record of medication administration Remember to plan ahead and stay organized. This will help reduce the likelihood of errors The medication Triple Check is reviewing the label for the five rights of medication administration three times, before the medication is administered. The three times include: 1. Just as you pull the medications out of the storage area/cabinet; 2. When you are getting ready to prepare the dose; and 3. Just before administering the medication or as you are storing the medication container Several general procedures for many medications were described in this lesson, including: Always check the label and make sure you are giving medications correctly Help people understand the risks and benefits of medications and the consequences of refusing medications Review Accompanying Handouts for Module IV and Complete Post Test for Module IV Administration of Medications and Treatments