Penticton & District Community Resources Society Child Care & Support Services Medication Control and Monitoring Handbook Revised Mar 2012
Table of Contents Table of Contents MEDICATION CONTROL AND MONITORING... 1 Policy... 1 Legal Compliance... 1 SERVICE PLANNING AND CONSENTS FOR MEDICATION... 1 Education and Training... 1 Authorized Staff / Training of Authorized Staff... 2 Medical Resources... 2 Safety... 3 PRN Medications... 3 Medication Supply... 3 Side Effects... 4 Emergency Response... 4 Step-by-Step Procedures for Medication Administration... 5 Medications Brought in by Participants and their Families... 6 Documentation for Administered Medication... 6 Documentation for Medication Not Administered... 7 Crushed & Liquid Medication Guidelines... 7 Spoiled Medication... 7 Medication Errors... 8 Reporting Medication Incidents... 8 PROTOCOLS AND CONTROLS... 8 Medication Storage... 9 LABELLING AND PACKAGING OF MEDICATION... 9 DISPOSAL OF MEDICATIONS, SUPPLIES AND WASTE... 10 WRITTEN ORDERS... 10 ASSESSING THE EFFECTS OF MEDICATION... 11 Medication Reviews... 11 UNIVERSAL PRECAUTIONS... 12 i
MEDICATION CONTROL AND MONITORING Policy The Society will ensure that programs have appropriate controls to ensure safe administration of medication. Child Care & Support Services programs and staff will follow the controls described in the program procedures below to ensure the safe administration of medication to our participants. Authorized CCSS program staff will monitor the administration of medication. Legal Compliance All monitored and administered medications will comply with provincial and federal laws and regulations that govern medications and controlled substances. Only medications ordered by licensed physicians will be administered. In monitoring and administering medications, program staff will obtain written, informed consent of the participant or his/her legal guardian, document the medication administration, and follow all program procedures and safety protocols. SERVICE PLANNING AND CONSENTS FOR MEDICATION Participants may self-administer their medications to develop or maintain an optimal level of functioning and independence. Participants who self-administer may require some assistance, such as reminders or help opening containers. Staff must ensure that self-administered medications are securely stored. Staff will supervise participants who self administer their own medication. As applicable, special dietary needs and restrictions associated with medication use will also become part of their individual service plan. If the medication is ongoing, service plans will address the fact that the participant is taking medication. They will integrate medication use with the planning of services and supports for the participant. Staff will obtain the written, informed consent from the legal guardian, authorizing the administration of any medication by non-medically trained program staff. Program staff will support the participant s efforts to become informed. The participant s legal guardian will sign the CCSS Consent to Administer Medication form. Form can be found on the website under CCSS Forms. The CCSS Consent to Administer Medication will be reviewed at least quarterly, and with each medication change. Education and Training Training may be provided by a medical or nursing professional as appropriate, and may include: Med Control Handbook - 2012 Page 1
How the medication works The risks associated with each medication The intended benefits Side effects Contraindications Appropriate knowledge of adverse interactions between multiple medications and food The importance of taking medications as prescribed The need for laboratory monitoring The rationale for each medication Alternatives to the use of medications Signs of non-adherence to medication prescriptions Potential drug reactions when combined prescription and non-prescription medications, including alcohol, tobacco, caffeine, illicit drug, and alternative medications Instruction on self-administration, when applicable The availability of financial supports and resources to assist the participant with handling the costs associated with medications Authorized Staff / Training of Authorized Staff Authorized personnel may include program staff or program supervisor. Unauthorized staff members will not be permitted to access or to administer medication. No medication will be administered by staff without a doctor s written prescription. Following the information in the Medication Control and Monitoring Handbook, authorized staff will be instructed and trained in correct medication control and administration procedures. This includes observing and following: General procedures Program-specific procedures Participant-specific procedures New authorized staff will be oriented to the medication administration procedures before their first shift with a participant within a program. Instruction and training will provide competency to new staff through successful demonstration and through the successful completion of a medication administration quiz. CCSS medication control and monitoring will be reviewed and tested at least annually. Medical Resources Primary medical resources will include: The participant s personal physician. The delivery of the participant s medication needs will be coordinated with the physician. Med Control Handbook - 2012 Page 2
Mental Health professional. Nursing professional including Nursing Supports Services Coordinator. Emergency Department of Penticton Regional Hospital, phone: 250-492-4000. Secondary medical resources include: Written materials and documentation provided by the participant s physician, health professional and/or pharmacist, Recent edition of the Compendium of Pharmaceuticals and Specialties(CPS), Reliable Canadian website medication and health references can be found at: Healthy Ontario: Health Canada: Ministry of Health, BC: http://www.healthyontario.com/drugsearch.aspx?search=a www.hc.sc.gc.ca www.health.gov.bc.ca Safety Safety procedures will be followed throughout the administration process. To ensure participant and staff safety, as well as the safety and security of medications, staff will follow the procedures outlined in the PDCRS policies & procedures regarding medication use. At all times staff will follow Universal Precaution Guidelines and standards of best practice. During the administration of medications, staff will follow all principles of infection prevention and control, and wash hands before handling medication. Staff will make sure they are working at a clear and clean surface. Staff will inform the program supervisor immediately of any medication safety or security risks they find or become aware of. The supervisor will immediately address and correct any medication safety or security risks that have been reported or that they have become aware of. PRN Medications PRN Definition: The term PRN medication, means: medication when necessary ; or medication as needed. The abbreviation or acronym PRN, derives from the Latin term Pro Re Nata, which means, for an occasion that has arisen; for an existing occasion; as circumstances require; as needed; as matters are; and so on. PRN medication will only be administered by Child Care and Support Services Staff as described within a medical services plan authorized by medical professional. Medication Supply Parents/guardians will maintain an adequate supply of medications for each participant. The supply will ensure sufficient medications for the time the child is participating in the child care program. Med Control Handbook - 2012 Page 3
Staff members will check all medication to: Ensure there is a correct and adequate supply Confirm the expiration date of each medication Staff will check and compare all medications/blister packs received against the Medication Administration Log (MAR sheets) to make certain that the 8 Rs are met: Right PERSON Right MEDICATION Right REASON Right DOSE Right FREQUENCY Right SITE (arm, hip, etc.) Right TIME Right ROUTE (oral, eye, ear, injection, anal) At medication administration time, staff will crosscheck medications with the Medication Administration Log (MAR sheet (8 R s)), and will initial the appropriate space on the Medication Administration Log (MAR sheet), noting time and dosage at time of administration. Side Effects Information on pertinent potential side effects and/or drug interactions will be identified and provided by the doctor, provided by the dispensing pharmacy, and/or provided by support medical or nursing personnel. Program staff will have access to resource materials on pertinent potential side effects and/or drug interactions. Staff will review the information warning of possible effects from medication(s). Staff will remain vigilant towards any possible medications side effects they witness. Any side effects or possible reactions to medications will immediately be brought to the attention of the supervisor and documented in the participant s case notes. All side effects/reactions will be documented and discussed as soon as possible with the participant s /parent/guardian/doctor/nurse/pharmacist. By Participant Emergency Response As part of their education on medication, participants will be taught how to access help when they encounter an emergency related to the use of medications. The usual route for a participant to follow is: 1. Phone 911 2. Contact the program supervisor or staff, or 3. Contact family or service provider. Med Control Handbook - 2012 Page 4
By Staff In case of emergencies related to the use of medications, staff will engage the following procedures: 1. Call 911 if immediate medical emergency 2. Inform Program Supervisor 3. Supervisor to contact parent/guardian For reference, the Poison Control Center phone number is: 1 800-547-8911 Step-by-Step Procedures for Medication Administration Medications will be administered as close to the prescribed time as possible. If medication is not administered during the time span ½ hour before or ½ hour after the prescribed time, the parent/guardian must be called, the supervisor must be notified, and an incident report must be completed. Personnel who administer medication will: 1. APPLY PRINCIPLES of infection prevention and control and Universal Precautions 2. PROVIDE A CLEAR and CLEAN dispensing surface 3. WASH HANDS before handling medication containers 4. DO NOT TOUCH medications directly with fingers. If medications must be handled, staff will use new gloves or a clean spoon 5. COLLECT the correct medication from the blister pack, and any other medications to be administered (creams, eye/ear drops, etc) 6. CHECK the 8 R S before, during, and after dispensing the medications: Right PERSON Right MEDICATION Right REASON Right DOSE Right FREQUENCY Right SITE (arm, hip, etc.) Right TIME Right ROUTE (oral, eye, ear, injection, anal) 7. CHECK for any special instructions on top of the blister pack (e.g. take with food) 8. DISPENSE the medication directly into a volumetric medication cup directly under the blister pack 9. IDENTIFY the person before administering the medication 10. ADMINISTER the medication, offering a glass of water unless otherwise specified (e.g. with food) 11. OBSERVE the participant to ensure they have swallowed the medication while in your presence Med Control Handbook - 2012 Page 5
12. MONITOR the participant after administering the medication, and intervene if necessary (e.g. for adverse reaction) 13. DOCUMENT in the appropriate space on the Medication Administration Log (MAR sheets), and in case notes, as needed 14. AFTER completing the above administration of medication, be sure that: All medication is returned to the designated locked cabinet All documentation is completed, signed / initialled as required All unused or wasted medication is disposed of using the correct procedure (see below) All empty blister packs and other medications are replaced with appropriate replacements, and empty packs and containers are given to parent or guardian. The area is clear and clean Check the Medication Administration Log (MAR sheets) for the next scheduled medication administration time, and set any appropriate reminders ALWAYS document and inform the supervisor first of unusual occurrences and any medication problems or difficulties. ALWAYS CHECK the Medication Administration Log (MAR sheet) to see if any medication needs to be administered. It is strongly recommended that you create a reliable, personal reminder system, such as setting the alarm on your watch to ring for the next medication administration time. Important Guidelines for Medication Administration DO NOT ADMINISTER medications that are found (e.g., by the bedside, on the floor). They are to be treated as spoiled medication. REPORT all found and lost medications. DO NOT GIVE medications that have been prepared by someone else. NEVER leave dispensed medications unattended. If unable to administer the medication immediately, leave the medication in a safe place, labelled with the participant s name and the time for administration. Safe place is defined as a locked medication cabinet. Medications Brought in by Participants and their Families ALL medications brought in by participants or by their families MUST be ordered by the participant s doctor/medical professional. Staff will NOT administer any medications without the participant s doctor/medical professional order. Contact the program supervisor for further direction. Documentation for Administered Medication The Medication Administration Log (MAR sheet) will be kept in the locked medication cabinet and will be checked at the time of administering the medication. Med Control Handbook - 2012 Page 6
Each time the medication is administered the CCSS staff will complete the Medication Administration Log including: time, dosage, and any observations. Staff will then sign each time the medication is administrated. There will be one Medication Administration Log form per child per each medication that is administered. Completed Medication Administration Logs will be kept in the participants file. Documentation for Medication Not Administered Missed medications will be recorded on the Medication Administration Log (MAR sheet) Missed medications will also be reported to the supervisor and recorded on a PDCRS incident report form. Unusual Occurrences to note that may result in missed medications: 1. Refused 2. Nausea, Vomiting 3. Hospitalized 4. Social Leave 5. Drug Ordered, Not Received 6. Withheld 7. Borrowed 8. Drug Wasted In addition, staff must document in the participant s case notes the reason why the medication was not administered. Crushed & Liquid Medication Guidelines If a medication is to be crushed, staff must check whether the medication is able to be crushed. Offer fluids before and after administering crushed medications to prevent irritation of the mouth and throat. If dispensing liquid medication that is not supplied in pre-measured doses, be as accurate as possible. Use a volumetric medication cup, or a syringe, as appropriate. Place the cup on a level surface and bring your eye down to the cup to accurately read it. Spoiled Medication Spoiled or wasted medication will be placed in a bottle or pill container marked Waste Medication Only Do Not Use and will be stored in a locked cabinet until it can be returned to the parent/guardian so it can be safely disposed of. If medication is dropped, dispose of it appropriately, and: Obtain the participant s corresponding medication from another day in the same time slot. Med Control Handbook - 2012 Page 7
Inform the supervisor of your actions Notify the parent to obtain a replacement medication as soon as possible. Provide parent/guardian with wasted medication for disposal. Medication Errors As part of risk management, the following will be considered to be (but not limited to) medication errors: Unauthorized drug use. Dispensing errors. Prescribing errors. Failure to document an unusual occurrence on the Medication Administration Log (MAR sheet) Medication documentation errors, including missing signatures Administration errors, including: Medication omissions Incorrect labelling Incorrect person Incorrect medication Incorrect reason Incorrect dose Incorrect frequency Incorrect site Incorrect time Incorrect route Medication errors will be reported to the participant s parent/guardian. Medication errors will be documented on a PDCRS Incident Report Form as well as on the participant s file in Case Notes. Medication errors and adverse drug reactions will be reviewed as part of the Continuous Quality Improvement (CQI) process. Reporting Medication Incidents Staff are responsible to complete an incident report form for any medication errors they have made, as well as for any medication error made during a prior shift which they discover. Staff must report each occurrence of a medication error on the appropriate PDCRS incident report form. PROTOCOLS AND CONTROLS Program staff will follow all protocols and controls that govern the proper monitoring of medication administration and storage of prescribed and over-the-counter medication. Med Control Handbook - 2012 Page 8
Medication Storage CCSS programs will keep all prescribed and over-the-counter medications and medical supplies (except for first aid kits) in a locked medication cabinet. All medications must be kept in original containers, be properly labelled, including doctor s orders, display the medication name, participant name, dosage and time of administration. Medications requiring protection from light will be kept in the program s locked medication cabinet. A medication administration record will be kept with the medications at all times. Medications requiring refrigeration will be kept in a locked and labelled storage container in a designated area of a designated program s refrigerator. Except when medication is being administered by staff, cabinets will be kept locked at all times. Medications with abuse potential will be designated with a warning label. Only authorized personnel will supervise and have access to medication cabinets. Authorized personnel include program staff, program supervisor, and nursing staff, where applicable. LABELLING AND PACKAGING OF MEDICATION Program staff will ensure that prescription medications are properly labelled and packaged. An up-to-date Medication Administration Log (MAR sheet) of all medications, including prescription and non- prescription medications, used by the participant will be kept. All medications will be packaged and stored in original containers. Medications must be properly labelled and kept locked in the program s medication cabinet. The records and labelling, where possible, will include: The participant s name The prescribing doctor name The doctor s orders, when given by the pharmacy The dispensing pharmacy name and contact information A number or code identifying the written order, when available The medication name The dosage, including strength or concentration The treatment method/instructions for use, including administration route The time of administration The expiration date of the medication Potential side effects Med Control Handbook - 2012 Page 9
DISPOSAL OF MEDICATIONS, SUPPLIES AND WASTE Program staff will ensure that the disposal of out-of-date or unused medication, syringes, medical waste, or medication prescribed to former service recipients will be disposed of following safety procedures. Empty blister packs and other containers will be returned by authorized personnel to the parent/guardian for disposal. Staff will use a permanent marker to black out all participant-identifying information on items to be returned. Until they are returned, empty blister packs and other containers will be stored in the locked medication cabinet. Any unused or out of date medication will be returned to the parent/guardian, by authorized program staff. Medications prescribed to former service recipients will be returned to them, whenever possible. If not possible, their medication will be brought to the pharmacist for disposal. A written record detailing the disposal will be entered into the former service recipient s file. Where possible, the record will contain: The participant s name The prescribing doctor name The doctor s orders, when given by the pharmacy The dispensing pharmacy name and contact information A number or code identifying the written order, when available The medication name The dosage, including strength or concentration The treatment method/instructions for use, including administration route The time of administration The expiration date of the medication Potential side effects Program staff will use the following safety procedures to dispose of out-of-date medications, unused medications, syringes, and medical waste: Obtain a disposal container from the pharmacy. Follow all written instructions on the management of biohazard materials that may be associated with the use of the medications. Use gloves for hand protection. Follow specific disposal instructions affixed to the container. Return all unused/unclaimed medications to the pharmacy. WRITTEN ORDERS Program staff will not accept verbal orders for monitoring the administration of medication. All orders must be in writing. Med Control Handbook - 2012 Page 10
According to participants personal service plan, attending staff members will supervise participants who take their own medication. Participants, families and other care providers will be required to have written orders accompany any medication to be monitored and administered. All orders for medication will be prescribed only by the participant s doctor or other authorized medical professionals. ASSESSING THE EFFECTS OF MEDICATION Program staff will, where applicable, observe and assess the effects of medication on the participant. Assessments of the effects of medication will be based on: Documentation in the participant s case notes. His/her medication profile. The observations of personnel, the participant and his/her family. Effects will be noted in participants case notes. As required, follow up will be initiated by program staff, program supervisor and relevant medical professionals. Medication Reviews Medications and their use by the participant(s) will be reviewed with their doctor at least annually, and as needed. The reviews will be documented and will be filed in the participant s case file. Medication reviews will typically address: The appropriateness of each medication, as determined by the needs and preferences of the participant. The efficacy of the medication. The presence of side effects, unusual effects, and contraindications. The use of multiple simultaneous medications. Medication interactions. The frequency of medication reviews will depend on: The degree of severity of the participant s medical condition. Whether multiple medications are provided and other contraindications exist. The average length of stay, if relevant. Guidelines related to the medication itself. Program medication control and monitoring reviews will be conducted on an annual basis by the program staff team and the pharmacist, where applicable. Med Control Handbook - 2012 Page 11
UNIVERSAL PRECAUTIONS Universal precautions refer to a set of guidelines created to assist with the prevention of the spread of certain infections through contact with contaminated blood or other bodily fluids. Practicing universal precautions helps decrease the risks of infection through contact with contaminated blood or other bodily fluids of known, unknown, or undiagnosed carriers. Universal precautions help to ensure that all staff and children receive equal and unbiased care. All staff will practice universal precautions for their own protection and for the protection of the children, families, and staff. 1. Always consider blood and other body fluids potentially infectious. 2. Follow general health care procedures of frequent and thorough hand washing and cleanliness. 3. If in contact with blood or other body fluid, wash immediately with soap and running water for at least 60 seconds. 4. Wear disposable gloves when assisting a bleeding child or if in contact with other body fluids. Wear disposable gloves when holding or touching items or surfaces soiled with blood or other body fluids. 5. Wearing disposable gloves does not eliminate the need for thorough hand washing. Always wash hands after removing gloves. Do not reuse disposable gloves. 6. Disinfect contaminated items and surfaces with recommended bleach solution. 7. Store clothing, bedding, etc. that have been soiled with blood in a separate, sealed plastic bag. 8. Do not allow the sharing of personal items which may become contaminated with blood (i.e. toothbrushes) or bodily fluids (i.e. eating utensils). 9. It is theoretically possible that a bite by a child infected with Hepatitis B or HIV/AIDS could result in the transmission of the disease if the bite draws blood. This has never been shown to happen in a home or child care setting. However, because of the potential concern and the much more likely danger of other infections resulting from bites, all biting should be taken seriously. If the skin is broken, it is recommended that the family physician be consulted. Report any bites on a PDCRS Incident Report Form. Community Care Facilities Licensing must be contacted. Med Control Handbook - 2012 Page 12