Workbook Describe pre-packaged medication and the process for its use in a health or disability context US 23685 Level 2 Credits 2 Name
Contents Before you start... 4 What is medication?... 7 Pre-packaged medication... 9 Types of pre-packaged medication... 10 Supporting a person to take pre-packaged medication... 17 Recording and reporting... 23 Important note about the scope of this unit standard: When you are assessed as competent in this unit standard, you will be able to describe pre-packaged medication and the process to be followed by a support worker when supporting a person to use pre-packaged medication. If you support any people who are self-medicating, you will also be able to check that they are about to take the right medication but only if this role is expected of you by your organisation and by the individual s service plan. Careerforce would like to make it clear that when you complete this workbook or unit standard, you are not adequately trained or competent to administer medication. Administer means to open the packaging or give the medication to the person, or both. If you are expected to administer pre-packaged medications, you will need to be trained for those specific medications. Those training needs will be addressed in your organisation s policies and procedures. 3
Before you start Welcome to this workbook for: Describe pre-packaged medication and the process for its use in a health and disability context Unit Standard 23685. For this unit standard you will have: this workbook. a trainee assessment. In this workbook you will learn more about: what medication is. types of pre-packaged medication. advantages and potential risks of pre-packaged medication. supporting a person to use pre-packaged medication. recording and reporting. How to use this workbook This is your workbook to keep make it your own by writing in it. Use highlighters to identify important ideas. Do the learning activities included throughout this workbook. Write your answers in the spaces provided. You might find it helpful to discuss your answers with colleagues or your supervisor. Finish this workbook before you start on the assessment. When you see a sticky note like this, it gives a tip or hint. 4
Workbook activities Stop check what you know about this topic You will see this stop symbol in places where you are asked to stop and think about what you know and: record your current knowledge or impressions. check your knowledge. This stop provides a reference point to return to later. Stop activities have blue shading like this. Learning activities You will come across learning activities as you work through this workbook. These activities help you understand and apply the information that you are learning about. Learning activities have yellow shading like this. Rewind When you see this rewind symbol, go back to: think about what you know. check your knowledge. This rewind gives you an opportunity to add to, change or confirm some of your initial thoughts and ideas. Rewind activities have green shading like this. The glossary and study hints book has study hints for all trainees. It also explains key words and phrases from the compulsory unit standards for Foundation Skills and Core Competencies. You can download it from www.careerforce.org.nz or order it from http://shop.careerforce.org.nz 5
Before you go any further in this workbook, think about... Medication Why do people take medication? What are three types of medication that you know about? 1 2 3 Where can people go to get medication? What do you think is meant by the term pre-packaged medication? 6
What is medication? Medication is a term that covers a range of medicines. Medicine is the term for a legal, therapeutic drug that has an active, chemical ingredient. Some medicines are prescribed by a doctor or other health professional such as a nurse, midwife, optometrist or dentist. Prescribed medication is dispensed by a pharmacist (chemist). Some medicines can be purchased over-the-counter (OTC) in pharmacies, health shops and supermarkets. Medicines are used to prevent, cure or control illness or to manage a chronic condition. They can be used to manage pain and other symptoms in order to help people live independent lives. Medication can come in many different forms, such as: injections or infusions. liquids to be swallowed. tablets or capsules. transdermal (skin) patches. creams and ointments. suppositories. inhalers. eye or ear drops. nasal sprays. herbal remedies. 7
Medicines must be taken the way they are prescribed or as directed by the instructions on the packaging. A doctor, nurse or pharmacist will explain how to take the medicine and any possible side effects. Medicines can make people ill if they are not taken in the way they are prescribed. If a person is self-medicating, it is their own responsibility to make sure they are taking the medicine in the correct way. They will take responsibility for administering their own insulin injections, for example, or taking a variety of prescribed tablets at the correct time and dosage. A side effect is something (usually undesirable) that occurs in addition to the intended effect of medication or therapy. LEARNING ACTIVITY Name a medicine that you, or a person you support, has taken. What form is this medicine usually taken in? Why would a person take this medicine? What positive benefit could be expected from taking this medicine? Are there any possible side effects from taking this medicine? What are they? 8
Pre-packaged medication Pre-packaged medication is prepared by pharmacists according to the prescription instructions from medical practitioners such as doctors. Packs can be supplied for daily, weekly, or monthly usage and are organised according to days and times. Tablets and capsules are the only forms of medication that can be pre-packaged. Medicines that are not suitable for pre-packaging include ointments and liquids, eye and ear drops, suppositories and PRN (taken as needed) medication. Each space in a prepared package may contain varying numbers and types of tablets and/or capsules. Medication details and instructions about how to take the medicine are also included on the pack. Pre-packaged medication may also be called: dose administration aids (robotic packaging). blister packs. monitored dosage systems. cassettes. Advantages of pre-packaged medication Some of the advantages of using pre-packaged medication are that: a person is more likely to complete a course of treatment. the system is easy to use and the potential for error is reduced. it is easy to see when a medicine should be taken and whether it has been taken. the medicine is available in the correct dose and the correct time. photo id can ensure that the right person is receiving the medication. the package is sealed and is less prone to moisture damage. limited amounts are dispensed at one time so there is less chance of using expired medicines and less wastage if the medication is stopped. staff spend less time in administration procedures. Potential risks of pre-packaged medication Some of the potential risks of using pre-packaged medication are that: some medications are not suitable for pre-packaging. a person may miss all the medicine that should be taken at a specific time. there is less flexibility for changes and issues may arise if one of the medications is modified or stopped. some people have difficulty in opening the packs. the packs may be bulky to store and forward planning is needed to keep a supply. some medicines deteriorate when stored together. there may be an extra cost in receiving medicines this way. 9
Types of pre-packaged medication Blister packs This is an example of the front of a blister pack designed to hold a week s medication. The company who distributes the pack, when it was packed and who packed and checked it The date the pack should be started. The time of day the medication should be taken. Directions on how to open the pack. Photo identification. This is the only person who is to take the medication in this pack. The person for whom the medication is for and their place of residence. The medication, packed so the person can take the right amount at the right time of day. Note that some time slots are not used in this pack. The day the medication needs to be taken. 10
Here is the back of the same blister pack. The person who is to take the medication, the prescriber of the medication (the doctor s name and surgery address), and who prepared the blister pack. The date the pack should be started. Directions on the quantity of medication to be taken and how it should be taken. The medicines included in the blister pack. A description of what each tablet looks like. The day and time the medication should be taken and who it is for. The day of the week the medication is to be taken. The type and the quantity of the medication contained in the blister. 11
LEARNING ACTIVITY What are two advantages of using pre-packaged medication such as a blister pack? 1 2 What are two potential risks of using pre-packaged medication such as a blister pack? 1 2 Why is Mrs Johnson s photograph on the front of her blister pack? Why are there no medications in half of the blisters in Mrs Johnson s pack? How many Metformin tablets does Mrs Johnson take at breakfast time? What does the Metformin tablet look like? 12
Tamper proof cassettes A cassette is a plastic package containing the medication prescribed to a person along with instructions on how and when the medication is to be taken. A cassette can be refilled by the pharmacist. Tamper proof means that the contents cannot be opened or altered without seals being broken. There is a plastic slider to pull out for each day, but individual doses for each time of day are also individually sealed. Medications in tamper proof cassettes should never be used if they have been opened before the right time. The backing sheet will contain information on all the medication a person is taking, including things that aren t contained in the cassette such as ointments or suppositories. The medication contained in the cassette is listed above the heavy black line in the example below, with other prescribed medication below the line, with any instructions on how it is to be taken. 13
The information on the back of the cassette package should be easy to read and understand for both the people who are taking the medication and support workers who are involved with their care. Here is another example of a backing sheet for a tamper proof cassette. LEARNING ACTIVITY Find the answers to these questions on the backing sheet for Nora Robinson s medication cassette (shown above). What time of day do the Phenytoin tablets have to be taken each day? How many Phenytoin tablets are to be taken each day? What should not be taken at the same time as the Phenytoin tablets? 14
Robotic packaging Robotic packaging is designed for situations where there are multiple dosages to be dispensed daily to a range of people. This could apply to: a residential rest home. a hospital. other patient care facilities. Computer software at a pharmacy instructs a robot machine to select and package medications into a single dose supply. Each dose is then sealed in an envelope as part of a continuous strip or roll. The strip can contain enough medication for a month. 15
Each envelope of the robotic strip is printed with information. The name and address of the person the medication is for. The date and day on which the medication is to be taken. The time the medication needs to be taken (24 hour clock). The name and quantity of the medication included in the package. The name and address of the pharmacy which has distributed the medication. This is the 18 th dose. LEARNING ACTIVITY Find the answers to these questions on the example of robotic packaging above. Who should be taking the medication contained in this strip? What day of the week should the 17 th dose be taken? What time of day should the 18 th dose be taken? 16
Supporting a person to take pre-packaged medication Supporting people with their medication should always be carried out by an appropriately trained person. Your organisation will have policies about who is approved to support people to self-medicate. If this is one of your responsibilities, you must follow the procedures set by your organisation at all times. Self-medicating means that the person who has been prescribed the medicine, opens the medication package and takes the medicine. Supporting someone to self-medicate means doing checks before the person opens and takes that medicine and providing assistance (if needed) to make sure the medicine is taken safely. If your organisation allows you and trains you to support people to self-medicate you will need to: check each person s support plan to see whether or not to support the person in that way. If it s not mentioned in the plan, you don t have to remind or support them. Many people will be independently taking their medication without needing support. ask the person what instructions were given by the pharmacist or the person who prescribed the medication. be able to read a label or backing sheet accurately. record the taking of any medication if your organisation requires this. report any concerns. ask your supervisor if you have any doubts. You do not have to know what a medication is for in order to be able to support a person to self-medicate. 17
The 5Rs The 5Rs are the golden rules for supporting a person to self-medicate. Your organisation s policies and procedures will tell you how to check the 5Rs. If there is anything you are not sure about, discuss this with your supervisor. Right person The person s name on the medication is the same name as the person taking the medicine. Check the person s identity with their identification bracelet (id) or name tag or badge if they are wearing one, or look at their photograph on medication packs or medication order sheets or in their support plan. You must NEVER give medication to a person who is not named on the pack. Right medicine The name of the medicine matches the blister pack or cassette label and the medication sheet. Right dose The dose of the medicine matches the medication label or sheet. Right route The way the medicine enters the body (for example, taken by mouth or absorbed through the skin) matches the medication label or sheet. Right time The time (and date) the medication is taken matches the label or sheet (for example, breakfast time on Tuesday 8 th March). 18
Taking medicine safely All medication should be taken according to the instructions. Even medicines bought over-the-counter from the pharmacy, supermarket or natural health store should be taken according to the instructions written on the packet or bottle. Never support a person with any medication from blisters or cassettes that have broken seals. When the people you are supporting take tablets or capsules, you need to have a whole glass of water ready, to help them swallow their medicine. Some medicines can cause damage to the lining of the throat and/or stomach if they are not washed down properly. You need to make sure that the person: has clean hands. is sitting upright. is fully alert. has a sip of water before starting to take tablets. A moist mouth helps stop tablets sticking. has a sip of water between taking the tablets if there are more than one to take. has a full glass of water after taking the last tablet to fully wash the tablets out of the mouth and throat and into the stomach. 19
Cautionary notes Cautionary notes may be written on the label or may be little yellow stickers that are applied by the pharmacist when dispensing medication. These notes are applied as a warning to the people taking the medication and the people who may be supporting them to do so. They cover a range of topics, from advice on the correct way to take the medication to warnings on possible side effects. LEARNING ACTIVITY When is the best time to take medication if it has to be taken on an empty stomach? Name a route by which medication can be taken into the body. Why is water important when a person is taking tablets? 20
Supporting a person to use a blister pack All blister packs must be opened from the back. The packs should not be twisted or the tablets popped out as this may damage the medication. Only open blister packs if you are authorised to do so and have been trained by your organisation. Do not open blisters until after you have checked the label. The company supplying blister packs may also supply a special opener like this one. If there is no opener supplied, the end of a teaspoon handle may be used. Instructions for opening blister packs include: Separate the blister you need from the pack. Run your fingers over the back of the blister until a ring appears. Using the special blister pick or the end of a teaspoon handle, puncture a hole in the foil. Run the spoon end or pick around the inside of the ring. Peel back the foil and check the contents. Once opened, the blister provides a cup containing the medication which is now ready for the person to take. 21
Things to avoid doing when opening a blister pack Don t open packs from the front. Don t twist the packs or individual blisters. Don t try to pop out the tablets. Storage Blister packs and cassettes and all other medication should be stored in a suitable locked trolley, drawer or cupboard. They should only be removed during times when medication is to be administered. In a residential care facility, a ring-binder folder may be used to manage multiple medication packs. Your organisation will have policies and procedures covering the correct storage of medicines. 22
Recording and reporting Keeping records Your organisation will have policies and procedures about when and how to record the taking of medication. If it is your responsibility to support a person with self-medication you will probably have to sign or initial the appropriate place on the medication sheet in a person s support plan. If medication is not taken, this will need to be recorded. Here is an example of a code that may be used to describe why the medication was not taken. The abbreviation would be written into the place that would otherwise be signed or initialled on the medication sheet to record that the medication was taken. R = Refused N = Nausea or vomiting H = in Hospital A = Away on holiday D = Destroyed D/C = Discontinued If you are required to support a person to self-medicate and you notice anything of concern, then it is your responsibility to report it to your supervisor. Things that might be of concern include: a person has forgotten or refused to take their medication. the medication has been taken at the wrong time. too much medication has been taken. a person has spat out their medication or vomited a short time after taking it. a person tells you about side effects the medication is having. the person you are supporting is worried about the medication they are taking. 23
Making reports Whenever you report any information verbally or record it in writing, it is important to report facts, not opinions. A fact is a piece of information about something that actually exists or has happened. An opinion is what someone thinks may have happened or will happen. You can find out the facts about a situation or event if you can answer these questions: Who is it about? What has happened? When did it happen? Where did it happen? Why or how did it happen? Ask your supervisor to show you where and how to record issues that may arise when you are supporting a person to self-medicate. There may be a form, or a part of a form, to fill in. If a person has taken too much medication, for example, it could be considered to be an incident (something that may cause harm to a person or property). 24
LEARNING ACTIVITY Read this short scenario about Mrs Johnson. Fill in the example form to record what happened. Scenario One of the tablets that Mrs Johnson takes every day is quite large. Usually, she has no trouble taking it because her support worker, Dot, encourages her to take it first, with lots of water to help wash it down. This morning, Dot was running a bit late because she got held up in bad traffic. Mrs Johnson decided she was quite capable of taking her tablets by herself for once. She started with the smaller pills because they were easier to swallow. By the time she got to the largest tablet, there wasn t much water left in the glass. When Mrs Johnston tried to swallow the large tablet, it got stuck in her throat. She felt like she couldn t breathe and became very frightened that she was choking. Dot arrived to find her very distressed, trying to cough but unable to take a big enough breath. Dot knew to get Mrs Johnson to bend forward as she slapped her on her back. Mrs Johnson was able to cough up the tablet but she was still very upset. With Dot s reassurance, Mrs Johnston finally calmed down but she was too frightened to try taking the big pill again. Dot rang her supervisor to report what had happened and an urgent appointment was made to discuss the problem with Mrs Johnson s doctor. Dot was asked to fill in an incident report to go in Mrs Johnson s support plan to take to the doctor s appointment. WHAT HAPPENED? 25
Rewind to pages 8, 9 and 18... What is meant by the term side effect? Name two types of pre-packaging for medication. 1 2 What is a type of medication that would not be suitable for pre-packaging? What are the 5Rs or golden rules that your organisation has for supporting a person to self-medicate? 1 2 3 4 5 26
Completion and assessment Congratulations! You have come to the end of the workbook. Please check over all the activities in this workbook to make sure you have completed them. Your assessment is next You need to complete the trainee assessment successfully to be credited with this unit standard. Acknowledgements Careerforce thanks the people who have contributed to this workbook by: researching and validating content. providing advice and expertise. testing the activities. sharing personal experiences. appearing in photographs. The images contained in these workbooks are visual illustrations only and are not representative of actual events or personal circumstances. Creative Commons This work is licenced under a Creative Commons Attribution-NonCommercial Licence. You are free to copy, distribute and transmit the work and to adapt the work. You must attribute Careerforce as the author. You may not use this work for commercial purposes. For more information contact Careerforce www.careerforce.org.nz 27