Presentation Transcript

1. Assisting with the Administration of Medication

   Johnson`s Children Services Inc.
2. Why Medication Training? Goal: Maximizing safety for persons in your care who have medication treatment plans. After completing this lesson you will be able to: List reasons for medication administration training Explain staff responsibilities in the medication cycle Describe common attitudes about medication and how these affect outcomes Predict benefits of participation in medication cycle Correctly demonstrate how to document a med pass Correctly demonstrate how to assist with oral, topical and rectal medications
3. Why have training in assisting with medication administration? Medication is complicated To encourage safe environments To encourage quality performance from support professionals Required by the Ministry Regulations
4. Medication Administration – Policy and Procedures Policy: Medication shall be administered and distributed in a timely manner, according to the orders of the prescribing physician, in accordance with the laws and regulations of the Province of Ontario and in accordance with established best practices in the management of medication in foster care.
5. Medication Cycle As a staff person providing care to others you may be required to assist with the administering of medications or assist in the use of medications. Proper use of medications is a process that involves more than simply taking pill or applying a liquid. The medication cycle consists of several important steps:
6. Medication Cycle Step 1 Observe- for signs of physical and / or behavioral changes Step 2 Report- Any notable changes to the right people in a timely manner Step 3 Communication- Your findings to the doctors, nurses and others healthcare professionals. Step 4 Record- Information should be accurately documented on the correct forms. Step 5 Assist- With administering medications using the correct techniques Step 6 Review- In order to ensure quality these steps need to be regularly monitored Remember: Your role as an authorized staff person is very important to the health and wellness of the individuals you work with.
7. Quality Assurance These steps are designed to encourage good practices in supporting people with their medication plans. Only licensed health care professionals may administer medications. The only unlicensed persons who my assist with medication administration are those who have received up-to-date training from an authorized instructor and have met all of the course requirements. Successful completion of the requirements for Johnson`s Children Services includes: Pass the course which includes and in class practicum Complete all supervised medication passes This Training Course prepares and authorizes non-medical agency staff to ASSIST with the administration of only oral, topical (skin), eye and ear preparations, epinephrine (adrenaline) injections for allergic reactions, vaginal and rectal suppositories.
8. Quality Assurance Individuals who are capable of and recognized to self medicate may require staff/foster parent to observe, assist or record their dose. Please remember that all medication related questions, advice, and technical assistance for assisting with medication administration must be provided by a registered nurse, a registered pharmacist, or the individual's doctor. The individual`s doctor should be consulted for specific information about the individual. Make sure you have the names and telephone numbers of the agency and on-call persons readily available.
9. When Visiting a Health Care Provider Complete the paper work you need for the appointment before you leave. Tell the individual you support about the appointment Help at the appointment Share information with the health care provider Record and bring any concerns you have to the appointment Write down information given to you during the appointment Ask the health care provider questions. Ask the health care provider for written orders. All prescriptions (for each medication) must be written on the physicians order pad (prescription pad) or called into the pharmacy by the health care provider`s office.
10. Medication: What You need to do: Get the medication from the pharmacy. Copy (Transcribe) orders for medication treatments to the Medication Administration Record (MAR). Assist the individual with their medication, using the “seven rights”. Document the medication on the correct forms. Properly store the medication Observe the individual to see if there are any changes. Report any changes in the individual`s health to the doctor, Johnson`s Children Services, and the social worker.
11. Guidelines for Handling Medications 1. Safety First 2. Always ask if you have a question. 3. Wash your hands before and after 4. Wash your hands After you use the toilet Before and after you handle food or medications After you sneeze or blow your nose 5. Take your time. 6. Work in an area that has enough light 7. Check the name, dose and instructions for the medication EVERY time you assist the individual with taking his or her medication. 8. Know all about the medication 9. Read the pharmacy label four times 10. Before you give the medication. Make sure you: Have all the right information, the medication has been stored correctly. (Refrigerated, double locked etc.) and the medication is being given in a way that is prescribed for the individual.
12. Procedures for Assisting an Individual with the Administration of Medications There are 12 steps to assisting with the administration of medications. Make sure you know them all, including the Four Checks (described below). As you do this, keep in mind the Seven rights (7Rs): Are you giving the medication to the Right Individual? Are you giving the Right Medications? Are you giving the Right Dose? Are you giving it at the Right Time? Are you giving it by the Right Route? Are you using the Right Method? (shaken, with Food or Milk) Are you ensuring the individual is in the Right Position?
13. JCS/JAFC Standards Anyone involved in the distribution of medication in JCS/JAFC must verify the following before administering any drug: Right Patient: staff must verify the full name of the youth receiving the medication. JCS/JAFC foster parent must not issue medication to anyone whom he or she cannot identify. Right Drug: JCS/JAFC foster parent must not ever administer nor prepare for distribution medications that cannot be properly identified. In order to ensure that right drug is administered, all medication must be stored only in their original containers (for OTC drugs) or in the container prepared by the pharmacist. Right Dose: All medications must be administered in the proper dosage as prescribed by the physician or by the manufacturer in the case of OTC medications. Right Time for Administration: In order to ensure therapeutic effectiveness, drugs must be given at the prescribed time(s) or interval(s) and continued for the full duration or days of treatment. Missed dosages should be avoided but when it happens, the missed dosage must be recorded and communicated. Right Route of Administration: Because some drugs can be given via more than one route (i.e. injection, oral, intravenous, topically, etc.), staff must verify the prescriber’s order or manufacturer’s directions concerning route of administering a drug. JCS/JAFC foster parent must exercise particular care that otic (ear) drops are not accidentally instilled in the eyes, intramuscular injections are not injected intravenously, etc. Right chart: Medication must be given to the patient before they are checked off and signed for on the Medication Administration Record (MAR). Secondly, the person administering the medication must record it on the MAR sheet.
14. JCS/JAFC Standards In addition, there are two human rights that parents and youth have with respect to medication: 1.7 right to refuse: under section 102 of the CFSA, the child’s parent has the right to give or refuse medical treatment for the child unless the child is under a CFSA court order in which case the CAS has this right. Under section 132 of the CFSA, no psychotropic medication may be administered to young people over 16 years without their written and informed consent. Furthermore, under section 132 (3), staff must first consider the views and preferences of children under the age of 16 years before administering psychotropic medication. This right does not apply to children who are deemed to lack capacity or in clinical emergencies that require action to prevent serious harm. 1.8 right to be informed: under section 104 of the CFSA, the child or youth has a right to be consulted in significant decisions affecting his life, specifically medical treatment; under section 132 of the CFSA.
15. Medication Administration Record Sheet -2.1 Medication Administration Record Sheets: {a} Medication Administration Record sheets, usually called MAR sheets, are a monthly listing of all the medications administered to a child or adult in JCS/JAFC. There is a separate MAR sheet for each child or adult. The MAR sheet is initialled by JCS/JAFC foster parent to witness every dose which is given or refused etc. (see MAR Codes sheet).   {b} JCS/JAFC foster parent must match the information on the MAR sheet with the drug container or blister pack before administering the medication. The following information must be matched and verified twice before administering medication: the right patient, the right drug, the right does, the right time for administering and the right route of administration. After administering the medication, the same facts must be verified a third time and the MAR sheet initialled by the JCS/JAFC foster parent. {c} Previous months MAR sheets are filed by date in each client’s medical file, which is stored in the main office. {d} Never use white-out or an eraser on MAR sheets – if a recording error occurs, cross out the erroneous entry and write in the correct one underneath it. {e} Each month the newly-printed MAR sheet must be checked by the JCS/JAFC foster parent. Only medications supplied by the Johnson’s designated Pharmacist will be printed on the MAR sheet. Over-the-counter medication (OTC) are printed on a separate MAR sheet.
16. Medication Administration Record2.1 {g} When any change is made in a medication, even a change in timing or dosage, cross off the old box and re-enter the drug entirely in a new box (thereby staring a new row for the rest of the days in the month). Draw a line through the days of the month to the “start date” of the new medication. Draw a line from the “discontinued date” to the end of the month if the medication is terminated earlier than expected. {h} The MAR sheet contains the following information: {g.1} name of client, current month and year {g.2} name of drug and prescribed dosage (or manufacturer’s recommendation if OTC) {g.3} name of prescribing physician or GP (if OTC) {g.4} time or “hour” for each dose to be given – one row for each hour {g.5} 31 columns corresponding to the days of the month note: there is space for 6 doses a day per drug; for additional doses make a second entry box for the drug, if necessary.
17. Drug Cards, Blister Packs and Medication containers: 2.2 Drug Cards, Blister Packs and Medication containers: {a} A blister pack (called a drug card) may be the “container” for prescription medication. The drug card (or accompanying instructions on the bottle) contains identifying data on the drug, the dosage, the patient and physician, plus additional information on the route of administration and possible complications or contraindications. {b} Never remove medication from their original container or blister pack except to administer the prescribed dosage or to deposit the drug in a dosette for later administration while the child is on a home visit or the adult client is away overnight. {c} Do not write on the drug labels: if the doctor issues new instructions for the same drug (such as a change in the time or dosage), the drug is then discontinued. The pharmacist may prepare a new sticker for the blister pack – with the new instructions – and affix it to the “discontinued blister pack”; only then may JCS/JAFC foster parent continue to administer the drug. In many cases, the discontinued blister pack is returned to the Pharmacist and a new blister pack is sent. Follow the procedures in 2.1 {g} to amend the MAR sheet for this month. {d} If pill(s) are spoilt, the pharmacist will send make-up pill(s) in a vial. This should be elasticized to the current drug card. {e} Keep all medication in a locked cupboard except when administering the medication.
18. Steps to Follow Positively identify the individual you will be giving medication to. Wash your hands Gather all the equipment you need to give the medication Unlock the storage area Read the Medication Administration Record (MAR)and identify the right medication in the storage area. This is the First Check. Compare the pharmacy label to the MAR. Make sure all the information matches. Remember the Seven Rights. This is the Second Check. Prepare an accurate dose, making sure it is the right dose and the right strength. Sign Count Sheet for countable medications. Compare the pharmacy label to the Medication Sheet again. Use the seven rights. This is your Third Check. Assist with the administration of medication to the right individual by the right route. Make sure the individual is in the right position to receive the medication and that you are using the right method for the medication. Remember: Lock the area as you leave, and lock the medications back up if you have to leave the storage area to give the medication. As you document the medication you gave, compare the pharmacy label to the Medication Sheet. Use the seven rights. This is your Fourth Check. Return the medication to the correct storage area. Lock the storage area. Don’t forget to wash hands Observe the individual for any unusual or adverse effects. Remember: Stay focused and do not get distracted by other people. Most medication errors happen when there are distractions.
19. “MAR” CODES 2.3 Drug Cards, Blister Packs and Medication containers: {a} A blister pack (called a drug card) may be the “container” for prescription medication. The drug card (or accompanying instructions on the bottle) contains identifying data on the drug, the dosage, the patient and physician, plus additional information on the route of administration and possible complications or contraindications. {b} Never remove medication from their original container or blister pack except to administer the prescribed dosage or to deposit the drug in a dosset for later administration while the child is on a home visit or the adult client is away overnight. {c} Do not write on the drug labels: if the doctor issues new instructions for the same drug (such as a change in the time or dosage), the drug is then discontinued. The pharmacist may prepare a new sticker for the blister pack – with the new instructions – and affix it to the “discontinued blister pack”; only then may JCS/JAFC foster parent continue to administer the drug. In many cases, the discontinued blister pack is returned to the Pharmacist and a new blister pack is sent. Follow the procedures in 2.1 {g} to amend the MAR sheet for this month. {d} If pill(s) are spoilt, the pharmacist will send make-up pill(s) in a vial. This should be elasticized to the current drug card. {e} Keep all medication in a locked cupboard except when administering the medication.
20. “MAR” CODES "5"On Hold ► By Doctor: write on MAR “on Hold” under date. ► Turn drug card backwards in basket with Note + Date ► Reassess weekly. Time limit 1 month. "6"Hospitalized ► Write “In Hospital Hold All Meds” fold MAR sheet in half and draw a line through each day. ► Turn all the drug cards backwards in the baskets. Write on back Reason / Date ► Draw a line and “Returned” upon re-admission. "7"Sleeping – code not used at Bayfield "8"Nausea/Vomiting: Do not administer oral medication if the client is nauseated or vomiting. "9"Pulse Rate Below 60 B.P.M. – code not used at Bayfield "10" Other – provide explanation on back of MAR sheet and send note to medical co-ordinator
21. MAR Sample Sheet
22. 2.5 Medication Error If you discover – after administering the medication – that you made an error (as in the wrong patient, the wrong drug, the wrong time, the wrong dose or the wrong route), then mark the MAR sheet with “10” and specify on the back of the MAR sheet the date, time, drug name, site of administration, reason for administering and the results. Take careful note of any changes in the client’s physical well-being or behaviour. Secondly, prepare an incident report.
23. 2.31 PRN medication "PRN" means "as needed" - no times are to be printed in the Hours column; see section 2.7 ► PRN orders must include criteria for giving and may only be given for the specified criteria. ► Record all doses given, dates/times, reason and results on the back of the MAR sheet.
24. 2.7 PRN Medications (i.e. “as needed”) PRN’s are only to be given for the Criteria listed Whenever a PRN is given to a client, turn over the MAR sheet and record on the back the following information: date, time, name of drug, dose, reason for giving and results If a skin condition, cough etc. has cleared up, write “Cleared up – Discontinued” on the MAR sheet
25. 2.8 Discontinued Medication/2.9 Receiving in Refills Remove all cards/containers (including Spares) Place all discontinued medication in the red bag for “discontinued medication” and give this to the Pharmacist. Receiving in Refills: Check every medication very carefully against the MAR sheet as follows: ► client’s name ► match drug name and directions with drug name on MAR sheet ► check that the pills look the same as the old card
26. 2.9 Receiving in Refills Check every medication very carefully against the MAR sheet as follows: ► client’s name ► match drug name and directions with drug name on MAR sheet ► check that the pills look the same as the old card
27. Review Questions How many steps are needed to assist with administering medications? How do you know you have the right individual? How many checks do you do? What are these checks for? Why do you have to wash your hands before and after administering medication?
28. Routes Of Medication Administration
29. This section describes ways or routes of giving medication. Most of the time you will be giving medication by mouth (orally), but you will also at the times be giving medication in order ways (routes). Some of these ways, may require additional training. Some of the ways that medications are given include: Oral (by mouth) Sublingual (under the tongue) Pulmonary inhalant (breathed in through the nose or month) Topical On the skin or hair On or into the rectum Into the eye (ophthalmic) Into the nose (nasal) Into the ear (Otic) Injection (Auto-injector)
30. Foster parents and authorized staff are allowed to assist individuals with their medications that are: Oral (mouth) Sublingual (under the tongue) Pulmonary inhalant (breathed in through nose or mouth) Topical (as listed above) Additional training by authorized staff will be required for all staff assisting with non-traditional situations. The following procedures are designed to ensure that medications are safely and effectively administered in JSC/JAFC in accordance with the eight standards listed above.
31. Administering Medication on Home Visits and Field Trips Policy: Prescription or non-prescription medication required by a client shall be administered by the JCS/JAFC foster parent whenever possible. However, it may be necessary for a client to receive medication on home visits or on field trips either as PRNs or as a routine dose. Special procedures are required to ensure the proper administration and record of medication.
32. What is “psychotropic” medication? The Expert Panel on the Administration of Psychotropic Medication defined psychotropic medication as “any drug prescribed to stabilize or improve mood, mental status or behavior”.
33. Ministry of Children and Youth Services (MCYS) In 2007 the Minister of Children and Youth Services appointed an Expert Panel for the Administration of Psychotropic Medications to Children and Youth in Licensed Residential Settings (the Panel) to respond to a situation where a young person was allegedly overmedicated in a licensed residential setting. In January 2009, the Minister approved a focused plan to implement a number of the Panel’s recommendations. MCYS recognizes that an increasing number of children and youth in residential settings are being prescribed psychotropic and other medications. The policy requirements are intended to improve protection for vulnerable children and youth who take psychotropic and other medications in licensed residential settings.
34. Members of the Panel The Panel was comprised of leading health and social services professionals with expertise that is directly relevant to the administration of psychotropic medications to children and youth in licensed residential settings. Members were drawn from a wide range of fields including: • Pharmacology/toxicology; • Clinical child and adolescent psychology; • Child and adolescent psychiatry; • Child and youth mental health; • Neuro-psychology; • Medication safety; • Social work; • Youth justice; and • Child protection. In developing their recommendations, the Panel looked at best practices from other jurisdictions and drew on the work of experts in the area of psychotropic medications.
35. Panel Recommendations The Panel developed recommendations in areas such as: documentation of current and past medications, the informed decision-making process, increased medication documentation and monitoring, safe administration, storage and disposal of psychotropic medication and effective communication and transfer of medication information. To access a summary of the Panel’s report, visit the MCYS website at: http://www.children.gov.on.ca/htdocs/English/documents/topics/specialneeds/residential/summary_report.pdf The two policy requirements focus on the safe administration, storage and disposal of medication and the improved communication and transfer of medication information.
36. The Health Care Consent Act, 1996 (HCCA) As a residential staff person, foster parent or CAS worker, how can I verify that a child or youth has been informed of his/her rights or has made an informed decision regarding treatment? It is the legal and professional responsibility of health practitioners to inform children and youth of their right to make an informed decision regarding treatment. In cases where the health practitioner has determined that an individual is not capable of making a decision regarding treatment, a substitute decision-maker would make a decision in their place. For children and youth in care, the substitute decision-maker could be their CAS worker. If you are concerned that a child or youth has not made an informed decision regarding treatment, you may wish to contact his or her health practitioner.
37. How does the HCCA relate to the Personal Health Information Protection Act(PHIPA)? The HCCA establishes the individual right to make an informed treatment decision and to consent to treatment (when deemed capable by a health practitioner). PHIPA establishes rules for the collection, use and disclosure of personal health information to protect individual privacy while facilitating effective health care provision. The HCCA overrides the provision in the Child and Family Services Act regarding consent to treatment. For more information about these pieces of legislation, please visit the e-laws website at: http://www.e-laws.gov.on.ca.
38. PERSONAL HEALTH INFORMATION PROTECTION ACT, 2004 Elements of consent. 18 (1) If this Act or any other Act requires the consent of an individual for the collection, use of disclosure of personal health information by a health information custodian, the consent, (a) must be a consent of the individual; (b) must be knowledgeable; (c) must relate to the information; (d) must not be obtained through deception or coercion 2004, c.3, Schedule.A. s.18 (1).
39. Storage and Care of Medications How to Store Medications: Storing medication properly is very important. First and foremost, it is a matter of safety. It is also a matter of law. It is very important that all medications be properly stored, and that all of you who handle medications know the rules and methods for proper storage.
40. General Rules All medications must be locked up. Double-lock all Psychotropic Medications and syringes. Store internal medications from external medications. Keep medications at the proper temperature. Lock medications that are stored in a refrigerator. Store all medications in their original container. Keep medications together by person and then by type (internal vs. external). NEVER combine two partially used containers of medication. Stores all medication away from food and toxic materials. Store meds in a lit area with adequate room.
41. Storage ExerciseWhat`s wrong with this Picture? 1. ___________________________________________________________2. ___________________________________________________________ 3. ___________________________________________________________ 4. ___________________________________________________________ 5. ___________________________________________________________
42. When and How to dispose of Medication All unused or discontinued medications must be returned to the pharmacy. Dispose of medication according to regulations. Return controlled medications must be properly documented and returned to the pharmacy. Document all actions. DO NOT keep medication that has been discontinued. Maintain at minimum a 3-day supply of medications. Refill orders should be placed with the pharmacy when there is no less than a 7-8 day supply on-hand.
43. Emergency Admission to a Hospital a)Notifying the placing agency (if applicable) and parent or guardian of emergency hospital admission. b) Contacting the hospital to provide relevant contact and medical information and obtaining time of anticipated discharge if no placing agency, parent/guardian, foster parent or staff is able to accompany the child or youth to the hospital. c) Documenting attendance or the reasons for not attending and other pertinent information (e.g., treatment and diagnosis) in the child or youth’s case record.
44. Caution! Alert! Caution! Your first role is to observe. For emergencies such as these below, immediately call 911 or the emergency. The individual is having trouble breathing The individual has noisy breathing The individual is unconscious The individual has chest pain The individual is sleepy or dizzy The individual is acting different than usual. Once the individual is cared for, call your Johnson`s Children Services immediately.
45. Do Not Assist With Medication If: The label on the medication does not match the medication and treatment order. The medication in the container does not seem to be the same as you usually give the individual. You think the medication might have been tampered with. It is documented that the individual is allergic to the medication You are not sure of the Seven Rights.
46. Your Role in Self-Administration Whenever possible, individuals should be taught and encouraged to take their medications by themselves or as independently as possible. This is called self-administration. Deciding whether an individual can self-administer medication is a very important decision-making process that must involve. The individual Authorized direct care staff, members of the support team Advocates who may include family members Before an individual can be given responsibility for self-administration, there must be an assessment (evaluation) of the individual`s for self-administer medications. The individual`s foster parent/ team does the assessment. An individual`s POC will include an assessment and, if learning to self-medicate, a supplemental learning plan will be developed.
47. Your role as an authorized Foster Parent/Staff at Johnson`s Children Services is very important to the health and wellness of the individuals we serve.