Providing Medication Assistance

Outline:

1. Introduction

2. Terminology and phrases

a. Independent administration

b. Adverse effect

c. Assisting with medication administration

d. Medication administration

e. Medication reminding

f. Authorized person

g. Controlled substance

h. Enabler

i. Error

j. Medication administration record (MAR)

k. Medication organizer

l. Legend drug m.Narcotic medication

n. Over-the-counter (OTC)medication

o. Prescribed medication

p. Prescriber

q. PRN medication order

r. Side effect

3. What is a medication?

a. Generic names

i. Given by manufacturer

ii. Usually chemical name of drug

iii. One generic name for each drug

b. Brand names

i. Given by drug company that produces the drug

ii. Identify medications by brand or generic name

iii.Use a medication resource book for information

c. Controlled substances

i. Numeric system to identify level of abuse and/or addiction potential

ii.Secure storage

iii.Shift to shift accountability

iv. Wasting and partial dose

v.Verbal orders

vi.Learning engagement: multiple choice questions

d.Schedule 1

i.High-abuse potential and are illegal in U.S.

1.Examples: heroin

e.Schedule 2

i.High-abuse potential, but are legal in U.S.

1.Example: Medications for pain, such as Fentanyl, Morphine, Oxycodone, Dilaudid

f.Schedule 3

i.High-abuse potential though not as high as schedule 2; legal in U.S.

1.Examples: Hydrocodone, Tylenol with codeine

g.Schedule 4

i.Less abuse potential than Schedule 3

1.Examples: Ativan, Xanax, Valium

h.Schedule 5

i.Minimal abuse potential

ii.Examples: Lomotil

iii.Usually not double locked or counted

i.Learning engagement: True/False questions

4.Forms and routes of medications

a.Forms

i.Aerosol

ii.Caplet

iii.Capsule

iv.Cream

v.Elixir

vi.Extract

vii.Liniment

viii.Lotion

ix.Ointment

x.Paste

xi.Pellet/bead

xii.Pill

xiii.Solution

xiv.Spray

xv.Suppository

xvi.Suspension

xvii.Sustained release

xviii.Syrup

xix.Tablet

1.Scored

2.Enteric-coated

xx.Tincture

xxi.Transdermal

5.Routes for medication delivery

i.Buccal

ii.Ear

iii.Eye

iv.Inhalation

v.Injectable

vi.Nasal

vii.Oral

viii.Rectal

ix.Sublingual

x.Topical

6.Orders for medications

a.Who can prescribe

b.Regularly scheduled medication

c.PRN medication

i.Prescription medication

ii.Non-prescription medication

7.Medication Labels

a.Information on a prescription medication bottle

i.Prescription

ii.Prescriber

iii.Resident name

iv.Name of medication

v. Exact dose of medication

vi.Route of delivery

vii.Instructions

viii.Refills

ix.Warnings

b.Labels for PRN medications

i.Name of resident

ii.Name of medication

iii.Exact dosage

iv.Route of delivery

v.Reason for medication

vi.Minimum hours between doses

vii.Maximum hours between doses

viii.Maximum doses to be given in a 24-hour period

c.Information on OTC medication labeling

i.Active ingredient

ii.Purpose or type of drug

iii.Uses (symptoms or diseases being treated)

iv.Warnings

d.Do not alter the label

8.Medication Services

a.Regulations

i.Differ by state

ii.Differ by care environment

iii.Documentation of training

b.Administering versus assisting

1.Transferring medications from containers

2.Injectable medications

3.Medication alteration

ii.Learning engagement activity: true/false

9.Steps to medication assistance

a.Prescription order/physician authorization

b.Order to pharmacy

i.Dispensed and delivered

c.Receipt and storage of medication

i.Maintain log of centrally stored medications

1.Conduct count of medication received

2.Compare with order

3.System for refills

ii.Medication storage

1.Central and locked

2.Not accessible to others

3.Storage of non-prescription medication

d.Documentation of self-administration of medications

i.Medication administration requirements

ii.Regularly scheduled

iii.PRN

e.Prepared for self-administration at correct time

i.Order and label/prescription verification

ii.Removal from container

iii.Transporting medication to resident

iv.Respecting privacy

v.Document on the MAR

f.Wasting Medications

g.Refusal of medications

h.Destroying, disposing, donating medications

i.Medication log

ii.Medication errors

i.PRN medications

i.Able to communicate

ii.Unable to communicate

10.Promoting medication safety

a.Requirements for safe medication assistance and management

i.Prescription

ii.Report problems and concerns

iii.Provide all medications as ordered

iv.Know why person is taking medications (reason it was prescribed)

1.Monitor for medication effectiveness

a.For example, blood pressure medication; measure blood pressure, monitor for reduced or elevated blood pressure, side effects

v.Side effect versus adverse effect.

1.Examples of an adverse effect

2.Examples of a side effect

vi.Learning engagement activity: Questions (multiple choice and true/false)

11.Case studies

a.Case: John Jones

i.Wears nitroglycerin patch

b.Case: Bessie Burton

i.Has Parkinson's disease, uses eye drops

c.Learning engagement activity: Case study questions true/false

d.Case: Marjorie Maxwell

iForgetful

e.Self-administration with assistance

i.Opening containers

ii.Reading labels

iii.Applying or instilling (skin, nose, eye, ear)

iv.Placing in person's hands

v.Alteration of medication

vi.Active participation

vii.Right to refuse

viii.Learning engagement activity: Questions true/false

f.Case: Frank Ford

i.Unable to remember meds or why taking them, not able to self-administer

1.Medication Administration

a.If cannot safely self-administer

g.Case: Alberta Callahan-multiple medication service needs

i.Administer

ii.Assist

iii.Independent

12.The six rights

a.The six rights

i.Right person

ii.Right drug

iii.Right dose

iv.Right time

v.Right route

vi.Right documentation

13.Conclusion and summary

Holly Carlson, MS, RN, CCRN, was a subject matter expert for Relias. She has 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes leadership and management across the healthcare spectrum. She has owned and operated an assisted living business. Carlson's clinical practice includes acute care, long-term acute care, home health and hospice. Carlson has served for over a decade in various board positions for State Nursing Associations, including president. She has been a nurse planner for multiple continuing education events and has experience as a leader in the design and implementation of an ANCC-CNE accredited approver unit for a multi-state nursing consortium. Carlson is certified as Critical Care Registered Nurse.