Key Benefits
APD 65G-7 MEDICATION MANAGEMENT PROGRAM
- Meets or exceeds State of Florida requirements
allowing unlicensed staff to assist with medication administration for
Agency for
Persons with Disabilities.
- Training consists of on-site lecture,
practical training and evaluation to be completed.
- E Mail
Medication Administration Training
Instruction Training Manual
1. Table of Contents:
Definitions 2
Course Rationale 7
Objectives 8
Target Population 9
Validation Requirements 10
Determining the Need for Assistance 12
Fully Capable of Self Administration 12
Supervision of Self Administration 13
Administration of Medication 14
Informed Consent for Medication Administration 15
Six Rights of Medication Administration 16
Documentation of Health Care Practitioner Order to MAR 18
Prescription Medications and Medication Labels 19
Prescription Medication 20
Medication Labels, Prescriptions, and Orders 20
Sample Medication 20
PRN Medication 21
Over the Counter Medication (OTC) 23
Controlled Drugs 24
Forms of Packaging 26
Common Prescription Abbreviations 28
Safety and Sanitation 29
Procedures for each route of Medication Administration 31
Oral Medication 31
Buccal or Sublingual Medication 32
Inhaled Medication 33
Transdermal Medication 36
Topical Medication 37
Eye Medication 39
Ear Medication 40
Rectal Medication 42
Enteral Medication 44
Positioning for Medication Administration 47
Documentation on the MAR 48
Documenting on the PRN MAR 51
Documenting Missed Medications 53
Do’s and Don’ts of Medication Administration 54
Other Documents 56
Common Medications – Indications, Side Effects, Adverse Reactions 58
Medication Errors 73
Refusal of Medication 75
Medication Storage 76
Medication Disposal 77
Off-site Medications 78
References 80
Bibliography 81
Appendices 82
2. Definitions:
The terms and phrases used in this chapter shall have the meanings defined
below:
(1) "Administration of medication" means the obtaining and giving of one or
more doses of medicinal drugs by a legally authorized person to an Agency
client for his or her consumption (65G-7 F.A.C.).
(2) "Adult Day Training" (ADT) provides training services to enrolled APD
adults. The ADT program is intended to support the participation of people in
daily, valued routines of the community, which may include work-like settings
that assist the recipient to achieve his or her defined outcomes (goals)(Chapter
393, 2008 F.S.).
(3) "Area Office" is the local office responsible for managing one of the
Agency’s fourteen service areas (65G-7 F.A.C.)..
(4) "ARNP" is an Advanced Registered Nurse Practitioner, licensed by the
Department of Health, practicing within the scope of his or her license,
pursuant to Chapter 464, F.S. (Chapter 464, 2008 F.S.).
(5) "Authorized representative" means the client’s parent if the client is
a minor, the client’s authorized guardian, court-appointed guardian advocate,
health care surrogate, or a health care proxy appointed in accordance with
chapter 765, F.S., or any other client advocate legally authorized to make
decisions on behalf of a client (65G-7 F.A.C.)..
(6) "Central Office" is the Agency’s headquarters, situated at 4030
Esplanade Way, Suite 380, Tallahassee, FL, 32399-0950; main phone number (850)
488-4257 (65G-7 F.A.C.)..
(7) "Client’s record" means a file maintained for each client that contains
the client’s name and date of birth, written authorization for routine
medical/dental care from the client or guardian and medical summary, the name
address and telephone of the client’s physician and dentist, a record of the
client’s illnesses and accidents, the legal status of the client, current
services and implementation plan, and client financial documentation (65G-7
F.A.C.).
(8) "Controlled medication" means any substance enumerated in Schedules I,
II, III, IV, and V in s. 893.03, F.S. (65G-7 F.A.C.).
(9) "Corrective Action Plan" means a written plan of action developed by
the Agency for the purpose of correcting cited deficiencies in compliance with
rule 65G-7 F.A.C. (65G-7 F.A.C.)..
(10)"Debridement" is the surgical removal of dead tissue, or infected
tissue or foreign material from a wound. (Anderson, et al, 2002)
11) "Enteral medication" means medication delivered by tube via the body’s
gastrointestinal system. (65G-7 F.A.C.)
(12) "Facility" means a residential facility licensed under Chapter 393,
F.S., or other facility staffed by direct service providers where Agency
clients receive training, respite care, or other services on a regularly
scheduled basis (65G-7 F.A.C.).
(13) "Inhaled medication" means the delivery of medication droplets or
moisture suspended in a gas, such as oxygen, by inhalation through the nose or
mouth. (65G-7 F.A.C.)
(14) "Medical Case Manager" means a registered nurse or ARNP employed by
the Agency to provide nursing consultation and technical assistance to an Area
office regarding the medical care of Agency clients. (65G-7 F.A.C.).
(15) "Medication Administration Record (MAR)" means the chart maintained
for each client which records the medication information required by this rule
chapter. Other information or documents pertinent to medication administration
may be attached to the MAR. A copy of the Agency’s form "Medication
Administration Record," APD Form 65G7-00, may be obtained by writing or
calling the Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite
380, Tallahassee, FL, 32399-0950; main phone number (850) 488-4257 It may also
be obtained on the internet at http://apd.myflorida.com/forms/ (65G-7 F.A.C.).
(16) "Medication Assistance Provider" (MAP)" means a direct service
provider not otherwise licensed to administer medication that has successfully
completed an agency-approved training course and has current validation to
provide clients with medication administration or to assist clients with
self-administration of medication. (65G-7 F.A.C.).
(17) "NKDA" is an acronym that stands for "No Known Drug Allergies."
(18) "Nebulizer" means an atomizer equipped to produce an extremely fine
spray for deep penetration of the lungs. (65G-7 F.A.C.).
(19) "Over-the-counter (OTC) medication" means a medication for general
distribution and use without a prescription in the treatment of human
illnesses, ailments, or injuries. (65G-7 F.A.C.).
(20) "Ophthalmic medication" means a solution or ointment to be instilled
into the eye or applied on or around the eyelid. (65G-7 F.A.C.).
(21) "Oral medication" means any medication in tablet, capsule, or liquid
form introduced into the gastrointestinal tract by mouth. (65G-7 F.A.C.).
(22) "Otic medication" means solutions or ointments to be placed in the
outer ear canal or applied around the outer ear. (65G-7 F.A.C.).
(23) "Parenteral" means injected into the body through some route other
than the alimentary canal. (65G-7 F.A.C.).
(24) "P.O. (per os)" means by way of mouth. (65G-7 F.A.C.).
(25) "Physician" means a doctor of medicine or osteopathy who holds a valid
and active license in full force and effect pursuant to the provisions of
Chapter 458 or 459, F.S. (65G-7 F.A.C.).
(26) "Prescribed medication" means simple or compound substances or
mixtures of substances that are prescribed for the cure, mitigation, or
prevention of disease or for health maintenance prescribed by a licensed
practitioner, such as a M.D., A.R.N.P., D.O., etc. (65G-7 F.A.C.).
(27) "Prescription" means any order for drugs, medical supplies, equipment,
appliances, devices, or treatments written or transmitted by any means of
communication by a licensed practitioner legally authorized to issue such an
order, or any order issued by the lawfully designated agent of such
practitioner, intended to be filled, compounded, dispensed or furnished by a
person authorized by the laws of the State to do so. (65G-7 F.A.C.).
(28) "Primary Care Practitioner (PCP)" is the licensed practitioner (MD,
DO, PA, or ARNP) who the client sees for routine medical care.
(29)"Provider" is the organization or individual enrolled with the Agency
for Persons with Disabilities who is responsible for the delivery of services
to the Medicaid Waiver client.
(30) "PRN (pro re nata)" means the administration of medication on an
as-needed basis rather than according to a prescribed schedule. (65G-7 F.A.C.).
(31) "Rectal medication" means any prescribed medication, capsule, enema or
suppository to be administered via the rectum. (65G-7 F.A.C.).
(32) "RN" is a registered nurse, licensed by the Department of Health,
practicing within the scope of his or her license following Chapter 464 F.S.
(Chapter 464, 2006 F.S.)
(33) "Supported living services" means the provision of supports necessary
for an adult who has a developmental disability, to establish, live in, and
maintain his or her own household in the community. (65G-7 F.A.C.).
(34) "Supervised self-administered medication" means direct, face-to-face
observation of a client during the client’s self-administration of medication
and includes instruction or other assistance necessary to ensure correct
self-administration of the medication. (65G-7 F.A.C.).
(35) "Topical medication" means a salve, lotion, ointment, cream, shampoo
or solution applied locally to a body part. (65G-7 F.A.C.).
(36) "Transdermal patch" means an adhesive or non adhesive patch containing
a pre-measured amount of topical medication that is absorbed into the body via
the epidermis (outer layer of skin) at a fixed rate. (65G-7 F.A.C.).
(37) "Unlicensed" means, for purposes of this rule, not authorized,
certified, or otherwise permitted by Florida law to administer medication or
to supervise self-administration of medication. (65G-7 F.A.C.).
(38) "Validation" means an unlicensed direct service
provider’s demonstration of competency in administering or supervising
self-administration of a medication to a client certified by a licensed,
registered nurse or licensed physician following the provider’s successful
completion of an Agency-approved medication administration training course.
(65G-7 F.A.C.).
3. Course Rationale
This course is prepared to train unlicensed staff who are working through
the Agency for Persons with Disabilities to supervise clients who are self
administering medications or to administer medication to clients of APD who
have been determined by their primary care practitioner (PCP) to require this
service.
This medication administration course must be taught by an APD approved
trainer using an APD provided or approved training course (this list can be
found at any Area office). Only RNs or ARNPs will be approved to teach this
course.
Persons with developmental disabilities are living in a wide variety of
settings that do not provide 24 hours per day of professional health care
services. Unlicensed persons who give medications need training to do so
safely. This medication administration course is designed to familiarize
participants with the procedural aspects of providing medication
administration and supervision while self administering of medications as
outlined in Florida Administrative Rule 65G-7 Medication Administration
(Appendix). Successful completion will depend upon attendance and obtaining a
passing score of 80% or above on an exam at the end of class. A certificate
will be awarded and will contain at a minimum:
Name of Agency or Individual who is authorized by APD to be a Trainer
Approved Course number
Date(s) of course
Name of Student
Name and signature of instructor
The intent of this course is to provide guidelines to all unlicensed direct
care staff serving individuals with developmental disabilities in adult day
programs, foster homes, group homes, independent living, and supported living
arrangements. These guidelines include: (1) when supervision of self
administration of medication is appropriate; (2) what may and may not be done
while supervising the self administration of medication; (3) when unlicensed
direct care staff may administer medication; (4) how to safely administer
oral, topical, transdermal, rectal, inhaled, ophthalmic, otic, and enteral
medications; (5) how to safely handle medication and (6) when and how to
report concerns/errors.
Administrative Rule 65G-7 does not apply to clients who are
authorized to self administer their own medications without supervision. It
also does not apply to family members or friends who administer medications or
assist individuals with self administration of medications without
compensation, or to health care practitioners whose professional licenses
include administration of medications. Also, excluded are those employed by or
under contract to Intermediate Care Facilities for those with Developmental
Disabilities (ICF/DD’s), home health agencies, hospices, or Assisted Living
Facilities (ALFs).
4. Outcomes or Objectives:
By the end of this course participants will be able to:
Discuss the validation requirements
Demonstrate the ability to accurately complete and maintain all forms
required for the process of medication administration and supervision of
self administration of medication.
Understand the rules for Authorization for Medication Administration and
for Informed Consent for Medication Administration.
State and demonstrate the six rights of medication administration
Discuss and demonstrate correct supervision of self-administration of
medications
State medical indications/primary effects/purposes, symptoms of adverse
reactions, and side effects of commonly used medications
Demonstrate understanding of medication instructions by reading and
following instructions on a prescription label or health care practitioner’s
order, and accurately completing a MAR
State conditions under which PRN medications may be administered.
Demonstrate proper safety and sanitation procedures.
Demonstrate proper positioning of clients.
Demonstrate correct preparation and administration of medication via
oral, topical, transdermal, ophthalmic, otic, rectal, inhaled, and enteral
routes
Explain the steps to take if a medication error is made.
State principles of safe storage of medications (prescription,
controlled, and OTC)
Demonstrate proper disposal of expired or discontinued medications
List steps to be taken when medications are to be taken off-site with the
client.
5. Target Population
This course is intended for unlicensed direct care staff working directly
with persons with developmental disabilities in their homes or day programs
who intend to perform MAP duties. Waiver Support Coordinators (WSC),
Supported Living Coaches (SLC), ADT staff, program managers, personal care
assistants, in home support staff, and anyone else who has
responsibility for persons with developmental disabilities may complete the
course. Family members of persons with developmental disabilities are also
welcome to take this course.
6. Validation Requirements (Appendix: Validation Certificate APD form
65G7-04)
Upon successful completion of this medication administration training
course with a score of 80% or above on the final exam, a student may have his
or her skills validated by a MD, RN or ARNP. Florida Administrative Rule
65G-7.004(4) requires that a student demonstrate in an actual on-site client
setting the student’s ability to correctly administer medication and supervise
the self administration of medications in a safe and sanitary manner,
including a demonstration of the following:
The ability to comprehend and follow medication instructions on a
prescription label, health care practitioner’s order, and the ability to
properly complete a MAR form.
The ability to administer medication by oral, enteral, transdermal,
ophthalmic, otic, rectal, inhaled, or topical administration routes
The ability to obtain pertinent medication information, including the
purpose of the medication, its common side effects, and symptoms of adverse
reactions to the medication, either from the package insert that comes from
the pharmacy, or a Physician’s Desk Reference or other professionally
recognized medication resource, and to maintain this information for easy
access and future reference
The ability to write legibly, communicate information accurately, and
comply with medication administration record keeping requirements
Knowledge of the proper storage and handling of medications
Knowledge of proper disposal of expired or unused medications
Knowledge of special requirements relating to storage and disposal of
controlled medication
Knowledge of requirements for obtaining authorizations to determine need
for assistance using form 65G-7.01, and informed consent using form
65G-7.02.
Knowledge of the correct positioning and use of any adaptive equipment or
use of special techniques required for the proper administration of
medication.
Once a student has successfully completed the validation, he or she may now
be called a "Medication Assistance Provider," or MAP, and will receive a
Validation Certificate (Form 65G-7.004). The MAP shall keep the original, and
provide copies to his or her employer. Routes by which the MAP is validated to
administer medication(s) are noted on the back of the certificate, signed, and
dated.
REMEMBER: Validation is by route. Once validated on a particular route a
MAP may administer medication via that route to all assigned clients.
When a MAP is validated, it may be that there is no client receiving
medications by some of the routes of administration. A MAP will not be able to
be validated on these routes until there is a client who needs medications by
that route, so it will not be unusual for one or more of the routes on the
back of the validation form to be blank. A MAP may not give medications by
any route for which he or she has not been validated! If a client is
ordered a medication that a MAP cannot administer for lack of validation, the
MAP’s employer or the client’s WSC is notified immediately, so that
he/she can make sure that the client has all of his/her needs met. A MAP
should take advantage of any opportunity to become validated on each route of
medication administration for which he or she is not currently validated.
A MAP must revalidate skills annually, within the 60 days preceding
the expiration of his or her current validation. If a MAP fails to revalidate
as required, he or she will not be allowed to administer medications or
supervise the self administration of medications until he or she has
successfully retaken a Medication Administration Training course, and
successfully revalidated his or her skills. A MAP may also be required by his
or her employer or the APD Area office to retrain or revalidate at any time.
This would usually be in response to a medication error that showed a need for
further training.
7. Determining the Need for Assistance: (Appendix: Authorization for
Medication Administration APD form 65G7-01)
The client’s physician (MD or DO), physician assistant (PA) or Advanced
Registered Nurse Practitioner (ARNP) are the persons who decide how much help
a client needs with medication administration. They must fill out a form
called "Authorization for Medication Administration." It must be reviewed by
the health care practitioner every year, and when there is any significant
change to the client’s medical condition, or self sufficiency that might
affect his or her ability to self administer medication or to tolerate a
particular administration route.
This is APD form 65G7-01 which has three levels of need for assistance with
medications. These levels are:
Fully capable of self administering his/her medications
Requires supervision while self administering his/her medications
Requires medication administration
Clients who are "fully capable of self administering their medications"
may take their own medications by themselves, without any supervision. A MAR
is not kept for these clients because a MAP only documents what he or she
does, and he or she is not assisting these clients to choose which medicine to
take, or watching these clients to make sure they take the medications. This
does not mean, however, that these clients may not need a little help. The MAP
may be asked to bring them medications if the medications are centrally
stored, and the MAP may need to remind these clients that it is time to take
medications. These clients may also need assistance reordering or getting
medications from the pharmacy. These clients may use a "pill minder" container
to store their medications in if they so wish, but these clients or a family
member or friend must fill it. If these clients live in a group home or a
multi-person supported living environment they may keep their medications in a
locked storage area in their room. Under certain circumstances these clients’
medications may be required to be centrally stored. These are:
If the client’s health care practitioner documents that leaving the
medications in the client’s possession would threaten the health, welfare,
or safety of the client or others;
If the client doesn’t keep the medication in a locked place;
The MAP, the administrator of the facility, or APD decide that the
physical arrangements in the home or the habits of other residents make it
unsafe for the client to keep their medications; or
The client or their authorized representative asks for the medications to
be centrally stored.
Clients who do not require medication assistance and live in their own home
with no other clients are not required to keep their medications locked up.
Clients who "require supervision while self administering their
medications" will need the assistance of a properly trained and validated
MAP. This help will not be the same for every client, as each needs to be
encouraged and trained toward independence. The MAP may need to complete the
following duties
Prompt the client and observe him/her taking the medication
Confirm that client is taking the dosage as prescribed
Check the self administered medication dosage against the label of the
medication
Open the medication container for a client who is physically unable to do
so
Document in writing on a MAR that the client has taken (or refused to
take) the medication
Supervision of self administration includes instructions or any other
assistance necessary to ensure the correct self administration of
medication. This means the client may need the MAP’s assistance more for
some things than others – some examples:
A client may be able to identify an oral dose, and take the
medication out of the bottle and self administer it with supervision
only… but requires assistance to instill eye drops or ear drops or to
insert a rectal suppository.
A client may be able to identify medications needed, and communicate
the route… but may be unable to remove the medication from the
container, or self administer. There may be days a client can do
something, followed by days they cannot – flexibility is necessary to
promote independence.
A client may be able to self administer a topical medication in an
easy to reach area, but need the MAP to apply it on a less easy to reach
area.
REMEMBER:
The MAP must assist with every scheduled medication delivery.
The MAP documents on a MAR that he or she observed the client
appropriately received the scheduled medication.
Clients who require supervision with self administration must have their
medications centrally stored.
Clients who "require medication administration" are not yet able to
safely give their own medications, and must have medications given to them.
The MAP will have to prepare and give all of their medications. Then the MAP
must document the medications immediately after being given, on the MAR.
It is still important to remember that the goal is to help clients become
more independent with their medications. If the client can help the MAP apply
a topical by rubbing it in after it is applied to the skin, the MAP has taken
a small but important step in helping them to care for themselves. In
assisting the clients with each medication, the MAP should tell the name of
the medication, and the reason for it. An example might be, "John, this pill
is vitamin C, and you take one every morning to help you stay well. You need
to chew this pill up before you swallow it, please."
Clients who require medication administration must also have their
medications centrally stored.
The MAP’s input can be very helpful to the health care health care
practitioner when he/she is trying to decide the client capabilities of
self administration or need for administration. Remember the MAP will
review this with the health care practitioner every year or with any health
status change. The MAP is with the client and knows a lot about his/her
abilities. The goal is to help him/her to be more independent. One way to
achieve this is by stating the name of the medication, reason for use, and
directions on administration, and then allowing the client to help as much as
possible.
8. Informed Consent for Medication Administration (Appendix: Informed
Consent APD form 65G7-02)
A MAP must also obtain from the client or the client’s authorized
representative an "Informed Consent for Medication Administration."
This is APD form 65G7-02, which authorizes a MAP to assist with medication
administration. The Informed Consent must be signed by the client or his/her
representative before an unlicensed person gives the client medication,
or supervises the client administering his/her medications. By signing this
form, the client or client’s representative acknowledges that he/she knows
that the person assisting with medications does not have a license to practice
nursing or medicine.
If the client is not able to sign the form because of age or legal
competency status, it must be signed by a representative of the client. This
form may not be signed by the MAP, or anyone representing the agency
responsible for assisting the client with medications. In practical effect, if
the MAP signed this form as the client’s representative, the MAP would be
giving oneself permission to assist the client with medications – a clear
conflict of interest. The MAP may witness and sign the form in the witness
space.
9. The Six Rights of Medication Administration
To safely give any medicine, a MAP must first know and understand the
Six Rights of Medication Administration.
Right Client – Verify the identity of the client if it is unknown.
Identity must never be assumed. The MAP always checks first. The MAP could ask
another staff member, or the record or MAR may have a picture of the client.
Many clients will tell their name if asked, "What is your name?" It is not a
good idea to ask a client "Is your name Jack Sparrow?" Many clients will say
"yes," or nod their head, either because they cannot hear, do not understand,
or for some other reason.
Right Medication – Check the label of the medication to ensure that the
name of the medication on the label is the name of the medication on the MAR,
and that it is the same as the name of the medication on the prescription or
doctor’s order. If any differences in the name of the medication are found the
MAP should
not give the medication
re-check the medication label with the MAR and the original
prescription
inform the supervisor or administrator immediately or follow the
facility’s policy
Right Dosage – Ensure that the amount of medicine prescribed on the
label is the same on the MAR. If any differences are found, the MAP should
not give the medication
re-check the medication label with the MAR and the original
prescription
inform the supervisor or administrator immediately or follow the
facility’s policy
Right Time – Ensure that medication is given within one hour before to
one hour after it’s scheduled time. Check the medication label for the time of
day the client is to take the medication, and verify with the MAR. If any
differences are found, the MAP should
not give the medication
re-check the medication label with the MAR and the original
prescription
inform the supervisor or administrator immediately or follow the
facility’s policy
Remember: Some medications must be given at specific intervals so the MAP
may not rearrange the schedule for the convenience of client or MAP
Right Route - Ensure that oral medications are swallowed; eye medicines
are placed in the eye; ear medications are placed in the ear, etc. Remember
that the MAP must be validated on each route individually before he or she can
assist with that route.
Right Documentation – The sixth right was added to the medication
rights in the last few years. Medication administration must be documented on
the client’s MAR as discussed in the "Proper Completion of a MAR" section. PRN
(as needed) medications must be documented on the PRN MAR. With PRN
medication, the MAP should document in the comments section the client’s
status prior to, during, and after administration, and whether there are any
adverse reactions or if the results are the intended ones (laxative to relieve
constipation or bronchodilator (inhaler) to relieve respiratory distress).
It is important to remember that all PRN medications must also be given for
the Right Reason. This means that if a PRN is ordered for
itching, it may not be given for any other reason. A common example of this is
Tylenol ordered for a fever over 101 degrees. If a client complains of a
headache, and the Tylenol is only ordered for fever, the MAP may not give
it for a headache.
Remember that the MAP MUST compare the order or prescription to the
medication label and to the MAR to make sure they all match!!! IT IS THE
RESPONSIBILITY OF THE MAP TO ENSURE THEY ALL MATCH.
10. Documentation of Health Care Practitioner’s Orders to MAR
Health Care Practitioner writes the prescription
MAP makes copy of the prescription for the client record and takes
original to the pharmacy to be filled
Current copies of prescription are kept in the MAR for reference
Archive discontinued prescription orders for reference.
Write prescription order on the client MAR
When medication is picked up or delivered from pharmacy, the label is
compared with a copy of the prescription and with the MAR
All information must match in all three places
Medication should be started in a reasonable time frame once ordered
(within 24 hours or as determined by the health care practitioner)
Medication is given as prescribed
Supervision of self administration or administration of medication is
documented appropriately on the MAR
11. Understanding Prescription Medications and Medication Labels
Prescription Medication
A prescription is a written order by a licensed medical professional for
the preparation and use of a medication. Only licensed healthcare professional
can prescribe medications. They include:
Medical Physician or Psychiatrist (MD)
Osteopathic Physician (DO)
Advanced Registered Nurse Practitioner (ARNP)
Physician Assistant (PA)
Dentist (DDS or DMD)
Optometrist (OD)
Podiatrist (DPM)
A pharmacist is the professional who dispenses, labels, and packages
medications.
Prescription medications can be either brand name or generic name. Generic
medications are usually less expensive than brand name medications. Some
healthcare insurance plans require generic medications be used.
Example:
Tylenol is a brand name and acetaminophen is the generic name.
Motrin is a brand name and Ibuprofen is the generic name.
Lanoxin is the brand name and digoxin is the generic name.
Medication labels, prescriptions, and orders:
Doctors often change medication orders based on the client’s response or
condition. For example, the dosage may be increased or decreased or the timing
may be changed (for example: from morning to bedtime). All medication changes
must be accompanied by a written prescription from the client’s health care
practitioner. It is acceptable for the health care practitioner to fax the new
order to the facility, or a copy or pharmacy profile signed by the pharmacist
may be obtained from the pharmacy. The new directions shall be recorded on the
MAR. The current prescription may be re-packaged and re-labeled by the
pharmacist so that the new medication order matches the new order on the MAR.
The old prescription may also be archived and the new prescription started.
Contact the physician if the pharmacist is unable to fill the new prescription
for any reason.
No prescription medication may be kept in the facility unless it is
properly labeled and dispensed.
Sample medication given by a MD office to the client must be accompanied by
a prescription and have a professional label signed by the physician. Maintain
medication samples in their original containers labeled by the dispensing
health care practitioner with the client’s name, the practitioner’s name, and
the directions for administering the medication. The MAP must initial the
label and add the date the medication is opened.
Only a pharmacist may transfer medications from one container to another
container. This is called dispensing.
"As directed" on a prescription, label, or order will need more specific
instructions obtained from the health care practitioner prescribing the
medication before the medication can be given.
The provider must maintain a copy of the prescription or order with the
client’s MAR or in a place readily accessible to the MAP.
Important: A MAP cannot make changes on a prescription label. Only a
pharmacist can change a prescription label.
PRN or "As Needed" Prescription Medications both Prescribed and
Over-the-counter (OTC)
Some medications are ordered by the licensed healthcare professional to be
given "as needed". Medications that are given "as needed" may also be called
p.r.n. medications. "As needed" medications are not scheduled to be
given at specific times. They are given when the resident "needs" them because
of a certain circumstance.
Examples include:
The client complains of a headache
The client complains of diarrhea
The client has an upset stomach
Medication example: prn for fever> 101 F. Notify MD if fever is 102 or
greater or if fever persists beyond 3 days.
The prescription must contain the following information:
The name of the medication Tylenol
The strength of the medication 325 mg
Route of administration by mouth
Amount of medication 2 tablets (650 mg)
Time of administration every 4 hours
Specific reason for medication fever > 101 F
Conditions to notify MD fever > 102 F
Maximum number of days/ doses 3 days
As an unlicensed person, a MAP is prohibited by law from administering or
supervising medication that requires judgment or discretion. A MAP may not
administer or supervise self administration of medication when he or she sees
directions such as:
Lasix 40 mg PO prn for fluid retention.
A MAP is not trained to assess for fluid retention. Notify the health care
practitioner to clarify PRN orders like the above Lasix order. This order,
correctly written, might look like this:
Lasix 40 mg PO QD PRN for fluid retention, as evidenced by weight gain of
2 pounds or more in 24 hours. Client must be weighed QAM at the same time.
Call MD if weight gain is 5 pounds or more in 24 hours. If needed for more
than three days in a row, call MD before giving fourth dose for further
instructions.
Pain medication may only be given for a specific site of pain or diagnosis.
Examples: Pain left shoulder, Arthritis, Generalized Pain.
The MAP may not assist with PRN medications, including OTC medications,
unless a health care practitioner has provided written directions for the
medication. The provider must attach to the client’s MAR a copy of the
prescription or order legibly displaying the following information:
The name of the medication;
The prescription number, if applicable;
The prescribed dosage; and
Specific directions for use, including the medical reason for the
medication, the time intervals for administration, the maximum number of
doses, the maximum number of days that the medication should be
administered, and conditions under which the health care practitioner should
be notified.
Over the Counter Medication (OTC)
These are medications that are available to buy at pharmacies, grocery
stores, etc. Clients may take them as regularly scheduled medications. It is
very common for a low dose of aspirin to be ordered daily, as well as vitamins
or stomach medications such as Prilosec OTC. Over the counter medications are
frequently used as PRNs. Acetaminophen (Tylenol), ibuprofen(Advil or Motrin),
colace, Pepto-Bismol, cough syrups, diphenhydramine (Benadryl), and antibiotic
ointments are all examples of common PRN OTCs.
Group homes, ADTs, and supported living arrangements with more than one
client may keep stock supplies of OTCs for the use of more than one client.
OTC medications do not have to be labeled with instructions by the
pharmacist for the client to use them. MAPs should refer to the order given by
the client’s health care practitioner for instructions on how much of the
medication to give, and how often to give it. The health care
practitioner’s order must be followed exactly when using over the counter
medication.
Over the counter medication requires:
An order by the health care practitioner for each medication
Documentation on the MAR
A copy of the order kept with the MAR.
Medication must be discarded by the expiration date.
The medication container be initialed and dated when first opened, The
medication container should not be used if the original seal has been
broken.
12. Controlled Medication (Appendix: Control Medication Count APD form
65G7.07)
Controlled medications are regulated under the jurisdiction of the
Controlled Substance Act of 1970 and are divided into 5 groups listed as
Schedule I thru Schedule V. The abuse potential is the highest with the
Schedule I drugs and there is limited abuse potential with the Schedule V
medications.
Examples:
Schedule II: Ritalin, Codeine, Demerol, Duragesic patch, Percocet
Schedule IV: Phenobarbital, Valium, Ativan
Controlled medications also need to be signed out on a separate Control
Sheet and the MAR. The pharmacy can provide the Control sheet and stamp the
sheet with a "C".
Controlled medication storage requires the following additional safeguards:
The medications must be stored separately from other prescription and OTC
medications in a locked container within a locked enclosure. (double
locked).
For facilities operating in shifts, a MAP must perform controlled
medication counts for each incoming and outgoing personnel shift, as
follows:
The medication count must be performed by a MAP and witnessed by
another MAP;
Both providers must verify count accuracy by documenting the amount
of medication present and comparing that amount to both the previous
count and number of doses administered between counts;
The providers must record the medication count on a "Controlled
Medication Form," APD Form 65G7-07. The form must be signed and dated by
the providers verifying the count.
For facilities with only one medication assistance provider per shift,
the medication assistance provider must conduct, document, and sign a daily
medication count on the Controlled Medication Form.
For facilities with no shifts, the medication assistance provider must
conduct, document, and sign a controlled medication count at least once each
day (EVERY 24 HOURS) on the Controlled Medication Form, using the same
counting and documentation technique.
Following a medication count, the medication assistance provider must
report a discrepancy in the accounting of controlled substances by 5:00 p.m.
of the next business day following discovery of the error to the Area office
and, if applicable, to the facility supervisor.
Medication assistance provider will have to sign on MAR, Controlled
medication count sheet and Controlled Medication Form," APD Form 65G7-07.
Use a new Controlled Count Sheet form every month.
Example:
If a new medication is received on the 10th of the month the
form should be viewed as a shift to shift count of the medications for that
month, beginning in the space that is numbered "10." When the following
month begins the count is moved to the 1st of the month and when
new medication is added then the count will reflect the new amount plus the
old amount. Have the staff note on the count sheet when the new medication
was received so to show how the total is correct.
April 10 received 30 Darvocet
May 1st have 10 Darvocet left to begin the month-
May 7th receive 30 Darvocet so the count that should be on the
sheet will equal 40 Darvocet (staff to note when new Darvocet received)
13. Forms of Packaging
A facility may use one or more of the following methods of medication
distribution systems:
Client’s medication stored in labeled bottles
Individual’s medicine stored in sealed, labeled plastic "bubble packs" or
"bingo cards".
Color coding on packaging for different time periods.(Only developed by
the Pharmacy)
Unit dose dispensing system.
All medication must be stored in the original container in which the
pharmacist dispensed it. The labels must be kept intact and legible.
The pharmacist must be called immediately if the medication label is torn,
damaged, incomplete or unreadable. Only a pharmacist may make changes to the
prescription label. A MAP must not make any marks or changes on prescription
label.
The prescription label according to law must contain:
Name, telephone number and complete address of dispensing pharmacy.
Either brand name or generic name of the medication. If the generic name
is used, the manufacturer or distributor’s name will also appear.
Strength of prescribed medication.
The quantity dispensed.
The date that medication was dispensed.
The identifying number under which the prescription is recorded in the
pharmacy’s files.
It may also include the name of the client, name of physician, physician
office information, name and license/DEA numbers, refills, expiration date,
and directions for use (dosage instructions and special instructions).
Manufacturers Label for over the counter medication
The manufacturers label will contain:
Name of medication
Strength of medication
Purpose of medication
Amount of medication included in container
Directions for use
Active and inert ingredients
Possible side effects
Warnings - possible drug interactions, maximum dosage
Storage conditions
Name and address of the manufacturer
Expiration date
Lot number
14. Common Prescription Abbreviations
The following chart includes a list of some common medical abbreviations.
They are used daily in medicine as "medical shorthand."
|
Abbreviation |
Meaning |
| a.c. |
Before meals |
| ad lib |
As directed |
| BID |
Twice a day |
| cap |
capsule |
| D/C or d/c |
Discontinue (do
not use) |
| gtt |
drop |
| H.S. or h.s. |
Hour of sleep, or
bedtime |
| mg |
Milligram |
| ml |
Milliliter |
| od |
Right eye |
| os |
Left eye |
| ou |
Both eyes |
| po |
By mouth |
| p.c. |
After meals |
| pr |
Per rectum |
| prn |
As needed |
| QD |
Daily, once per
day |
| QOD |
Every other day |
| Tab |
Tablet |
| Q3h |
Every 3 hours |
| QID or qid |
Four times daily |
| sig |
Label |
| TID or tid |
Three times daily |
| U or u |
units |
When writing an order on the MAR, it is usually best NOT to use the
abbreviations. While many health care practitioners still use them,
abbreviations have been identified as the main cause of many medication
errors. They can be very confusing! For instance, it is better to write out
"daily" than to use "QD," which is easily confused with "QID" or "QOD." "PO,"
"pc," "pr," and "prn" look very similar, but mean very different things.
15. Safety and Sanitation
Hand washing should be done before and after each contact with a client,
and between each different route of medication administration. Steps to follow
include:
Collect soap (avoid bar soap if possible), paper towels, and a trash
basket.
Turn the water on and adjust the temperature to warm.
Wet hands up to wrists.
Apply soap using enough to create a good lather.
Spread soap to back and front of hands up to wrists, being sure to reach
under nails. Use firm rubbing and circular movements to wash the palms, back
of hands, and wrists. Keep rubbing while rotating fingers through each other
up to your wrists for 15-30 seconds (about the amount of time it takes to
sing the "Happy Birthday" song).
Rinse hands, avoiding contact with the sink and the faucet area. Allow
the water to run downward from the wrist area when rinsing.
Dry hands with paper towels and use the towels to turn the faucet off.
Keep the area used to prepare medications clean! Clean the counter surfaces
often and wipe up spills immediately.
The area where medications are stored should be well organized, with no
clutter. It should also be quiet, well lit, and separate from places where
people gather.
Know the client:
Be familiar with the client’s medical history.
Know the client’s medication background, allergies and diet.
Locate the name and contact numbers of the client’s health care
practitioner so that questions may be asked about the client’s medications,
if necessary.
Understand the best positioning and adaptive devices for each particular
client. If the positioning for a specific client’s medication administration
is unknown, ask the supervisor!
Other safety concerns:
There should be no use of cell phones during medication administration.
Other distracters to avoid would be attention to other household tasks-i.e.
laundry, cleaning of floors or bathrooms, meal preparation, watching
television, etc.
16. Procedures for each Route of Medication Administration
Oral Medication
Wash hands.
Gather equipment – medication spoon or syringe, medicine cup, gloves,
pill cutters or crushers, paper towels, glass of water or other liquid with
which to take or follow medication.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR and check expiration dates.
Follow any special instructions, for instance "take on empty stomach,"
"take with food," "check pulse and hold for pulse less than 60," "do not
give if client is having diarrhea."
Place a dot on the MAR.
Pop or pour the medication into a medication cup – remember to pour a
pill from the container into the lid, then into the medication cup. If too
many pills are poured into the lid, the MAP can pour them back into the
bottle and try again. Do not touch with fingers.
For liquid medications, shake bottle before pouring (as directed by
label), make sure that the cup is on a level surface for accurate measuring,
pour away from the label. Wipe the lid and neck of the bottle with a
dampened paper towel before returning to storage. Read the amount of
medication at the bottom of the curve of the liquid in the medication cup at
eye level.
Crush medications if directed to do so, and mix with applesauce, pudding,
or ordered substance.
Compare the label on the medication to the directions on the MAR again.
Return the medication to the storage area and lock.
Hand the medication cup to the client, followed by glass of liquid with
which to swallow the pills. Verify that the client swallows the medication.
Give pills first, liquids last. If giving a medication for cough, it should
be given last to coat the throat.
Again check the label against the MAR. Sign the MAR and blister pack, if
used.
Wash hands.
Document on the MAR. Controlled substances requires additional
documentation on the Controlled Drug Count Form (see attached)
Check on client and assist to comfortable position, if needed.
Check client for response to medication, especially if PRN medication.
Buccal or Sublingual medication
Wash hands.
Gather equipment-medication cup, gloves, glass of water or other liquid
with which to take or follow medication.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR and check expiration date.
Follow any special instructions, for instance "take on empty stomach."
"take with food," "check pulse and hold for pulse less than 60," "do not
give if client is having diarrhea."
Place a dot on the MAR.
Pop or pour the medication into a medication cup-remember to pour a pill
from the container into the lid, then into the medication cup. If too many
are poured into the lid, the MAP can pour them back into the bottle and try
again. Do not touch with fingers.
Compare the label on the medication to the directions on the MAR again.
Return the medication to the storage area and lock.
Hand the medication cup to the client and instruct them to place the
medication under their tongue if sublingual, or between cheek and gum if
buccal. If the client is unable to do this, the MAP should carefully place
the medication in the appropriate spot.
Instruct the client not to drink liquids until the medication has
dissolved and been absorbed.
Tell the client not to swallow the pill, and to let it dissolve by itself
Again check the label against the MAR. Sign the MAR and blister pack, if
used.
Wash hands.
Document on the MAR. Controlled substances require additional
documentation on the Controlled Drug Count Form (see attached).
Check on client and assist to comfortable position, if needed.
Check client for response to medication, especially if PRN medication.
(if PRN medication document response on back of MAR)
Inhaled medications
Inhalers (such as albuterol)
Wash hands.
Gather equipment – spacers, glass of water, tissue,
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Remove the cap from the inhaler and ensure that mouthpiece is clean;
shake if indicated.
Ask the client to exhale and then place the mouthpiece, tilted slightly
upward, into his/her mouth. Instruct the client to close lips around
mouthpiece.
Use a spacer attached to the mouthpiece as instructed if the client is
unable to close lips around mouthpiece.
Ask the client to inhale slowly as you push the cylinder of the
medication down against the mouthpiece one time.
Ask the client to hold his/her breath for several seconds.
Remove the mouthpiece from the client’s mouth.
Ask the client to exhale slowly through pursed lips.
If a second puff is required, wait at least one minute between each puff,
and then repeat above instructions.
Ask the client to rinse out his/her mouth.
Rinse the mouthpiece with warm water, dry with a paper towel, and recap.
Store medication in properly locked area.
Wash hands.
Document on the MAR.
Have the client use any inhalers first and then take oral medications.
Dry powder inhalers (such as Advair)
Follow the steps above for inhalers through placing a sot on the MAR.
Pull back the dose lever until it clicks into place. Do not tilt the
inhaler, and ask the client not to breath into the inhaler.
Ask the client to exhale.
Place the mouthpiece into the client’s mouth, and instruct the client to
close his/her lips around it.
Instruct the client to inhale forcefully and deeply.
. Ask the client to hold his/her breath for several seconds.
Remove the mouthpiece from the client’s mouth.
Ask the client to exhale slowly through pursed lips.
If a second puff is required, wait at least one minute between each puff,
and then repeat above instructions.
Ask the client to rinse out his/her mouth.
Store medication in properly locked area
Wash hands.
Document on the MAR.
Have the client use any inhalers first and then take oral medications.
Nose sprays
Wash hands.
Gather paper towels or tissues and gloves.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Put on gloves.
Ask the client to blow his/her nose gently to clear the nasal passages.
Ask the client to tilt his/her head backwards; making sure the neck is
supported.
Elevate the nostrils slightly by pressing the thumb against the tip of
the nose.
Hold the spray just above the client’s nostril, without touching it. Use
spray as directed by the prescription or order.
Ask the client to inhale slowly and deeply through the
nose, hold breath for several seconds and then exhale slowly. Client may
blot nose with tissue, but caution client to not blow nose for several
minutes following instillation.
Rinse the tip of the spray bottle with hot water or wipe with an alcohol
pad and dry with tissue before recapping.
Remove gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on the MAR.
Nose drops
Follow the directions for nasal sprays above, making sure to use the
correct number of drops.
Do not touch the nostrils with the dropper.
Document on the MAR.
Transdermal Medication – self adhesive patches
Wash hands.
Gather equipment – gloves, washcloth and towel.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Provide for privacy for client.
Wear gloves; check client for latex allergies if using latex gloves.
Remove old patch and dispose of appropriately.
Make sure site for new patch is clean and dry. If needed, clean area with
soap and warm water and then pat area dry. Do not apply over a bony
prominence such as the collarbone or shoulder blade. Do not apply the
patch over a pacemaker site. Apply in a hairless area. Apply the patch to a
different site with each new patch application. Avoid areas of increased
warmth (such as the back if bed-ridden) which would promote faster
absorption. Do not apply to areas with redness, rash, or broken skin. Report
these areas to your supervisor.
Open the package and remove the patch.
Date and initial the patch.
Remove the backing from the patch.
Apply the patch to the chosen spot, pressing firmly around the edges to
adhere.
Apply, and cover patch, if applicable, making sure it is dated and
initialed.
Remove gloves and dispose of properly
Place medication back in locked storage area.
Wash hands.
Document on the MAR.
Topical Medications (such as ointments, lotions, creams, sprays)
Wash hands.
Gather equipment – gloves, applicators, wash cloth and towel, water.
Verify first five Rights of Medication Administration, making sure you
understand where on the client’s body the medication is to be applied.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Provide for privacy for client.
Wear gloves: check client for latex allergies if using latex gloves.
Make sure site for medication is clean and dry. If not, cleanse gently
with soap and warm water and pat dry, unless the prescription directions say
otherwise. Previous medications are usually removed before applying
additional medication, except for lotions which are used for soothing the
skin).
Squeeze a small amount of medication (if a cream, ointment, or lotion)
onto the applicator. Always shake lotions to activate ingredients. If
applying to a large surface area, warm lotions/creams in hands before use so
the client does not chill. Keep powder away from the nose and mouth to keep
the client from inhaling it. If applied to the face, apply while the client
exhales. If applying nitroglycerin ointment, measure in centimeters or
inches on special provided paper or applicator. Do not apply to areas
with redness, rash, or broken skin unless you are treating that area (rash).
Apply gently to correct site.
If a spray, hold the can about 6" away from site and spray.
Discard applicator.
Gently lay dressing over site, if applicable, and secure. MAP may only
apply simple dressings which are intended to cover and protect, such as
Band-Aids, Telfa or gauze pads.
Discard gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on the MAR.
Eye Medications (ointments and drops)
Wash hands.
Gather equipment – gloves, cotton balls or gauze, tissues, clean wash
cloth, towel, warm water, simple dressing, if ordered.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR. Check number of drops and eye (right,
left, both).
Place a dot on the MAR.
Wear gloves: check client for latex allergies if using latex gloves.
Assist the client to a comfortable position either sitting or lying down
with head tilted back. May turn the head slightly toward the affected side
to prevent medication or tears from flowing toward the opposite eye. If
using both drops and ointment, administer the drops first and wait 5 minutes
before applying the ointment.
Give client a tissue to remove solution/tears that may spill from eye
during the procedure.
Clean eye area if discharge or crusting is present. Use cotton balls
moistened with warm water (unless ordered otherwise). Use each cotton ball
for only one stroke, starting at the inner eye corner and working outward
away from the nose. If using wash cloth instead of cotton balls, rotate to
new area of wash cloth with each stroke.
After removing the lid to the medication, place on a clean tissue, on its
side.
Gently pull down on the lower eyelid.
Ask the client to look upward.
Approach the eye from the side and drop medication into the center of the
lower lid. Do not touch the eye with the dropper, or drop medication
directly onto the surface of the eye.
If using ointment, gently apply the prescribed length of ointment in a
thin line along inner edge of the lower lid moving from the inner corner to
the outer corner. Do not touch the eye with the end of the tube. If the
client blinks, closes eye, or if drops/ointment lands on the outer lid
margin, repeat the procedure
Release the lower lid after the eye drops or ointment is administered.
If drops, ask the client to close eyes slowly, but not to squeeze or rub
them. Apply gentle pressure over inner corner of eye to prevent eye drops
from flowing into tear duct. If ointments, ask the client to close eye and
rub lid gently in circular motion, if rubbing is not contraindicated.
Client may open eyes after 30 seconds and gently wipe off excess
medication or tears with a tissue.
If multiple medications are needed for the same eye, you must wait at
least 5 minutes between medications.
Remove gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on MAR.
Ear Medications
Wash hands.
Gather equipment – gloves, tissues clean wash cloth and warm water.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Put on gloves.
Assist the client to a comfortable position either sitting with head
tilted to the side or lying down so that ear needing drops is up.
Warm the medication to body temperature (hold in hand, or place in cup of
warm water for a few minutes) to minimize discomfort to the client.
Gently pull ear up and back if the client is an adult, and down and back
if a child.
Place drops in the ear according to the prescription
letting the drops fall on the side of the ear canal and not directly on the
eardrum. Take care not to touch the ear with the dropper.
Release the ear and have the client hold the head position for at least
2-5 minutes.
Allow client to wipe ear with a tissue.
Instill drops in the other ear, if prescribed, using the same procedure.
MAP may insert or remove cotton portion (wick) into or from outer part of
canal if ordered.
Remove gloves and dispose of properly.
Place medication back in locked storage area.
Wash hands.
Document on MAR.
Rectal Medications
Suppositories
Wash hands.
Gather equipment – gloves, tissues, water soluble lubricant (K-Y jelly)
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Place a dot on the MAR.
Return the medication to the storage area and lock.
Explain to the client what is going to be done, and provide for privacy.
Place the client in a side lying position, preferably on the left, with
the right leg bent at the knee and drawn up towards the stomach. Keep client
covered as much as possible. Place waterproof pad or other absorbent
material beneath client’s hips and buttocks.
Remove wrapper and lubricate the suppository rounded end or remove cap
and lubricate tip (if applicable) and finger tips with a water soluble gel
(K-Y jelly).
Separate the buttocks and then have client relax by breathing slow, deep
breaths through the mouth while the suppository is gently inserted through
the anus about 4 inches for adults and 2 inches for children and infants. Do
not attempt to push the suppository through stool. Instead try to place it
along the side of the rectal space.
Hold the buttocks together, or press lightly against the anus with a
tissue until the urge to push the suppository out has passed. Ask client to
remain on side or flat for at least 5 minutes.
Remove gloves and disposes of properly.
Assist client to rearrange clothing, etc. Be sure that client understands
that he/she is to retain the suppository, usually for 30-45 minutes after
insertion. Have some way (bell) for client to alert staff of urgency if the
suppository was a laxative or stool softener.
Wash hands
Document on MAR.
Observe and record effects of suppository in comments section of MAR
Enemas (such as Fleet’s)
Follow steps through placing the client in the proper position for
suppositories.
Remove cap and gently insert lubricated enema tip slowly into rectum
until the entire tip is in the rectum (3-4 inches): if the tip is not
lubricated, use water soluble gel (K-Y) to lubricate. It is best to guide
along the rectal wall, and not try to push it through any stool that may be
present.
Gently squeeze the enema bottle slowly (to prevent cramping) to expel the
contents into the rectum and colon.
If the client begins to cramp, stop squeezing until the cramp eases and
then resume squeezing slowly. Encourage the client to hold the enema for as
long as possible until the urge to have a bowel movement occurs (2-5
minutes).
Assist the client to the toilet, beside commode, or bedpan, if necessary.
Attend to any cleaning of client that is needed.
Remove gloves and dispose of properly.
Wash hands.
Document on MAR. Also document results of enema per the company policy
and in the comments section of the MAR.
Enteral Medication
For clients receiving continuous feeding through their tube, make sure to
turn the feeding off at least 30 minutes before giving medication. Get a
written order for when to pause pump and for when to resume feeding.
It is extremely important that the MAP understand how to use the type of
tube a particular client has. If at any time a MAP is asked to give medication
through a tube or device with which the MAP is unfamiliar, the MAP must ask
for help. The MAP may need to be validated by a RN or MD if the device is
unfamiliar to you. The MAP should check with the supervisor.
Wash hands.
Gather equipment – gloves, extension tubing, cup, warm water, pill
crusher, 30-60 cc oral, enteral or catheter tipped syringe.
Verify first five Rights of Medication Administration.
Unlock the medication storage area and remove one client’s medication at
a time.
Select the needed medications, making sure to compare the label to the
order or prescription to the MAR.
Prepare the medications as appropriate for administration through the
tube – an order is needed to crush, dissolve, or dilute any medications. If
the medication is not a liquid and there is an order to mix, then mix with
10-30 cc of warm water. Liquids should not be mixed with water. Each
medication must be administered separately from others. Place a dot on the
MAR.
Position the client appropriately. If in bed, the head of the bed must be
elevated at least 45 degrees in the position that is specific to that
individual. Explain to the client what you are going to do.
Put on gloves.
Connect the extension tubing, if necessary.
Flush the tube with at least 30cc of warm water, or the amount ordered by
the health care practitioner. Do not force a flush if the tube is not
flowing easily. Contact supervisor.
Pour the first medication into the syringe, and allow to flow slowly by
gravity.
Flush with at least 5cc water via gravity after each medication, and
repeat with each medication until all medications are given. It is a good
idea to give liquid medicines first, medicines that need to be dissolved
second and thick medications last.
Once all medications are administered, flush tube with at least 30cc warm
water via gravity, or the amount ordered by the health care practitioner.
Reclamp tube, or disconnect the extension set and reinsert the stopper or
plug.
Rinse equipment with warm water and dry. Replace equipment every 24
hours.
Keep the individual upright for at least an hour.
Remove gloves and dispose of properly.
Wash hands.
Document on MAR.
These are general instructions for giving medications through a feeding
tube. Check with the prescribing health care practitioner about specific
instructions for the client being assisted.
Positioning for medication administration:
|
ROUTE
|
BEST BODY POSITION
|
|
PO – By mouth
|
Sitting upright
|
|
Ophthalmic (eye medication)
|
Sitting upright with head tilted back and supported – OR Lying on back
with head tilted back over a pillow
|
|
Otic (ear medication)
|
Lying on the opposite side that medication is given or sitting with
head tilted to side with ear needing medication is up.
May turn to the other side after 5 minutes if medication is ordered for
both ears
|
|
Topical medications
|
No specific positioning is needed. If possible, keep the client off of
the body part being treated for a few minutes.
|
|
Transdermal patches
|
No specific positioning needed.
|
|
Nasal drops and sprays
|
Sitting with the head tilted back and supported – OR
Lying in bed with the head tilted back
|
|
Inhalers
|
Sitting upright in chair or in bed with head of bed at a 45 degree
angle.
|
|
Rectal
|
Side-lying, preferably on left side with right knee bent with knee
pulled up toward stomach.
|
|
Enteral (G-tube)
|
Lying in bed with head of bed at a 45 degree angle or higher – OR
Sitting upright in a chair
|
17. Medication Administration Documentation (Appendix: Medication
Administration Record (MAR) and PRN MAR APD form 65G7-00)
When a MAP gives a medication, or supervises the client giving him/herself
medication it must be written down and recorded somewhere. This is done on a
Medication Administration Record, commonly called a MAR. Documenting that the
medication has been taken is done AFTER the person has actually swallowed the
medication, or after it has been applied, inhaled, inserted, etc – by method
that the medication has been given.
This MAR is a LEGAL record of what medication a client has received during
his/her day. All entries, even errors, must always remain. This means that the
MAP may not change an entry – he or she may only cross it out with one line
and initial with the word "error." Any clarifications may be made in the notes
section on the back of the form.
There is an APD approved MAR that may be used. It is also permissible to
use a facility or pharmacy generated form, as long as it contains the required
information, as follows:
Client’s name
Allergies to food or medication or other substances
Name of each medication the client takes
Strength of the medication – for instance, 5mg per tsp
Health care practitioner who prescribed the medication
Date the medication was ordered
Any date the medication was changed, including the date the medication
was discontinued
Prescribed dosage for the medication – for instance, 10mg, or 15mg tab,
give two tabs
Times the medications are to be given
Route by which the medication is to be given
Instructions for crushing, mixing or diluting the medication, if there
are any
Dates each medication is to be given
Each MAP’s initials and signature for identification of initials
A record of any missed medications
MAP must initial and circle the correct square on the MAR
Must turn the MAR over, and write down the reason the medication was
not taken, using the codes on the back of the form
MAR documentation
The medication order written on the MAR must match the pharmacy label
exactly. If the pharmacy label states "Buspar 5 mg-- take 2 tablets by mouth
daily", the MAR cannot read differently.
Do not use abbreviations on the MAR.
Dot system: (this is a best practice system) The MAP prepares the
medication. Recheck the MAR prior to giving the medication and place a dot
in the place provided for initials. Immediately following administration of
medication, return to MAR and add MAP initials.
Complete administration for one client before starting another client’s
medication pass.
Use code sheet to identify the reason a medication is not given (see How
to Document Missed Medication, below).
When an order is changed, the original medication entry on the MAR should
not be changed. Instead the original order should be marked discontinued
with the date and time, initialed, and highlighted in yellow. The new order
should be written in a new space.
MAR must be initialed and signed with full signature of all individuals
who administer medications or supervise self administration of medication.
Medication errors-follow medication error guidelines per Florida
Administrative Code chapter 65G-7 (see medication error section).
Any changes in directions for a medication must be accompanied by a
written prescription issued and signed by the client’s health care
practitioner. A faxed copy of the prescription is acceptable.
Authorization for Medication Administration," APD Form 65G7-01, Informed
Consent for Medication Administration" APD Form 65G7-02, and a copy of the
updated prescriptions and side effect sheets must be readily available for
review by the MAP. Best practice is to keep these in the onsite client
Medication Administration Record (MAR) book, but they may also be kept
separately, as long as they are easily accessible to the MAP giving the
medications.
An updated picture of the client should be in the Medication Administration
Record book (Best practice, but not required).
Documenting on the PRN MAR
There is an APD approved PRN MAR that may be used. It is also permissible
to use a facility or pharmacy generated form, as long as it contains the
following information:
Client’s name
Allergies to food, medication, or other substances
The month and year this MAR covers
The ordering MD (or other prescriber)
The date of the order
The medication name, dose, and route
The date and time given with the MAP’s initials
The signature of the MAP at the bottom of the form to identify the
initials.
A copy of the prescription or order must be kept with the MAR or easily
accessible. It must contain the following information:
The name of the medication
The prescription number, if applicable
The prescribed dosage
Specific directions for use of the medication, including:
the reason it should be given (fever over 101, or cough, for
instance)
the time intervals for giving it (Q2hrs, QHS, etc)
the maximum number of doses
the maximum number of days the medication should be given
the conditions under which the health care provider should be
notified (fever over 102.5, pain not relieved within 24 hrs, swelling or
redness, etc)
A MAP may only give a PRN medication for the reason it was prescribed.
Some examples:
If Benadryl (diphenhydramine) is ordered for itching, the MAP may NOT
give it to help someone sleep, even though it is often used for that. If
it is ordered for sleep, the MAP may NOT give it for itching.
If acetaminophen (Tylenol) is ordered for temperature over 101 or
headache, a MAP may NOT give it for muscle aches.
If Vicodin is ordered for backache that is the only reason the MAP
may give it. If the client complains of foot pain, he/she could not have
the Vicodin for that.
When administering PRN medications, a MAP must observe the client for a
minimum of 20 minutes. If the client continues to have the same complaint
(itching, or headache, for example), the MAP should inform the supervisor.
As with the regular MAR, abbreviations should not be used, and the order
written on the MAR should match the label on the medication exactly, if
there is one. Many PRN orders are for OTC medications, which will not have a
pharmacy label. The MAP must be very careful to compare the order to the
MAR, and to the label on the medication to make sure he or she is giving the
correct dose of the correct medication.
For example:
Acetaminophen 650mg PO is ordered for headache. A bottle of Tylenol
325mg tablets in house stock. Acetaminophen is the generic name for
Tylenol and will be noted as such on the label, so the MAP could give
the medication. The order is for 650mg, so the MAP would need to give
two tablets (325mg + 325mg = 650mg)
Atarax 50mg is ordered for itching. Diphenhydramine 25mg capsules are
in house stock. While 2 capsules would equal 50mg, the MAP cannot give
diphenhydramine instead of Atarax – they are NOT the same drug. In this
case, the MAP should look in the client’s own medication supply for the
Atarax – it would probably not be a house stock medication. This
illustrates that the MAP may not guess!!! The MAP must look it up
in a drug reference or call the pharmacy to ask if he or she is not
sure. The MAP never gives a medication unless he or she is sure it is
the one that was ordered!
How to Document missed medication
Procedure:
Obtain the MAR (Medication Administration Record)
Determine the reason the client is not taking the medication.
Place the staff initials on the front of the MAR and circle initials then
place the appropriate code number, date and time on the back of the MAR:
1. Home visit
2. ADT/ School/ Work
3. ER/ Hospitalization
4. Refused/ Chose not to take
5. Medication not available—explain on back of MAR
6. Held per MD order/ NPO—explain on back of MAR
7. Other—explain on back of MAR
If code #5, #6 or #7 is used, the MAP must explain on the back or
explanation area of the MAR. The explanation area should contain the name
and dose of the medication, date and time of occurrence, the MAP’s signature
and initials, and an explanation of what occurred, and who was notified.
The MAP should notify the designated person for his or her facility,
(e.g. supervisor, WSC, nurse, MD).
Remember that the facility may be using a different code than is listed
above, if it is using a pharmacy or facility created MAR. This is fine, as
long as all of the items listed are present.
18. The Do’s and Don’ts of Medication Administration
DO’s:
Identify client prior to medication administration.
Call client by name
Ask client to tell you his/her name if possible
Use photo ID if present in MAR
Ask another staff member to identify client
The staff member that prepares and performs the three medication checks
must be the person who administers the medication to the client.
Do administer medication within one hour of designated time.
Provide liquids (preferably water if on empty stomach-at least ½ cup) or
food to aid in swallowing medication.
Ask client to open his/her mouth and visually check that medications have
been swallowed.
Report all problems to nurse or supervisor per the facility’s policy.
Make at least 2 attempts to educate client to take medication. If
medication is refused, MAP is to contact the supervisor immediately.
Observe client for at least 20 minutes for adverse medication reactions
after the first 3 doses of any new medications, and report immediately if
noted. (time frame of reaction may vary per individual)
Be kind and friendly to clients and assist as needed.
Always listen to the client. Double check any questions he or she has.
Administer medications to one client at a time.
Only administer or assist with self administration of medications
prescribed in writing by the health care practitioner and properly labeled
and dispensed.
Return each person’s medication to its storage location before assisting
another individual and retrieving his/her medications.
Have understanding of how to operate equipment used in medication
administration.
Check for special instructions such as check blood pressure or heart rate
before administration.
Ensure that all prescriptions are filled on time. If the MAP is not
directly responsible for routine refills he or she should notify the
provider that is responsible for refilling the medications and let him/her
know of need for more medications. Document notification.
DON’Ts:
Do not assume anything—always consult with the designated person at the
facility (nurse preferably) if there are any doubts or questions regarding
medication orders.
Do not prepare syringes for injection.
Do not administer vaginal or tracheostomy medications.
Do not mix or pour medication administered through intermittent positive
pressure breathing machines unless trained by certified equipment
technician, respiratory therapist, or registered nurse, one-on-one,
step-by-step, in proper use and maintenance of such equipment. Training and
qualifications of trainer, and description of breathing equipment used must
be documented in the client’s file.
Do not do any irrigations or debridement of skin structures. Do not do
any dressing changes. The MAP may reinforce dressing to keep body fluids
from contaminating clothing, etc. The MAP may only change those dressings
that are intended to cover and protect an area. Some examples would be
Band-Aids, Telfa pads, or gauze dressings. A MAP may not change or apply
dressings to decubitus ulcers (bedsores), or surgical wounds that require
packing, or irrigation. If in doubt, the MAP should ask the supervisor.
Do not give any medication for which administration requires judgment or
discretion by unlicensed MAP.
Never give medication to a client that has been prepared by another staff
member.
Do not administer a medication if it is expired or is no longer
prescribed - always check the directions and expiration date of medications.
Do not cut or break any unscored tablets. MAP’s can cut scored tablets,
however it is best practice for the tablets to come from the pharmacy in
proper dosage.
Do not record that medications have been given until you ensure all
six rights of the individual have been met.
19. Other Documents (and where they are kept)
In the client record where the client lives:
Completed MAR forms
Completed controlled medication count forms
Authorization for Medication Administration form
Original Informed Consent form
Off-Site Custody of Medication form for each absence
Depending on where the client lives, there may be a MAR book for the entire
facility with all clients included (usually seen in group homes), or each
client may have a separate record that includes the MAR (usually in supported
living or family home). Wherever the current MAR is, the information about
side effects, adverse reactions, and drug interactions for each medication
must be kept in the back of that client’s MAR. Copies of prescriptions or
orders for current meds are kept in the same area of the book or record.
Sometimes this may take the form of a "pharmacy profile" from the pharmacy,
signed by the pharmacist. It is good to have copies of any lab report or
consultations related to these medications also with the MAR.
For instance… in X group home, all clients’ MARs are kept together in a big
notebook – behind each client’s MAR there should be a section or set of drug
information sheets from the pharmacy for each medication, as well as the
orders, prescriptions, or pharmacy profiles for that client.
MAPs should keep their original copies of their validation certificates and
also their Certificate of Completion of the Medication Administration Course.
Employers should be provided with a copy of these certificates.
20.Common Medications – Indications, side effects, and adverse reactions
(Clark, 2008)
Below are examples of classes of drugs and the most common medications in
each
Cardiovascular System Medications
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Vasodilators
|
Relax or dilate the walls of arteries. Used especially to control
angina.
|
Sublingual Nitroglycerine (Nitrostat); Isosorbide (Isordil, Imdur)
|
|
Diuretics
|
Helps to eliminate excess fluid through urinary excretion. Often given
in conjunction with antihypertensive drugs to treat high blood pressure,
used to treat congestive heart failure (CHF)
|
Hydrochlorothiazide (HydroDiuril);
Spironolactone (Aldactone);
Furosemide (Lasix) and Demadex
Bumetadfine (Bumex)
|
|
Antihypertensive
|
Drugs that lower blood pressure
|
Hydralazine (Apresoline); Captopril (Capoten); nifedipine (Procardia);
metoprolol (Lopressor), verapamil (Calan, Isoptin)
|
|
Antiarrhythmic
|
Drugs that treat irregular heartbeats
|
Digitalis (Lanoxin); Quinidine (Quinora); Procainamide (Pronestyl)
|
|
Anticoagulants
|
Prevents blood from clotting
|
Warfarin (Coumadin), Affronex, Plavix
|
Most side effects from cardiovascular drugs come from overdosage. Report any
of the following side effects to the health care provider immediately:
Headache, nervousness, "pounding pulse", weakness, flushing of skin,
fainting
WARNING: MONITOR THE USE OF ASPIRIN WITH ANTICOAGULANTS! This is
because both aspirin and anticoagulants thin the blood, which can lead to
bleeding. Make sure the client’s PCP is aware if both are prescribed.
Respiratory System Medications
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Antitussives
|
Cough Suppressants
|
Codeine is a narcotic antitussive
Dextromethorphan (Dimetapp-DM, non-narcotic antitussives.
|
|
Expectorants
|
Break up thick mucus secretions in the lungs and bronchi
|
Robitussin
|
|
Decongestants
|
Reduce swelling and some dry up the mucous membranes
|
Neo-Synephrine, Benzedrex; Afrin
|
|
Bronchodilators
|
Relaxes and expands the bronchioles. Most often prescribed as inhalers
|
Albuteral (Proventil and Ventolin); Primatine Mist; Theophyllin (Slo-Bid
and Theo-Dur).
|
Medications for the Skin
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Protectives and Astringents
|
To cover, cool, dry or soothe inflamed skin. They form a long-lasting
film protecting the skin from water, air, and clothing. Astringents shrink
blood vessels, dry up secretions from scrapes and cuts, and lessen
sensitivity of the skin.
|
Dimeticone, Stoma, Conotrane
Zinc oxide, Calamine lotion
Allentoin
|
|
Antipruritics
|
Relieve itching caused by inflammation
|
Emollients, Oils, Creams, Lotions sooth and relive the itching.
|
|
Anti-Inflammatory (topical corticosteroids)
|
Relieve itching; suppress the body’s natural reactions to irritation;
tighten the blood vessels in the area of the inflammation
|
Triamcinolone (Aristocort, Kenalog) and Hydrocortisone
|
|
Anti-Infective Drugs
|
Kill or inhibit organisms that cause skin infections
|
Antibiotic ointments: Neosporin and Bactroban
|
|
Antiseptics
|
Inhibit germs on skin surfaces
|
Alcohol; Betadine
|
|
Topical Anesthetics
|
Relieve pain on the skin surface or mucous membranes by numbing
|
Solarcaine
|
|
Parasiticides
|
Kills insect parasites that infest the skin, (Scabies, Lice)
|
Kwell, Nix
|
Urinary System Medications
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Antibiotics
|
One of its uses is to treat urinary tract infections
|
Cipro, Bactrim, Septra, Macrobid
|
|
Diuretics
|
Increases the output of water. Often given to maintain normal urine
production for persons with kidney disorders.
|
Triamterine, (Dyazide); Hydrochlorothiazide (HCTZ), Furosemide (Lasix)
Esidrix, Serpasil
|
|
Analgesics
|
Relieve pain from UTI
|
Pyridium
|
Urinary analgesics may stain the urine bright orange. Make sure that the
client and/or caregivers are aware of this so that they don’t become alarmed.
Gastrointestinal System Medications
Most gastrointestinal disorders not only require medications but also
physical care. If a person suffers from chronic GI problems they should be
overseen by a doctor.
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Antacids
|
Relieve gastric and ulcer pain
|
Milk of Magnesia; Maalox; Gelusil; Mylanta
|
|
Acid Blockers
|
Block acid from entering the stomach
|
Ranitidine (Zantac), Axid, Prevacid and Prilosec
|
|
Antiflatulents
|
Relieves gassiness and bloating that accompany indigestion
|
Phazyne, Di-Gel, Maalox, Mylanta
|
|
Emetics
|
Produce vomiting in cases of poisoning
|
Ipecac Syrup
|
|
Anticholinergics and Antispasmodics
|
Treat ulcers and irritable bowel syndrome (IBS)
|
Dicyclomine (Bentyl); Levsin
|
|
Anti-inflammatory drugs
|
Used to treat colitis
|
Medrol and Prednisone
|
|
Gastrointestinal stimulant
|
Speeds transit time of food through the bowel, relieves nausea,
promotes gastric emptying
|
Metoclopramide (Reglan)
|
|
Laxatives and Purgatives:
|
Promote bowel movements
|
|
|
Stimulants
|
Helps push fecal matter through the intestines
|
Castor Oil, Senokot, Dulcolax, Ex-Lax
|
|
Saline
|
Softens feces and stimulates bowel movements
|
Milk of Magnesia, Epson Salts
|
|
Bulk Formers
|
Stimulate bowel movements
|
Metamucil
|
|
Emollients and Lubricants
|
Allow fecal matter to pass more easily through the intestine (stool
softeners)
|
Docusate (Colace), Peri-Colace and Senokot-S
|
Medication that helps aid digestion must be given before, during, or after
meals as prescribed. Some must be given without food. Pay close attention to
the instructions. Side effects may include diarrhea and/or nausea; with the
use of metoclopramide, assess client for tardive dyskinesia (jerky movements
of the limbs) regularly.
Endocrine System Medications
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Antidiabetic Agents/Oral
|
Oral medications used to control blood sugar levels
|
Glipizide (Glucotrol); Metaformin (Glucophage); Glyburide (Micronase
Diabeta)
|
|
Antidiabetic Agents/Injectable
|
Injectable Antidiabetic Agents
|
Humalog, Novolin, Humulin
|
|
Hormonal Drugs
|
Used for disorders related to problems with thyroid, pituitary glands,
adrenal, pancreas, ovaries and testes by regulating hormones
|
Thyroid, Synthroid, Vasopressin (Pitressin), Corticotropin (ACTH),
Androderm
|
Ensure that residents take these medications at their regularly scheduled
times. DO NOT MISS DOSAGES. If the resident stops taking this
medication, notify the health care provider
Please remember that MAPs are not permitted to assist with injectable
medications. If a client is authorized to self administer without supervision,
a MAP may remind them that it is time for them to take their medications, and
may bring the medications to the client – but they may not fill syringes,
inject medications, or supervise a client who is using injectables.
NERVOUS SYSTEM MEDICATIONS
|
TYPE
|
USE
|
COMMON DRUGS
|
|
Anticonvulsants
|
Used to treat seizure disorders
|
Phenytoin (Dilantin); Depakote, Carbamazepine (Tegretol); Clonazepan (Klonopin),
Gabapentin (Neurontin)
|
PSYCHIATRIC MEDICATIONS are given to decrease the symptoms of mental
disorder. Each medication helps a certain set of symptoms.
ANTI-DEPRESSANTS are used to decrease symptoms of depression such as
troubled concentration, loss of enjoyment, changes in sleeping and eating
patterns, or thoughts of wishing to die.
|
BRAND NAME
|
GENERIC NAME
|
|
Elavil
|
Amitriptyline
|
|
Norpramin
|
Desipramine
|
|
Tofranil
|
Imipramine
|
|
Pamelor
|
Nortriptyline
|
|
Sinequan
|
Doxepin
|
|
Ludiomil
|
Maprotiline
|
|
Paxil
|
Paroxetine
|
|
Prozac
|
Fluoxetine
|
|
Wellbutrin
|
Bupropion
|
|
Zoloft
|
Sertraline
|
|
Desyrel
|
Trazodone
|
ANTI-ANXIETY Medications are given to decrease symptoms of anxiety
such as panic, intense fears, repetitious thoughts, stomachaches, fast
breathing and heartbeat, and tremors. THESE MEDICATIONS ARE OFTEN HABIT
FORMING.
|
BRAND NAME
|
GENERIC NAME
|
|
Ativan
|
Lorazepam
|
|
Klonopin
|
Clonazepam
|
|
Librium
|
Chlordiazpoxide
|
|
Serax
|
Oxazepam
|
|
Tranxene
|
Clorazepate
|
|
Valium
|
Diazepam
|
|
Xanax
|
Alprazolam
|
|
Buspar
|
Buspirone
|
ANTI-PSYCHOTIC MEDICATIONS are given to decrease symptoms of
psychosis such as hallucinations, delusions, or disorganized thinking.
|
BRAND NAME
|
GENERIC NAME
|
|
Mellaril
|
Thioridazine
|
|
Stelazine
|
Trifluoperazine
|
|
Thorazine
|
Chlorpromazine
|
|
Trilafon
|
Perphenazine
|
|
Navane
|
Thiothixene
|
|
Loxitane
|
Loxapine
|
|
Moban
|
Molindone
|
|
Clozaril
|
Lozapine
|
|
Risperdal
|
Risperidone
|
|
Haldol
|
Haloperidol
|
|
Prolixin
|
Fluphenazine
|
|
Zyprexa
|
Olanzapine
|
|
Seroquel
|
Quetiapine
|
Some side effects that are associated with anti-psychotic medications are
dangerous. Tardive dyskinesia is often seen in persons taking anti-psychotic
medications. Untreated the symptoms that are characteristic of this side
effect can become permanent. These include involuntary movements such as
facial tics; facial grimacing, eye blocking, lip smacking, tongue thrusting,
foot tapping, shuffling gait, head nodding, and moving ones head to the back
or to the side. If the MAP notices any of these symptoms, the health care
provider must be notified as soon as possible. One of the most serious side
effects is a life threatening problem called neuroleptic malignant syndrome
(NMS) which is a medical emergency. One would suspect NMS if the client has
a high fever, stiff muscles, sweating, fast or irregular heartbeat, change
in blood pressure, and confusion.
MOOD STABILIZING MEDICATIONS are used to treat the symptoms of mania
such as not sleeping for several nights, frantic highs, and drastic lows.
|
BRAND NAME
|
GENERIC NAME
|
|
Lithium
|
Lithobid, Lithium
|
|
Eskalith
|
Lithium
|
|
Tegretol
|
Carbamazepine
|
|
Depakote
|
Depakene, Valproic Acid
|
Lithium Toxicity occurs when the body has too much lithium and is a
potentially life-threatening side effect. It can also occur due to
dehydration. Dehydration results from diarrhea, too much alcohol, a bad
sunburn, vomiting or anything that causes the person to lose a lot of body
fluids.
Some or all of the following symptoms would be present if a person is
suffering from lithium toxicity: slurred speech, mental confusion, vomiting,
diarrhea, severe muscle tremors, severe drowsiness, poor coordination, and
coma. If a resident is showing these signs contact the health care provider
immediately or call 911.
UNDERSTANDING SIDE EFFECTS OF MEDICATION
A side effect is the body’s reaction to a medication, which is
different from that which was intended by the health care provider. There are
some general side effects that one should be aware of. Some mild side effects
can be taken care of by simple techniques. More severe side effects should be
reported to the consumer’s healthcare provider immediately (these are commonly
called ‘adverse reactions’. The facility should have clear procedures
for responding to changes in a client’s condition. These procedures should
describe the type of changes which should be documented in the client’s
records, when changes should be reported to the supervisor, nurse, or health
care provider, and who should call the health care provider. Before
administering a medication, find out what the facility’s procedure is.
Remember, the MAP is responsible for safely administering the needed
medications and for noticing side effects and responding to them in a timely
manner.
COMMON MILD TO MODERATE SIDE EFFECTS
|
SYMPTOM
|
ACTION TO BE TAKEN
|
|
Eyes sensitive to strong sun or light
|
Wear sunglasses, hat or visor, avoid prolonged exposure in the sun
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Dryness of lips and/or mouth
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Increase fluid intake; rinse mouth often with water, keep sugarless gum
handy, offer ice chips
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Occasional upset stomach
|
Drink small amounts of water; eat dry saltines or toast. DO NOT TAKE
antacids without consulting the health care provider or pharmacist
|
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Occasional constipation
|
Increase water intake; increase physical exercise; eat leafy green
vegetables or bran cereals, drink lemon juice in warm water
|
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Occasional dizziness
|
Get up slowly from a sitting or lying-down position
|
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Tiredness
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Take a brief rest period during the day; consult health care provider
|
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Dryness of skin
|
Use mild shampoo and soap, use hand and body lotion after each bath;
wear seasonal protective clothing
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Mild restlessness, muscle stiffness or feeling slowed down
|
Exercise, take short walks, stretch muscles, relax to music
|
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Weight gain
|
Increase exercise, watch diet and reduce overeating.
|
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Dark or discolored urine.
|
Increase fluid intake.
|
CALL THE HEALTH CARE PROVIDER IF NO RELIEF IS OBTAINED BY FOLLOWING THESE
SUGGESTIONS
MORE SERIOUS SIDE EFFECTS ‘ADVERSE REACTIONS’
If any of the following symptoms occur, the MAP must call the supervisor
and the health care provider immediately:
|
SYMPTOM
|
EXPLANATION
|
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Blurred vision
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Difficulty focusing eyes
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Drooling or difficulty swallowing
|
Spasms of swallowing muscles
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Body tremors or spasms
|
Involuntary shaking or tightening of muscles
|
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Diarrhea
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Liquid stools (for more than two days)
|
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Severe constipation
|
Unable to move bowels (for more than two days)
|
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Muscle rigidity
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Difficulty moving (e.g., mask-like face)
|
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Nervousness, inability to sit or lie still, or inner turmoil
|
Muscle restlessness in body, arms or legs
|
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Rash
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Skin eruptions, pimples on body
|
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Skin discoloration
|
Excessive pigmentation
|
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Sexual difficulty or menstrual irregularity
|
Delayed ejaculation; impotence; breast changes; unusual erections;
changes in periods
|
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Sunburn
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Over sensitivity to sun’s rays
|
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Tardive dyskinesia
|
Slow involuntary movements of mouth, tongue, hand or other parts of the
body
|
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Sleepiness during the day
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Excessive sedation
|
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Extreme difficulty urinating
|
Bladder tone relaxed
|
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Shortness of breath
|
Difficulty breathing, with or without exertion
|
Allergic reactions
An allergy is an abnormal response to something such as mold, pollen,
insect bites, foods and medications.
Mild – runny nose, sneezing, watery eyes, itchy skin with a rash, nausea,
vomiting, diarrhea.
More severe – we call anaphylactic shock. This is life threatening.
Symptoms include:
Flushing, rash and itchiness
Tingling of lips and tongue, may also have a metallic taste in mouth)
Heart racing, feels dizzy , anxious, has a feeling of doom
Swelling of tongue, lips and throat
Difficulty breathing as all air passages swell
Collapse
use epi- pen if applicable and call 911
COMMON SIDE EFFECTS AND DRUG INTERATIONS
|
Category
|
Frequently Used
|
Watch For
|
|
HEART
|
Digoxin, Procardia, Nitropatch, Calan
|
Slow pulse, weakness, agitation, dizziness, headache, local skin
irritation from Nitro ointments
|
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DIURETICS
|
Lasix, Bumex, Hydrodiuril, Demadex
|
Nausea, vomiting, loss of appetite, rash, dizziness headache
|
|
HIGH BLOOD PRESSURE
|
Tenorim, Capoten, Aldomet, Zestril. NO GRAPEFUIT JUICE WITH PROCARDIA
|
Fatigue, low blood pressure and/or pulse, nausea, vomiting, diarrhea,
rash, difficulty breathing, headache
|
|
RESPIRATORY TRACT
|
Antihistamines, Expectorants, Inhalants
Bronchodilators; Atrovent; Ispurel, Albuterol, Alupent, Theo-Dur,
Benadryl
|
Restlessness, nausea, vomiting, diarrhea, palpitations, dizziness,
headache
|
|
ANTIBIOTICS
|
Penicillin, Ceclor, Tetracycline, Erythromycin, Cipro, Amoxicillin.
WATCH ANTACIDS AND MILK PRODUCTS
|
New rash, itching, nausea, vomiting, stomach/abdominal pain, diarrhea
|
|
GI TRACT
|
Antacids, anti-diarrheals, laxatives, anti-ulcer (Tagamet, Axid,
Zantac)
|
Dizziness, nausea, vomiting, rashes, itching, constipation.
|
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STEROIDS
|
Medrol, Prednisone
|
Delayed wound healing, gastric ulcer
|
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SEDATIVES
|
Nembutal, Seconal, Restoril, Halcion, Ambien, Dalmane
|
Lethargy, hangover, rash, itching, nausea, vomiting
|
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ANTIDIABETIC AGENTS
|
ORAL: Glucotrol, Diabeta, Micronase
INJECTIONS: Humulin, Novolin
|
Nausea, heartburn, rash, facial flushing, dizziness
Low blood sugar, itching, local reaction at injection site
|
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THYROID HORMONES
|
Synthroid, Armour Thyroid, Levothroid
|
Nervousness, insomnia, tremor, nausea, diarrhea, headache
|
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SEIZURES (ANTI-CONVULSANTS)
|
Dilantin, Dilantin with Phenobarbital, Klonopin, Neurontin
|
Slurred speech, dizziness, insomnia, twitching, headache, increased eye
movement, confusion
|
|
ANTIDEPRESSANTS
|
Elavil, Wellbutrin, Prozac, Pamelor, Zoloft, Desyrel, Paxil NO ALCOHOL
|
Drowsiness, dizziness, rapid pulse, blurred vision, nausea, vomiting,
rash, itching
|
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ANTI-PSYCHOTICS
|
Thorazine, Clozaril, Haldol, Prolixin NO ALCOHOL
|
Low blood pressure, sedation, dry mouth, urinary retention,
constipation, rash, muscle stiffness, slow jerky movements
|
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PARKINSON’S
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Eldepryl, Sinemet, Levodopa
|
Aggressive behavior, involuntary grimacing or jerking motions, blurred
vision, nausea, vomiting, loss of appetite, dry mouth, bitter taste,
urinary frequency
|
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ANTICOAGULANTS
|
Coumadin: watch foods high in Vitamin K, watch aspirin
|
Bruising, hemorrhage, nausea, vomiting, diarrhea, rash
|
|
OPHTHALMIC (EYE) AGENTS
|
Pilocarpine drops, Betoptic drops, Timoptic, Xalatan
|
Diminished vision, burning or stinging
|
|
ANALGESICS FOR PAIN AND FEVER
|
Aspirin, Tylenol, Motrin
Narcotics: Tylenol #3, Darvocet N, Percocet
|
Rash, itching, GI tract sensitivity Watch for signs of distress, i.e.:
nausea, vomiting, diarrhea, and ANY SIGN OF BLEEDING
Lethargy, sleepiness, over-excitement, tremors, dizziness
|
|
MISCELLANEOUS
|
Fosamax
Miacalcin Nasal Spray
|
Wait 30 minutes after administering before taking any food or other
medication
Store in refrigerator. (Keeps 2 weeks after opening.)
|
21. Medication Errors (Appendix: Medication Error- APD form 65G7-05)
The National Coordinating Council for Medication Error Reporting and
Prevention defines a medication error as "any preventable event that may cause
or lead to inappropriate medication use or patient harm while the medication
is in the control of the health care professional, patient, or consumer. Such
events may be related to professional practice, health care products,
procedures, and systems, including prescribing; order communication; product
labeling, packaging, and nomenclature; compounding; dispensing; distribution;
administration; education; monitoring; and use."
Conditions which may lead to medication errors:
Preparing or administering medication in poor lighting.
Distractions of any kind while preparing and administering the
medication.
Talking to others
Talking on a cell phone, or sending and receiving text messages
Watching TV or listening to the radio
Attending to other tasks while preparing medications
Preparation of medication for more than one client at the same time.
Pre-pouring medications
A medication error is any of the following actions:
Giving the wrong medication
Giving the wrong dose of a medication
Giving the medication by the wrong route, for instance, putting eye
medication in the ear, or topical medication in the eye.
Giving a medication for any symptom, illness or reason other than the one
for which the medication was prescribed (most commonly seen with PRN
medications).
Giving a medication to the wrong client.
Giving the medication at the wrong time. Medications must be given within
60 minutes of the scheduled time.
Not documenting on the MAR immediately and accurately
Not filling a newly prescribed prescription within twenty four hours of
receiving the prescription.
Not refilling a current medication on time, resulting in one or more
missed doses of medication.
Giving an expired or improperly labeled medication.
Failing to conduct an accurate medication count for controlled
medications.
Immediately following a medication error, the MAP and/or facility
administrator must take the following steps:
Notify any supervisory personnel, per the agency’s policy.
In the case of giving a wrong medication or a wrong dosage, watch the
client closely for a minimum period of 20 minutes or longer if
necessary after the medication was given, and immediately report any
observed changes in the client’s condition to the prescribing heath care
practitioner. Best practice is to notify the health care practitioner upon
discovery and let him/her know that you will observe and notify of changes
and obtain any additional instructions from the health care practitioner.
Call 911 to request emergency services if the client exhibits respiratory
difficulty or other potentially life-threatening symptoms.
Notify the client’s prescribing health care practitioner of the error,
and ask them to fax an order addressing the error to the client’s home,
facility, or pharmacy, and document the health care practitioner’s response
to this request. If the order is to be faxed to the client’s pharmacy, the
MAP should alert the pharmacy to expect the fax, and to keep it until it can
be picked up.
Fully document all observations and contacts made regarding a medication
error in a "Medication Error Report," APD Form 65G7-05.
If the medication error occurs in a facility, the MAP must submit copies
of the report to the facility administrator and to the APD Area Office
within 24 hours of the discovery of the error. A copy of the error report
should be kept in client’s file.
If the medication error occurs in a client’s home and the medication
assistance provider committed the error, the provider must submit a
Medication Error Report to the APD Area Office within 24 hours of the
discovery of the error. A copy of the report must be kept in the client’s
file, easily accessible for review.
Following a medication count, the medication assistance provider must
report a discrepancy in the accounting of controlled substances by 5PM of
the next business day following the discovery of the error to the APD Area
office, and if applicable, to the facility supervisor.
Medication Refusal:
Clients have the right to refuse some or all of their medication. This
is not a medication error, but should be documented in the client record. The
MAP should make several attempts during the medication pass to encourage the
refusing client to take their medications. The MAP’s supervisor or the
client’s WSC should be made aware of all refusals, and the health care
practitioner notified if refusals are frequent. If the client is incompetent
or a minor the guardian as well as the supervisor and WSC should be notified
immediately. Document notification in the client record.
22. Medication Storage
All Medication must be kept centrally stored in a locked cabinet, locked
cart or locked storage area at all times.
Controlled medications must be double locked.
Medications must be kept in their original or legally dispensed labeled
package including OTC medications. Each medication must be returned to its
portable or permanent storage unit immediately following medication
administration assistance.
Each client’s medication must be kept separate from other client’s
medication.
Creams, ointments, eye and ear drops, and inhalers must be stored
separately from oral medication by a physical barrier. A MAP may use a zip
lock bag or place in a separate container.
Medication storage areas need to be free of dampness and at normal
temperatures (away from abnormally warm place such as close to refrigerators,
motors, or ovens) unless the medication needs refrigeration.
Refrigerated medication must be kept in the refrigerator in a locked
container clearly labeled as containing medication or the refrigerator must be
locked or the room must be locked.
Keys need to be stored in a safe area which is inaccessible to clients. If
the MAP or licensed health care practitioner leaves the facility with the
keys, he or she must return them immediately.
Written procedural provisions for accessibility to medications in case of
emergency will be provided by a licensed health care practitioner or a MAP
–i.e. extra key maintained by supervisor, return key immediately upon
discovery if taken home by mistake, or keys maintained in key lock box with
combination lock. Supervisor, MAP, and director have combination.
Storage of medication is also addressed in section 7
23. Medication Disposal (Appendix: Medication Destruction Record - APD form
65G7-06)
Expired medications or discontinued medications must be destroyed and the
disposal documented on the Medication Destruction Record.
There are two ways to dispose of discontinued or expired medications:
The medication may be returned to the pharmacy in a sealed container or
bubble pack.
The medication may be destroyed by the administrator or person designated
by the administrator and one witness. The MAP should consult with
the pharmacist as to safe destruction practice of the medications.
Destruction of medications is recorded on the Medication Destruction Log.
Medications that are contaminated or refused may be destroyed at the
facility using procedure # 2 above. The reason the medication was destroyed is
documented on the back of the MAR.
The Medication Destruction Log should be completed with this information:
Name of client.
Medication name, strength, dose and quantity to be destroyed.
Method of destruction – use method approved by the facility.
Destruction of all medication will be witnessed by administrator or
designated personnel.
Both staff and witness initial and sign the destruction log.
Destruction log is returned to appropriate area.
24. Off-Site Medication (Appendix: Off-site Custody of Medications - APD
form 65G7-08)
Purpose: To maintain a record when a client leaves the facility with
medications.
Procedure:
Obtain medications needed to be signed out for leave. (The entire
container of medication (bottle or bubble pack) or the specially packaged
off site medications will be needed.) Medication may not be transferred from
its original container to a weekly pill organizer or otherwise co-mingled
unless the client’s primary care provider determines that the client is able
to self-administer that medication without supervision; in that case,
only the client, the client’s family member, or a legal guardian may
transfer the medications from the original container.
Obtain a copy of the current MAR to give to the client’s responsible
party, if requested. The MAP must provide the name and telephone number of a
contact person and the name and telephone number of the client’s prescribing
practitioner to the person who will assist the client with medication
administration while the client is offsite.
Release all medications the client is currently prescribed, unless they
are stock medications that the facility provides to all to use. If facility
has prior notice, try to obtain off site medications from the pharmacy.
Instruct the responsible party in the correct medication, dose, time and
route. Include how to administer or assist the client with the medication.
Complete the Off Site Medication Form, to include: the client’s name,
each medication, dose, medication times and quantity. Give a copy to the
responsible party, and record both medication counts on an "Off-site
Medication Form," APD Form 65G7-08
Staff and client’s responsible party sign Off Site Medication Form.
Remind the responsible party that if the medications are not returned with
the client that the client will have to replace missing medications with
their own money.
Chart on MAR using the reason medication not administered code (i.e.
#1-Home) for all days that client is away from the facility. Place the Off
Site Medication Form in front of the client’s MAR.
Upon return to the facility, the MAP will verify that each medication is
returned against the Off Site Medication Form. The MAP will note quantity of
returned medications. The MAP will notify the supervisor immediately for any
noted discrepancies. Any discrepancies should be documented and education
should be provided to the family regarding the importance of giving
medications as ordered.
Once medications are verified correct, the MAP and responsible party will
sign the Off Site Medication Form.
If the responsible party requested a MAR copy to take home, the MAP will
make sure that this copy is NOT brought back to the facility and entered
into the client record.
If a medication error is made by family members, the medication error
report is not required. All family errors should be documented in the client
record. If a pattern of errors is noted, the supervisor and the health care
practitioner must be contacted. The MAP should also contact the APD Area
Medical Case Manager for consultation and assistance.
References
Anderson, D.M., Keith, J., Novak, P.D., and Elliot, M.A. (Eds.) (2002).
Mosby’s Medical, Nursing, and Allied Health Dictionary (6th
ed.). St. Louis: Mosby, Inc.
Clark, C. G. (2008). Medication Administration Training Curriculum for
65G-7. Tampa: Agency for Persons with Disabilities Area Suncoast Agency for
Persons with Disabilities.
Florida Administrative Weekly and Florida Administrative Code, Department of
Children and Family Services, & Agency for Persons with Disabilities. (2008).
Rule: 65G-7 Medication Administration. Retrieved January 30, 2009 from
https://www.flrules.org/gateway/ChapterHome.asp?Chapter=65G-7
Potter, P.A. & Perry, A.G. (2005). Fundamentals of Nursing (6th
ed.). St. Louis: Elsevier Mosby.
The 2008 Florida Statutes (2008). Title XXIX Public Health. Chapter 393
Developmental Disabilities. Tallahassee, Retrieved on December 10, 2008 from
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=Ch0393
The 2008 Florida Statutes (2008). Chapter 464 Nursing. Tallahassee:
Retrieved on 12/10/08 from
http://www.leg.state.fl.us/statutes/index/cfm?App_mode=Display_Statute&URL=Ch0464/ch
The National Coordinating Council for Medication Error Reporting and
Prevention. (1998-2009). The National Coordinating Council for Medication Error
Reporting and Prevention: NCC MERP: The First Ten Years "Defining the Problem
and Developing Solutions December 2005".
http://www.nccmerp.org/pdf/report Final 2005-11-29.pdf
bliography
Anderson, D.M., Keith, J., Novak, P.D., and Elliot, M.A. (Eds.) (2002).
Mosby’s
Medical, Nursing, and Allied Health Dictionary (6th
ed.). St. Louis: Mosby, Inc.
Clark, C. G. (2008). Medication Administration Training Curriculum for
65G-7. Tampa:
Agency for Persons with Disabilities Area Suncoast Agency for Persons with
Disabilities.
Florida Administrative Weekly and Florida Administrative Code, Department of
Children
and Family Services, & Agency for Persons with Disabilities. (2008).
Rule:
65G-7
Medication Administration.
Retrieved January 30, 2009 from
https://www.flrules.org/gateway/ChapterHome.asp?Chapter=65G-7
Naranjo, J. (2008) Medication Administration Instructor Training Material.
Course No.
02-1108-001. Marianna, FL: Jackson ARC, Inc.
Potter, P.A. & Perry, A.G. (2005). Fundamentals of Nursing (6th
ed.). St. Louis: Elsevier
Mosby.
The 2008 Florida Statutes (2008). Title XXIX Public Health. Chapter 393
Developmental Disabilities. Tallahassee: Retrieved on December 10, 2008 from
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=Ch039
3…
The 2008 Florida Statutes (2008). Chapter 464 Nursing. Tallahassee:
Retrieved on
12/10/08 from http://www.leg.state.fl.us/statutes/index/cfm?App_mode=Display_Statute&URL=Ch046
4/ch...
The National Coordinating Council for Medication Error Reporting and
Prevention.
(1998-2009). The National Coordinating Council for Medication Error Reporting
and
Prevention: NCC MERP: The First Ten Years "Defining the Problem and
Developing Solutions December 2005".
http://www.nccmerp.org/pdf/report Final 2005-11-29.pdf
Appendices
Forms
MARs
Authorization for Medication Administration
Informed Consent
Medication Error Report
Medication Destruction Record
Controlled Medication Count
Off-site Custody of Medications
Administrative Rule 65G-7
2008 Florida Statute 393.506
Appendix One
Forms
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Medication Administration Record (MAR)
Name:_____________________________________ Month:______________, Year: 20___
Allergies:
_________________________________________________________________ |
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Time |
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Prescribed By: |
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NOTES: |
Signature |
Initial |
Signature |
Initial |
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Authorization for Medication Administration
APD Client’s Name______________________ Date of Birth ___________
Health Care Provider ___________________________________________
I am a physician, physician’s assistant, or Advanced Registered Nurse
Practitioner licensed to practice in the State of Florida, and a provider of
health
care services for the above-named client receiving developmental disabilities
from the Agency for Persons with Disabilities. It is my professional opinion,
based on my knowledge of his/her health status and physical condition, that
he/she is:
______ Fully capable of self-administering his/her medications; or
______ Requires supervision while self-administering his/her
medications by a validated medication administration assistant; or
______ Requires medication administration by a validated medication
administration assistant; or
_____________________________ ___________________________
Health Care Provider’s Signature Date of Authorization
APD Form 65G7-01, adopted 3/10/08 by Rule 65G-7.002(1). F.A.C.
Informed Consent
Section 393.506, Florida Statutes, authorizes an independent direct service
provider (including a direct service provider employee) not licensed to practice
nursing or medicine to administer medication or supervise the
self-administration of medication following completion of medication
administration training and current annual competency validation by a licensed
registered nurse or physician. This form authorizes medication assistance by a
trained, validated provider.
I, ____________________________, as the below-named client or client’s legal
(Printed name of client or client’s
representative)
representative, contingent upon the authorization of my health care provider,
provide my consent to ________________________________ to:
(Printed name of validated medication
assistance provider)
______
Administer medications prescribed for me by my professional
health care provider; or
______ Supervise my self-administration medications prescribed for me by my
professional health care provider.
__________________________________ ____________
Signature of Client or Client’s Legal
Representative Date
__________________________________ ____________
Printed name of person signing Date
(NOTE: A validated unlicensed direct service provider cannot consent as the
client’s legal representative.)
______________________ ____________________ __________
Signature of Witness No. 1 Printed Name of Witness No. 1 Date
______________________ ____________________ __________
Signature of Witness No. 2 Printed name
of Witness No. 2 Date
This document remains effective until ______________________, unless I
(Twelve months from signature date)
elect to withdraw my consent.
APD Form 65G7-02, adopted 3/30/08 by Rule 65G-7.002(5), F.A.C.
65G-7.001 Definitions.
The terms and phrases used in this chapter shall have the
meanings defined below:
(1) "Administration of medication" means the obtaining and
giving of one or more doses of medicinal drugs by a legally authorized person to
an Agency client for his or her consumption.
(2) "Area Office" is the local office responsible for
managing one of the Agency’s fourteen service areas.
(3) "Authorized representative" means the client’s parent if
the client is a minor, the client’s authorized guardian, court-appointed
guardian advocate, health care surrogate, or a health care proxy appointed in
accordance with Chapter 765, F.S., or any other client advocate legally
authorized to make decisions on behalf of a client.
(4) "Central Office" is the Agency’s headquarters, situated
at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number
(850) 488-4257.
(5) "Client’s record" means a file maintained for each client
that contains the client’s name and date of birth, written authorization for
routine medical/dental care from the client or guardian and medical summary, the
name address and telephone of the client’s physician and dentist, a record of
the client’s illnesses and accidents, the legal status of the client, current
services and implementation plan, and client financial documentation
(6) "Controlled medication" means any substance enumerated in
Schedules I, II, III, IV, and V in Section 893.03, F.S.
(7) "Corrective Action Plan," for purpose of this rule, means
a written plan of action developed by the Agency for the purpose of correcting
cited deficiencies in compliance with this rule chapter.
(8) "Enteral medication" means medication delivered by tube
via the body’s gastrointestinal system.
(9) "Facility" means a residential facility licensed under
Chapter 393, F.S., or other facility staffed by direct service providers where
Agency clients receive training, respite care, or other services on a regularly
scheduled basis.
(10) "Inhaled medication" means the delivery of medication
droplets or moisture suspended in a gas, such as oxygen, by inhalation through
the nose or mouth.
(11) "Medical Case Manager" means a registered nurse or ARNP
employed by the Agency to provide nursing consultation and technical assistance
to an Area office regarding the medical care of Agency clients.
(12) "Medication Administration Record" or "MAR" means the
chart maintained for each client which records the medication information
required by this rule chapter. Other information or documents pertinent to
medication administration may be attached to the MAR. A copy of the Agency’s
form "Medication Administration Record," APD Form 65G7-00 (3/30/08),
incorporated herein by reference, may be obtained by writing or calling the
Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite 380,
Tallahassee, FL 32399-0950; main phone number (850) 488-4257.
(13) "Medication Assistance Provider" means a direct service
provider not otherwise licensed to administer medication who has successfully
completed an agency-approved training course and has current validation to
provide clients with medication administration or to assist clients with
self-administration of medication.
(14) "Nebulizer" means an atomizer equipped to produce an
extremely fine spray for deep penetration of the lungs.
(15) "Over-the-counter (OTC) medication" means a medication
for general distribution and use without a prescription in the treatment of
human illnesses, ailments, or injuries.
(16) "Ophthalmic medication" means a solution or ointment to
be instilled into the eye or applied on or around the eyelid.
(17) "Oral medication" means any medication in tablet,
capsule, or liquid form introduced into the gastrointestinal tract by mouth.
(18) "Otic medication" means solutions or ointments to be
placed in the outer ear canal or applied around the outer ear.
(19) "Parenteral" means injected into the body through some
route other than the alimentary canal.
(20) "Physician" means a doctor of medicine or osteopathy who
holds a valid and active license in full force and effect pursuant to the
provisions of Chapter 458 or 459, F.S., or the applicable laws of the state in
which the service is furnished.
(21) "Prescribed medication" means simple or compound
substances or mixtures of substances that are prescribed for the cure,
mitigation, or prevention of disease or for health maintenance prescribed by a
licensed practitioner authorized by law to prescribe such substances.
(22) "Prescription" means any order for drugs, medical
supplies, equipment, appliances, devices, or treatments written or transmitted
by any means of communication by a licensed practitioner legally authorized to
issue such an order, or any order issued by the lawfully designated agent of
such practitioner, intended to be filled, compounded, dispensed or furnished by
a person authorized by the laws of the State to do so.
(23) "PRN" ("pro re nata") means the administration of
medication on an as-needed basis rather than according to a prescribed schedule.
(24) "Rectal medication" means any prescribed medication,
capsule, enema or suppository to be administered via the rectum.
(25) "Supported living services" means the provision of
supports necessary for an adult who has a developmental disability to establish,
live in, and maintain his or her own household in the community.
(26) "Supervised self-administered medication" means direct,
face-to-face observation of a client during the client’s self-administration of
medication and includes instruction or other assistance necessary to ensure
correct self-administration of the medication.
(27) "Topical medication" means a salve, lotion, ointment,
cream, shampoo or solution applied locally to a body part.
(28) "Transdermal patch" means an adhesive patch containing a
pre-measured amount of topical medication that is absorbed into the body via the
epidermis (outer layer of skin) at a fixed rate.
(29) "Unlicensed" means, for purposes of this rule, not
authorized, certified, or otherwise permitted by other Florida law to administer
medication or to supervise self-administration of medication.
(30) "Validation" means an unlicensed direct service
provider’s demonstration of competency in administering or supervising
self-administration of a medication to a client, certified by a licensed,
registered nurse or licensed physician following the provider’s successful
completion of an Agency-approved medication administration training course.
Specific authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.002 Determining Need for Assistance; Informed
Consent Requirement.
(1) An Agency client’s need for assistance with medication
administration or ability to self-administer medication without supervision must
be documented by the client’s physician, physician assistant, or Advanced
Registered Nurse Practitioner, licensed under Chapter 464, 458, or 459, F.S., to
practice in the State of Florida, on an "Authorization for Medication
Administration," APD Form 65G7-01, (3/30/08), incorporated herein by reference.
A copy of the form may be obtained by writing or calling the Agency for Persons
with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950;
main phone number (850) 488-4257.
(2) A client who is authorized, as provided above, to
self-administer medication without supervision shall be encouraged to do so. The
medication assistance provider shall assist the client by making the medication
available and reminding the client to take medication at appropriate times.
(3) The medication assistance provider must maintain a
current Authorization form, reviewed by the client’s physician, physician
assistant, or ARNP at least annually and upon any change to the client’s medical
condition or self-sufficiency which would affect the client’s ability to
self-administer medication or to tolerate particular administration routes.
(4) An unlicensed provider is not authorized to administer
medication or assist a client with self-administration of medication unless he
or she has successfully completed an Agency-approved medication administration
training course and has obtained a current validation.
(5) In addition to an executed Authorization for Medication
Administration and before providing a client with medication assistance, a
provider must also obtain from the client or the client’s authorized
representative an "Informed Consent for Medication Administration" APD Form
65G7-02 (3/30/08) incorporated herein by reference. A copy of the form may be
obtained by writing or calling the Agency for Persons with Disabilities, at 4030
Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number (850)
488-4257. The Informed Consent form must contain a description of the medication
routes and procedures that the medication assistance provider is authorized to
supervise or administer.
(6) The medication assistance provider may not also act as
the client’s health care surrogate or proxy, or sign the Medication
Administration Informed Consent form referenced above. Providers or other
facility staff may witness the execution of the form.
(7) A medication assistance provider will limit his or her
assistance to the minimum necessary to ensure proper administration or
self-administration of the medication while preserving the client’s
independence.
(8) The requirements of this rule chapter do not apply to the
following:
(a) Health care practitioners whose professional licenses
include administration of medication;
(b) Client family members or friends who provide medication
assistance without compensation, as permitted by Section 464.022(1), F.S.;
(c) Providers employed by or under contract with State
Medicaid intermediate care facilities for the developmentally disabled,
regulated through Chapter 400, Part VIII, F.S., providers employed by or under
contract with licensed home health agencies regulated under Chapter 400, Part
III, hospices regulated under Chapter 400, Part IV, or health care service pools
regulated through Chapter 400, Part IX, F.S., or providers employed by or under
contract with assisted living facilities regulated through Chapter 429, Part I,
F.S.; and
(d) Clients authorized to self-administer medication without
assistance or supervision, as documented by an executed Authorization, APD Form
65G7-01 (3/30/08) incorporated herein by reference. A copy of the form may be
obtained by writing or calling the Agency for Persons with Disabilities, at 4030
Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number (850)
488-4257.
Specific Authority 393.501 FS. Law implemented 393.506 FS.
History–New 3-30-08.
65G-7.003 Medication Administration Training Course.
(1) Medication administration training courses not offered
through the Agency must be approved by the Agency in order to provide
qualification for validation. To obtain Agency approval, a course provider must
submit an application on a "Medication Administration Provider/Course Approval
Form," APD Form 65G7-03 (3/30/08) incorporated herein by reference. A copy of
the form may be obtained by writing or calling the Agency for Persons with
Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main
phone number (850) 488-4257. Course providers offering medication administration
training at the time this rule is adopted shall have 180 days from the effective
date of the rule to request and receive Agency approval for their course, during
which time they may continue to offer the training.
(2) The application must include the following information:
the total number of training course hours; a course syllabus; a detailed outline
of the contents of the course; and the names, qualifications, and license
numbers of all proposed instructors known at the time of the application.
(3) If the Agency denies an application for course approval,
it will identify the reasons for the denial in writing. A course may be
resubmitted to the Agency with modifications.
(4) Only licensed registered nurses or Advanced Registered
Nurse Practitioners may conduct training courses for medication administration
assistance certification.
(5) Medication administration training courses must provide
training curriculum and step-by-step procedures covering, at a minimum, the
following subjects:
(a) Safe storage, handling, and disposal of medications;
(b) Comprehensive understanding of and compliance with
medication instructions on a prescription label, a health care practitioner’s
order, and proper completion of a MAR form;
(c) The medical indications and purposes for commonly used
medications, their common side effects, and symptoms of adverse reactions;
(d) The proper administration of oral, transdermal,
ophthalmic, otic, rectal, inhaled or topical medications;
(e) Safety and sanitation practices while administering
medication;
(f) Medication administration documentation and
record-keeping requirements;
(g) Medical errors and medical error reporting;
(h) Determinations of need for medication administration
assistance and informed consent requirements;
(i) Procedural arrangements for clients who require
medication offsite; and
(j) Validation requirements.
(6) Medication administration courses may be administered
either through web-based distance learning or in a traditional classroom
setting, utilizing an Agency or Agency-approved medication administration
training curriculum.
(7) A course provider applying for Agency approval of
web-based distance learning must submit documentation indicating the following:
(a) The means by which the course will demonstrate
interactivity between the student and course provider within a maximum of 24
hours, which interactivity promotes student involvement and demonstrates that
the course measures learning and addresses comprehension of content at regular
intervals;
(b) The means by which the course provider is able to monitor
student enrollment, participation, and course completion;
(c) The means by which the course provider will be able to
satisfactorily demonstrate that stated course hours are consistent with the
actual hours spent by the student to complete the course;
(d) The means by which the provider will assure qualified
instructors will be available to answer questions and provide students with
necessary support during the course; and
(e) A requirement that the student complete a statement at
the end of the course indicating that he/she personally completed each
module/session of instruction.
(8) Each medication administration course must consist of a
minimum of four hours of instruction and classroom courses must be limited to no
more than 20 participants for each class.
(9) Any change to an approved course curriculum or protocol
requires new agency approval for that course.
(10) The Agency shall assign to approved courses a course
number that the course provider must display in the course syllabus and all
other materials used in connection with the course.
(11) The Agency may deny or withdraw course approval for any
of the following acts or omissions:
(a) Obtaining or attempting to obtain course approval through
fraud, deceit, false statements, or misrepresentation of material facts, whether
such statements are made knowingly or negligently;
(b) Failure to provide complete and accurate information in
the initial application for approval or in any notification of change in
information;
(c) Failure to notify the Agency within six weeks of a change
in the information required for course approval;
(d) Falsification of any records regarding the course
conducted by the provider or persons attending the course;
(e) Failure to maintain any required records regarding the
course conducted by the provider or persons who attended the course;
(f) Failure to maintain the course curriculum in the format
and content approved by the Agency;
(g) Advertisement or administration of the course before the
date it is approved by the Agency;
(h) Administration of course training by instructors not
licensed as registered nurses or Advanced Registered Nurse Practitioners;
(i) Failure to maintain records of course administration and
attendance.
(12) As a prerequisite to validation as a medication
assistance provider, the applicant must achieve a score of at least 80% on an
agency provided or agency-approved medication administration training course
exam. Upon successful completion of the examination, the course provider shall
issue the examinee a certificate containing the name of the provider, the course
number, date(s) of course administration, name of the student and, for
classroom-based courses, the name and signature of the course instructor.
(13) Medication assistance providers must maintain proof of
certification and validation. Employers of medication administration assistance
providers also must maintain a copy of the certificate and proof of current
validation for each employee providing medication assistance.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.004 Validation Requirements.
(1) An unlicensed provider applying for validation as a
medication assistance provider must be assessed and validated at least annually,
through demonstration, as competent to administer medication or to supervise the
self-administration of medication. Successful completion of an Agency-approved
medication administration course is a prerequisite to an assessment of
competency validation.
(2) Only a registered nurse licensed pursuant to Chapter 464,
F.S., or a physician licensed pursuant to Chapter 458 or 459, F.S., may validate
the competency of an unlicensed direct service provider to provide medication
administration assistance.
(3) The applicant for validation must complete an on-site
assessment with 100% proficiency documented on a "Validation Certificate," APD
Form 65G7-004 (3/30/08) incorporated herein by reference. A copy of the form may
be obtained by writing or calling the Agency for Persons with Disabilities, at
4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number
(850) 488-4257. The form must contain the following information:
(a) The name and address of the applicant being validated
and, if an employee, the name of the employing entity;
(b) The date of assessment and validation;
(c) A description of the medication routes and procedures
that the applicant is authorized to supervise or administer;
(d) Any limitations on the applicant’s validation to
administer medication, such as limitations on validated routes of medication
administration;
(e) The printed name and original signature of the validating
nurse or physician as it appears on his or her license; and
(f) The validating nurse or physician’s license number and
license expiration date.
(4) Successful assessment and validation requires that the
applicant demonstrate in an actual on-site client setting his or her capability
to correctly administer medication and supervise the self-administration of
medications in a safe and sanitary manner as required by this rule chapter,
including a demonstration of the following proficiencies:
(a) The ability to comprehend and follow medication
instructions on a prescription label, physician’s order, and properly complete a
MAR form;
(b) The ability to administer medication by oral, transdermal,
ophthalmic, otic, rectal, inhaled, or topical administration routes;
(c) The ability to obtain pertinent medication information,
including the purpose of the medication, its common side effects, and symptoms
of adverse reactions to the medication, either from the package insert that
comes from the pharmacy, or a Physician’s Desk Reference or other professionally
recognized medication resource, and maintaining this information for easy access
and future reference;
(d) The ability to write legibly, convey accurate
information, and comply with medication administration record-keeping
requirements;
(e) Knowledge of the proper storage and handling of
medications;
(f) Knowledge of proper disposal of expired or unused
medications;
(g) Knowledge of special requirements relating to storage and
disposal of controlled medications;
(h) Requirements for obtaining authorizations for assistance
with medication administration, authorization for self-administration of
medication without supervision, and informed consent for medication assistance;
and
(i) Adequate training on the correct positioning and use of
any adaptive equipment or use of special techniques required for the proper
administration of medication.
(5) When a client is prescribed a medication requiring an
administration route for which the medication assistance provider has not been
validated, the provider must obtain an assessment and validation for that
specific administration route before administering the medication to the client.
(6) A medication assistance provider must be re-validated
annually within the 60 days preceding the expiration of his or her current
validation. An unlicensed provider may not under any circumstances administer or
supervise the self-administration of medication before receiving validation or
following expiration of an annual validation.
(7) Medication assistance providers who fail to acquire
re-validation before the expiration of the current validation must retake the
medication administration training course and obtain current validation before
assisting with the administration or self-administration of medication.
(8) Any employer or contractor who offers medication
assistance provider services is responsible for maintaining a record of the
provider’s training certification and annual validation and for making such
records available for Agency review upon request.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.005 Medication Administration Procedures.
(1) Upon certification and validation as provided by this
rule chapter, unlicensed providers are authorized to assist with the
administration of prescribed medications via the following medication routes:
(a) Oral;
(b) Transdermal;
(c) Ophthalmic;
(d) Otic;
(e) Rectal;
(f) Inhaled; and
(g) Topical.
(2) A validated medication assistance provider must comply
with the following requirements:
(a) Before providing any medication assistance, become
familiar with the client’s medical history and medication background and locate
the name and contact numbers of the client’s prescribing practitioner for
consultation regarding the prescribed medications;
(b) Perform appropriate hand sanitation measures before
providing medication assistance, with repeated sanitization as needed during
medication administration;
(c) Assist only one client at a time with medication
administration in a quiet location free from distraction;
(d) Following medication administration or assistance with
self-administration, return each client’s medication to its portable or
permanent medication storage location before assisting another client;
(e) Limit administration, or assistance with
self-administration, to medications prescribed in writing by the client’s health
care practitioner and properly labeled and dispensed in accordance with Chapters
465 and 499, F.S.;
(f) Immediately report torn, damaged, illegible, or
mislabeled prescription labels to the dispensing pharmacist or health care
practitioner and, if a client is residing in a residential facility, notify the
facility supervisor;
(g) Check the directions and expiration date of each
medication to ensure that expired prescription medications or those no longer
prescribed are not administered;
(h) Verify that the correct medication is administered to the
correct client, at the correct time, with the correct dosage, by the correct
route, and for the correct reason, as prescribed by the health care
practitioner;
(i) Observe complete ingestion of oral medication before
leaving the client and before recording or documenting the administration of the
medication on the MAR;
(j) Record the date, time, dosage, and name of each
medication in the MAR immediately following administration and sign the entries;
(k) Observe the client directly for a minimum of 20 minutes
following the first three doses of a new or PRN medication in order to detect
and respond immediately to potential side effects, unless ordered differently by
the prescribing health care practitioner, and review the MAR for any special
instructions by the prescribing practitioner regarding required observations.
(3) A medication assistance provider may not assist with the
administration of any OTC medication or medication samples without a written
order by the client’s primary care physician or Advanced Registered Nurse
Practitioner.
(4) Medications may not be crushed, diluted, or mixed without
written instructions from the prescribing health care practitioner in the MAR.
(5) The medication assistance provider is responsible for
ensuring that the prescription for a medication is promptly refilled so that a
client does not miss a prescribed dosage of medication. If the medication
assistance provider is not responsible for routine refills of a medication, he
or she shall notify the provider responsible for refilling the client’s
prescriptions that the client is in need of medication and document this
notification.
(6) The medication assistance provider may not assist with
PRN medications, including OTC medications, unless a health care practitioner
has provided written directions for the medication. The provider must attach to
the client’s MAR a copy of the prescription or order legibly displaying the
following information:
(a) The name of the medication;
(b) The prescription number, if applicable;
(c) The prescribed dosage; and
(d) Specific directions for use, including the medical basis
for the medication, the time intervals for administration, the maximum number of
doses, the maximum number of days that the medication should be administered,
and conditions under which the health care practitioner should be notified.
(7) A medication assistance provider may not perform the
following acts of assistance:
(a) Prepare syringes for a client’s use during the
self-administration of medication via a subcutaneous, intra-dermal,
intra-muscular or intravenous route;
(b) Administer, or supervise self-administration of,
medications that are inserted vaginally, administered enterally, or administered
via a tracheostomy;
(c) Mix or pour medications administered through intermittent
positive pressure breathing machines or nebulizers, unless the medication
assistance provider and client who self-administers medication with supervision
have received one-on-one, step-by-step, training in the proper use and
maintenance of such equipment from a certified equipment technician, respiratory
therapist, or a registered nurse, with documentation in the client’s file of the
date of training, the name and qualifications of the persons providing the
training, and a description of the breathing equipment that was the subject of
the training;
(d) Administer medications via a subcutaneous, intra-dermal,
intra-muscular or intravenous route;
(e) Perform irrigation of partial or full thickness wounds (
such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical wounds) or
apply agents used in the debridement of necrotic tissues in wounds of any type;
and
(f) Assist a client with medications for which the health
care provider’s prescription does not specify the medication schedule,
medication amount, dosage, route of administration, purpose for the medication,
or with medication which would require professional medical judgment by the
medication assistance provider.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.006 Medication Errors.
(1) A "medication error" is any of the following actions:
(a) Administration of a wrong medication;
(b) Administration of a wrong dose;
(c) Administration of medication via the wrong route;
(d) Administration of medication for any symptom, illness, or
reason other than the one for which the medication was prescribed;
(e) Failure to administer medication or assist with
self-administration within 60 minutes of the prescribed dosage time;
(f) Administration of a medication, or the provision of a
self-administered medication, to the wrong client;
(g) Failure to immediately and accurately document
administration on the MAR;
(h) Failure to fill newly prescribed medications within
twenty-four hours of receipt of the prescription;
(i) Failure to promptly refill current medications, resulting
in one or more missed doses of medication;
(j) Administration or assistance with self-administration of
an expired or improperly labeled medication; and
(k) Failure to conduct an accurate medication count for
controlled medications.
(2) Immediately following a medication error, the medication
assistance provider or facility administrator must take the following steps:
(a) Notify any supervisory personnel;
(b) In the case of administration of a wrong medication or a
wrong dosage, observe the client closely for a minimum period of 20 minutes
after the medication was administered or self-administered, immediately report
any observed changes in the client’s condition to the prescribing health care
practitioner, and call 911 to request emergency services if the client exhibits
respiratory difficulty or other potentially life-threatening symptoms;
(c) Notify the client’s prescribing health care practitioner
of the error, request that the practitioner prepare and fax a medication
directive addressing the error to the client’s home, facility, or pharmacy, and
document the client’s health care practitioner’s response; and
(d) Fully document all observations and contacts made
regarding a medication error in a "Medication Error Report," APD Form 65G7-05
(3/30/08) incorporated herein by reference, and place a copy of the Report in
the client’s file. A copy of the form may be obtained by writing or calling the
Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite 380,
Tallahassee, FL 32399-0950; main phone number (850) 488-4257. An electronic copy
of the form is available at http://apd.myflorida.com/medication/forms.
(3) If a medication error occurs in a facility, the
medication assistance provider must submit copies of the Report to the facility
administrator and to the Agency area office within 24 hours of discovering the
error.
(4) If a medication error occurs in a client’s home and the
medication assistance provider committed the error, the provider must submit a
Medication Error Report to the Agency area office within 24 hours of the
discovering the error and maintain a copy of the report in the client’s file or
other location easily accessible for review.
(5) Following a medication count, the medication assistance
provider must report a discrepancy in the accounting of controlled substances by
5:00 p.m. of the next business day following discovery of the error to the Area
office and, if applicable, to the facility supervisor.
(6) If the Agency Medical Case Manager determines that a
medication assistance provider’s medication error justifies corrective action,
including additional training, the Area Office will notify the provider in
writing of the necessary corrective action plan, including a specific and
reasonable timeframe for completion of the corrective action plan. If the
medication assistance provider fails to comply with the corrective action plan,
the Agency will revoke the medication assistance provider’s validation, subject
to the provisions of Chapter 120, F.S.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.007 Storage Requirements.
(1) Medication assistance providers must observe the
following medication storage requirements:
(a) Store each medication at the temperature appropriate for
that medication, including refrigeration if required;
(b) Destroy any prescription medication that has expired or
is no longer prescribed and document the medication disposal on a "Medication
Destruction Record," APD Form 65G7-06 (3/30/08) incorporated herein by
reference. A copy of the form may be obtained by writing or calling the Agency
for Persons with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL
32399-0950; main phone number (850) 488-4257. Sign the Record before a
third-party witness;
(c) Maintain medication samples in their original containers
labeled by the dispensing health care practitioner with the client’s name, the
practitioner’s name, and the directions for administering the medication. The
medication assistance provider must initial and add to the label the date the
medication is opened.
(d) Maintain OTC medications in their original stock
containers.
(2) A residential facility or supported living client who
does not require medication assistance or supervised self-administration may
store his or her medication in secure, locked place within his or her room.
However, a client’s medications must be centrally stored and retrieved by the
medication assistance provider if:
(a) The client’s physician documents in the client’s file
that leaving the medication in the personal possession of the client would
constitute a threat to the health, safety, or welfare of the client or others;
(b) The client fails to securely maintain the medication in a
locked place;
(c) The medication assistance provider, facility
administrator, or Agency determines that, based on the home’s physical
arrangements or the habits of other residents, the client’s personal possession
of medication poses a threat to the safety of others; or
(d) The client or the client’s authorized representative
requests that the client’s medication be centrally stored.
(3) If the client requiring medication assistance is residing
or receiving services in a facility setting, the medications must be centrally
stored in a locked container in a secured enclosure.
(4) Either a licensed health care practitioner or medication
assistance provider must securely maintain keys to the locked containers and
storage enclosures containing controlled medications, and provide written
procedural provisions for accessibility to medications in cases of emergency.
(5) Stored medications must be organized and maintained in a
manner that ensures their safe retrieval and minimizes medication errors.
(6) Medications requiring refrigeration must be stored in a
refrigerator. The medications shall be stored in their original containers
either within a locked storage container clearly labeled as containing
medications or in a refrigerator located in a locked, secured medication storage
room.
(7) Each medication must be returned to its portable or
permanent storage unit immediately following medication administration
assistance.
(8) Controlled medication storage requires the following
additional safeguards:
(a) The medications must be stored separately from other
prescription and OTC medications in a locked container within a locked
enclosure.
(b) For facilities operating in shifts, a medication
assistance provider must perform controlled medication counts for each incoming
and outgoing personnel shift, as follows:
1. The medication count must be performed by a medication
assistance provider and witnessed by another medication assistance provider;
2. Both providers must verify count accuracy by documenting
the amount of medication present and comparing that amount to both the previous
count and number of doses administered between counts;
3. The providers must record the medication count on a
"Controlled Medication Form," APD Form 65G7-07 (3/30/08) incorporated herein by
reference. A copy of the form may be obtained by writing or calling the Agency
for Persons with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL
32399-0950; main phone number (850) 488-4257. The form must be signed and dated
by the providers verifying the count; and
4. Immediately document and report any medication
discrepancies to the facility supervisor.
(c) For facilities with only one medication assistance
provider per shift, the medication assistance provider must conduct, document,
and sign a daily medication count on the Controlled Medication Form; and
(d) For facilities with no shifts, the medication assistance
provider must conduct, document, and sign a controlled medication count at least
once each day on the Controlled Medication Form, using the same counting and
documentation technique described above.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.008 Documentation and Record Keeping.
(1) An up-to-date MAR shall be maintained for each client
requiring assistance with medication administration, except when the client is
off-site. The medication assistance provider must document the administration of
medication or supervision of self-administered medication immediately on the
MAR, using either APD Form 65G7-00 (3/30/08), incorporated by reference at
subsection 65G-7.001(12), F.A.C., or on an alternative MAR form that includes
the following information:
(a) The client’s name;
(b) Any client food or medication allergies;
(c) The name of each medication prescribed for the client;
(d) The medication strength (i.e., 5mg/ tsp);
(e) The prescribing health care practitioner for each
medication;
(f) The date that the medication was ordered and any date the
medication was changed (including D/C date);
(g) Prescribed dosage for each medication;
(h) Scheduled time of administration for each medication;
(i) Prescribed route of administration for each medication;
(j) Prescribed instructions for crushing, mixing or diluting
of specific medications, if applicable;
(k) The dates each medication was administered;
(l) The initials and signature of the medication assistance
provider who assisted with medication administration;
(m) A record of any medication dosage refused or missed,
documented by the medication assistance provider responsible for administering
the scheduled dosage, by drawing a circle around the appropriate space on the
MAR form and initialing it; and
(n) The reasons for not administering a medication, annotated
and initialed by the medication assistance provider in the comments section on
the MAR form using the following system, or a comparable numbering and coding
system containing the same information: 1 – home, 2 – work, 3 – ER/hospital, 4 –
refused, 5 – medication not available (explain on back of MAR form), 6 – held by
MD (explain on back of MAR), 7 – other (explain on back of MAR).
(2) Each client record must contain the following medication
documentation readily available to the medication assistance provider and for
Agency review upon request:
(a) Completed MAR forms;
(b) A list of potential side effects, adverse reactions, and
drug interactions for each medication;
(c) A record of drug counts for each controlled medication;
(d) Written determination by the client’s physician that the
client requires assistance with the administration of his or her medications;
and
(e) The original Informed Consent form permitting a
medication assistance provider to assist with the administration of medication.
(3) The validated medication assistance provider or the
provider’s employer must maintain documentation that the medication assistance
provider has completed an approved medication administration course and is
currently validated as competent to assist with the administration of
medication.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08.
65G-7.009 Off-site Medication Administration.
(1) If a client will be away from a licensed residential
facility or supported living home and requires during that time administration
of medication by persons other than the medication assistance provider, the
medication assistance provider must comply with the following requirements to
assure that the client has appropriate medications during his or her absence:
(a) Provide an adequate amount of medication for
administration of all dosages the client requires while away;
(b) Perform a count of the medication amounts provided to the
client for administration during the absence and a second count of the
medication amounts received upon the client’s return;
(c) Record both medication counts in an "Off-site Medication
Form," APD Form 65G7-08 (3/30/08), incorporated herein by reference. A copy of
the form may be obtained by writing or calling the Agency for Persons with
Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main
phone number (850) 488-4257.
(2) Medication may not be transferred from its original
container to a weekly pill organizer or otherwise co-mingled unless the client’s
primary care provider determines that the client is able to self-administer that
medication without supervision; in that case, only the client, the client’s
family member, or a legal guardian may transfer the medications from the
original container.
(3) The medication assistance provider must provide the name
and telephone number of a contact person and the name and telephone number of
the client’s prescribing practitioner to the person who will assist the client
with medication administration while the client is offsite.
Specific Authority 393.501 FS. Law Implemented 393.506 FS.
History–New 3-30-08
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The 2008 Florida Statutes
Title XXIX
PUBLIC HEALTH
Chapter 393
DEVELOPMENTAL DISABILITIES
View Entire Chapter
393.506 Administration of medication.--
(1) A direct service provider who is not currently
licensed to administer medication may supervise the self-administration of
medication or may administer oral, transdermal, ophthalmic, otic, rectal,
inhaled, enteral, or topical prescription medications to a client as
provided in this section.
(2) In order to supervise the self-administration of
medication or to administer medications as provided in subsection (1), a
direct service provider must satisfactorily complete a training course of
not less than 4 hours in medication administration and be found competent to
supervise the self-administration of medication by a client or to administer
medication to a client in a safe and sanitary manner. Competency must be
assessed and validated at least annually in an onsite setting and must
include personally observing the direct service provider satisfactorily:
(a) Supervising the self-administration of medication by
a client; and
(b) Administering medication to a client.
(3) A direct service provider may supervise the
self-administration of medication by a client or may administer medication
to a client only if the client, or the client's guardian or legal
representative, has given his or her informed consent to self-administering
medication under the supervision of an unlicensed direct service provider or
to receiving medication administered by an unlicensed direct service
provider. Such informed consent must be based on a description of the
medication routes and procedures that the direct service provider is
authorized to supervise or administer. Only a provider who has received
appropriate training and has been validated as competent may supervise the
self-administration of medication by a client or may administer medication
to a client.
(4) The determination of competency and annual validation
required in this section shall be conducted by a registered nurse licensed
pursuant to chapter 464 or a physician licensed pursuant to chapter 458 or
chapter 459.
(5) The agency shall establish by rule standards and
procedures that a direct service provider must follow when supervising the
self-administration of medication by a client and when administering
medication to a client. Such rules must, at a minimum, address requirements
for labeling medication, documentation and recordkeeping, the storage and
disposal of medication, instructions concerning the safe administration of
medication or supervision of self-administered medication, informed-consent
requirements and records, and the training curriculum and validation
procedures.
History.--s. 1, ch. 2003-57; s. 113, ch. 2004-267; s.
1, ch. 2006-37; s. 16, ch. 2006-197; s. 11, ch. 2008-244.
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