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Medication Administration

Training Curriculum

for

Non-Licensed

Personnel

Student Manual

Current Curriculum April 2012

Revised Curriculum April 1999

Original Curriculum February 1989

Department of Developmental Services

Medication Administration

Training Curriculum

Session 1 Nurse Delegation & Introduction to

Medication topics

Session 2 “The Five Rights” and the

“Rule of Three”

Session 3 Site of Medication Action and

Transcription

Session 4 Routes, Forms, and Techniques

Session 5 Med Classifications and Major

Side Effects

Med Classifications for Medical

Conditions

Session 6 Charting with the Court in Mind

Session 7 Review

Session 8 Glossary

Welcome to the Department of Developmental Services

Initial Medication Administration Course

The course consists of 21 hours of classroom instruction and a four hour laboratory practicum. The primary objective is to learn how to administer medications in compliance with the state statutes that govern DDS, so that the consumers we care for can receive medications in the safest and most effective way possible.

In order to participate in a DDS medication administration course you must: Be currently working for DDS or an agency licensed or funded by DDS Have a high school diploma, GED, or be sponsored by your agency Have any medication related conviction reviewed by the DDS Med Admin Unit Never had a medication administration certification revoked

Because individual states and state agencies have their own regulations and curriculum for medication certification, DDS cannot honor certification from any other source.

What to Expect

You must attend 100% of the class. Participants cannot arrive late or leave early. If you are late or absent, you will be required to start the course process from the beginning.

Cell phones must be turned off or set to vibrate mode. Texting during class is prohibited

Disruptive, rude or disrespectful behavior is reason for expulsion. Be considerate of others.

The final exam is 100 multiple choice questions. You must score 80% or better to pass

On exam day, you must arrive 15 minutes prior to the start of the exam, bring identification and a pencil. No other items will be allowed into the exam room except car keys. Exam scores will be reported to your agency as soon as they are available. Do not call DDS for your score.

Inclement Weather Inclement weather may require a class cancellation. Notice of class cancellation will be posted two hours prior to the start of the class. Please call 860-616-2045 Ex 5 for this information. If the weather is bad on an exam day, watch local stations for cancellation information at the community colleges.

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I have read and understand the class policies

Student Signature___________________________________________________________________

Date_____________________________ Agency_________________________________________

Session 1

1. Welcome

2. Nurse Delegation

3. Brief History of Medication Therapy

4. Sources of Medication

5. Names of Medications (Chemical, generic, brand)

6. Special Regulations for Controlled Substances

7. Receipt and Disposition Form

8. Documentation of Controlled Drug Count

9. Factors That Influences Medication Effects

10. Effects of Medications

11. Medication Interactions

12. Food to Medication Interactions

13. Abbreviations

14. Medication Measurements and Conversions

Module Objectives

At the end of this module, the student will be able to:

 Define nursing delegation and delegating nurse.

 Describe nursing delegation in relation to non-licensed personnel.

 Identify the intervals at which the nursing delegation will need to be obtained.

 Describe ways in which the delegating nurse will need to assess for competency.

 Identify 4 sources from which medications can come.

 Discuss 4 purposes for medication therapy.

 Describe the difference between the chemical, generic and brand name.

 Discuss 6 effects medications can have when taken.

 Identify the steps required for receiving, storing, monitoring and documentation for

controlled medications.

 Discuss the 6 factors that can influence how medications work in the body.

 Define the metric equivalent of teaspoon, tablespoon, ounces and cups.

 Identify the type of equipment acceptable to measure these units.

 Calculate the volume of medication needed to meet a specific prescriber order.

Nursing Delegation

Nursing Delegation (definition) : Transferring the authority to perform a selected nursing task in a selected situation.

Delegating Nurse (definition): The RN who retains the responsibility and accountability for the delegated task. This is typically the RN who is responsible for the day to day operations of your site.

Criteria for delegating nursing functions:  Care delegated is within the scope of practice of the delegating RN.  It is delegated only at the sites designated by the delegating RN.  Staff must be delegated at each site they work at by the delegating RN.  The outcome of the delegated task is predictable.  The delegating RN maintains the responsibility to verify that staff have adequate skills for the task which consists of: o Education with staff observations followed by demonstration back to the RN. o Successfully passing the initial course and final exam indicating baseline competency. o Completing an annual pass and pour with the certified non-licensed staff. o Completing the re-certification process successfully every two years which consists of a pass and pour and exam. o It is the sole responsibility of your agency delegated RN to delegate Medication Administration to staff which means the successful completion of an on-site practicum prior to passing medications independently.  Carry your certification card with you whenever you are responsible for passing medications. You cannot administer medications without a valid certification card in hand. Remember: Do not go outside the medication administration delegation guidelines. Do what you are taught to do and you will be safe.

Brief History of Medication Therapy

Medication therapy dates back to primitive times, starting with when people had strong beliefs in the spirit

world which was seen as invisible, ever watchful, a good or evil population that was thoroughly integrated

into the lives of each tribe. Medicine men and women were held in high esteem as they were the tribal

members who interceded with the gods. They began medical care, as we know it today, by their use of

roots, berries, bark, seeds and other natural substances to treat a variety of ailments, illnesses and injuries,

often with great success.

Medication therapy (definition): The use of specific substances to cure (i.e. antibiotics for infections),

relieve symptoms (i.e. analgesics or pain meds), prevent disease (i.e. vaccines like hepatitis B) or diagnosis

a disease (i.e. barium used to diagnose dysphagia).

Sources of Medication

Medications come from 4 sources – Synthetic.

Plants, Animals, Minerals, and

Made from Made from Mined out Made in the flowers, leaves the secretions of of the ground laboratory. and bark. Animals and ocean.

Digitalis comes Insulin comes Iron Birth Control Pills f from the Foxglove from cows, plant. pigs, Epsom Salts Thyroid p An ingredient and sheep. Baking Soda Antibiotics in aspirin comes Premarin Sodium Bicarbonate from the willow comes from Majority of tree the urine of a medications Pregnant Horse. I .

Names of Medications

Names under which medications may be known include chemical, generic or brand.

Let’s look at the medication Tylenol as an example: Category Chemical Name Generic Name Trade Name

Example NO (4-hydroxyphenyl) acetamide

Acetaminophen Tylenol

Definition The actual chemical composition of the medication.

A shortened, more simple name of the chemical name although it reflects the chemical description.

Known as the brand name.

Purpose Useful to chemists in understanding medication components.

Shortened version of chemical name. Easier to understand. Name used in group homes.

Name pharmaceutical company chooses for marketing purposes.

 General rules: o Generic names are not capitalized. o Medications are listed in reference books by their generic names. o Trade names are capitalized. o In the group home we use the Generic and Trade names of medications. o By law—if the authorized prescriber does not write ―Brand Name Medically Necessary‖ or Equivalent, the pharmacy must send the generic form.

 Illustration: Another way to remember the difference between a generic and brand name is with shoes. We all wear sneakers/shoes (generic name) but we may buy New Balance, Jordan, Nike, Mizuno (brand names)

Generic Shoes

Brand Shoes

Special Regulations for Controlled Substances

Controlled substance (definition): A drug or chemical whose manufacture, possession, and use are

regulated by the government.

 They are classified controlled medications because they are habit forming and can be abused.  They must be kept in a locked cabinet, separate from non-controlled medications, in a non- removable locked box. (Should have 2 locks with different keys.)  Ordered in small quantities.  Counting of these medications must be done by oncoming and off-going med certified staff, even if the medications are not due to be administered during that shift or when accepting or relinquishing responsibility for the keys typically.  So to recap the times the count must take place at a minimum , it is: o When starting your shift. o If you hand the keys off to another certified non-licensed staff during your shift. o When you are going home from your shift.

Now let’s continue and learn about the documentation

required when working with controlled medications.

Required documentation for controlled medications includes:

 A “Receipt and Disposition Form ‖ (used to document the administration of controlled substances) o Typically provided to the home by the pharmacy when controlled medications are delivered. o When signing in a controlled substance from the pharmacy, the following information should be included on the form (to be completed as soon as a controlled medication is received)  The 5 rights (client name, time given/frequency, drug, dose, and route)  Name of the ordering authorized prescriber.  Prescription number/date/expiration (Number on the receipt disposition form and prescription number must match.)  Pharmacy name/date  Client allergies  Name of the person receiving the medication from the pharmacy.  DO NOT SIGN YOU RECEIVED THE MEDICATION UNTIL YOU HAVE VERIFIED ALL OF THE INFORMATION NEEDED AND VERIFY THE QUANTITY RECEIVED. The number of pills in the bubble pack must match the number of pills listed on the pharmacy receipt. If they do not, the amount needs to be corrected or the delivery refused. o When a controlled substance is administered, the information to be documented:  Date the dose was given.  Time the dose was given.  Amount of dose given.  Signature of person removing the dose.  Quantity left in the bubble pack. (The number of pills in the bubble pack must match the number of pills listed on the form. If they do not—CALL YOUR NURSE IMMEDIATELY)  If the medication is wasted (dropped or refused), it must be countersigned.

 Shift to Shift Controlled Med Count Sheet o Documentation of Controlled Drug Count form is where staff sign for doing the count at the appropriate time each shift. o When signing the document, staff are verifying that the number on the Receipt and Disposition Form and the number in the bubble pack are correct. o Controlled drugs included in this count include all controlled medications stored at the site even if they are not passed during the shift for which the count is being done. This control count should include even those controlled medications set for destruction. They are part of the count until they are destroyed.

Blister/Bubble Pack

Department of Developmental Services Documentation of Controlled Drug Count

Month:_____________ Year_______________ Location________________________

1 st^ Shift 2 nd^ Shift 3 rd^ Shift Signature of On-coming Staff

Signature of Off-going Staff

Signature of On-coming Staff

Signature of Off-going Staff

Signature of On-coming Staff

Signature of Off-going Staff 1 Charlie Brown Tinker Bell^ Lucy Van Pelt^ Charlie Brown Tinker Bell^ Lucy Van Pelt (^2) Charlie Brown Tinker Bell Lucy Van Pelt^ Charlie Brown Peter Pan Lucy Van Pelt 3 Charlie Brown Peter Pan Lucy Van Pelt^ Charlie Brown Tinker Bell^ Lucy Van Pelt 4 5 6 7 8 9

10 11 12 13 14 15 16 17 17 19 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Factors That Influence Medication Effects

There are many factors that can influence the effect of medication in the body which are:

Age - a significant factor affecting a drug action. Two examples where age has a demonstrated affect on drug action are the elderly and the newborn. Elderly persons usually have decreased hepatic (liver) function, less muscle mass, and diminished kidney function. Therefore, they need lower doses and sometimes longer dosage intervals to avoid toxicity. Similarly, the newborn have underdeveloped metabolisms and immature renal function. They need highly individualized dosages and careful monitoring.

Weight - an important consideration in dosage levels. Body weight is an important factor when prescribing medications for infants, children and the elderly. There is a definite relationship between the amount of drug administered and the amount of body tissue serviced by the drug.

Gender - plays a part in drug therapy calculations. Women tend to have a higher concentration of body fat than men; medications that are more soluble in fat are more quickly absorbed in women. The most important consideration concerning gender, however, would have to be the pregnant woman and the risk of damage to the fetus or risk of premature labor due to drug therapy.

Underlying Disease - Any body system disorder can effect a way the drug will be utilized by the body. For example liver disease effects metabolism, kidney disease effects excretion, cardiac .circulation and diabetes … overall use and absorption.

Nutritional Status - poor nutritional status can inhibit the metabolism of medications.

Adequate enzyme and protein levels must be maintained in order to metabolize the medications. This is not

necessarily related to prescribed diet but rather the body’s ability to maintain an adequate level of

necessary nutrients – ie – protein.

Routes of Medication - a factor that can affect absorption. Before a medication can act within the

body, it must be absorbed into the bloodstream. Oral medication, the most common route of medication,

takes 30 to 60 minutes to be absorbed and begin to act. An inhalant medication can begin to act within

minutes.

Effects of Medication We are individuals, and so are our responses to any drug. The way an individual responds to medications depends on differences in the body’s cellular response and the differences in the body systems that metabolize and excrete medications.

There are several ways any medication can affect the body:

 Therapeutic Effect - the desired effect. The medication is accomplishing the results you intended. It works! Therapeutic level - that level reached in the blood when the drug is working effectively. Example: Antibiotics curing ear infections or analgesics helping menstrual cramps.

 No Apparent Effect - the drug does not treat the health problem. A caregiver needs to be aware of the treated person’s signs, symptoms, and methods of communication to know whether or not those conditions being treated are actually relieved. Examples: The antibiotic does not cure the strep throat, the anti- hypertensive does not lower the blood pressure.

 Side Effects - any effect of a drug other than the one for which it is administered. Side effects usually refer to mild, but predictable reactions to the drug. These effects are generally undesirable but tolerable. Examples: dry mouth caused by an antihistamine; diarrhea caused by an antibiotic.

 Adverse Effects - severe, side effects or toxicity caused by the administration of medication. Onset of such reactions may be sudden or take days to develop. Usually, an adverse reaction would cause the authorized provider to change the dosage or discontinue the medication. Examples: Severe liver toxicity caused by anticonvulsants or bleeding ulcers caused by aspirin.

 Allergic Reaction - hypersensitivity to particular allergens that usually involve skin, mucous membranes and bronchial tubes. It provokes characteristic symptoms whenever encountered, whether inhaled, ingested, injected, or otherwise contacted. Pollens, fur, feathers, insect bites or stings, mold, dust, foods, medications, cosmetics, and a host of other chemicals can cause an allergic reaction. Most allergies occur in people who have had a family history of allergies. Most reactions involve the skin, mucous membranes, or the respiratory tract

 Anaphylaxis (anaphylactic): acute systemic allergic reaction (life threatening) Typically the person experiences vague feelings of uneasiness, becomes anxious, becomes flushed. They may develop a rash, hives or swelling. Coughing, sneezing, and difficulty breathing may follow and symptoms of shock may occur. Loss of consciousness and death occur if immediate medical attention is not sought. Example: A common medication classification that can cause anaphylaxis is antibiotics Treatment - This is a medical emergency. Call 911 immediately. Death can occur in minutes. Do CPR if necessary

Drug to Drug and Drug to Food Interactions

Medication Interactions – This is a factor to be considered when multiple medications are administered to the same person. The effects of one medication may be increased or decreased by the other medication. Whether they are given at the same time or hours apart they still can have an effect on each other.

These interactions are divided into 2 categories – ANTAGONISTIC and SYNERGISTIC.

Antagonistic reaction - One medication may inhibit or decrease the actions of another medication.

This could be considered harmful in the sense it reduces the effects of another medication.

It’s like 2 people fighting they are working against the other.

Example: antibiotics decreasing the effect of birth control pills.

Synergistic reaction – when one medication increases the action of another medication.

Often, two drugs with similar actions are given together because the additives affect the results. The results the 2 meds have on each other are greater than if they were given separately.

+ =  RESULTS

Example: Abilify and Prozac

Food to Medication Interactions

Some medications need to be taken with food

and some need to be taken on an empty stomach.

Here are some key points to remember with food to medication

interactions:

 Timing of medication administration can be important.

 Medications that should be taken without food need the acidity of an empty stomach to enact full absorption.

 Sometimes giving an oral medication during or shortly after a meal can alter the absorption of the medication.

 Examples: o Ibuprofen is recommended to be taken with food to offset GI upset and irritation o Certain antibiotics cannot be combined with dairy products, such as milk, as this combination inactivates the effect of the antibiotic.

o Some medications may not be taken with grapefruit. o Some medications cannot be taken with any aged foods like wine, pickles, saurakraut, lox, or beer just to name a few.

:

To ensure a medication is given on an empty stomach,

it must be given

one hour prior to eating or two hours after eating.

.

Abbreviations

Time of Administration

qd every day or once daily bid twice a day tid three times a day qid four times a day q every qh every hour q2h every 2 hours q4h every 4 hours qod every other day ac before meals pc after meals hs hour of sleep prn as needed stat immediately

Location of Administration AD right ear AS left ear AU both ears OD right eye OS left eye OU both eyes po by mouth NPO nothing by mouth PR per rectum sl sublingual optic eye otic ear

Allergies NKA No known allergies NKDA No known drug allergies

Measurements cc cubic centimeter gm gram gtt drop mcg microgram mg milligram ml milliliter oz Ounce tsp teaspoon TBSP tablespoon i One

Additional Abbreviations _ c with

_

s without

_

ss half

tab tablet MAR Medication Administration Record, Kardex

PRC Program Review Committee

Rx prescription sig directions D/C Discontinue

liq liquid cap capsule supp Suppository

Note: There is only one letter difference between o p tic and otic. When looking to remember right and left in relation to the eyes and ear, think of right as d ominant and left as s outhpaw. When you think of ears think A for auditory. For eyes think O for optometrist.

Medication Measurements and Conversions

There are three types of measurements used in pharmacology today:  Metric (decimal system): most accurate, includes measurements of weight, volume and length.  Apothecary : includes measurements of weights and volumes. Rarely used.  Household measures : Not recommended due to variation in spoons, cup, etc. If used, standard is to be a measuring spoon to determine the amount of medication and not flatware.

Here are the equivalents in these systems:

1 tsp (teaspoon) = 5 cc (cubic centimeters) or 5 ml (milliliters) 1 TBSP (tablespoon) = 3 teaspoons=15 cc or 15 ml 2 TBSP = 1 oz (fluid ounce) = 30 cc or 30 ml 1 measuring cup = 8 oz or 240 ml

You may notice orders in milliters (ml) or cubic centimeters (cc). A milliliter and a cubic centimeter are roughly equal.

It is okay to use “measuring spoons” but not a spoon from your “flatware”.

Common measurement abbreviations: cc cubic centimeter ml milliliter mg milligrams oz ounce tsp teaspoon TBSP tablespoon ss one half Common Numerical Symbols (apothecaries system) gtt drop T 1 TT 2 TTT 3

The key symbols in the Apothecary System is i (it is an i with a line between the dot and the line). The number of lines with the dot above it indicates the quantity to be given. (e.g. i=1, ii=2, iii=3, etc)

Now what are those measurements?

Medication Measurements and Conversions continued

Example –

The authorized prescriber writes an order for Depakote Liquid 500mg PO BID x 10 days. The consumer has Depakote Liquid, but the label says 250mg /5cc. The 250mg/5cc is the concentration of the medication. So, how much do you pour? The information that you need to know is what you have on hand (250mg/5cc ) and what the authorized prescriber wants you to give (500mg).

**Have on hand - 250mg (per) / = 5 cc (or ml’s) (Label)

• 250mg / 5 cc (or ml’s)**

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What you want - 500mg / 10 cc (or ml’s) (authorized prescriber order)

**Through simple math you can calculate that you need to pour 10cc for your client.

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Example - Additional Method of Calculation

250mg = 500mg 250 times xcc = 250 x 500 times 5cc = 2500

5cc = xcc

2500 ÷ 250 = 10cc

ADMINISTERING LIQUID MEDICATIONS

Things to Remember about liquid medications Plastic medication cups are to be used to administer the prescribed dose of medication. The strength of the medication -milligrams (mg.) is different than the amount of the liquid (number of ccs or mls) to be given. Some liquids that are a combination of ingredients are ordered by the amount of liquid only. You must read the label carefully to know how much liquid you need to pour into the cup to give the person the dose that was prescribed for them.

1. The order says 2. The order says 3. The order says Carbamazepine 500mg Robitussin 200mg PO q4hr Valproic Acid Liquid po TID PRN for cough 750 mg PO Bid

The label says : The label says : The label says : Carbamazepine liquid Robitussin liquid Valproic Acid Liquid 100mg / 5 cc 100mg / 5 cc 250mg /5cc How much do you give? How much do you give? How much do you give?

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4. The order says 5. The order says 6. The order says Zoloft Oral Concentration Dilantin Liquid 375 mg Keflex Liquid 1000mg 120mg PO qd PO qd PO Bid

The label says : The label says : The label says : Zoloft Oral Concentration Dilantin liquid Keflex Liquid 20mg / 5 cc 125mg / 5 cc 250mg /5cc How much do you give? How much do you give? How much do you give?

How much do you pour?

1. The authorized prescriber orders 500mg of Carbamazepine Liquid for a consumer. You have 100mg / 5cc of the medication on hand.

How much do you pour?__________________________

2. The authorized prescriber orders 400mg of Robitussin liquid for a consumer. You have 200mg / 5cc of the medication on hand.

How much do you pour?________________________

3. The authorized prescriber orders 750mg of Amoxicillin Liquid for a consumer. You have 250mg / 5cc of the medication on hand.

How much do you pour?________________________

4. The authorized prescriber orders 300mg Dilantin Liquid for a consumer. You have 100mg / 5cc of the medication on hand.

How much do you pour?________________________

5. The authorized prescriber orders 300mg of HCTZ Liquid for a consumer. You have 50mg / 5cc of the medication on hand.

How much do you pour?________________________

6. The authorized prescriber orders 120mg of Zoloft Oral Concentration for a consumer. You have 20mg / 5cc of the medication on hand.

How much do you pour?________________________

7. The authorized prescriber orders Depakote 1000mg for a consumer. You have 250mg tabs of the medication on hand.

How many tabs do you pour?_______________________

8. The authorized prescriber orders Lasix 60mg for a consumer. You have 20mg tabs on hand.

How many tabs do you pour?_______________________

9. The authorized prescriber orders Neurontin 300mg for a consumer. You have 600mg tabs on hand.

How many tabs do you pour?__________________________

10. The authorized prescriber orders Lithium 600mg for a consumer. You have 300mg/5cc of the medication on hand.

How much do you pour?__________________________

11. The authorized prescriber orders Indocin Susp 75 mg for a consumer. You have 25mg/5cc of the medication on hand.

How much do you pour? __________________________

12. The authorized prescriber orders Pen-V-K 750mg for a consumer. You have 250mg/5cc of the medication on hand.

How much do you pour?__________________________