MAP Manual

Medications Right way

a d m i n i s t e R i n g

the

maRgaRe t Casey-medeRios RnCC&R healthcare solutions winthrop, massachusetts

Administering Medications the Right Way

Author: Margaret Casey Mederios, R.N.

Writer: Kathleen Masucci, R.N.

Editors: Lonnie Christiansen, ELS Sarah Campbell

Copyright 2005, 2012 by CC&R Health Care Solutions

Library of Congress Registration Number: TX 5-912-197

ISBN: 978-0-9857646-1-6

Version Number 4.1.1

CC&R Healthcare Solutions P.O. Box 520086 Winthrop, MA 02152 Phone: 877-539-0109 Fax: 617-539-3036 Web: www.medicationadministration.com

This book is available from CC&R Healthcare Solutions. For more information, please call 877-539-0109 or visit our website at http://www.medicationadministration.com

All rights reserved. No part of the publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopied, recorded or otherwise changed without prior permission from the author.


Author: Margaret Casey Mederios, R.N.

Writer: Kathleen Masucci, R.N.

Editors: Lonnie Christiansen, ELS Sarah Campbell

Copyright 2005, 2012 by CC&R Health Care Solutions

Library of Congress Registration Number: TX 5-912-197

ISBN: 978-0-9857646-1-6

Version Number 4.1.1

CC&R Healthcare Solutions P.O. Box 520086 Winthrop, MA 02152 Phone: 877-539-0109 Fax: 617-539-3036 Web: www.medicationadministration.com

This book is available from CC&R Healthcare Solutions. For more information, please call 877-539-0109 or visit our website at http://www.medicationadministration.com

This is not a free ebook. If you did not receive it from the author, please let us know at 877-539-0109.

All rights reserved. No part of the publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopied, recorded or otherwise changed without prior permission from the author.

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Table of ConTenTsTo the student . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiHow the Manual Is organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

What You Will Learn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixSpecial Learning Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xMelissa, Chip, and Freddy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

a note on language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

seCTIon 1: The basics of Medication administration . . . . . . . . . . . . . . 1 Module 1: administering Medications the Right Way . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Proper Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Getting to Know the People You Support . . . . . . . . . . . . . . 5How to Give Medications . . . . . . . . . . . . . . . . . . . . . . . . 6Principles to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . 7Understanding the Cycle of Responsibility. . . . . . . . . . . . . . 10The Cycle of Responsibility Comes Full Circle. . . . . . . . . . . . 13Making the Cycle Part of Your Daily Routine . . . . . . . . . . . . 15Skills You Need as a Direct Support Staff Member . . . . . . . . . 17Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Module 2: Medications and What You need to Know . . . . . . . . . . . . . 21Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Medication: What Is It? . . . . . . . . . . . . . . . . . . . . . . . . . 23Categories of Medications . . . . . . . . . . . . . . . . . . . . . . . 24Effects of Medication . . . . . . . . . . . . . . . . . . . . . . . . . . 26Medication Interactions . . . . . . . . . . . . . . . . . . . . . . . . . 30Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

seCTIon 2: The Techniques of Medication administration . . . . . . . . . . 37Module 3: How to observe and Report Information . . . . . . . . . . . . . . 37

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Objective and Subjective Information . . . . . . . . . . . . . . . . 39The Importance of Accurate Observations and Reporting. . . . . 41

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When to Report Information . . . . . . . . . . . . . . . . . . . . . . 42Remembering Your Observation, Recalling Details, and Forms for Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . 46Report Information to the Right People . . . . . . . . . . . . . . . 47Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Module 4: How to Prevent and Control Infection . . . . . . . . . . . . . . . 49Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Standard Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . 50Hand Washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Wearing Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Module 5: How to administer Medications . . . . . . . . . . . . . . . . . . . 55Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Support Visits to the HCP . . . . . . . . . . . . . . . . . . . . . . . . 57Communicating with the Pharmacist . . . . . . . . . . . . . . . . . 59Record Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Store Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63The Five Rights of Giving Medications . . . . . . . . . . . . . . . 63Special Instructions or Precautions . . . . . . . . . . . . . . . . . . 70Crosschecking to Ensure Safe Administration . . . . . . . . . . . . 71General Cautionary Guidelines . . . . . . . . . . . . . . . . . . . . . 74Three Parts of Administering Medications . . . . . . . . . . . . . . 75Prepare for Medication Administration . . . . . . . . . . . . . . . . 77Administer Oral Medication . . . . . . . . . . . . . . . . . . . . . . 79Complete Medication Administration . . . . . . . . . . . . . . . . 81Liquid Oral Medications . . . . . . . . . . . . . . . . . . . . . . . . . 85Preparing for Administration of Liquid Medication . . . . . . . . . 87Administering Liquid Oral Medication . . . . . . . . . . . . . . . . 89Completing Administration of Liquid Oral Medication . . . . . . . . . . . . . . . . . . . . . . . . 92Medication Refusals . . . . . . . . . . . . . . . . . . . . . . . . . . . 95PRN Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Standing Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

*MassaCHUseTTsNon-Mandatory Content

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Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Module 6: How to Handle special situations . . . . . . . . . . . . . . . . . . 103Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Managing Behavioral Symptoms . . . . . . . . . . . . . . . . . . . . 104Aging and Chronic Changes . . . . . . . . . . . . . . . . . . . . . . . 105Swallowing Difficulty (Dysphagia) . . . . . . . . . . . . . . . . . . . 106Administering Several Different Medications . . . . . . . . . . . . 107Maximizing Capabilities During Medication Administration . . . 108The Goals of Self-Administration . . . . . . . . . . . . . . . . . . . 110Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

seCTIon 3: The Management of Medication administration . . . . . . . . . 113Module 7: obtaining Medications . . . . . . . . . . . . . . . . . . . . . . . . . 113

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Key Term to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Information to Give to the HCP . . . . . . . . . . . . . . . . . . . . 114Encouraging Participation in the HCP Visit . . . . . . . . . . . . . . 117Information to Get from the HCP . . . . . . . . . . . . . . . . . . . 119Information on a Prescription . . . . . . . . . . . . . . . . . . . . . 120Getting Prescriptions Filled . . . . . . . . . . . . . . . . . . . . . . . 121Ensuring the Pharmacy Provided the Right Medication . . . . . . 122The Pharmacy Label . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Telephone/Fax Orders . . . . . . . . . . . . . . . . . . . . . . . . . . 124Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Module 8: Documentation, Recording, and storage . . . . . . . . . . . . . . 128Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129The Medication Book . . . . . . . . . . . . . . . . . . . . . . . . . . 129Recording Information onto the Medication Sheet. . . . . . . . . 132Remembering the Rights . . . . . . . . . . . . . . . . . . . . . . . 136The Importance of Accurate Documentation . . . . . . . . . . . . 136Countable Substances . . . . . . . . . . . . . . . . . . . . . . . . . . 143Storing Medications at the Home . . . . . . . . . . . . . . . . . . . 147Disposing of Medications . . . . . . . . . . . . . . . . . . . . . . . . 148


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Handling and Storing Medications Outside the Home, Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . 149Medication Occurrences . . . . . . . . . . . . . . . . . . . . . . . . 151Documenting Medication Occurrences . . . . . . . . . . . . . . . . 151Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

seCTIon 4: Reference Information for Medication administration . . . . . 158Common Diseases, Illnesses, and Conditions, and the Medications to Treat Them . . . . . . . . . . . . . . . . 158Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Other Routes of Medication Administration . . . . . . . . . . . . 170Information Needed for a First-Time HCP Visit . . . . . . . . . . . 189

Massachusetts specific forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

lIsT of sKIlls skill 1: How to Wash Your Hands . . . . . . . . . . . . . . . . . . . . . . . . . . 51 skill 2: How to Take Your Gloves off . . . . . . . . . . . . . . . . . . . . . . . . 53 skill 3: oral administration of Medication . . . . . . . . . . . . . . . . . . . . 76 skill 4: How to Use an oral Medication Cup . . . . . . . . . . . . . . . . . . . 86 skill 5: How to Use an oral Dosing syringe . . . . . . . . . . . . . . . . . . . . 86 skill 6: How to Use a Dropper . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 skill 7: administering a liquid oral Medication . . . . . . . . . . . . . . . . . 87 skill 8: Recording Information onto the Medication sheet . . . . . . . . . . 132 skill 9: Documenting Medication administration . . . . . . . . . . . . . . . . 136 skill 10: Documenting a Missed Dose . . . . . . . . . . . . . . . . . . . . . . . . 137 skill 11: Documenting a PRn Medication . . . . . . . . . . . . . . . . . . . . . . 139 skill 12: Documenting a Discontinued Medication . . . . . . . . . . . . . . . . 140


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Introduction

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To THe sTUDenTAs a direct support staff you have the privilege of giving medications to the people you support. How you handle this major responsibility can make a big difference in the quality of their lives. It is your responsibility to help create an environment where you can give medications safely. It is also your responsibility to watch for changes in the people you support and to report your observations so that others know whether a medication is working or not.

In this manual you will learn how to administer (give) medications in a mindful, occurrence-free manner. This means administering medications in a careful way, using a step-by-step process, and thinking about why each step is important as you do it. If you conscientiously follow the steps each time you administer medication, you will not make a Medication Occurrence, which could hurt the people you support.

This manual will guide you during your training and be a good reference for you afterwards. Referring back to the manual will help you stay knowledgeable and refresh your memory about the proper procedure for administering medications. So be sure to use it as a tool. The manual is easy to read and full of examples, exercises, stories, and questions designed to teach you how to administer medications safely.

Think about the importance of this manual for a moment. If every staff member followed the steps described here, Medication Occurrences could be a problem of the past.


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HoW THe ManUal Is oRGanIzeDThis manual focuses on the principles of safe medication administration, using oral medications as the primary example.

The manual is divided into 4 major sections that contain a total of 8 modules or training units that cover a single topic at a time. Sections 13 gradually build your knowledge of safe medication administration. These sections also describe in detail your roles and responsibilities in administering medications safely. Section 4 provides reference information, which you will not be required to master without more training. But you can use this information as a reference if you need it. The sections and modules of this manual are outlined below.seCTIon 1: The Basics of Medication Administration Module 1: Administering Medications the Right Way Module 2: Medications and What You Need to KnowseCTIon 2: The Techniques of Medication Administration Module 3: How to Observe and Report Information Module 4: How to Prevent and Control Infection Module 5: How to Administer Medications Module 6: How to Handle Special SituationsseCTIon 3: The Management of Medication Administration Module 7: Obtaining Medications Module 8: Documentation, Recording, and StorageseCTIon 4: Reference Information for Medication Administration

Introduction

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What You Will learnThink for a moment about what it takes to build a safe, sturdy house. The three most important parts are the foundation, the walls, and the roof. If they are not well built, your house will be unsafe. The information in the first three sections of this manual provide for you the three most important basic concepts. If you study these sections carefully, the information will help you administer medications more accurately and safely. You will also be prepared to add to your basic knowledge as you work and learn more.

figure i1: The first three sections of this manual are like the three most important parts of building a safe, sturdy house.

Roof

Walls

Foundation

In Section 1, you will learn the basics of medication administration. This section explains three important principles to keep in mind whenever you administer a medication. It describes the Cycle of Responsibility and your role in it. And it explains different medications and their effects on the body. Section 1 is your foundation.

In Section 2, you will learn how to give medications in a safe manner. This section explains how to observe and report information, control infection, and follow the step-by-step procedure for administering medications. Section 2 is the core of the process. Think of Section 2 as the walls of the house. They are built on the foundation and are needed to support the roof.


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In Section 3, you will learn how to manage medication administration. After you give a medication, your job is not done. You must document that you administered it and store the medication properly. Also, you must communicate with the health-care provider, receive medications from the pharmacy, and order refills on time. Managing medication administration is just as important as giving the medications, and like the roof of the house, protecting everything under it.

special learning aidsEach module in this manual has special aids to help you master the information you need to administer medications safely. These aids will guide you, test your knowledge and skills, and reinforce what you have learned. Below is a description of these aids:

objectives objectives are statements at the beginning of each module that tell you the key ideas you must learn. They also state what you will be able to do after completing the module. The objectives are numbered 1, 2, 3, 4, etc.

Terms to studyWhen acquiring any new skill, you must learn the special words related to that skill or activity. Terms to study will help you understand the vocabulary of medication administration. These terms appear in boldface type and are defined at the beginning of each module.

apply What Youve learnedThroughout each module you will find problems called Apply What Youve learned . These are real-life situations that challenge you to apply your new knowledge. These problems also teach you what can happen if you do not follow a particular procedure. There may be several right answers. The key is to think about the situation, jot down your solutions, and discuss them with your co-workers and trainer.

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exercises exercises throughout the modules help you make sure that you understand the information you just read about. Review exercises at the end demonstrate whether you have learned the important ideas from the module. These exercises include fill-in-the-blank questions, matching terms to definitions, word searches, and crossword puzzles. Review exercises also help reinforce the language of medication administration.

Melissa, Chip, and freddyIn addition to the learning aids, this manual introduces three fictional characters whose problems are typical of people you may be helping. These fictional characters are called Melissa, Chip, and Freddy. Getting to know them will help you apply the knowledge and skills you need when administering medication, and will help you through your training. Whenever you find a problem or question that mentions Melissa, Chip, or Freddy, review the descriptions below to help you answer the question thoughtfully.

Meet MelissaMelissa is a 29-year-old woman with many diagnoses: Cerebral Palsy (a brain disease she was born with that resulted in limited movements and spasticity), seizure disorder (episodes of uncontrolled, involuntary movement), intellectually disabled, Aicardis syndrome (a rare condition in which the eyes and brain do not develop correctly), scoliosis (curve of the spine). She needs total assistance in all activities of daily living (ADLs). She cannot speak. She uses an adaptive cup holder that lets her drink independently. However, she must be supervised at all times when eating and swallowing medications because she has dysphagia (difficulty swallowing).

Meet ChipChip is a 45-year-old man with Trisomy 21 (Down syndrome). He has moderate to severe intellectually disabled. He speaks in single words and short sentences. Chip can label things or point to things


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he wants, but he cannot explain how he feels. Chip has multiple physical problems. He was born with heart disease and takes two different heart medications each day. He also takes medications for hypothyroidism (low thyroid hormone), hypertension (high blood pressure), arthritis (red, swollen painful joints), COPD (a chronic lung disease), and GERD (gastroesophageal reflux disease, which often causes heartburn). Chip has an anxiety disorder so that at times he may be afraid or uneasy and he can show hyperactivity and self-destructive behavior (such as head slapping) when he is anxious. This condition is treated with a medication given 2 times a day and PRN. Chip lives in a community home with two other people. He is picked up daily to attend a day program where he works on various projects.

Meet freddyFreddy is a 30 year old man with schizophrenia (severe, chronic, disabling brain disorder often associated with symptoms such as hearing voices, belief that people are reading their mind and/plotting to hurt them. As a result of the symptoms the person may withdraw and live in constant fear). Freddy lives in a supported housing apartment with two other gentlemen. He interacts with his roommates, works part-time two mornings a week at the local supermarket, and likes to go to the clubhouse two to three times a week. He is learning to self-administer and packages his medication weekly according to his Plan. Currently he is on six medications that he takes twice a day. The medications he takes regularly are for high blood pressure, high cholesterol, constipation and to control his symptoms of schizophrenia. He also has 2 PRN medications for anxiety and sleep. Freddy knows the names of his medications and can tell when he needs to take them. When asked he does not know the purpose or side effects of his medications. He takes his medications consistently in the AM but forgets at times to take his PM medications. Direct support staff visit three times a week to assist with grocery shopping, meal planning, housekeeping and other issues. Freddy uses the bus to get back and forth to work, the clubhouse and appointments. Freddy usually manages his

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appointments, work schedule and social activities on his own. He has a good relationship with his roommates and often includes them in his plans. When Freddys schizophrenia symptoms increase, he becomes less independent, he isolates in his room, sleeps more during the day and will refuse his medication or stop taking it altogether. His hygiene and housekeeping duties also will decline. At this time Freddy needs more support and guidance.

a noTe on lanGUaGeIn this manual the author uses terms that may be different from those used by your agency. For example, the people to whom you administer medications are called:

3 The person, or 3 People you support

The author also recognizes that there are various practitioners and specialists who may prescribe medications. In this manual the prescribing practitioner is called:

3 The Health Care Provider, or 3 HCP

This manual uses the term intellectually disabled at times to describe the people you support. The author realizes the sensitivity around this language and recognizes that other terms for the same condition may be developmentally disabled, developmentally delayed, or mental retardation.

a noTe on DaTesThe author recognizes the HCP may order medications in 30, 60, or 90 day intervals as well as annually for certain medications. For training purposes only, the year (yr) has not been designated on the Health Care Provider order, pharmacy label, and medication sheet.

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*MassaCHUseTTs

Consult the individual's health care provider for specific info about the individual.

*MassaCHUseTTs

The MAP Consultant must be a physician, registered nurse, or registered pharmacist who provides advice and technical assistance to Certified staff members.

For example:

* interpreting prescriptions

* providing information about medications

* recommending how to handle a Medication Occurrence


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about the authorMargaret (Peggy) Casey-Mederios, Founder and President of CC&R Healthcare Solutions, is a registered nurse for more than thirty years and has authored numerous manuals and books for nurses, nurse assistants, and home health aides since 1983. The primary focus of the material she has developed has always been the desire to teach caregivers how to balance the tasks of their jobs with the ability to care. Peggy believes this balance is necessary to ensure quality care while maintaining the resident, clients or patients quality of life. Peggys vast experience working with frontline staff has given her a unique ability to write material that is comprehensive as well as user-friendly.

administering Medications the Right Way is one step in the direction of creating assurances that the frailest population in the country, our intellectually disabled, our mentally ill and elderly are receiving medications in a safe manner. Her goal, hope and vision with this Manual is to make a difference in that arenato do quality training and to assure that people are safe.

CC&R Healthcare solutions, based in Winthrop, MA is dedicated to developing and implementing quality caregiving solutions for the health care industry. These solutions include providing services that assess the caregiving functions in various settings, and develops trainingincluding customized texts and competency testing programs for states, and individual employers.

acknowledgmentsKathy Masucci, Rn provided invaluable assistance and is also the co-author of Administering Medications the Right Way Trainers Manual.Kathy and I would like to extend our sincere appreciation to the following: Jill Morrowbarbara breensharon oxxWalter PoleskyJohn boisseauMarie brunelleCatherine Cordeiroamy avakianKathy leber

Dorothea federicolinda GoodaleGina Huntlisa Kalitonbetsy KenersonTed KirbyRosemary sullivan, for her inspiration about Melissa

sue lyaslinda McCallJeanne ReedJoanne sheabarbara sudanoadam Wilczekbob boyerCarolyn Whittemorenoreen egan

DedicationThis book is dedicated to our families, our husbands, Frank and Rich, and our children, Mairead, Ricky, Ryan and Matty, for giving up precious time so we could write this training book. We believe it will make the difference in the lives of people who need our support and protection the most. Thank you, we hope you are proud of us.

D&S Testing Process a

MaP CeRTIfICaTIonPlease note that MAP Certification is not valid for administration of medications to individuals who are:

Under the age of 18

In certain DDS day programs

Residing in nursing homes

In long-term (generally more than 30 days) respite programs

In crisis intervention, stabilization, or hospital diversion centers and programs

In hospitals

In Intensive Residential Treatment Programs (IRTP)

In programs licensed or Certified by other departments such as the Office for Children, Department of Youth Services, or Department of Social Services.

In DMH and DDS sites not possessing a Massachusetts Controlled Substance Registration (MCSR) from the Department of Public Health.

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D&S Testing Process b

CeRTIfICaTIonYou qualify to take the MAP test after successful completion of an approved MAP Training program.

The Massachusetts Department of Developmental Services (DDS) and Department of Mental Health (DMH) have contracted with D&S Diversified Technologies to provide testing, scoring and registry services. A MAP Testing Candidate handbook is available at www.hdmaster.com. (No PIN is required.) For questions not answered here please contact:

D&S Diversified TechnologiesPO Box 418, Findlay, OH 45839Toll free 1.877.851.2355 Fax 1.419.422.7395

It is to your advantage to spend time on your own taking sample tests on a computer. To access the sample computer based test (CBT) go to www.hdmaster.com.

Click on Massachusetts MAP Testing and RegistryClick on Sample Test ShortcutEach sample test is 10 questionsTo end the exam, type SUNSET in the top right boxClick on Stop Exam

You will see your results (the % answered correctly).If questions were answered incorrectly you will also see the topic of the question missed.

Re-CeRTIfICaTIonRe-certification is required every two years. Once a candidates Certification expires, he/she may no longer administer medications. Candidates will be eligible to re-certify if they are in good standing per the Massachusetts MAP Registry maintained by D&S Diversified Technologies. You can be re-certified by taking the re-certification test through the D&S Diversified Technologies or your provider.

It is strongly recommended that you take a review course before testing.

It is important to update any change in your name, address, telephone number, or email address at the following website: www.hdmaster.com.

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fReQUenTlY asKeD QUesTIons 1. What is a MAP-Certified staff person?

Direct support staff, including licensed nurses whose job description does not require a nursing license, who have a current MAP Certificate to administer medications in DMH/DDS adult residential and day programs.

2. Where is my MAP Certification valid?

Certification is transferable between registered MAP programs only.

3. How long is my Certificate valid for?

MAP Certification is effective on the date that test results are posted on the D&S Diversified Technologies website (www.hdmaster.com).

MAP Certification is valid for two years until the last day of the month in which you passed the test. For example, if you passed the test on January 6, 2012, your expiration date is January 31, 2014.

4. What happens if my MAP Certification expires?

If your MAP Certification expires, you have one year to re-certify. If you do not get re-certified within one year, you must complete the full MAP Certification training program again and retake the written and skills tests. You cannot administer medications until you complete the training and testing.

5. What happens if I do not pass the re-certification test?

You cannot administer medications and are no longer considered MAP Certified until you pass the re-certification test.

6. Do I have to keep track of my expiration date?

Yes, you are responsible for ensuring that your certification remains current and valid.

All DMH/DDS community programs are required to maintain acceptable proof of staff MAP Certification (in other words, a print out of the Massachusetts MAP Certification) available at www.hdmaster.com MAP Online Registry Click Public Verification

D&S Testing Process c

SECTION 1: Module 1 11

seCTIon

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THe basICs of MeDICaTIon aDMInIsTRaTIon

Before you can give medications to the people you support, you must understand certain critical information. The information you learn in Section 1 is the foundation for everything

else you need to know to administer medications safely. Section 1

of this manual has two modules:Module 1: administering Medications the Right WayModule 2: Medications and What You need to Know

administering Medications the Right Way

After studying this module, you will be able to:

1 . Explain why you need training in medication administration.

2 . Define the term standardization and explain why it is important in medication administration.

3 . Explain why you need to know the people you support.

4 . Name two rights of the people you support that relate to medication.

5 . Describe the three principles to consider in administering medication and why each is important.

6 . Describe the eight parts of the Cycle of Responsibility and your particular role in each part.

7 . List the skills you need to be successful in medication administration.

Administering Medications the Right Way22

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accurate free from occurrence or mistakes; correct.

acute illness that is sudden, brief, and severe.

administer manage or give medications.

Chronic illness that continues for a long time or comes back often.

Communication talking, listening, being able to tell accurately what you have observed about the people you support.

Document a printed or handwritten paper recording information; to write down information; to keep a record of.

expired a medication or a HCP order that is outdated.

Maximizing capabilities making the most of what people can do; supporting people to their highest level of independence.

Medication chemical substance used to treat illness and disease; medicine; sometimes called meds for short.

Mindfulness the state of being attentive, careful, observant; always paying attention to details when giving medications.

oral a medication taken by mouth.

Pharmacist a person skilled in preparing medications and having the license to do so; a druggist.

Health Care Provider (HCP) a person who is medically trained to care for people who are sick. This person can be a doctor, nurse practitioner, physicians assistant or a psychiatric nurse who is licensed to prescribe medications and treat the people you support.

PRn Latin abbreviation for medications that you give as needed.

Process A systematic, continuous series of actions directed to an end .

Response an effect that occurs as the result of a medication; what happens after a person has received medication.

Regulate keep control of a medication.

self-administration the act of taking and being responsible for ones own medication or to have the medication administration under the complete control of the person.


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side effects effects caused by the medication that are not wanted or intended.

standardization the process of always following the same steps in administering medications.

Topical a kind of medication that you apply to a persons skin.

introduction

In this module you will learn why it is important to standardize the administration of medication. Standardizing means always following the same steps. You will learn the importance of getting

to know the people you support, and that there are principles you

must consider each time you administer a medication. You will

review the Cycle of Responsibility and the importance of each

of its parts in the administration of medications. Finally, you will

understand your role in administering medication.

Proper Training Medication is used to treat or prevent many acute and chronic health problems. Many of the medications taken by the people you support are prescribed to eliminate or lessen symptoms of a disease or behavior rather than to cure it. The goal of medication is to improve quality of life.

Almost all adults in our society understand that health care providers (HCPs) prescribe medications, and pharmacists fill prescriptions. Even a person who has never taken a medication prescribed by a HCP is familiar with medications through advertisements on television, in newspapers, and on the radio. Medications can be purchased in every drugstore and in many grocery stores.

Because medications are so common and most people take them, you may think you do not need training in medication administration. But there is a big difference in administering medications to people in the environment where you work. The people you support need your help, and you have a responsibility


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to make sure each person receives the best care. Training in medication administration helps ensure that support. An agency, such as the one for which you work, assumes responsibility for the care and protection of each person it supports. By following the procedures outlined in this manual, you will ensure that each person receives medication safely.

You may also be wondering why standardization of medication administration is so important. There are many reasons why. Serious Medication Errors are often made even in simple family situations. Because service agencies are much more complexwith many different staff, many different people needing support, staff turnover, changing shifts, and multiple medicationsthe chance for occurrence is much greater. Therefore, standard procedures and steps are needed to make sure that medications are administered correctly every time. You must learn these procedures and follow these steps each time you administer a medication. (You will learn these steps in Section 2 of this manual.)

It is important to follow standard steps when administering medications. It is also important to create a home-like environment for the people you support. Your training will help you achieve both these goals.

Think about how you take or give medication at home. Then put a checkmark next to the situations you think promote a home-like environment.

____ Carrying a tray full of medications for more than one person

____ Checking name badges

____ Having people line up to take medication

____ Preparing medications for one person at a time

____ Not drawing attention to the people on medications

____ Shouting names of people who are on medications

____ Hanging medication charts on the walls for everyone to see

*MassaCHUseTTs

An error in the administration of a medication is called a Medication Occurrence.

*


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Getting to Know the People You support In addition to following standard procedures, you need to know the people you support. A big part of your job is looking for changes in their physical condition or behavior. The only way you can do that is by getting acquainted with themlearning about their personality, physical conditions, current medications, and capabilities. Once you know the people you support, you will become more alert to changes in them.

Some of the people you support may not be able to tell you about themselves because they cannot speak. Others may need some encouragement to talk. Here are some ways to get acquainted:

3 Ask the person questions (if the person can respond).3 Talk to family members and friends.3 Read the persons Individual Support Plan. 3 Read the persons Health History. 3 Talk with other staff.3 See how the person behaves around others.3 Pay attention to things that change the persons behavior

or condition.

Learning about the people you support will help you recognize changes in them, and help you to report information.

Respecting the Persons Rights As a direct support staff, you have a responsibility to treat everyone with dignity and respect. All the people you support have the same rights as you do, regardless of their capabilities or where they live.

One example is the persons right to be free from too much medication. If you notice someone is so sleepy that they cannot participate in activities of daily living, you must report the situation. It could mean the person is getting more medication than needed or is having a bad response.

**MassaCHUseTTs

Antipsychotic medications are used to decrease symptoms of mental illness. These medications cause side effects.

In November 1983, the Massachusetts Supreme Judicial Court issued a decision that is called the Rogers Decision. This gave individuals who take antipsychotic medications new rights. These rights help protect them from the overuse of these medications.

DDS and DMH have a set of guidelines to help determine which individuals might need their antipsychotic medications administered under a Rogers Decision.

**


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Another example is the persons right to know what medications they are taking and its risks and benefits. When you administer a medication, you must explain what it is and answer any questions the person may have. Another right a person has is to refuse any medication. If someone refuses their medication, you should ask them why and report this to the appropriate agency staff. If you follow these guidelines, you will be respecting each persons rights.

apply What Youve learned Think about the people you support, and answer the following questions.

1 . How should you treat the people you support?

2 . What do they have the right to know about their medications?

3 . Name three ways you can get to know the people you support.

How to Give MedicationsWhen giving medications, you must pay attention not only to following the right steps but also to the way you perform them.

To understand this concept, take the simple task of opening a door. The steps are always the same, but how you open the door can send different messages. You can open a door so hard that it bangs against a wall, or so carefully that no one hears you enter. How you do something as simple as this can show how you feelyour anger, frustration, or distractionor it can show your support and consideration for others. When giving medications, it is important to pay attention to the steps and always to be considerate of those people you support.


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Principles to ConsiderWhenever you give medication, you must keep in mind three principles:

3 mindfulness3 maximizing capabilities3 communication.

These principles will help ensure that you give medication the right way. Each principle is described below.

MindfulnessBeing mindful is a special way of paying attention. When you are mindful, you are thinking about what you are doing. You are not distracted or preoccupied with other thoughts. The opposite of mindfulness is performing a routine task so automatically that you hardly think about it at all. If you let that happen when administering medication, you risk hurting the people you support. So in order to be successful in medication administration you must adopt a mindful, thoughtful, open attitude. You must pay attention to each step you are performing to ensure a safe administration. Here are some ways to help you become mindful when you are giving medication:

3 Say out loud what you need to do before you perform a step.

3 Read the steps each time you do them. 3 If more than one person needs a medication at the same

time, change the order of who goes first, second, or third. This will help you pay attention to each step so that the process does not become routine.

Being mindful also means being observant, and reporting your observations in detail to the appropriate staff. Being mindful requires that you create an environment that minimizes distractions. You must give all your attention to safe medication administration.


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Maximizing capabilities Before you administer any medication, you should ask yourself: Am I helping the person to function as independently as possible? You should always encourage people to take as much responsibility for their own medication administration as they can. But your primary concern is always the proper administration of medications, whether done by you or the person you support.

Over a period of time, many people can be taught to take partial or even complete responsibility for administering their own medication. If the people you support are capable, you should consider teaching them how to self-administer. Take advantage of the time you have with a person when giving medication. Tell the person what you are doing, and say the steps out loud. With repetition, the person may be able to participate in their own care. You will learn more about how to help a person self-administer in Module 6.

Below are some suggestions for creating an environment to maximize the capabilities of Melissa, Chip, and Freddy. (For details about their conditions, medications, and capabilities, please refer back to page xi.)

3 Melissa is now able to hold her own cup. It would be very important for you to encourage and support this new step toward independence. You could place her cup in her hand and encourage her to take a sip with her medications.

3 Chip often tries to refuse his medications. You can help maximize Chips capabilities by explaining the importance of each medication and reminding him how good he feels when he takes his medications regularly.

3 With little assistance, Freddy is learning to read the calendar hanging on the wall in his room which gives the daily times for his medication, and his pharmacy labels; pour the correct dose of his medications and take his medication independently. But sometimes Freddy forgets to take his medication in the evening. To help Freddy remember, you could assist in setting his wristwatch alarm to go off at the right time or staff can call to remind him to take his evening medication.


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Communication A big part of your job involves talking with the people you support, the HCP, the pharmacist, and other staff. But communication is more than just words. It includes body language or non-verbal communicationsuch as a smile of encouragement, a touch, or simply careful listening. Communication also includes written notes. You can communicate in many ways.

When you communicate with the people you support, other staff, and the HCP, you must practice good communication skills. Here are some tips to help you express yourself effectively:

3 Speak clearly and slowly.3 Use words you are comfortable with and know the

meaning of.

3 Look directly at the person you are speaking to.3 Write information down so you do not forget anything.3 Use notes to keep yourself organized. 3 Listen carefully. 3 Repeat information given to you to make sure you

understand correctly.

Remembering the principles Mindfulness, maximizing capabilities, and communication. Think of these principles as the chorus of a song. A chorus is repeated over and over. Although the words of the verses may change, the chorus stays the same. The task of administering medications to each person is like a song. The specific medication may change for each person, but the steps and the principles to consider always stay the same. In every medication you administer, remember the principles of mindfulness, maximizing capabilities, and communication. Safe medication administration means following the step-by-step procedure and keeping these three principles in mind.


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apply What Youve learned Think about the principle of maximizing capabilities. When giving Melissa her morning seizure medication, how could you make the most of her capabilities? Put a checkmark next to the answer you think is best. (Remember Melissa? For details about her conditions and capabilities, refer back to page xi.)

1 . Explain to Melissa what you are doing.

2 . Place her cup in her hand and encourage her to take a sip.

3 . Leave her medication on her table and tell her to try to pick them up.

4 . Hold her cup up to her mouth after you place her medications in her mouth.

Understanding the Cycle of Responsibility The task of giving medications is just one part of a larger process. This process is known as the Cycle of Responsibility (Figure 11). A cycle is a series of actions that come full circle. Each part of the cycle relies on the one before and the one after it to be complete. For safe administration of medications, none of the parts of the cycle can be skipped, eliminated, or performed mindlessly (without thought). In addition, in each part of the Cycle of Responsibility, you must keep in mind the principles to consider so that you administer medications the right way.

The parts of the Cycle of Responsibility are described in more detail on the following page. As you read this information, ask yourself if any part of the cycle can be left out. If one was left out, think about what might happen.


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A Cycle of Responsibility

figure 11: Safe medication administration involves all of these parts or responsibilities.

observe or watch for changes (physical & behavioral)

Report changes

support visits to the HCP

Communicate with the pharmacist

Record information

store medication

administer medication

Document the medication administration

observe or watch for changesBecause you spend more time with the person you support than anyone else, you are the one most likely to notice a change, which could be physical or behavioral. Being alert to any change is important because it may signal a problem. Being conscientious in your observations helps make sure that the people you support get the treatment they need.

Report changesReport information based on your actual observationsnot a hunch or a guess of what you believe to be important or what you think is happening. You must be factual and provide all the details of what you observe, so that important information is not missed. It is your responsibility to know to whom you must report information, when to report it, and what documentation you need to keep on file. Being conscientious in reporting the changes you observe is an important part of your job. For many of the people you support, you are their eyes, ears, and voices.

*MassaCHUseTTs When you report information

regarding medications, it is important to document the MAP

Consultants instructions.

*


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support visits to the HCP Another part of the Cycle of Responsibility is to take the person you support to the HCP. One of your roles is communicating accurate information to the HCP if the person cannot. If the person is able to give information, however, you must encourage such independence. Information must be clear and accurate. If you (or the person you support) do not give information correctly, a medication may or may not be prescribed correctly or at all. This can result in time lost treating the persons problem.

After the visit, you must communicate (give information) about the visit to the other members of the staff. It is very important that you share this information so that other staff member(s) know about any new or changed medications the HCP may have ordered. If the person goes to HCP alone, you will have to track all information received.

Communicate with the pharmacist If you receive a prescription from the HCP, you must follow your agencys policy for getting it filled by a pharmacist. Section 3 of this manual gives general guidelines for how to obtain medications.

Record informationOnce you have the HCP order and after the prescription is filled, you must carefully record the information from the HCP order and pharmacy label. Write it down (or transcribe) on the medication sheet so that you and others can track the administration of the medication. Accurately writing down the HCP order and pharmacy label information helps prevent Medication Occurrences. The medication sheet is important because it tells you exactly what medication to give, how much, and how often.

store medicationIn addition, all medications must be stored properly. How medications are stored is determined by the type of medication, the abilities of the people living in the home, and your state and agencys policy. You will learn more about storing medications in Section 3.

*MassaCHUseTTsDDs onlY

If you work for the MA DDS, you must bring a completed

Health Review Checklist to all Primary Health Care Provider visits including the annual physical exam.

*MassaCHUseTTsIn Massachusetts, a medication

sheet may be called a medication administration record or a

medication administration sheet.

*

*


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administer medicationAfter recording accurate information and storing the medication, you are ready to administer it to the person you support. You will learn how to administer medications safely in Section 2.

Document the medication administrationAfter administering the medication, you must document on the medication sheet that you gave the medication.

The Cycle of Responsibility Comes full Circle You are the key to safe medication administration. When you give a medication to a person, you have brought the cycle full circle. You must begin the cycle again by observing the person for any physical/behavioral changes and reporting the information. Reporting your observations right away can help prevent problems that could be harmful or even fatal. You will learn about responses and side effects of medication in Module 2.

Match the part of the Cycle of Responsibility in the left column to the activity in the right column. Select only one answer.

a Cycle of Responsibility

1 . Observe for changes, a . Help the person tell the HCP physical and behavioral. about the reason for the visit.

2 . Report changes. b . Give a medication.

3 . Support visits to C . Tell your supervisor about your the HCP. observations.

4 . Communicate with D . Notice that the person vomits the pharmacist. after taking a medication.

5 . Record information. e . Write the HCP order and pharmacy label information to the medication sheet.

6 . Store medications. f . Placing a medication in a secure area.

7 . Administer medications. G . Receiving a filled prescription.

8 . Document the administration. H . Place initials on a medication sheet.


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Now you understand the Cycle of Responsibility and the principles to consider in administering medications. Under each part of the cycle below, put a checkmark next to the principles you think are most important for the tasks related to that part of the cycle. Be prepared to discuss your answers with your co-workers and trainer. Note: There may be more than one answer.

observe for physical and behavioral changes .

Mindfulness

Maximizing capabilities

Communication

Report changes .

Mindfulness


Communication

support visits to the HCP .

Mindfulness


Communication

Communicate with the pharmacist .

Mindfulness


Communication

Record information .

Mindfulness


Communication


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store medications .

Mindfulness


Communication

administer medications .

Mindfulness


Communication

Document the medication administration .

Mindfulness


Communication

Making the Cycle Part of Your Daily Routine How you incorporate the Cycle of Responsibility into your daily routine can make a big difference in the quality of life for the people you support. Every day it is your responsibility to help create a distraction-free environment in which you can give medications safely. It is also your responsibility to observe the people you support and to report your observations so that others can determine whether or not a medication is working.

Here are some tips for making the Cycle of Responsibility part of your daily routine:

3 Come to work with an open, undistracted mind. 3 Talk with the staff who are leaving to find out whats been

happening.

3 Visit and greet each person you support. Ask them how they are doing and if there is anything new.

3 If the person cannot communicate, pay attention to their behavior and look for any changes.


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Remember, the Cycle of Responsibility begins with you. If you observe and report information mindfully, the people you support will get the best results from their medications.

apply What Youve learned You have been supporting Melissa for six months. Since she started her new seizure medication 3 months ago, she has not had a seizure. You arrive at work after being off for three days. Melissa has a seizure during your shift and has also started vomiting. (Remember Melissa? For details about her conditions and capabilities, refer back to page xi.)

Think about this situation with Melissa and your responsibilities in the Cycle of Responsibility. Put a checkmark next to the part(s) of the Cycle of Responsibility you should do immediately. Explain your answer.

1 . Observe or watch for changes (physical and behavioral).

2 . Report changes.

3 . Support visits to the HCP.

4 . Communicate with the pharmacist.

5 . Record information.

6 . Store medication.

7 . Administer medication.

8 . Document the medication administration.

Explanation


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skills You need as a Direct support staff MemberAs a staff member, you will administer medication or help people to learn how to take it themselves (self-administration). In doing so, your job may involve several parts of the Cycle of Responsibility.

Studies have shown that staff members need certain knowledge and skills to successfully implement all parts of the Cycle of Responsibility. These skills are summarized in Figure 12 . Under each heading in the table is a list of the specific tasks you must perform to be successful. This manual and your training will give you the knowledge and skills you need to administer medications safely. Be sure to review this list often in your job.

summary

In Module 1, you learned some of the basics of medication administration. Here are the key points:

3 Proper training gives you the skills and knowledge you need to administer medications safely.

3 Standardization, or performing the same steps every time, helps ensure safe medication administration.

3 Getting to know the people you support will help you become alert to physical and behavioral changes.

3 Whenever you administer medication you must think about the three principles of mindfulness, maximizing capabilities, and communication.

3 You are a key player in the Cycle of Responsibility.

You now know how the Cycle of Responsibility works. Remember, the cycle is continuous, starting with observing, then reporting changes, assisting with visits to the HCP, and communicating with the pharmacist, recording information, storing medications, administering them and finally documenting the administration. Your important role in the Cycle of Responsibility never ends.


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figure 12: skills needed to administer Medication safely

observation and Reporting3 Respond to medication emergencies

(such as a person not breathing).3 Observe and report changes in

behavior.3 Report changes in condition. 3 Report Medication Occurrences.3 Use reference materials to look up

information about medications.3 Identify when medications have

been tampered with.3 Report medication losses.3 Read medication and treatment

book.3 Read and understand medication

information sheets.3 Determine when not to administer

a medication as directed by the HCP.3 Recognize physical and behavioral

changes.3 Report refused and missed doses.

Documentation3 Gather information for the visit

to the HCP. 3 Complete required paperwork

before visiting the HCP.3 Communicate information to

the HCP.3 Communicate to others about the

HCP order.3 Write information from the HCP

order and pharmacy label onto the medication sheet.

3 Write a note about the visit to a HCP.3 Document that the medication

was given. 3 Verify counts of countable

substances.3 Enter information into a computer

(if applicable).

administration3 Administer oral medications.3 Administer PRN medications

(medications given as needed, for specific reasons written in HCP order). 3 Administer medications through

other routes (with additional training). 3 Administer medications via tubes

(with additional training). 3 Encourage self-administration

of medications.3 Support refusal of medications.

Management3 Store medications.3 Control or regulate access to

medications.3 Obtain medications from the

pharmacy. 3 Dispose of unused or expired

medications. 3 Complete records for disposing

medications.


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Crossword Puzzle Complete this crossword puzzle using the clues below and the Terms to study at the beginning of the module.

across 2 . illness that is sudden, brief, and severe 4 . a printed or written paper recording

information

5 . talking, listening, telling what you have observed

7 . illness that continues for a long time or comes back often

8 . free from occurrence or mistakes; correct 9 . a person skilled in preparing medications and

having the license to do so; a druggist

11 . the state of being attentive, careful, observant, and always paying attention to details

13 . an effect that occurs as the result of a medication

Down 1 . making the most of what people can

do; supporting their highest level of independence (2 words)

3 . manage or give medications 6 . Latin abbreviation for medications that are

given as needed 10 . chemical substance used to treat illness and

disease; medicine

12 . a person licensed to prescribe medications and treat people with diseases and illnesses (abbreviation)

7

6

11

10

1

2

5

3

4

8

12

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Review Questions Please write your answers to the following questions on the lines below.

1 . In your own words, describe why medication administration should be standardized.

2 . Name the eight parts of a Cycle of Responsibility.

3 . List the three principles you should consider when administering medications.

4 . List ten skills you are responsible for as a direct care worker when administering medications.


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obJeCTIves

Medications and What You need to Know

After studying this module, you will be able to:

1 . Define what a medication is.

2 . Describe different categories of medications.

3 . Explain how medications affect a persons body.

4 . Explain desired effect, no apparent desired effect, and unwanted effects.

5 . Understand where to get more information about medications.

adverse response or effect an unwanted or bad response to a medication.

allergic reaction an abnormal response of the bodys immune system to a medication. In an allergic reaction the immune system starts fighting harmless substances, like medications. Allergic reactions cause a rash, hives, or runny nose. Allergic reactions can range from mild to severe.

anaphylactic reaction a very dangerous allergic reaction that can affect the whole body, causing difficulty breathing, hives, and changes in blood pressure. An anaphylactic reaction can be life threatening and requires immediate medical attention.

brand-name medication a medication made by a specific pharmaceutical company.

Countable substances prescription medications that require special tracking. This requires 2 staff medication administrators count the medications each time the staff changes or each time the keys change hands.

Desired effect the response or result expected from a medication; therapeutic effect.

Generic medication a medication called by its chemical name; a generic medication has the same chemicals as a brand-name medication. A generic medication may be manufactured by several different companies, other than the company that originally made it.

*MassaCHUseTTsMedication administrators are

called Certified Staff.

*


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Holistic/herbal compounds natural substances that you can buy without a prescription.

Indication the intended use of the medication.

Medication Information sheet is a specific resource that contains information about medications a person is taking. You can obtain this information from medication books, the pharmacy or a reputable online source.

Medication interaction a change in the effect of a medication when it is given at about the same time as another medication. Medication interaction can change the effects of one or both of the medications. Interactions can also occur with certain foods as well as with alcohol, nicotine, caffeine, and other chemical substances.

Medication sensitivity how a person responds to a medication or other substance. Some people react more strongly than others to the same amount of medication.

no apparent desired effect no response to a medication; lack of the response expected from a medication.

nonprescription medications medicines you can buy without a prescription; over-the-counter medications.

over-the-counter medications (oTC) medicines you can buy without a prescription.

Paradoxical effect a response to a medication that is the opposite of what is expected.

Prescription medications (controlled medications) medications for which you must present a prescription from the HCP to the pharmacy in order to buy.

side effect an unwanted or unintended response to a medication.

Therapeutic effect the response or result expected from a medication; the desired or beneficial effect.

Toxicity a condition in which the body stores up more of a medication than it can handle or does not process the medication properly. Toxicity may indicate that the dose is too high.

Unwanted effect an unplanned and undesired response to a medication, including allergic reactions, side effects, paradoxical effects, etc.


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introduction

Medications are used to treat, cure, prevent, or relieve various health problems in the people you support. To be successful administering medications, you need to understand

how medications can affect the person. Without this general

understanding of medications, you cannot effectively observe

and report information about the person. In this module you will

learn what a medication is and how medications work in the body.

You will learn about some categories of medications and how

medications can affect people. Finally, you will learn where to

find additional information about medications.

Medication: What Is It? Everyone knows at least something about medications from either personal experience or the media and social interactions. You might think of medication as a pill that makes you feel better or takes pain away. Your past experiences with medications influence how you think about them. You probably know that medication usually produces a response that is predictable. For example, when you take an antibiotic, your infection goes away. You also know that some medications can cause side effectsunexpected and unwanted responses. As you study this module, its important to remember that each person can react to medication in different ways. But what exactly are medications?

Medications are chemicals that enter the body and change one or more ways that the body works. Medications are often used because some part of the body is not working well or needs help. When a medication is given, the hope is that it will provide the desired effect and improve the persons health. However, medications may also do other things to the body. Some of these responses may be good and desirable, but others may not.

It also is very important to understand that a medication can affect different parts of the body at the same time. This will help you understand what you observe and what the


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person experiences after taking a medication. Remember, all medications have the potential to cause side effects . It is important that you watch for both the desired effect and side effects when the people you support are taking medication. For example, you may notice that if you take a cold medication, your runny nose dries up (desired effect), but it also may make you sleepy (side effect).

Categories of Medications There are many ways to define medications. But as a direct support staff, you only need to understand those medications taken by the people you support. Medications can be grouped into the following categories and are described below.

3 Prescription (controlled medication)3 Nonprescription or over-the-counter (OTC) 3 Brand name 3 Generic (chemical) name 3 Countable substances3 Holistic/herbal compounds, vitamins, and other substances

Prescription Medications (Controlled Medications)Prescription medications are received through a prescription written by a health-care provider. The HCP writes the name of the medication, the dose (how much should be given), how often the medication should be taken, and for how long. The written prescription is given to a pharmacist, who fills the order from the prescription. You need an order from a HCP to administer prescription medications.

nonprescription or over-the-Counter Medicationsnonprescription or over-the-counter (oTC) medications are medications that can be bought without a prescription at a drug store or supermarket. OTC medications are very popular. Even though a prescription is not required, you need an order from a HCP to administer OTC medications to the people you support. For all nonprescription medications, the HCP must give you an


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order for you to administer the medication. You need to know the name of the medication and the dose, as well as when, how, and why to administer it.

brand-name Medicationsbrand-name medications are medications made by a specific pharmaceutical company. Sometimes the HCP writes a prescription for a brand-name product and writes no generic substitution or brand necessary. This means that the pharmacist must provide the brand-name medication and cannot switch to a generic medication from another company. Examples include Tylenol and Advil.

Generic MedicationsGeneric medications are medications that are labeled by their chemical name. These medications are basically the same as brand-name medications but are made by different companies. They are usually less expensive than the brand-name product. Examples include Acetaminophen and Ibuprofen.

Countable substancesAll prescription medications should be stored properly. But certain prescription medications are also considered countable substances . These medications have specific requirements for storing, packaging, tracking, or counting. Medication control agencies consider the medications in this category to have a high potential for abuse. Examples of countable substances include certain medications prescribed for sleep, pain, anxiety, or agitation.

Holistic/Herbal Compounds, vitamins and other substancesHolistic and herbal compounds can be bought at health-food stores, grocery stores, and pharmacies. These compounds can interact with prescription and OTC medications. Therefore, the HCP must provide you with a HCP order for any holistic or herbal compound before they can be used by the people you support.

In addition, substances such as alcohol, caffeine, and nicotine can interact with medications. If a person you support is using these substances, you should report this information to the HCP.

*MassaCHUseTTs For example, countable

medications must be double locked.

*


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nsa note on Categories of Medications Often a medication fits into more than one category. Tylenol is a good example. Tylenol is a brand name and an over-the-counter medication. Another example is oxycodone. Oxycodone and acetaminophen is the generic name for Percocet (a pain medication) which is a prescription medication, a controlled substance, and a countable substance.

apply What Youve learned Freddy has been coming home feeling unusually tired for the last week. You find out that he recently started taking a holistic/herbal compound that he keeps in his locker at work. You wonder whether this compound is interacting with his other medications. What should you do? Put a checkmark next to the answer you think is best. (Remember Freddy? For details about his conditions and capabilities, refer back to page xii.)

1 . Tell Freddy to bring home the substance, and you will give it to him.

2 . Tell Freddy to bring home the substance so you can ask the HCP if its okay to take it.

3 . Tell Freddy not to take any more holistic/herbal compounds.

4 . Say nothing since Freddy can take whatever he wants.

effects of MedicationAs you learned earlier in this module, a medication is given with the hope that it will produce the desired effect and improve the persons health. You learned that some responses to medication may be good, but others may not. You also learned that medication can affect different parts of the body at the same time.

Medications can cause several possible effects. People usually respond to medications in similar ways. But they may experience different side effects. They may also have different medication sensitivity to what they are taking; this means that people may react differently to the same amount of medication. Each person may have a different responsebe more or less sensitive


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depending on their age, body weight, and general health. As a medication administrator, you must look for any changes in the persons physical condition or behavior. Noticing changes may be harder if the person has trouble communicating how they feel. The important thing to remember is that any medication a person is taking may cause physical and behavioral changes. You are in the best position to observe and report any and all suspected changes. It is your responsibility to carefully observe the people you support for three possible outcomes:

3 desired effect3 no apparent desired effect3 unwanted effects

Desired effect/Therapeutic effectWhen a prescribed medication works correctly as intended, it produces the desired effect, also called the therapeutic effect . The desired effect is the beneficial result of the medicationwhat the HCP wants the medication to do. Examples are reducing seizures with a medication called Tegretol, getting rid of a headache with Tylenol. When giving a medication to a person you are supporting, you should know the medications desired effect or what it should do. You must also observe the persons response to the medication.

no apparent Desired effectno apparent desired effect means that the medication is not working as intended, and the person is still experiencing the problem. In some cases, this happens because it may take time before the full effect of the medication can occur. In other cases, the person does not benefit at all from the medication because their body is different in some way.

The term no effect means that after enough time passes for the medication to be fully effective, there is still apparently no desired effect. For example, suppose that the health-care provider prescribes amoxicillin (an antibiotic) to be given three times a day for an infection. If the persons fever does not go down after 24 hours, the amoxicillin has had no effect on the infection.


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There is always a reason for prescribing a medication. So if it is not working, the HCP needs to know that the fever did not go down after taking the amoxicillin. The HCP may then prescribe a different medication, or in other cases may increase the dose of the first medication.

Unwanted effectsWhether or not the desired effect occurs, there is always the possibility that other, unwanted effects will occur. These are also called side effects or adverse responses. The term unwanted effect means that the medication is causing effects that are not intended or wanted. Unwanted effects may show up as physical or behavioral changes. Some changes are easy to spot, such as a rash, diarrhea, vomiting, or fainting. Other changessuch as blurred vision, dry mouth, confusion, anxiety, or drowsinessmay be harder to recognize.

Side effects can range from minor to serious. For example, an antibiotic may help cure an infection, but cause nausea. The nausea may be annoying but not serious enough to stop the medication. An adverse response, however, is an unusual and more serious side effect. If an adverse response occurs, the HCP may discontinue the medication. For example, if the antibiotic causes vomiting that results in dehydration (loss of fluid from the body), the HCP will stop the medication or replace it with a different medication to treat the infection.

Other unwanted effects include:

3 allergic reaction: the persons immune system is overreacting. It starts fighting a harmless substance, like medication, as if defending the body from attack. allergic reactions can cause problems like rash, hives, or runny nose.

3 anaphylactic reaction: a very dangerous allergic reaction that can involve the whole body. It can be life threatening and requires immediate medical attention. A person having an anaphylactic reaction may have difficulty breathing, break out in hives, or experience changes in blood pressure.


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3 Paradoxical effect: the medication does the opposite of what it is supposed to do. A paradoxical effect sometimes occurs with medications used to calm a person. When this happens, the medication makes the person restless or excited rather than calm.

3 Toxicity: occurs when the body builds up more of a certain medication than it can handle. Toxicity can be life threatening. Certain medications are more likely to cause toxicity than others. In some cases, one additional dose can cause toxicity. If a person is taking a medication known to cause toxicity, their blood must be checked regularly in the lab.

apply What Youve learned Think about Melissa. Since taking Mysoline, her new seizure medication, she had been seizure free for 3 months. In this situation, her seizure medication was achieving the desired effectto control her seizures. However, some side effects of Mysoline are dizziness, poor coordination, blurred or double vision, nausea, and vomiting. On the medic

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MAP Manual