NORTH DAKOTANORTH DAKOTADEPARTMENT OF CORRECTIONS & DEPARTMENT OF CORRECTIONS &

REHABILITATIONREHABILITATION

CMT IICMT II

Correctional Medical Training IICorrectional Medical Training IIPreviouslyPreviously

Medication Assistant IMedication Assistant IPROGRAM IN COLLABORATION WITHPROGRAM IN COLLABORATION WITH

MINOT STATE UNIVERSITYMINOT STATE UNIVERSITY

NORTH DAKOTA BOARD OF NURSING

CERTIFICATE OF APPROVAL

Medication Assistant Program I

Offered by

NORTH DAKOTA DEPARTMENT OF CORRECTIONS AND REHABILITATIONBISMARCK, NORTH DAKOTA

Has met the standards for a medication assistant program IAnd is approved by the North Dakota Board of Nursing

From November 2007 to November 2011

Jo Ann Sund, RN Constance B. Kalanek

PhD, RNNovember 16, 2007 November 16, 2007

RequirementsRequirements

Passed CMT IPassed CMT I CPR certificationCPR certification Detailed start and finish date of Detailed start and finish date of

course work.course work. Clinical check list score of 90%Clinical check list score of 90% Student written exam of 85%Student written exam of 85% North Dakota Board of Nursing North Dakota Board of Nursing

regulations allow no more than one regulations allow no more than one retake without further instruction.retake without further instruction.

MedicationMedication

Prevent DiseasePrevent Disease Aid in diagnosis of diseaseAid in diagnosis of disease Treat a disease or reduce symptomsTreat a disease or reduce symptoms Restore normal body functionRestore normal body function Maintain normal body functionMaintain normal body function

Why training to give medications in Why training to give medications in corrections?corrections?

Medications can be dangerousMedications can be dangerous Medications may be unfamiliarMedications may be unfamiliar Rules and procedures are required Rules and procedures are required

by law in correctional facilities.by law in correctional facilities. Correctional facilities must control Correctional facilities must control

medication storage and delivery.medication storage and delivery.

Correctional Delivery ModelCorrectional Delivery Model

Physician or dentistPhysician or dentist PharmacistPharmacist NurseNurse Correctional staff or officerCorrectional staff or officer ***As Correctional staff not allowed ***As Correctional staff not allowed

to make judgments about to make judgments about medication, only observe and report.medication, only observe and report.

Medication CycleMedication Cycle

Observation (observe the offender and Observation (observe the offender and report changes, report side effects)report changes, report side effects)

Prescription (report any known Prescription (report any known complications such as an allergy)complications such as an allergy)

Administration (Monitor correct dose Administration (Monitor correct dose to be given)to be given)

Documentation (check and record on Documentation (check and record on MAR)MAR)

Correctional staff responsibilitiesCorrectional staff responsibilities

Adherence to laws and correctional Adherence to laws and correctional facility policiesfacility policies

Observing for side effectsObserving for side effects Ensuing safety and sanitation policies Ensuing safety and sanitation policies

are followed.are followed.

What are your institutions policies?What are your institutions policies?

Prescription medicationPrescription medication

Non prescription medicationNon prescription medication

LawsLaws

Food and Drug ActFood and Drug Act

Controlled Substance Act of 1970Controlled Substance Act of 1970

Observation SkillsObservation Skills

VisualVisual

AuditoryAuditory

SmellSmell

TouchTouch

General AppearanceGeneral Appearance Body PostureBody Posture General State of Health and Appetite.General State of Health and Appetite. Physical Activity LevelPhysical Activity Level Physical condition of skinPhysical condition of skin Facial expressions and speechFacial expressions and speech General emotional state and state of General emotional state and state of

awarenessawareness Bowel and bladderBowel and bladder

Report any Report any observed observed concerns to concerns to licensed nurse or licensed nurse or shift supervisorshift supervisor

Medication VerificationMedication Verification Proper label on medicationProper label on medication Name of pharmacyName of pharmacy Address of pharmacyAddress of pharmacy Number of prescriptionNumber of prescription Offenders nameOffenders name Physician namePhysician name Date filledDate filled Type of medication and amountType of medication and amount Instructions for taking medicationInstructions for taking medication Initial of pharmacistInitial of pharmacist

References for verifying References for verifying medicationsmedications

Call pharmacyCall pharmacy Call physicianCall physician Call nearest hospital or poison controlCall nearest hospital or poison control Call facility nurseCall facility nurse Mosby or Sanders Nursing Drug Mosby or Sanders Nursing Drug

Reference HandbookReference Handbook Facility nurse or supervisor should be Facility nurse or supervisor should be

notified if problems or questions.notified if problems or questions.

MAR or Medication Administration MAR or Medication Administration RecordRecord

Keep on person medicationsKeep on person medications

Storage in a cool dry area unless Storage in a cool dry area unless otherwise instructed.otherwise instructed.

6 rights to medication delivery6 rights to medication delivery

Right IndividualRight Individual

Right DocumentationRight Documentation

Right DoseRight Dose

Right RouteRight Route

Right Time Right Time

Right MedicationRight Medication

Before meals a.c.Before meals a.c. Every qEvery q Every hour qhEvery hour qh Every six hours q6hEvery six hours q6h After meals p.c.After meals p.c. Three times an day tidThree times an day tid Two times a day bidTwo times a day bid As needed prn As needed prn

By mouth p.o.By mouth p.o. Intramuscular I.M.Intramuscular I.M. Intravenous I.V.Intravenous I.V. Suppository supp.Suppository supp. Pertaining to eyes OphthPertaining to eyes Ophth Pertaining to the ear OticPertaining to the ear Otic Subcutaneous SQSubcutaneous SQ Sublingual SLSublingual SL Inside cheek bucInside cheek buc

Body systemsBody systems

Skeletal Skeletal Bones and joints Bones and joints Body support, protect organsBody support, protect organs

MuscularMuscular MusclesMuscles Body movementBody movement

NervousNervous Brain and spinal cordBrain and spinal cord Control body activityControl body activity

CirculatoryCirculatory Heart and bloodHeart and blood Carry oxygen and nutrients to the Carry oxygen and nutrients to the

cellscells

RespiratoryRespiratory Nose and lungsNose and lungs Provide airProvide air

UrinaryUrinary Kidneys and bladderKidneys and bladder Remove wastesRemove wastes

GastrointestinalGastrointestinal Mouth, stomach and bowelMouth, stomach and bowel Digest food remove wasteDigest food remove waste

EndocrineEndocrine Thyroid and pancreasThyroid and pancreas Secrete hormonesSecrete hormones

SkinSkin SkinSkin ProtectionProtection

SensorySensory Eye, ears, noseEye, ears, nose Sight, hearing and soundSight, hearing and sound

Effects of medicationEffects of medication

Follows the same route as food Follows the same route as food Body WeightBody Weight AgeAge SexSex Pregnancy and lactationPregnancy and lactation Genetic factorsGenetic factors Psychological factorsPsychological factors Illness/diseaseIllness/disease

Desired effectsDesired effects

Side effects (allergy)Side effects (allergy)

No apparent effectNo apparent effect

Medication InteractionsMedication Interactions

PotentiationPotentiation

AntagonismAntagonism

Unique effectUnique effect

Any change in behavior or physical Any change in behavior or physical condition the first few days of condition the first few days of starting a new medication should be starting a new medication should be reported to nurse or shift supervisor.reported to nurse or shift supervisor.

Medication namesMedication names

Trade or brand namesTrade or brand names

Generic namesGeneric names

Chemical namesChemical names

Family or categoryFamily or category

Steps in oral medication procedureSteps in oral medication procedure

Correct time or medication times scheduleCorrect time or medication times schedule Hand washingHand washing Unlock storage areaUnlock storage area Check label, Remove right dose from Check label, Remove right dose from

containercontainer Report changes in appearance of medication Report changes in appearance of medication

to nurse, supervisor, or pharmacistto nurse, supervisor, or pharmacist Observe swallowing of medicationObserve swallowing of medication Replace medication in locked storage area.Replace medication in locked storage area. Chart medicationChart medication Observe for desired or side effectsObserve for desired or side effects

Steps in liquid medication deliverySteps in liquid medication delivery

Time scheduleTime schedule Hand washingHand washing Unlock storage areaUnlock storage area Check labelCheck label Shake before pouring and pour away from label Shake before pouring and pour away from label

side.side. Pour at eye level and pour right before givingPour at eye level and pour right before giving Don’t mix other medications or with other liquid Don’t mix other medications or with other liquid

medicationmedication Observe swallowing of liquidObserve swallowing of liquid Replace in locked storage areaReplace in locked storage area Chart medication Chart medication Observe and report medication effectsObserve and report medication effects

Special Medication ProceduresSpecial Medication ProceduresCorrectional staff Correctional staff

What is the purpose and desired effect of What is the purpose and desired effect of medication given.medication given.

Response timeResponse time Side effectsSide effects Possible interactions with other medications.Possible interactions with other medications. Special storage or administration procedures.Special storage or administration procedures. Controlled substance counted and controlled Controlled substance counted and controlled Controlled substances are not advocated to Controlled substances are not advocated to

be used in correctional facilities.be used in correctional facilities.

What is your facility’s procedure if What is your facility’s procedure if offender is away from facility regarding offender is away from facility regarding medication delivery?medication delivery?

Procedures for verbal orders. Only a Procedures for verbal orders. Only a licensed nurse can take a verbal order.licensed nurse can take a verbal order.

Procedures for prn medications. Most Procedures for prn medications. Most correctional facilities don’t allow. Must be correctional facilities don’t allow. Must be documented appropriately.documented appropriately.

Eye drops or ointmentsEye drops or ointments Wash hands soap and water. Use glovesWash hands soap and water. Use gloves Avoid touching around the eye with dropper or Avoid touching around the eye with dropper or

vehicle for dispensing. Keep dropper and eye vehicle for dispensing. Keep dropper and eye area clean.area clean.

Lying down position or head tilted back.Lying down position or head tilted back. Index finger pull eye lid down to form a Index finger pull eye lid down to form a

pocket. Support rest of hand on nose and pocket. Support rest of hand on nose and cheek.cheek.

Drop desired amount in pocketDrop desired amount in pocket Replace cap and have offender close eye Replace cap and have offender close eye

gently gently Wash hands after removing gloves and return Wash hands after removing gloves and return

to storage area.to storage area.

Ear dropsEar drops Wash hands soap and water Wash hands soap and water Check medication delivery systemCheck medication delivery system Medication bottle and ear are cleanMedication bottle and ear are clean Warm drops in hand shakeWarm drops in hand shake Tilt ear up. Hold ear lobe down and backTilt ear up. Hold ear lobe down and back Place prescribed amount in ear.Place prescribed amount in ear. Don’t put dropper into the ear canal.Don’t put dropper into the ear canal. Keep ear tilted awhile and then insert Keep ear tilted awhile and then insert

cotton plug.cotton plug. Wash handsWash hands

Topical medicationTopical medication Position offender in a comfortable positionPosition offender in a comfortable position Wash hands wear glovesWash hands wear gloves Check labelCheck label Follow directions on label can use a tongue bladeFollow directions on label can use a tongue blade Creams rub gentlyCreams rub gently Lotions pat or dab on skinLotions pat or dab on skin Liniments rub vigorouslyLiniments rub vigorously Aerosol sprays 3-6 inch away Aerosol sprays 3-6 inch away Form medication place next to skin and sprayForm medication place next to skin and spray Remove gloves wash hands and store properly.Remove gloves wash hands and store properly.

Nebulizer treatmentNebulizer treatment Wash hands: prepare supplies and set up Wash hands: prepare supplies and set up

equipmentequipment Offender sit upright check heart rate and Offender sit upright check heart rate and

respiration rate and record.respiration rate and record. Check MAR and appropriate dosage of Check MAR and appropriate dosage of

medicationmedication Place mouth piece in mouth and start Place mouth piece in mouth and start

machine. When medication is gone, shut machine. When medication is gone, shut off machine.off machine.

Check heart rate and respiration rate and Check heart rate and respiration rate and record.record.

Wash equipment and handsWash equipment and hands

Transdermal patchesTransdermal patches

Wash hands wear glovesWash hands wear gloves Check medication label with MARCheck medication label with MAR Date and initial patch before applyingDate and initial patch before applying Remove old patchRemove old patch Apply to non-hairy area as directedApply to non-hairy area as directed Place patch on skin and hold down with Place patch on skin and hold down with

palm 30 secondspalm 30 seconds Remove gloves, wash hands and Remove gloves, wash hands and

document in MARdocument in MAR

Difficulty swallowingDifficulty swallowing

Sitting positionSitting position Small sips waterSmall sips water Take one tablet at a timeTake one tablet at a time Rest between tabletsRest between tablets Put medication in a teaspoon of Put medication in a teaspoon of

pudding etc.pudding etc. Check if comes in a liquid.Check if comes in a liquid.

Refusal of medicationRefusal of medication

Document the reason for refusal and Document the reason for refusal and follow facility policy for medication follow facility policy for medication refusal.refusal.

Allow time to pass and reoffered Allow time to pass and reoffered medication?medication?

Notify nurse or shift supervisorNotify nurse or shift supervisor

Errors in medication administrationErrors in medication administration

Use facility policy such as an incident Use facility policy such as an incident report or variance.report or variance.

Wrong individualWrong individual Wrong medicationWrong medication Wrong doseWrong dose Wrong timeWrong time Wrong routeWrong route Wrong procedure/documentationWrong procedure/documentation

Anticonvulsant Anticonvulsant

Control seizuresControl seizures Side effectsSide effects DrowsinessDrowsiness Upset stomachUpset stomach Constipations Constipations Sore throat/infectionSore throat/infection Dizziness/unsteadinessDizziness/unsteadiness Slurred speechSlurred speech

AntibioticAntibiotic

Purpose treat infections given for 4-Purpose treat infections given for 4-10 days. It is important to take all 10 days. It is important to take all medication.medication.

Side effects Side effects Rash or hivesRash or hives ItchingItching Nausea or vomitingNausea or vomiting

AnalgesicsAnalgesics

Relieve painRelieve pain Side effectsSide effects DrowsinessDrowsiness ConstipationConstipation HeadacheHeadache Nausea/vomitingNausea/vomiting Slow respirationsSlow respirations

PsychotropicPsychotropic

Reduce symptoms of emotional Reduce symptoms of emotional disordersdisorders

Side effects Side effects Nausea and loss of appetiteNausea and loss of appetite Weight gain and metabolic syndrome Weight gain and metabolic syndrome

(diabetes and high cholesterol)(diabetes and high cholesterol) DiarrheaDiarrhea

HormonesHormones

Stimulate metabolismStimulate metabolism Birth ControlBirth Control InsulinInsulin SteroidsSteroids Hormone replacement therapy.Hormone replacement therapy.

AntacidAntacid

Relieve upset stomachRelieve upset stomach Side effectSide effect ConstipationConstipation

Anti hypertensiveAnti hypertensive CardiovascularCardiovascular Anti-inflammatoryAnti-inflammatory Protein pump inhibitorsProtein pump inhibitors