t
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M edications
Right way
Margaret Casey-Mederios RN
CC&R Healthcare Solutions
Winthrop, Massachusetts
Thisbook
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at 877-539-0109.
All rights reserved. No part of the publication may be reproduced, stored in a retrieval
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Table of Contents
1
1
1
2
3
3
5
6
7
10
13
15
17
17
19
21
21
21
23
23
24
26
30
34
35
37
37
37
38
38
39
41
iii
42
46
47
47
48
Non-Mandatory Content
49
49
49
50
50
51
53
53
54
iv
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Standard Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hand Washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wearing Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Non-Mandatory Content
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Managing Behavioral Symptoms . . . . . . . . . . . . . . . . . . . . 104
Aging and Chronic Changes . . . . . . . . . . . . . . . . . . . . . . . 105
Swallowing Difficulty (Dysphagia) . . . . . . . . . . . . . . . . . . . 106
Administering Several Different Medications . . . . . . . . . . . . 107
Maximizing Capabilities During Medication Administration . . . 108
The Goals of Self-Administration . . . . . . . . . . . . . . . . . . . 110
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Non-Mandatory Content
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
vi
To the Student
As 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-bystep 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.
Introduction
vii
viii
Roof
Walls
Foundation
Figure i1: The first three sections of this manual are like the three most
important parts of building a safe, sturdy house.
ix
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 Study
When 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.
Each 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:
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.
Meet Melissa
Melissa 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 Chip
Chip 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
Introduction
xi
Meet Freddy
Freddy 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
xii
A Note on Language
In 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:
*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
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:
A Note on Dates
The 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.
Introduction
xiii
Acknowledgments
Kathy 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 Morrow
Dorothea Federico
Sue Lyas
Barbara Breen
Linda Goodale
Linda McCall
Sharon Oxx
Gina Hunt
Jeanne Reed
Walter Polesky
Lisa Kaliton
Joanne Shea
John Boisseau
Betsy Kenerson
Barbara Sudano
Marie Brunelle
Ted Kirby
Adam Wilczek
Catherine Cordeiro
Rosemary Sullivan,
Bob Boyer
Amy Avakian
for her inspiration about Carolyn Whittemore
Kathy Leber
Melissa
Noreen Egan
Dedication
This 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.
xiv
MAP CERTIFICATION
Please 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.
CERTIFICATION
You 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:
RE-CERTIFICATION
Re-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.
D&S Testing Process b
SECTION
Administering Medications
the Right Way
Objectives
SECTION 1: Module 1
introduction
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
SECTION 1: Module 1
*MASSACHUSETTS
An error in the administration
of a medication is called a
Medication Occurrence.
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
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.
SECTION 1: Module 1
Apply What Youve Learned Think about the people you support, and
answer the following questions.
3. Name three ways you can get to know the people you support.
Principles to Consider
Whenever you give medication, you must keep in mind three
principles:
3 mindfulness
3 maximizing capabilities
3 communication.
These principles will help ensure that you give medication the
right way. Each principle is described below.
Mindfulness
Being 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:
SECTION 1: Module 1
Maximizing capabilities
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.
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:
SECTION 1: Module 1
10
4. Hold her cup up to her mouth after you place her medications
in her mouth.
A Cycle of Responsibility
Observe or watch for changes
(physical & behavioral)
Report changes
Administer medication
Store medication
Record information
Figure 11: Safe medication administration involves all of these parts or responsibilities.
Report changes
*MASSACHUSETTS
SECTION 1: Module 1
11
*MASSACHUSETTS
DDS ONLY
Record information
*MASSACHUSETTS
In Massachusetts, a medication
sheet may be called a medication
administration record or a
medication administration sheet.
Once 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 medication
In 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.
12
Administer medication
After 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.
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
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.
7. Administer medications.
13
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
Report changes.
Mindfulness
Maximizing capabilities
Communication
Support visits to the HCP.
Mindfulness
Maximizing capabilities
Communication
Communicate with the pharmacist.
Mindfulness
Maximizing capabilities
Communication
Record information.
Mindfulness
Maximizing capabilities
Communication
14
Communication
Store medications.
Mindfulness
Maximizing capabilities
Communication
Administer medications.
Mindfulness
Maximizing capabilities
Communication
Document the medication administration.
Mindfulness
Maximizing capabilities
Communication
3 Visit and greet each person you support. Ask them how they
are doing and if there is anything new.
SECTION 1: Module 1
15
Apply What Youve Learned You have been supporting Melissa for
16
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.
Summary
In Module 1, you learned some of the basics of medication
administration. Here are the key points:
SECTION 1: Module 1
17
Documentation
3 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.
18
to a HCP.
3 Document that the medication
was given.
3 Verify counts of countable
substances.
3 Enter information into a computer
(if applicable).
Administration
3 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.
Management
3 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.
Crossword Puzzle
Complete
this crossword puzzle using the clues below and
the Terms to Study at the beginning of the module.
1
10
11
12
13
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
SECTION 1: Module 1
19
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.
4. List ten skills you are responsible for as a direct care worker when
administering medications.
20
*MASSACHUSETTS
21
22
introduction
SECTION 1: Module 2
23
Categories of Medications
24
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 Medications
Generic Medications
Generic 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 Substances
*MASSACHUSETTS
For example, countable
medications must be
double locked.
25
Apply What Youve Learned Freddy has been coming home feeling
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 Medication
As 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
26
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.)
3 desired effect
3 no apparent desired effect
3 unwanted effects
Desired Effect/Therapeutic Effect
When 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.
SECTION 1: Module 2
27
Unwanted Effects
28
continued 3
SECTION 1: Module 2
29
3. Melissa has been seizure free for 3 months, she vomited today, and
had a seizure. She takes Mysoline 2 times/day.
Medication Interactions
Often people receive more than one medication at a time.
Whenever a person is taking two or more medications, an
unwanted effect may result from the interaction (mixing) of the
medications in the body. Every medication has the potential
to interact with another medication. In fact, interactions can
occur with any combination of medications, compounds, and/or
substances. For example, when Freddy takes the holistic/herbal
30
SECTION 1: Module 2
31
In the blank provided, write the letter of the definition that fits the term.
Effects and Categories of Medication
1. Medication Sensitivity
2. Toxicity
3. No Apparent Desired Effect
4. Allergic Reaction
6. Paradoxical Reaction
7. Anaphylactic Reaction
8. Unwanted Effects
9. Medication Interaction
10. Generic Medication
11. Prescription Medication
32
5. Desired/Therapeutic Effect
Fill in the information below using one of the resources mentioned above and
a medication you are familiar with.
Name of the medication
Therapeutic effect (what you expect to occur when the medication is given)
SECTION 1: Module 2
33
Summary
You may be wondering how you will ever learn all this
information about medications. Take one step at a time.
Start by getting to know the people you will be supporting.
Help with medication administration and learn about the
medications each person will be taking. Build on your
knowledge as new medications are ordered. Always be sure
you know the facts about a medication before giving it. Make
this your practice every day. Medication administration is an
ongoing learning experience. You will always find something
new to learn.
34
.
4. If a persons immune system overreacts to a medication or
other substance (by producing a rash or hives, for example), we
call this response an
.
5. The response wanted or expected from a medication is called
the
.
6.
/
compounds are
natural substances that you can buy without a prescription.
7. A medication
is a change in the effect of a
medication when it is given at about the same time as another
medication. This response can also occur with certain foods
as well as with alcohol, nicotine, caffeine, or other chemical
substances.
8. A response caused by the medication that is not wanted or
intended is called a
.
9. How responsive a person is to a medication or other substance
is known as their
.
10. A bad response to a medication is called an
effect.
11.
medications can
be bought in a drug store without a prescription from the HCP.
12.
SECTION 1: Module 2
35
14. An
is a very strong,
dangerous allergic reaction that can involve the entire body.
This reaction happens quickly, is often life threatening, and
requires immediate medical help.
15. An allergic reaction, side effect, or paradoxical effect that was
not planned is called an
.
True/False
In the blank provided, write T if the statement is true or F if the
statement is false.
36
SECTION
The Techniques of
Medication Administration
Objectives
37
Introduction
38
Report changes
Administer medication
Store medication
Record information
Figure 31: Observing or watching for changes begins the Cycle of Responsibility.
3 a cut that is red and swollen (which you can see and
maybe feel)
SECTION 2: Module 3
39
40
*MASSACHUSETTS
DDS ONLY
Remember, as the staff member who spends the most time with
the person, you are often the first one to observe a change.
Some changes may be due to illness and be serious, and others
may not. Changes include behavior that is unusual or not typical
for the person. Your responsibility is to report information.*
Without your observations and accurate reporting, small changes
and medication interactions may be missed. Never feel that
information you are reporting is not important. Always follow up
on information you report. Find out what action was taken, if any,
and what the results were.
Think about Melissa, Chip, and Freddy. They each have
different abilities to communicate how they feel. If you are the
person supporting Melissa, Chip, and Freddy, you would have
to report what you observed and what they communicated to
determine the effect of the medications they received. (For details
about their conditions, medications, and capabilities, please refer
back to the descriptions of Melissa, Chip, and Freddy, beginning on
page xi.)
Because you know Melissa, Chip, and Freddy, you are able to
observe them for changes. For example, Melissa cannot tell you
how she feels, but she may sleep more, groan, or smile to express
how she feels. Changes in her behavior or facial expressions may be
the only clues you have about how she is reacting to a medication.
If Melissa would not hold onto her cup when you were giving her
the morning dose of Mysoline, what would you do?
Or consider Chip. He normally takes his medication without
difficulty. But suppose you observe Chip pacing back and forth,
mumbling phrases over and over, and not making any sense. When
giving him his medications, he knocks the cup over and spills the
water on the floor. What would you do?
Suppose that Freddy will not get out of bed for work, and you
notice that he is not interested in working on self-administering.
What would you do?
SECTION 2: Module 3
41
True/False
42
4. Melissa would not hold her cup. There was a tear on her cheek
when she got her evening dose of Mysoline.
about them. For example, you should not share information with a
neighbor about the health of a person you support.
The timing of reporting is just as important as what you
report. In certain situations, timing can make a difference in the
quality of the support you give. Also remember that it is much
better to report often than to report once in a while. When in
doubt, report it.
Reporting information is your responsibility. In Figure 32
you can see that reporting changes is an important part of the
Cycle of Responsibility. Below are some guidelines to help you
understand situations that require immediate reporting, certain
time reporting, and routine reporting.
Report changes
Administer medication
Store medication
Record information
Immediate reporting
*Massachusetts
The DPH requires that the
telephone numbers for the MAP
Consultant, poison control, and
emergency numbers be posted
clearly and near the telephone in
all residences.
SECTION 2: Module 3
43
Routine reporting
Routine reporting is information about what happened with
the person on a particular day, and includes everyday activities.
In routine reporting, you should describe both subjective and
objective observations. You might report that Melissa seemed
happy because she was smiling every time you went into her
44
Read the descriptions of situations below. Then write yes if you would report
the situation or no if you would not report it.
1. No seizure activity noted today.
2. Change in mood.
3. Refused a PRN sleeping pill when they usually take one.
4. A fever that has not gone down an hour after taking ordered
acetaminophen.
5. Repeated episodes of angry or aggressive behavior, which are
manageable but not typical for the person.
6. A rash that lasts for several days or appears to be getting worse.
7. A complaint of sore throat.
8. A change in the type of seizure the person usually experiences.
9. An increase in seizure activity.
10. Unusually withdrawn behavior from a person who is usually
very social.
11. Refusal to take prescribed medications.
12. Changes in sleeping patterns (especially sleeping too much
or too little).
13. Seemingly minor problems such as colds or mild diarrhea.
14. Unexpected minor bruises.
15. Change in coordination.
continued 3
SECTION 2: Module 3
45
16. Rash.
17. No side effects noted from a new medication.
18. Call from the HCP about a persons blood level (normal results).
46
Summary
Do not think of administering medications as just a task
that has to get done during your workday. Your role as direct
support staff is important. Your conscientious observation
and reporting of changes in a persons physical condition
and behavior will contribute to their well being. Be sure to
report both subjective and objective information, following
the guidelines for reporting immediately, at a certain time, or
routinely.
SECTION 2: Module 3
47
4.
5. When you report what a person tells you about how they
feel, you are reporting
information.
6.
7.
True/False
In the blank provided, write T if the statement is true or F if the
statement is false.
1. You must only report subjective information.
2. You do not need to report changes in behavior.
3. Any significant changes in a persons physical condition
or general behavior could be important.
4. Use an incident report to document any injury.
48
3.
Objectives
*Massachusetts
Non-Mandatory Content
Introduction
SECTION 2: Module 4
49
Infection Control
Clean Versus Dirty
Standard Precautions
Standard precautions are a set of rules that you must follow
whenever you administer medications. Standard precautions
help protect you and the people you support from the spread of
infection. With this approach, you use the same procedures for
administering medications to someone you think is healthy that
you would use with someone you know is not. You assume that
everyones blood, other body fluids, and mucous membranes may
be infected. The procedures you will use in standard precautions are
related to administering medications. These precautions will reduce
the chance of spreading germs by making sure that the area you
are working in, the tools and medications you use, and you yourself
are clean. Even though these actions seem simple, they are very
important. The following are important steps for you to follow:
3 Make sure the place where you will prepare the medication
is clean. Scrubbing with water and soap or detergent will
clean most surfaces.
50
Hand Washing
According to standard precautions, you should wash your hands
according to these guidelines:
Skill 1
SECTION 2: Module 4
51
4. Rinse your hands. Allow the water to run from your wrist to
your fingers.
5. Dry your hands on a clean paper or cloth towel.
6. Turn off the faucet using the towel.
7. Throw away the paper towel.
Note: When soap and water are not available, apply an
antiseptic hand cleaner and rub your hands thoroughly until
they are dry, or use antiseptic wipes to wash your hands.
What did you forget to do the first time you washed your hands? Did you
at any point contaminate your hands? What did you do differently the
second time?
List 5 occasions when you should wash your hands. Think before or after
52
Hand washing
1: Go wash your hands.
2: Re-read the steps for washing hands properly.
3: Wash your hands again following the steps, one by one, paying attention
to every detail.
Wearing Gloves
In addition to hand washing, you may need to wear gloves at
times. For example, if you need to apply an ointment to an open
area of skin, you must wear gloves.
To put gloves on properly, wash your hands as described above
and then slip the gloves on, covering your entire hand and wrist.
Skill 2
Taking the gloves off correctly takes more practice. To take off
gloves properly, follow these steps. (If you are left-handed, use
the opposite hand from the one described.)
1. With your gloved right hand, take hold of the glove on the
left hand at the inside of the wrist, turning the glove inside
out as you pull it down over your left hand. This will help
keep the dirty or contaminated side of the glove away from
your hands. Roll the glove in a ball in your gloved right hand.
2. With your left hand, take hold of the inside of the top of
the right glove at the wrist. Then pull the right glove over
your right hand and cover the used glove held in that hand.
At this point, the right glove is inside out, with the left
glove tucked inside.
3. Throw away the gloves in the trash.
4. Wash your hands.
Summary
Understanding and practicing standard precaution procedures
is an important part of your responsibilities. These
procedures protect both you and the people you support.
When you practice the proper way to wash your hands, you
can dramatically reduce the spread of germs. Good infection
control procedures help everyone stay healthy.
SECTION 2: Module 4
53
Matching
Match
the term in the left column with the correct definition in
the right column.
A. A procedure that reduces the spread
of germs.
2. Infection
3. Hand washing
4. Mucous Membrane
2. In your own words, define Standard Precautions and explain why these
precautions are important.
54
1. Standard Precautions
55
Oral the route of getting medication into the persons mouth and
swallowed.
Parenteral intramuscular (into a muscle) or intravenous (into a
vein) administration of medications; injection.
Right proper or correct. You must give medications in a proper
manner by always checking for the right person, the right
medication, the right dose, the right route, and the right time.
Route the route is defined as how or where a medication gets
into or onto a person.
Getting Started
In Module 1 you learned that the process of administering
medications occurs in a cycle known as the Cycle of
Responsibility. Each part of the cycle relies on the one before
and the one after it to be complete. For safe medication
administration, none of the parts of the cycle can be skipped,
eliminated, or performed mindlessly. Remember, the parts of the
Cycle of Responsibility are:
Introduction
3 Store medication.
3 Administer medication.
3 Document the medication administration.
To administer oral medications correctly, you must understand
the information you receive from the HCP and the pharmacist.
Figure 51 shows you where the visit to the HCP fits in the
Cycle of Responsibility. What you receive from the HCP and
pharmacist is part of the cycle.
Report changes
Administer medication
Store medication
Record information
Figure 51: Supporting visits to the HCP is an important part of the Cycle of Responsibility.
57
Date: 1/1/yr
Allergies: Bactrim
Date: 1/1/yr
Ear Infection
Medication/Treatment Orders: Amoxicillin 250 mg 2 times a day by mouth
for 10 days
Health Care Provider Findings:
Instructions:
2 weeks
Dr. T. Smith
Follow-up visit:
Signature:
Posted
1/1/yr
Verified
Figure 52: Your agency will have a specific HCP Visit Form to be taken on a visit.
58
Report changes
Administer medication
Store medication
Record information
Figure 53: Communicating with the pharmacist is an important part of the Cycle of
Responsibility.
59
Pharmacy Label
2 Rose Garden Pharmacy
20 Main Street
Any Town, MA 01969
Freddy Connors 4
6
Amoxicillin 250 mg. 8
IC: Amoxil 250 mg.
10
9
Rx# 284-9726
1
3 800-555-1111
5 1/1/yr
7 Qty-20
11
16 Refills: 0
Figure 54: All medications from the pharmacy must have a clearly written pharmacy label.
60
Apply What Youve Learned Suppose you take one of the people
you support to the HCP for their annual check up. The HCP tells the
person to begin taking Inderal and writes a HCP order on the visit form
and a prescription for Inderal. When you receive the medication from the
pharmacy, the label lists the medication as propranolol (the generic form of
Inderal). What should you do? Is propranolol the right medication?
List three ways you can learn about medication you receive.
SECTION 2: Module 5
61
Report changes
Administer medication
Record information
Record Information
The information about the medication from the HCP order and
the pharmacy label must be written onto a medication sheet
by you or the responsible staff person in your agency. The
medication sheet is the legal record of documentation for all
medications administered. Figure 55 shows you where recording
information fits in the Cycle of Responsibility.
Note: Some pharmacies prepare medication sheets when
they fill a prescription. Each staff member administering any
medication must use the HCP order, the pharmacy label, and
the medication sheet for all the checks needed to administer
a medication safely. Section 3 will provide more details about
how to work with the HCP and pharmacist.
62
Store medication
Report changes
Administer medication
Store medication
Record information
Figure 56: All medications must be stored. You will learn about how medications are
stored in Section 3: Module 8.
Store Medication
After the information is recorded on the medication sheet you will
store the medication before it will need to be administered. In Section
3 you will learn more about storing medications. Figure 56 shows you
where storing medication fits in the Cycle of Responsibility.
*Massachusetts
To remember the 5 Rights use
the acronym I must do this
right.
I - Person
Must - Medication
Do - Dose
This - Time
Right - Route
63
Report changes
Administer medication
Record information
Figure 57: Administering medications the right way is part of the Cycle of Responsibility.
*Massachusetts
You must call your MAP
Consultant first.
3 Right person
3 Right medication
3 Right dose
3 Right time
3 Right route
64
Store medication
*Massachusetts
call your designated agency personnel immediately.*
If anything is wrong,
Select two of the rights from the previous page. In the space below, describe
what you believe could happen if the right turned out to be a wrong.
What could happen if you had the wrong
?
What could happen if you had the wrong
?
What exactly do these rights mean? Below is a description of
each one.
Right Person
To make sure you are giving medication to the right person, you
have to know the people you support. In Module 1, you learned
how important this is. If you are not certain that you have
identified the right person, you must get help. You can ask other
staff, check for a picture of the person or call your supervisor for
assistance. One thing you should not do is ask the person. The
people you support may answer to other peoples names. So do
not give any medication to anyone you are not positive is the
right person.
Right Medication
On the prescription, the HCP may write the brand name but
indicate that the generic medication may be used. In this case, the
pharmacist may put both the brand name and the generic name
on the label. Remember, if you are not sure of the name of the
medication, ask the pharmacist.
SECTION 2: Module 5
65
If you are familiar with the medication and notice that the size
or color has changed, you must not administer the medication.
Call the pharmacist and ask if the medication has changed.
Describe the medication that you have, and tell the pharmacist
the name on the container. You may also ask for a description of
the medication. Do not administer anything unless you are certain
it is the right medication.
Apply What Youve Learned Suppose you come on duty and are told
Right Dose
The right dose is how much medication you must give to the person
each time the medication is due, for example, 100mg. The dose
is what the HCP orders. The dose is usually written in milligrams
(mg). The strength of the medication is what the pharmacy
supplies. The strength can be the same as the dose ordered (100
mg in the example above), or it can be a number that adds up to
equal the dose. The amount is the number of tablets, capsules,
teaspoons, mLs, etc. that you put in the cup. When pharmacists fill
prescriptions, they may not always have the exact dose on hand.
So they will direct you on the pharmacy label (how much) you
have to administer to equal the dose ordered. For example, if the
HCP orders 100mg (dose), and the pharmacy only has 50mg tablets
(strength) of the medication, you will administer two (amount)
50mg tablets to equal 100mg.
66
by the previous shift staff that the HCP has ordered another anti-seizure
medication called Tegretol for Melissa, but it has not been delivered from
the pharmacy yet. When it arrives you notice that the label says Prozac
10mg, take 2 tablets by mouth in the morning. What should you do? Circle
your answer.
The left column shows the HCP order for a medication. The middle column is
the strength of the medication available at the pharmacy. In the right column,
write down the number of tablets you would expect to find on the pharmacy
label.
Imuran 100mg
50mg tablets
30mg tablets
Atenolol 25mg
25mg tablets
Lorazepam 0.5mg
0.5mg tablets
Prednisone 3mg
1mg tablets
Lipitor 20mg
10mg tablets
Right Time
The right time can mean a particular time of the day, the number
of times per day, and the time between doses of a medication.
There are many ways that the HCP may specify the time to give
a medication. For example:
67
Frequency
Twice a day
HOUR
8am
8am
8am
12pm
8pm
4pm
4pm
8pm
8pm
Figure 58: How many times a day to give meds. The specific times a day to choose to give meds.
68
The pharmacy label will tell you what the HCP ordered.
You will need to write on the medication sheet the times that
the medication is to be given. The actual time of day you give
a medication (based on the directions from the HCP) can vary
from agency to agency. For example, one agency may routinely
designate 8:00 a.m. as the time to give medications, ordered
once a day, while another agency may choose 9:00 a.m. as the
time. Frequency is a term that is sometimes used for Right time.
It means how often the medication should be given in a 24-hour
period or a day.
What is important about time is to follow the HCPs order
and the pharmacy labelespecially if the time is specific, in the
morning, for example. If you are allowed to determine the time to
administer, follow your agencys rules.
Also pay attention to medication orders that instruct you
to give the medication with a certain number of hours between
administrations. For example, Tylenol given every six hours around
the clock means to space the timing by six hours. A time schedule
every six hours could mean to give the medication at 12:00 a.m.,
6:00 a.m., 12:00 p.m., 6:00 p.m. Every agency will have a certain
timing structure to follow. Figure 58 gives an example of Right
time (frequency). You should always choose a specific time for the
medication. You cannot use time frames such as breakfast, lunch,
and dinner, without a specific time on the medication sheet. The
risk with doing so is that the medication times can vary day to
day, and benefits of the medication may not be achieved.
*Massachusetts
Right Route
The right route refers to where and how the medication gets into
the body. You will be administering medications orally (by mouth).
To administer medications using different routessuch as the skin,
ears, eyes, nose, vagina, and rectumyou will need to speak to
your supervisor about learning to administer medication by new
routes.
The HCP prescribes a medication in a certain form (tablets,
capsules, ointments, liquid, etc.). The form of the medication
determines the appropriate route. Capsules, tablets, and liquids
SECTION 2: Module 5
69
70
71
Crosschecks
Each time you give the medication, you must perform the
following crosschecks. Do these three crosschecks before you give
the medication:
1. When you take the medication out of the locked container,
and place it on a clean surface, check the HCP order to the
pharmacy label.
Crosscheck 1
HCP
Orders
Pharmacy
Label
Figure 59: In Crosscheck 1, compare the HCP orders to the pharmacy label. The reason for Crosscheck 1 is to make sure
the information on the pharmacy label agrees with the HCP order.
Crosscheck 2
=
Pharmacy
Label
Medication
Sheet
Figure 510: In Crosscheck 2, compare the pharmacy label to the medication sheet. The reason for Crosscheck 2
is to make sure the instructions and the amount on the label agrees with what is transcribed onto the
medication sheet.
72
Crosscheck 3
=
Pharmacy
Label
Medication
Sheet
Figure 511: In Crosscheck 3, compare the pharmacy label to the medication sheet. The reason for
Crosscheck 3 is to verify that the amount of the medication prepared is the same as what
the medication sheet and pharmacy label instruct.
SECTION 2: Module 5
73
Apply What Youve Learned You receive a renewal delivery from the
pharmacy for a persons blood pressure medication, Norvasc 5 mg, tablets.
When you look at the medication you notice that the tablets are blue
instead of white. What should you do?
Chips dose of digoxin 0.375mg was decreased to 0.125mg because his blood
level was too high, and he showed symptoms of toxicity. It is time for Chips
morning dose of digoxin. You take the first bottle of digoxin you see from
the storage area. You read the pharmacy label and assume the dose has not
changed. After administering the digoxin to Chip and beginning to document,
you notice that the dose of 0.375mg had been discontinued, and there is
another container labeled 0.125mg. Write down the checks that would have
prevented this Medication Occurrence.
74
Apply What Youve Learned Suppose that while you were on vacation,
*Massachusetts
75
76
77
Gather equipment.
Remember: Getting together the things that you need for the
medication administration helps you to be organized.
Identify and if possible bring the person to the area where you
will administer the medication and provide privacy.
Remember: By identifying the person, you are making sure you
have the right person. Bringing the person to the area where you
are working allows for privacy and a distraction-free environment.
Here you will be able to focus on the person and allow time to
maximize their capabilities.
Note: If you are unable to bring the person to the area where
you are working, or bringing the person to the area may be
a distraction, be sure to follow the same procedures and also
remember to lock the storage area before you leave to go to the
person.
78
The following are the standard administration steps for all oral
medication administrations.
Crosscheck 1 Read the medication sheet and identify the medication you
will be administering. Remove the medication from the storage
container and place it in a clean well-lit place. Perform Crosscheck
1. Compare the HCP order to the pharmacy label. As you do
Crosscheck 1, ask yourself, Do I have the right medication, for the
right person, in the right dose, at the right time, and by the right
route on these two documents? The reason for Crosscheck 1
is to make sure the information on the pharmacy label agrees
with the HCP order.
*Massachusetts
If a medication is a countable
substance, it must be in a
tamper-resistant package such as
a blister pack.
SECTION 2: Module 5
79
Crosscheck 3 Open the container and remove or pour the medication from
the container into the medication cup. Perform Crosscheck 3.
Compare the pharmacy label to the medication sheet. As you do
Crosscheck 3, ask yourself, Do I have the right medication, for the
right person, in the right dose, at the right time, and by the right
route on these two documents? The reason for Crosscheck 3 is to
verify that the amount of the medication prepared is the same as
what the medication sheet and pharmacy label instruct.
Note: Remember too that a combination of the strength and
amount must be equal to the dose. For example, the HCPs order
may read Amoxicillin 500mg, give two times a day, but the
pharmacy label reads Amoxicillin 250mg, give 2 tabs 2 times a
day. By giving two 250mg tablets each time, you will give the
proper dose of 500mg two times a day.
80
Note: There are times when the pharmacy will send a different
looking medication than what is usually administered. If you
are not sure, call the pharmacy. You must read the label for
any directions for giving the medication. For example, the
pharmacist may put a label on the medication with directions
to give the medication with water or food. Never alter a
medication by crushing it, dissolving it in water, mixing it with
food, or pouring the contents of a capsule into liquid unless
instructed by a pharmacist and ordered by the HCP. Never split,
cut, break, or open a tablet, pill, or capsule. Every medication
dispensed from the pharmacy must be ready for you to
administer. Never share or use another persons medication.
Make sure the person takes the medication, drinks, and swallows
the water.
Remember: By staying with the person, you can make sure the
person takes and swallows the medication without difficulty. If
the person has trouble swallowing tablets, you should call your
agency personnel for advice. Remember you cannot change a
medication without a HCP order.
SECTION 2: Module 5
81
Look again and compare the pharmacy label and the medication
sheet to be sure you have administered the right medication to
the right person, in the right dose, at the right time, and by the
right route.
82
Administering Medication
o Crosscheck 1. Check 5 Rights. (HCP order to
D
pharmacy label)
Do Crosscheck 2. Check 5 Rights. (Pharmacy label to
the medication sheet)
Prepare the medication correctly. Remove the
medication from the container; do Crosscheck 3. Check
5 Rights. (Pharmacy label to the medication sheet)
Tell the person what medication they are taking. Give
the person the medication.
Make sure the person takes the medication.
SECTION 2: Module 5
83
When you are administering medication, what principles should you consider?
Why?
84
Read the steps again for administering an oral medication. What principles should
you consider with each step? Remember the principles are mindfulness, maximizing
capabilities, and communication. Write your answer in the space below.
3 If the measuring device does not match the dose, do not
use it. Call your agency personnel for assistance.
3 Do not put any liquid medication back into the bottle that
has been poured into a cup.
SECTION 2: Module 5
85
Skill 4
Skill 5
Skill 6
86
SECTION 2: Module 5
87
Identify the person, bring the person to the area where you will
administer the medication, and provide privacy.
Remember: By identifying the person you are making sure you
have the right person. Bringing the person to the area where you
are working allows for privacy and a distraction-free environment.
Here you will be able to focus on the person and allow time to
maximize their capabilities.
88
Note: If you are unable to bring the person to the area where
you are working, be sure to follow the same procedures and
also remember to lock the storage area before you leave to go
to the person.
SECTION 2: Module 5
89
Remove the cap, and place it upside down on a clean flat surface.
Remember: Placing the cap upside down prevents germs from
getting into the cap and into the liquid medication. Some caps
may require that you press down as you turn, and then remove.
Read the directions on the cap.
eye level.
Remember: In order to get an accurate measurement, you must
have the medication cup or device on a flat surface at eye level as
you pour the liquid medication.
Note: Other measuring devicessuch as calibrated medication
droppers, spoons, or oral dosing syringescan be used to
measure correct doses of liquid medications. Before you fill the
measuring device, know to what level it should be filled. If you
are unfamiliar with the measuring device, ask your supervisor or
call the pharmacist for assistance.
90
Wipe off any excess liquid medication from the bottle, and put
the cap back on securely.
Remember: By wiping off the excess liquid medication, you
are keeping the bottle and the label clean and free from germs.
Putting the cap back on the bottle helps prevent any spillage. It
is important not to waste any medication so that you will have
enough for each dose.
Tell the person what medication you are administering. Hand the
medication to the person. Provide assistance as needed.
Remember: The person has the right to know what medication
the HCP has ordered and why. If the person is unable to take the
medication on their own, you need to help them while always
maximizing capabilities.
Make sure the person takes the medication and swallows it.
Remember: By staying with the person, you can make sure the
person takes and swallows the medication without difficulty.
SECTION 2: Module 5
91
Completing Administration
of Liquid Oral Medication
The following are the standard completion steps for
administration of liquid oral medication.
Look again and compare the pharmacy label and the medication
92
Administering Medication
o Crosscheck 1. Check 5 Rights. (HCP order to
D
pharmacy label)
Do Crosscheck 2. Check 5 Rights. (Pharmacy label to
the medication sheet)
Shake the bottle, if required, before giving the
medication.
Remove the cap, and place it upside down on a clean
flat surface.
Place the medication cup or measuring device on a
flat surface at eye level.
Identify the measurement and mark it on the
medication cup or measurement device with your
thumbnail.
Slowly pour the liquid medication into the
medication cup or measuring device; pour only to
your thumbnail marking the right amount. Be sure to
pour away from the label. Do Crosscheck 3. Check 5
Rights. (Pharmacy label to the medication sheet)
Wipe off any excess liquid medication from the
bottle, and put the cap back on securely.
Tell the person what medication you are
administering. Hand the medication to the person.
Provide assistance as needed.
Make sure the person takes the medication and
swallows it.
SECTION 2: Module 5
93
Note: A good way to learn the steps is to read them out loud
as you practice. If you work with a partner or partners, have
your partner read each step out loud as you practice, and then
you do the same for your partner.
Chip
Freddy
94
Medication Refusals
*Massachusetts
3 If the person refuses again, try one more time, in another 15
or 20 minutes before considering this a final refusal. Three
attempts should be tried before considering it as a refusal.
3 Be sure to ask why the person does not want to take the
medication. It might make them feel sleepy or bad in
some way.
3 Explain that you will call the HCP and discuss how the
SECTION 2: Module 5
95
Apply What Youve Learned Over the last three months you have
been supporting Freddy. His HCP prescribed Risperdal to help him with his
schizophrenia. Today you go to give Freddy his medication and he refuses.
Freddy tells you he does not need the medication. What would you do? Put
a check next to all of the actions you would take. (Remember Freddy? For
details about his conditions and capabilities, refer back to page xii)
A
sk Freddy at least 3 times before you say he refuses his medication.
T
alk with Freddy about what he is feeling, why he is refusing the
medication and what knowledge he has about his condition.
R
eport to the HCP what Freddy feels like when taking the medication
and why he doesnt want to take it.
PRN Medications
PRN medications are medications that are given only when
needed for specific reasons as written by the HCP. The HCP
orders a PRN medication to treat a specific problem or symptom.
The PRN order specifies the start and stop time if needed and
the dose to be given. For example, the HCP might order a PRN
medication for Ibuprofen, 600mg, every six hours, as needed,
by mouth for three days for complaint of lower back pain. This
means that when the person complains of lower back pain, you
can offer them the Ibuprofen. If the pain continues after three
days, you should call the HCP.
There is always a reason for giving a medication to the people
you support. You need to know that reason so you can explain
to the person what the medication is and why they should take
it. You also need to know the right reason so you can observe for
changes that will tell you whether the medication is working or
not. This is particularly true for PRN medications, which you can
only give for the reason specified by the HCP order. For example,
some people take Tegretol for their seizure disorder, and others
96
C
all your supervisor about formulating a plan with Freddy and other
staff to help him understand the important reasons for taking this
medication.
SECTION 2: Module 5
97
10 am
Ibuprofen 600mg
Low back pain
Reason
Kathy Masucci
98
Apply What Youve Learned Suppose that Chip has an order for Ativan
0.5mg for anxiety symptoms (such as head slapping and pacing). When you
come on duty, you notice that Chip is pacing back and forth and mumbling.
You try to calm Chip following the calming methods in his behavior
support plan. The behavior support plan is where information can be found
regarding Chips anxiety and what to try before administering Ativan. Chip
resists everything you try. You administer his PRN order for Ativan. Write a
progress note describing this situation. (Remember Chip? For details about
his conditions and capabilities, refer back to page xixii.)
Below is a list of medications that have more than one desired effect. Select
one of them. Using the resources you have available, list all the different
desired effects this one medication may have. For example, Elavil is used
to treat depression, but can also be used to treat insomnia and migraine
headaches.
Cytoxan
Prozac
Inderal
Elavil
Tegretol
SECTION 2: Module 5
99
Documentation
Report changes
Administer medication
Store medication
Record information
Figure 513: Documenting the administration must be done after each administration.
100
Summary
*Massachusetts
You must call your MAP
Consultant.
,
.
SECTION 2: Module 5
101
102
Write Stop on the blank if you think you should stop before administering
a medication under the circumstance. Write Go if you think you should
administer the medication.
How to Handle
Special Situations
Objectives
*Massachusetts
Non-Mandatory Content
Introduction
103
104
Apply What Youve Learned Lately when you call Chip to administer
his medication, he starts to pace and wring his hands. Sometimes he begins
to head slap. What could you do to help this situation? (Remember Chip? For
details about his conditions and capabilities, refer back to pages xixii.)
SECTION 2: Module 6
105
3 Have the person tilt their head forward, tucking the chin
3 After the administration, position and keep the person
upright for at least 15-20 minutes.
3 Decrease distractions.
3 Cue the person verbally and non verbally. (For example put
the cup to the persons lips.)
Choking
If the person begins to choke, you may have to administer the
Heimlich maneuver. You can learn more about the Heimlich
Maneuver by attending a Choke Saver or First Aid course given by
106
SECTION 2: Module 6
107
108
Think about Chip. He speaks in single words and short sentences. Chip can label
or point to things he wants. Next, review the steps for administering an oral
medication (summarized below). How could you involve Chip in administering
his own medications? Circle the steps you think he could do independently.
(Remember Chip? For details about his conditions and capabilities, refer back
to pages xixii.)
Administering Medication
Check that you have the right medication for the right person,
in the right dose, at the right time, and by the right route
(Crosscheck 1), by checking the HCP order to the pharmacy label.
Check again to be sure you have the right medication for the
right person, the right dose, the right time, and the right route
(Crosscheck 2), by checking the pharmacy label to the medication
sheet.
Prepare the medication correctly. Remove or pour the medication
from the container. Check again to be sure you have the right
medication for the right person, the right dose, the right time, and
the right route (Crosscheck 3), by checking the pharmacy label to
the medication sheet.
Tell the person what medication you are administering. Hand
the medication to the person with water. Provide assistance
as needed.
Make sure the person takes the medication, drinks, and swallows
the water
SECTION 2: Module 6
109
110
*Massachusetts
Certified staff are not permitted
to set up medication planners
or pill dispensers, or to pre-pour
medications for individuals
learning to self-administer.
Individuals may, under the
supervision of Certified staff
and/or licensed staff, pour
their own medications into
appropriately labeled weekly
medication containers.
*Massachusetts
See Massachusetts Specific
Forms for the Observation Tool
for Self Administration.
Summary
Depending on the changes a person is experiencing, you will need
to adjust how you administer medication. Be open and creative.
Consider each persons needs and maximize their potential to
help them achieve the highest level of independence.
SECTION 2: Module 6
111
True/False
Review Exercise
Freddy is learning to self-administer. Put a check next to the facts
that should be included in his plan. (Remember Freddy? For details
about his conditions and capabilities refer back to page xii.)
Information on each of the 6 medications he is taking.
Information about targeted symptoms for his PRN
medications.
A reminder to staff to check Freddys pill organizer for
missed doses.
A weekly review with Freddy to be sure he is aware of
the medication he takes.
A schedule of reminders to call Freddy to prompt him
to take his evening medications.
112
SECTION
The Management of
Medication Administration
Obtaining Medications
Objectives
After studying this module, you will be able to:
1. List what information is important to take on a visit to the HCP.
2. Describe what you can do to encourage the persons
involvement during the HCP visit.
3. Describe the information you must get from the HCP when a
new medication is prescribed or an existing one is changed.
4. List the information included on a HCP order and a
pharmacy label.
5. Explain how to determine whether the pharmacy provided
the right medication.
6. Describe the information you must get from the HCP when
taking a telephone or fax order.
SECTION 3: Module 7
113
Introduction
*MASSACHUSETTS
DDS ONLY
When visiting the HCP you
should bring the following
documents:
* Health Review Checklist
* Health Care Encounter Form
* Screening Guidelines
(for annual exam)
* Health Record
(for annual exam)
114
Ordering new medication begins with a visit to the HCP. You will
often accompany a person you support on this visit. Before the
visit you should gather information about the person and know
the reason for the visit so that the HCP can prescribe the most
appropriate treatments and medications. You should also obtain
any forms that you will need to bring back to the home. If this
is the persons first visit to the HCP, you should bring a summary
of their medical history.* (Section 4 includes a checklist of
information to take with you on a first visit.)
If the visit is routine (such as an annual check-up) or due to a
change in the persons health or behavior, your responsibility is to
present the facts about what you have observed about the person.
To prepare for the visit, ask yourself the following questions:
3 Has anything changed for the person?
3 Is the person experiencing any new symptoms?
3 If something has changed, can you describe in detail what
is going on?
3 Is the person taking all their medications?
3 Is the persons current medication doing what it is supposed
to do?
3 Is the person improving or not?
3 Are there any special instructions or monitoring (vital signs)
to be reported?
n this module, you will learn what information you must bring
to and receive from the HCP on a visit, how to encourage the
person to participate in the visit, and how to determine whether
you receive the right medication from the pharmacy. Keep in
mind that your knowledge of the medication is critical to safe
medication administration.
SECTION 3: Module 7
115
116
3 Review with the person what they will say to the HCP.
Practice with them before the visit. Play the role of the
HCP so that the person can become more comfortable
communicating.
SECTION 3: Module 7
117
Think about Melissa, Chip and Freddy. Describe how each could participate in a
visit to the HCP. (For details about their conditions and capabilities, refer back
to pages xixii.)
1. What could Melissa do?
118
*Massachusetts
If the HCP gives a sample
medication to the person you
take on a HCP visit, the HCP
must place a label with the
same information as on a
pharmacy label along with the
HCPs name.
*Massachusetts
DMH only individuals receiving
psychotropic meds shall be seen
at least every 3 months. See MAP
Policy 13-6 or p117.
SECTION 3: Module 7
119
You are on the evening shift and Freddy tells you he does not feel well and
he has a headache. You check the medication book and see that he does not
have anything ordered for a headache. Your supervisor tells you to call the
HCP to see if Freddy can receive some Tylenol. When you call the HCP, what
information do you want to be sure you receive? Place a check mark next to
each piece of information you must receive from the HCP over the phone.
Name of medication
Dose to be given
3 Frequency
3 Duration
3 Special instructions/Reason
3 Signature
120
Date: 1/1/yr
Allergies: Bactrim
Date: 1/1/yr
Ear Infection
Medication/Treatment Orders: Amoxicillin 250 mg 2 times a day by mouth
for 10 days
Instructions:
2 weeks
Dr. T. Smith
Follow-up visit:
Signature:
Posted
1/1/yr
Verified
Figure 71: A sample HCP visit form with the new medication order.
SECTION 3: Module 7
121
you fill out the medication sheet, however, you must make sure
you received the right medication.
3 If you took the person to the HCP, compare the HCP order
*Massachusetts
Controlled substances include
ALL prescription medications.
MAP Policy requires that
programs maintain a record of
when a prescription is filled and
the quantity of the medication
dispensed by the pharmacy.
In addition, certain controlled
medications, e.g., narcotics and
stimulants, are referred to as
countable medications. See
MAP Policy 10-3 for complete
information on managing
countable medications.
122
SECTION 3: Module 7
123
Pharmacy Label
2 Rose Garden Pharmacy
3 800-555-1111
20 Main Street
Any Town, MA 01969
Freddy Connors 4
5 1/1/yr
6
7 Qty-20
Amoxicillin 250 mg. 8
IC: Amoxil 250 mg.
11
10
9
Take one tablet twice a day for ten days by mouth.
13 Dr. T. Smith
Drink lots of water when taking. 12
Rx# 284-9726
1
16 Refills: 0
Telephone/Fax Orders
You may find that at times you might have to receive a telephone
or fax order for a medication needed. If these are allowed by
your state and/or agency, you must understand the procedure for
accepting these types of orders. Be sure the following information
is received:
3 HCPs name
3 Date/time the order was received
3 Person who accepted the order
3 Reason for the medication or the change in the medication
124
Lot# 323-3333 14
Time:
Name of Individual:
Allergies:
Generic Name:
Dose:
Brand Name:
Frequency:
Route:
Date:
SECTION 3: Module 8
125
*Massachusetts
Summary
In this module you learned that you have a very important
role in helping the people you support communicate their
needs during the visit to the HCP. Good communication
ensures they receive proper treatments and medications.
You also learned about the different ways you might receive
medications from the pharmacy. You play an important
role in preventing Medication Occurrences by paying close
attention to the information you receive from the HCP and
checking it against the medications you receive from the
pharmacy. This critical check can make a huge difference in
avoiding Medication Occurrences.
Review Exercise
In
your own words, describe the purpose of a prescription.
126
Content Review
List below the information you would bring on a HCP visit
with Melissa, following her seizure. (For details about Melissas
conditions and capabilities, refer back to page xi.)
SECTION 3: Module 7
127
Documentation, Recording,
and Storage
Objectives
Grid is the section of the medication sheet where you place your
initials after a medication has been administered. It is the part
of the medication sheet where the dates and time are found.
Medication Error a mistake in the administration, dispensing,
ordering, transcribing, or preparation of a medication that has
been given to a person. Medication Occurrences can involve
the wrong person, medication, dose, route, time, as well as the
omission of a prescribed medication.*
*Massachusetts
A medication error is called
a Medication Occurrence in
Massachusetts. A Medication
Occurrence is when one of the
five rights goes wrong.
128
Introduction
129
130
*Massachusetts
SECTION 3: Module 8
131
Route
Amount
Route
Amount
Route
Amount
Route
Dose
Frequency
Special Instructions/Reason:
Amount
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
MEDICATION SHEET
Allergies:
CODES
DP - day program
LOA - leave of absence
P - packaged
W - work
H-Hospital
Init.
Signature
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Site:
Name:
Stop
Start
Stop
Start
Stop
Start
Stop
Start
Medication Sheet
*Massachusetts
MAP Consultant
132
*Massachusetts
your name, date, and time next to the order being transcribed. In
addition, a second staff member must review the order that has
been transcribed. This ensures that the order has been transcribed
correctly. The second person must also document their name,
the date, and time. See Figure 82 next to the Label Medication/
Treatment Order on the sample HCP visit form.
Date: 1/1/yr
Allergies: Bactrim
Reason for visit: states he has headaches, feels pressure on his forehead,
states he feels down in the dumps, and dragging, tired,
feeling tired. Also has had decreased appetite.
Current Medication: none
Staff Signature: Kathy Mason
Date: 1/1/yr
Figure 82: A sample HCP visit form with the new medication orders.
SECTION 3: Module 8
133
Pharmacy Labels
Rx# 284-97226
Freddy Connors
Amoxicillin 250mg.
IC: Amoxil 250mg.
Acetaminophen 325mg.
IC: Tylenol 325mg.
Rx# 284-97228
Freddy Connors
Risperdal 0.5mg.
IC: Risperidone 0.5mg.
134
800-555-1111
1/1/yr
Dr. T. Smith
Refills: 0
800-555-1111
1/1/yr
Qty-60
Refills: 0
Qty-240
Dr. T. Smith
Dr. T. Smith
Refills: 0
Lot# 323-3863
Freddy Connors
1/1/yr
Qty-40
Rx# 284-97227
800-555-1111
SECTION 3: Module 8
135
9am
Generic
Dose 0.5 mg
Route
Amount
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Strength 0.5 mg
Risperidone
Bactrim
X X X X XX X X X X X X X XXX X X X XX
X X X X XX X X X X X X X XXX X X X XX
W-work
H-Hospital
P-packaged
CODES
DP-day program
LOA-leave of absence
Init.
Signature
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9pm
9am
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Risperdal
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Tylenol
Generic Acetaminophen
Special Instructions/Reason:
Allergies:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Stop
Start
Stop
Cont.
Brand Amoxil
Generic Amoxicillin
MEDICATION SHEET
((
1/1/yr
(' Start
Cont.
Stop
1/1/yr
Start
1/10/yr
Stop
1/1/yr
Start
136
Skill 9
1/1/yr
Stop
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic Amoxicillin
Brand Amoxil
9am
X X X X XX X X X X X X X XXX X X X XX
KM KM
Allergies:
MEDICATION SHEET
X X X X XX X X X X X X X XXX X X X XX
LL
Special Instructions/Reason:
CODES
DP-day program
LOA-leave of absence
Init.
KM
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Skill 10
*Massachusetts
When documenting a missed
dose, be sure to notify the
MAP Consultant as well as
your supervisor explaining the
missed dose and what the MAP
Consultant instructed.
SECTION 3: Module 8
137
*Massachusetts
Acceptable codes are:
LOA = Leave of Absence
DP = Day Program
P = Packaged for self
administration training
W = Work
H = Hospital, Nursing Home,
Rehabilitation Center
1/1/yr
Generic Amoxicillin
Brand Amoxil
MEDICATION SHEET
Stop
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
X X X X XX X X X X X X X XXX X X X XX
KM KM
Allergies:
X X X X XX X X X X X X X XXX X X X XX
LL
Special Instructions/Reason:
CODES
DP-day program
Init.
KM
LOA-leave of absence
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Progress Note
Progress Note: 1/2 yr Freddy missed 9am dose of amoxicillin
because he was at the HCP office visit. Beth Kerrigan RN
called: recommended to give missed dose when Freddy
comes back.
K. Mason
Figure 87: An example of a note that would be written for a missed dose.
forms.indd 6
138
9/19/05 2:01:55 PM
1/1/yr
Generic Amoxicillin
Brand Amoxil
MEDICATION SHEET
Stop
Start
1/1/yr
Stop
cont.
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
X X X X XX X X X X X X X XXX X X X XX
KM KM
Allergies:
X X X X XX X X X X X X X XXX X X X XX
LL
Generic Acetaminophen
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Tylenol
P
Strength 325 mg Dose 650 mg
R
Amount 2 tablets Route by mouth
1PM
N KM
Frequency every 6 hours
Special Instructions/Reason: PRN Headache
CODES
DP-day program
Init.
KM
LOA-leave of absence
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Progress Note
Progress Note: 1/1/yr 1pm Freddy stated
that he had a headache. Tylenol, 2 tablets (650 mg) given
by mouth. At 2pm Freddy stated that he felt much better.
The headache was all gone.
K. Mason
Figure 89: An example of a note that would be written for a PRN medication.
SECTION 3: Module 8
139
Skill 12
140
1/1/yr
MEDICATION SHEET
Stop
Brand Amoxil
9am
KM KM
X X X X XX X X X X X X X XXX X X X XX
BB
X X X X XX X X X X X X X XXX X X X XX
Start
1/1/yr
Generic Risperidone
Brand Risperdal DC
Strength 0.5 mg
Stop
Cont.
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic Amoxicillin
Strength 250 mg Dose 500 mg
1/10/yr
Allergies:
/yr
1/2
KM
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
KM KM
Dose 0.5 mg
/yr
DC 1/2
KM
9pm KM
DP-day program
CODES
Init.
KM
Signature
Kathy Mason
LOA-leave of absence
BB
Billy Beesley
Init.
Signature
P-packaged
W-work
H-Hospital
Practice documenting the following medications onto the medication sheet. Use
June 20th as the date. Medication sheets are on page 142 and 143.
1. Y
ou just received a new medication from the pharmacy for Chip. The
HCP ordered Zantac 150 mg by mouth twice a day. Written on the
pharmacy label is Zantac 75 mg two tablets by mouth two times daily.
formsEDIT.indd 7
2. A
t 9:00 a.m. today you gave Chip his dose of Ativan 0.5 mg. Use the
Medication Sheet on page 142 and the Countable Sheet on page 145 to
document.
9/19/05 2:07:10 PM
3. T
oday beginning at 9:00 a.m. you administered Melissas Mysoline 50 mg by
mouth which she gets two times daily.
4. A
t 9:00 p.m. today Melissa refused to open her mouth for her dose of
Mysoline 50 mg.
5. T
he HCP ordered Colace 100 mg by mouth (liquid) twice daily for Melissa.
Written on the pharmacy label is Give Colace 100 mg (10 mL) liquid form by
mouth twice daily. Use Melissas medication sheet to record (transcribe) the
new order. At 9:00 p.m. you give Melissa her Colace 100 mg by mouth in liquid
form as ordered. Document the June 20th, 9:00 p.m. administration.
SECTION 3: Module 8
141
6. T
oday the HCP discontinued Freddys hydrochlorothiazide 50mg by mouth
one time a day and has prescribed a new medication that just arrived from
the pharmacy. The new medication the HCP ordered is Lasix 40mg by
mouth one time a day in the morning. Written on the pharmacy label is
Lasix 20mg 2 tablets by mouth once a day in the morning. Transcribe the
new order and discontinue the hydroclorothiazide.
Questions 1 and 2
Month and Year: June/yr
Medication or Treatment
Start
6/1/yr
Strength 0.5mg
None known
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Brand Ativan
Allergies:
MEDICATION SHEET
P
Dose 0.5mg
Route by mouth
Start
Generic
Stop
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand
Strength
Dose
Amount
Route
Frequency
Special Instructions/Reason:
CODES
DP-day program
Init.
Signature
Init.
Signature
LOA-leave of absence
P-packaged
W-work
H-Hospital
Questions 3, 4, and 5
Month and Year: June/yr
Medication or Treatment
Start
4/2/yr
Stop
Cont.
None known
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Brand Mysoline
Strength 50mg
Allergies:
MEDICATION SHEET
9am LL LL LL LL KM KM KM
JF JF JF KM KM LL LL LL KM KM KM KM
Dose 50mg
9pm BS BS BS BS MT MT MT MT BS BS BS BS MT MT MT BS BS MT MT
Generic
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Special Instructions/Reason:
Start
Stop
Brand
Strength
Dose
Amount
Route
Frequency
Special Instructions/Reason:
CODES
DP-day program
LOA-leave of absence
P-packaged
W-work
H-Hospital
142
Init.
LL
BS
KM
JF
Signature
Lisa Long
Init.
MT
Signature
Melissa Thompson
Barry Stevens
Kathy Mason
Jeff Frank
9/19/05 2:16:19 PM
Stop
Amount 1 tablet
cont.
Question 6
Month and Year: June/yr
Medication or Treatment
Start
1/11/yr
Generic Hydroclorothiaxide
Brand Hydrodiuril
Strength 50mg
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
8am LL LL LL LL BB BB BB KM KM KM LL KM KM LL LL LL LL KM KM
Dose 50mg
Stop
Start
Generic
Cont.
Allergies:
MEDICATION SHEET
Stop
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand
Strength
Dose
Amount
Route
Frequency
Special Instructions/Reason:
CODES
DP-day program
Init.
LL
Signature
Init.
Signature
Lisa Long
LOA-leave of absence
KM
Kathy Mason
P-packaged
BB
Bill Beesley
W-work
H-Hospital
Countable Substances
*Massachusetts
All prescription medications are
defined as controlled substances.
Those medications which are
most likely to be abused must
be double locked and counted.
These medications are referred
to as countable. All countable
medications must be in tamperresistant packages. See MAP
Policy 10-2, 3, and 8 for complete
information on managing
countable medications.
*Massachusetts
formsEDIT.indd 11
9/19/05 2:18:07 PM
SECTION 3: Module 8
143
Shift Count
Date Time
1/3/yr
3pm
1/3/yr
11pm
1/4/yr
7am
1/4/yr
3pm
11pm
Staff Coming
Staff Going
On Duty
Off Duty
Karen Smith, Evening C. Staff
Lisa Long, Day C. Staff
Bill Stevens, Night C. Staff Karen Smith, Evening C. Staff
Lisa Long, Day C. Staff
Bill Stevens, Night C. Staff
Karen Smith, Evening C. Staff
Lisa Long, Day C. Staff
7am
Yes
Yes
3pm
Yes
144
1/4/yr
1/5/yr
1/5/yr
Count
Correct?
Yes
Yes
Yes
Yes
Countable Sheet
Countable Sheet
Chip Brown
C0401
Rx Number:
Doctor: Smith
Date Dispensed: 6/19/yr
Pharmacy: Sams Pharmacy
Amount Dispensed: 60
Medication and Strength: Ativan 0.5 mg
Directions: Take one tablet 2 times a day
2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions
Name:
Date
Time
6/19/yr 9AM
Amount
Tablets Amount Amount
on Hand Used
Left
Route
60
Signature
Figure 812: Document medication on the countable sheet. Use this count sheet to answer #2, p. 141 exercise.
*Massachusetts
*Massachusetts
*Massachusetts
SECTION 3: Module 8
145
Chip Brown
Ativan 0.5mg
Valium 2mg
Ambien 5mg
Percocet 5.325mg
Sonata 5mg
Page
Number
Signature of person
responsible for removing
medication from count
1
2
3
4
5
*Massachusetts
You must document prescription
medication losses using the
designated form and report
them to the Drug Control
Program at the Department of
Public Health (DPH) by the first
business day after discovery of
the medication loss. If the loss
relates to an over-the-counter
medication, you do not have to
report it to the DPH; however,
you must report all other losses.
146
Freddy Connors
Freddy Connors
Melissa Sullivan
Melissa Sullivan
Medication
and Strength
Using the blank countable sheet below, document that you have administered
the countable medication Ativan 0.5mg to Chip at 9 p.m. on June 19. The bottle
has a total of 60 tablets, and this is the first medication administration.
Countable Sheet
Chip Brown
Rx Number: C0401
Doctor: Dr. Susan Smith
Date Dispensed: 6/19/yr
: Sams Pharmacy
Pharmacy
Amount Dispensed: 60
and Strength: Ativan 0.5mg
Medication
: Take one tablet by mouth 2 times a day
Directions
Name:
Date
Time
6/19/yr
9am
Amount
Tablets Amount Amount
on Hand Used
Left
Route
60
Signature
SECTION 3: Module 8
147
Disposing of Medications
Certain procedures are recommended for disposing of and
destroying unused medication. Often a prescription medication is
148
*Massachusetts
You should fill out the DPH
Approved Controlled Substance
Disposal Record when disposing
of medication. Two signatures
are required with an explanation
in the count book. Please note
that the "amount used" column
should indicate the number of
pills destroyed and the "amount
left" column should indicate the
number of pills remaining even if
that number is zero.
*Massachusetts
MAP requires all medications
must be passed directly from
licensed/certified staff to
licensed/certified staff as
in medications provided by
residential programs to day
programs or day habs, hospitals,
nursing homes, etc.
A dated release document listing
the meds must be signed by the
staff releasing/accepting the
meds.
149
*Massachusetts
Child-proof container or a coin
envelope is acceptable.
*Massachusetts
150
Medication Occurrences
As you will recall, medication administration is a step-by-step
process that must be done in a mindful way. You must never
allow the steps to become routine or automatic. Medication
Occurrences can usually be traced to not following the step-bystep process.
As you review the list of Medication Occurrences in Figure 8
14, ask yourself at what point in the administration you could have
prevented the occurrence. Think in terms of the administration of
medication, beginning when you receive the medication from the
pharmacy and complete the medication sheet using the HCP order
and the pharmacy label. Think about the steps to administering
the medication and the guidelines for documentation. Medication
Occurrences can occur at any point in this process.
SECTION 3: Module 8
151
*Massachusetts
8. If it is a Hotline occurrence,
send a fax to DPH within 24
hours
9. Fax or mail the occurrence
form to the MAP Coordinator
within seven days.
*Massachusetts
152
Match the Medication Occurrence in the left column with the correct definition
in the right column. Select only one answer.
Medication Occurrences
1. Wrong dose
2. Wrong time
3. Wrong person
4. Wrong route
SECTION 3: Module 8
153
Apply What Youve Learned Imagine you return to work after being
154
off for a week. Your supervisor asks if you can cover a shift at another
home. Although you are not familiar with the people who live in the home,
you are confident in your ability to administer medications because you
have learned the procedure. When you arrive, you introduce yourself to
the staff from the shift before and receive a report on the people living
in the home. You are quickly introduced to each person and shown where
the medications are kept. When it is time to give the 4 p.m. medications,
you walk into the living area and say, Would John Pearson please come to
the kitchen area. A man tells you to bring his medication into the TV room
instead so that he can watch his favorite show.
You begin the procedure you learned in your training. You perform
your checks and pour the medication. You return to the living area, hand
Mr. Pearson his medication, and watch him take it. You then return to the
medication area and complete the procedure. A few minutes later another
person in the home comes up to you and says he needs his medication. You
ask his name, and he says John Pearson.
Summary
Matching
Match
the term in the left column with the correct definition in
the right column.
3. Storage
4. Medication occurrence
SECTION 3: Module 8
155
Content Review
Practice documenting information. Add the following new
medications to Chips medication sheet and discontinue his
synthroid. Use June 20 as the date. Below you will find the HCP
visit form with Chips new and changed medication orders. The
medication sheet for recording the orders is on p. 157. Written on
the pharmacy labels are:
one tablet.
Date: 6/20/yr
Allergies: none
Date: 6/20/yr
2 weeks
Susan Smith, MD.
Follow-up visit:
Signature:
Posted
156
6/20/yr
SECTION 3: Module 8
formsEDIT.indd 4
157
9/19/05 2:20:16 PM
MEDICATION SHEET
Allergies:
NKA
Route
Amount
Route
Amount
Route
Amount
Route
Amount
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Frequency
Special Instructions/Reason:
Dose
Strength
Brand
Generic
Special Instructions/Reason:
morning
W-work
H-Hospital
P-packaged
LOA-leave of absence
CODES
DP-day program
LL
Init.
KM
Lisa Long
Signature
Kathy Mason
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Synthroid
9am KM KM KM LL LL LL LL KM KM KMKM KM KM LL LL LL LL LL LL
Strength 0.125mg Dose 0.125mg
Amount 1 tablet Route by mouth
Frequency once a day in the
Stop
Start
Stop
Start
Stop
Start
Stop
Start
cont.
Stop
5/1/yr
Start
SECTION *
*MASSACHUSETTS
Non-Mandatory Content
3 Vital signs
3 Other routes of medication administration
Seizure Disorder
There are many different kinds of seizures, and they may be partial
or generalized. Partial seizures begin in a specific location of the
brain. Generalized seizures begin over the entire surface of the
brain. A seizure can happen when normal signals coming from the
brain are interrupted or changed. The resulting symptoms can range
from a mild shaking of a hand to violent shaking of the entire body.
There are many causes of seizures such as head trauma, epilepsy, or
a chemical imbalance. Your responsibility is to give medication to
the person who has seizures to help control them, and to keep the
person protected during a seizure by minimizing injury.
158
Bipolar Disorder
Bipolar disorder, previously called manic depression, is a fairly
common disorder. It causes the person to have extreme mood
swings that alternate between episodes of mania (highs) and
depression (lows). These episodes can come on suddenly
without any warning. Between episodes, a person can return to
normal. The cause of bipolar disorder is not known, but it can
be hereditary. Some scientists believe it is caused by a chemical
imbalance in the brain.
Following are examples of medications used to treat bipolar
disorder:
159
Constipation
Constipation happens when stool gets hardened and is difficult
to pass. It can be caused by many things like poor diet, lack of
exercise, medications, and certain illnesses.
Following are examples of medications used to treat
constipation:
Depression
Depression is an illness that can be serious. Everyone has
experienced some form of depression, feeling sad or blue. It is a
normal reaction to some of lifes problems. But when the sadness
doesnt go away and prevents a person from leading a normal life,
then the condition is more serious.
Symptoms of depression include low energy, irritability,
sadness, no appetite, and lack of interest in everyday life,
insomnia, thoughts of suicide, and in some cases, attempts at
suicide. There are different types of depression. Although the
160
Pain
hydrochloride
Vital Signs
Vital signs are literally signs of life, indicators of a persons health.
Vital signs are:
A persons pulse rate and blood pressure are the two vital signs
you will measure most often. Certain medicationssuch as those
used to treat high blood pressure and heart diseaserequire that
a persons vitals signs be measured or monitored before and after
receiving a medication. You must take all vital signs carefully and
record them accurately. Decisions about a persons medication
are often made based on vital signs. For example, you may need
to measure a persons temperature because the HCP has ordered
Acetaminophen for fever of 101 degrees or above.
You must learn the important steps to perform before, during,
and after taking a persons vital signs. And you must always follow
these standard steps.
SECTION 4
161
162
SECTION 4
163
3. Wait for the beep or signal that the temperature has been
completed.
4. Remove the thermometer.
5. Read the temperature, and write it down.
Oral Temperature
An oral temperature is the most common method of taking
a persons temperature. However, you cannot take an oral
temperature when the person:
164
3 Has diarrhea
3 Has had recent rectal surgery
3 Has hemorrhoids
3 Has a seizure disorder
Check with your supervisor to make sure you should take the
persons temperature rectally. Use the rectal thermometer probe
and a disposable thermometer cover that is lubricated.
Taking a Rectal Temperature
Gather the following items:
SECTION 4
165
Pulse Rate
The pulse rate is the number of times the heart beats in a minute.
You can feel the pulse in several body areasthe neck, temple,
groin, wrist, bend in the arm, behind the knee, and top of the foot.
The most common area for taking a pulse is at the wrist. This is
called the radial pulse. You can feel the pulse as a throbbing in an
artery each time the heart pumps blood through the body.
When taking a pulse, be sure that you:
3 Count the pulse rate, the number of beats you feel for
60 seconds.
166
The HCP will tell you what to watch for when taking the pulse
if it relates to the medication the person is taking. For example,
the HCP may write an order for Digoxin 0.25mg by mouth every
day. Please hold if the pulse is less than 60 beats per minute.
Taking a Radial Pulse
Gather the following items:
Respiratory Rate
Counting respirations is another part of taking a persons vital
signs. Respiration is the process of breathing air into the lungs
(inhaling) and breathing air out of the lungs (exhaling). Count the
respiratory rate by watching a person breathe in and out. One
respiration is equal to one inspiration (one breath in) and one
expiration (one breath out). Some medications can increase or
decrease a persons respirations. Some diseases, such as congestive
heart failure or chronic obstructive pulmonary disease (COPD),
SECTION 4
167
Blood Pressure
Blood pressure (BP) is the force of blood in the arteries. It is a vital
sign that may be monitored with certain medications. Very high
or low blood pressure can lead to medical conditions. With high
blood pressure, a person may experience a stroke, heart attack,
or other problems. With very low blood pressure, a person may
experience dizziness, tiredness, or weakness.
Two numbers are recorded for a blood pressure (for example,
120/70). The top number is called the systolic pressure, which
is the pressure in the artery when the heart is pumping. The
diastolic pressure is the pressure in the artery when the heart is
resting between beats. This is recorded as the bottom number.
Before administering any blood pressure medication, check to
make sure that the persons blood pressure is within the limits set
by the HCP.
Taking a Blood Pressure
Gather the following items:
168
SECTION 4
169
170
may be administered again if the person still has chest pain after
5 minutes. If after the 3 doses 5 minutes apart, the person is still
experiencing chest pain, call for emergency medical help.
Administering Sublingual, Buccal, and Translingual Medication
Begin by following the standard preparation steps for
administering medications. Then follow these steps:
SECTION 4
171
172
Read and follow the directions that come with the medication.
3 If you are assisting the person, you may have to read the
Step 5: Tell the person what medication you are administering. Hand the
173
174
SECTION 4
175
3 Take the medication out of the box (if there is one). Read the
3 Put on gloves. Then shampoo, rinse, and dry the persons hair.
3 Comb out any tangles.
3 Change your gloves before applying the medication.
3 Using your fingertips, begin by applying the medication to the
persons natural hairline part. Spread the medication evenly.
Continue to apply the medication every inch or so. Some
medication will need to be massaged into the scalp. Always
massage gently.
176
SECTION 4
177
3 Ask the person to lower their clothing from the waist down,
and assist as needed.
3 Ask the person to lie down on the bed on their left side, and
assist as needed.
3 Place a protective pad under the buttocks and a sheet over the
3 Put on gloves.
3 Clean the rectal area. Always use strokes from the front to the
back of the perineum (the area of skin between the opening
of the penis or vagina and the rectum). It is very important to
clean in a front-to-back direction, using different sections of
the washcloth for each stroke. These measures help prevent
infection.
178
1. Ask the person to lower their clothing from the waist down
and assist as needed.
2. Ask the person to lie down on their side and assist as
needed.
3. Put on gloves.
4. Place a disposable pad under the persons buttock and a
sheet over the person for privacy.
5. Clean the anal/rectal area to remove any cream or
ointment left over from previous applications. Clean the
area by always washing in a downward motion toward the
anal/rectal area. Use different corners of the washcloth for
each stroke. These measures will help prevent infection.
6. Place the cream or ointment on a disposable gauze pad or
on the tip of one of your gloved fingers.
7. Apply the cream or ointment to the anal/rectal area.
Complete the administration, remembering the standard
completion steps.
SECTION 4
179
3 Take the vaginal medication out of the box (if there is one).
Read all the directions and follow all the HCPs orders. Vaginal
medications are inserted into the vagina using an applicator
that comes in the box with the medication. Vaginal medications
come in different forms such as creams, suppositories, gels,
foams, and ointments.
clothing from the waist down. Assist as needed.
3 Put on gloves.
3 Ask the person to bend her knees and spread her legs apart.
Assist as needed.
180
3 Ask the person to void (urinate) first, and then to lower her
SECTION 4
181
3 Put on gloves.
3 Clean with soap and water the area of the body the HCP has
specified for application of the patch. Dry the skin gently.
Inspect the skin carefully for any changes.
3 Apply the patch to the area. If the HCP has not specified an
area, place the patch where the person will not be able to
remove it and where it will not rub against clothing.
3 Document the site on the medication sheet.
Notes about Transdermal Patches
Follow these guidelines when applying transdermal patches:
182
3 Always put the patch on the person at the same time each
day or as ordered. This allows for constant and controlled
dosage of the medication.
SECTION 4
183
184
4. Ask the person to blink the eyes gently (to spread the
medication over the entire eye), and then to close their eyes
for one or two minutes (to let the medication absorb).
SECTION 4
185
186
3 Put on gloves.
SECTION 4
187
Step 4: Elevate the persons head and upper body. The person must stay
in this upright position for 45 to 60 minutes after receiving the
medication to prevent fluid from getting into the lungs.
Step 13: Un-pinch the tube, instill the medication, and re-pinch the tube.
Step 14: If you need to give another medication through the tube, pour
5 to 10 mLs of warm water into the tube to clean it. Then secure
the tube.
Step 18: Pinch the tube, and reinsert the plug or close the cap.
Complete the administration remembering the standard
completion steps.
188
SECTION 4
189
Table of Contents
191
192
193-194
195
196-197
190
199-200
201-206
207
208-210
211
212
213-215
216
217
Name:
Allergies:
Reason for Visit/Symptoms:
Results/Diagnosis:
Tests/Treatment Ordered:
Special Instructions
Date/Time:
Date/Time:
If vital signs are indicated, please give parameters and when to call the health care practitioner.
Staff Follow-up:
Yes
No
N/A
Posted
Date
Provider Staff Signature
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Verified Date
Provider Staff Signature
Time
FORM HC-3 v2
191
Agency:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Page Number:
Program Site:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Reason:
Date:
Date Last
Filled:
Strength:
DPH Registration #:
Reason:
Date:
Date Last
Filled:
Strength:
Rx Number:
Pharmacy:
Page Number:
Countable
Controlled
Substance
Book Number:
Supervisor:
Rx Number:
Pharmacy:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Supervisor:
Date:
Date Last
Filled:
Strength:
Reason:
Supervisor:
Pharmacy:
Rx Number:
Reason:
Date:
Date Last
Filled:
Strength:
Rx Number:
Pharmacy:
Page Number:
Countable
Controlled
Substance
Book Number:
Rx Number:
Pharmacy:
Supervisor:
Page Number:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Date:
Date Last
Filled:
Strength:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Reason:
Pharmacy:
Signatures:
Staff:
Rx Number:
Supervisor:
Page Number:
Supervisor:
Page Number:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Page #
Destruction of all prescription medications in Schedules II -VI that are either out-dated, spoiled or have not been administered due to a change in the prescription or a stop order shall be documented on the DPH
approved disposal record. According to regulations at 105CMR 700.003(f)(3)(c): Disposal occurs in the presence of at least two witnesses and in accordance with any policies at the Department of Public Health.
DPH policy requires disposal to occur in the presence of two Certified or licensed staff of which one of the two is supervisory staff. Failure to maintain complete and accurate records of drug destruction could result in
revocation of your Controlled Substance Registration. Disposal must render the medication unusable and must be in accordance with acceptable DPH disposal practices. Unless prohibited by local ordinance,
acceptable practices include, but are not limited to, flushing (flushing should be restricted to those medications so labeled), crushing the medication and/or dissolving in water put into a sealable bag and mixing with an
unpalatable substance (such as liquid soap, used coffee grounds, kitty litter). Mixture should then be put into an impermeable, non-descript container, (e.g., detergent bottle) and placed in trash. Medications are not
permitted to be returned to the pharmacy for destruction. Medications returned to the program site (e.g., LOAs) must be destroyed as per DPH regulation. They cannot be reused by the program.
9/01/10
192
!!
Date of Occurrence
Individuals Name
Time of Occurrence
City/Town
A)
1
2
3
Zip Code
Medications(s) Involved
Medication Name
As Ordered:
4
5
Wrong Dose
Wrong Route
B)
Dosage
Frequency/Time
Route
As Given:
As Ordered:
As Given:
As Ordered:
As Given:
C)
MAP Consultant Contacted (Check all that apply)
Type
Name
Registered Nurse
Registered Pharmacist
Licensed Practitioner
Date Contacted
Time Contacted
D)
Hotline Events
Did any of the events below follow the occurrence?
Yes
No
If yes, check all that apply below, and within 24 hours of discovery fax this form to DPH (617) 524-8062 or call to notify DPH at
(617) 983-6782 and notify your DDS/DMH MAP Coordinator.
For All Occurrences, forward reports to your DMH/DDS MAP Coordinator within 7 days.
Medical Intervention (see Section E below)
Illness
Injury
Death
E)
MAP Consultants Recommended Action
Medical Intervention
Yes
No If Yes, Check all that apply.
Health Care Provider Visit
Lab Work or Other Tests
Emergency Room Visit
Hospitalization
Other: Please describe
F)
Supervisory Review/Follow-up
Contributing Factors: Check all that apply. If none apply, check none (7)
1
Failure to Properly Document Administration
4
2
Medication not Available (Explain Below)
5
3
Medication Administered by Non-Certified Staff
6
(includes instances of expired or revoked Certification)
7
Narrative: (If additional space is required, continue in box F-1)
Print Name
Print Title
Contact phone
number
E-mail
address
Clinic Visit
Date
193
Date of Occurrence
Individuals Name
Time of Occurrence
City/Town
Zip Code
F-1)
Supervisory Review/Follow-up [continued from section F)]
Use this section if needed for additional narrative.
Contact Information
Telephone Number:
(413) 587-6269
Fax Number:
(413) 587-6258
Telephone Number:
(508) 368-3519
Fax Number:
(508) 363-1508
DDS-Medication Administration
411 Waverly Oaks Road
Suite 304
Telephone Number:
(508) 977-3456
Fax Number:
(508) 977-3231
Northeast Region
DDS Northeast Region
P.O. Box A
Hathorne, MA 01937
Telephone Number:
(978) 774-5000 ext. 354
Fax Number:
(978) 739-0425
Telephone Number:
(617) 626-9269
Fax Number:
( 617) 626-9216
Southeast Region
Southeast Area Office DDS
68 North Main Street
Carver, MA 02330
Telephone Number:
(508) 866-8877
Fax Number:
(617) 727-7822
Telephone Number:
(617) 984 1078
Fax Number:
(617) 984 1040
194
140State
High Avenue
Street
171
Springfield,
MA
01105
Palmer MA
01069
Metro Region
Waltham, MA 02452
Contact Information
Telephone Number:
(413) 284-5055
Fax Number:
(413) 284-1516
Telephone Number:
(781) 314-7506
Fax Number:
(781) 314-7534
Contacts
DMH Area MAP Coordinators
DPH/DMH/DDS
Medication Administration Program Organizational Chart
Department of Public Health
Mary Rota, RN, BSN, MA
Clinical Reviewer
617.983.6720
Mary.Rota@massmail.state.ma.us
Department of
Developmental Services
Sharon Oxx, RN, CDDN
Health Services Director
617.624.7792
Sharon.Oxx@massmail.state.ma.us
Melissa Touadjine
Tel. 617.626.8074
Fax 617.626.8077
Melissa.Touadjine@massmailstate.ma.us
Robert Boyer
Robert.Boyer@massmail.state.ma.us
Central-West Area
Northampton State Hospital
P.O. Box 389
Northampton, MA 01061
Tel. 413.587.6269 Fax 413.587.6258
Carolyn Whittemore
Marie Brunelle
Marie.Brunelle@massmail.state.ma.us
Central-West Area
Worcester State Hospital
305 Belmont Street
Worcester, MA 01604
Tel. 508.368.3519 Fax 508.363.1508
Gina Hunt
Gina.Hunt@massmail.state.ma.us
DDS Northeast Region
P.O. Box A
Hathorne, MA 01937
Tel. 978.774.5000 ext. 354
Fax 978.739.0425
Lisa Kaliton
Lisa.Kaliton@massmail.state.ma.us
Metro-Southeast Area
Learoyd Building
P.O. Box 4007
Taunton MA 02780
Tel. 508.977.3456 Fax 508.977.3231
Rene Morin
Rene.Morin@massmail.state.us.ma
Metro- Southeast Area
85 E. Newton Street
Boston, MA 02118
Tel. 617.626.9269 Fax 617.626.9216
Carolyn.Whittemore@massmail.state.ma.us
Fax 617.727.7822
Noreen Egan
Noreen.Egan@massmail.state.ma.us
DDS Metro Region
411 Waverley Oaks Road Suite 304
Waltham, MA 02452
Tel. 781.314.7506
Fax 781.314.7534
Joanne Shea
Joanne.Shea@massmail.state.ma.us
Northeast-Suburban Area Office
40 Industrial Park Road
Plymouth, MA 02360
Tel. 508.746.3224 Fax 508.746.3224
195
To be used by clinical or support staff to record health-related information and to help communicate recent changes to a supervisor or
health care provider (HCP). Must be completed prior to annual physical and any visit to primary care physician (PCP).
NAME:_____________________________ DATE:______________ALLERGIES__________________________
FILLED OUT BY:________________________________HCP_________________________________________
Staff Name and Title
No
Yes
Dont
know
Check if
recent
change
FORM HC 2
196
Required
No
Yes
Dont
Know
Check if
recent
change
FORM HC 2
Required
197
Last date
screen
performed
Ask PCP to
evaluate need
for screening
Glaucoma
Assessment
Hearing
Assessment
Tetanus-diphtheria (TdaP)
Influenza vaccine
Pneumococcal vaccine
Hepatitis B vaccine
Last Date
FORM HC-1
include tests recommended previously or by other clinicians that have not yet been performed)
Preconception counseling.
Ask PCP
Date: _______________
Based on Massachusetts Health Quality Partnership (MHQP) Adult Preventive Care Recommendations 2007/8
Name: ___________________________Age:______
Annually
Annually
This format is to assist individuals, families, and other support providers to ensure that screening tests that are appropriate to the individual are considered at the annual physical. Review BEFORE the annual health visit.
All Adults
Height/Weight Measurement
Clinical breast/testicular exam
Every 1-2 years after age 40, at discretion of
physician/patient. Earlier if family history. Recommend
annually after age 50.
For women with prior sexual activity,
every 1-3 years after age 21. May be omitted after age
65 if previous screenings were consistently normal.
Fecal Occult Blood Testing annually after age 50
Sigmoidoscopy every 5 years after age 50
Cancer Screening
Colorectal
Cancer screen
Colonoscopy Every 10 years after age 50, per MD
recommendation or if above screen not performed.
Digital rectal exam (DRE) should be considered patients
with risk factors after age 40 and in all men after age 50
PSA test at physicians discretion after age 50
Mammography
(Women)
Prostate
cancer screen
(Men)
Total skin examination every 3 years from 20 39.
Annually age 40 and older.
Pap Smear
(Women)
Skin cancer
screen
Annually
Every 5 years or at physician discretion.
Fasting plasma glucose screen for people at high risk.
At least every 5 years until age 45. Every 3 years after
age 45.
Test annually for Hepatitis B carriers
Bone density screening per risk factors of general
population. Additional risk factors include medications,
mobility impairment, hypothyroid.
Screen for swallowing problems and symptoms of
GERD annually.
Annually, if at risk
Periodic testing if at risk.
Periodic testing if at risk.
Skin testing every 1-2 years for individuals at risk
198
199
19-29 Years
30-39 Years
40-49 Years
50-64 Years
First pap smear and HPV test by at 3 years after first sexual intercourse or by age 21. Every 1-3 years, at clinician/patients discretion. When speculum testing is too
traumatizing consider annual HPV testing via vaginal swab (*note: MHQP states annually if under 30)
Starting at age 50, Fecal Occult Blood testing (FOBT) and Sigmoidoscopy every 5
Not routine except for patients at high risk. Risk factors include: diagnosis of a close relative; specific genetic syndromes;
years OR annual FOBT OR Colonoscopy every 10 years. Screening after age 80 at
inflammatory bowel disease and noncancerous polyps.
clinician/patient discretion.
Testing at clinician/patients discretion considering
Discuss risks and benefits of prostate cancer screening with specific antigen (PSA)
Prostate cancer screening not routine unless at high risk. Clinical
risks/benefits of prostate cancer screening with PSA
blood test and/or digital rectal exam (DRE) with patients starting at age 50. Testing at
testicular exam at clinicians discretion.
blood test and/or digital rectal exam (DRE) for patients
clinician/patients discretion.
with risk factors (family history or African-American
ancestry).
Periodic total skin examinations every 3 years between the ages of 20 and 39 and annually at age 40 and older, regardless of skin tone and color. Frequency at clinician discretion based on risk factors.
patients
Screen annually. Re-evaluate if hearing problem is reported or a change in behavior is noted
(by ophthalmologist or
optometrist)
Hearing Assessment
Hypertension
Cholesterol
a healthy diet to maintain desirable weight for height. Offer more focused evaluation and intensive counseling for adults for BMI>30kg/m2 to promote sustained weight loss.
At every medical encounter and at least annually.
At clinicians discretion.
Every five years or at clinicians discretion.
Every 3 years after age 45. (HgbA1c or fasting plasma glucose) At least every 5 years until age 45 if at high risk. (obesity, family history of diabetes, low LDL cholesterol, high triglycerides, hypertension, sedentary ; and
Diabetes (Type 2)
for African-, Hispanic-, and Native-Americans, Asian).
Annually for Hepatitis B carriers. At clinicians discretion after consideration of risk factors including long term prescription medication.
Liver Function
Dysphagia & Aspiration Chronic Dysphagia and GERD are common in individuals with DD and neuromuscular dysfunction. Screen initially and inquire about changes at annual physical.
Cardiovascular Disease Screen for cardiovascular diseases and malformations earlier and more regularly than the general population. Specific syndromes and neuroleptic medications may increase risk for cardiac disease.2
Bone density screening (BMD) starting at age 19 when risk factors are present: long term polypharmacy, mobility impairments,
Provide BMD testing. Counsel elderly patients about specific measures to prevent
hypothyroid, post- menopausal women. Periodicity of screening at clinicians discretion. Annually counsel about preventive
Osteoporosis
falls.
measures including dietary calcium and vitamin D intake, weight-bearing exercise, and not smoking
ALL, including those with legal or total blindness, should be under an active vision care plan and eye examination schedule based on recommendations from an eye specialist ( ophthalmologist or optometrist.) Refer to eye
Eye Examination
specialist if new ocular signs and/or symptoms develop, including changes in vision/behavior. Annual comprehensive eye exam for patients with diabetes.
Glaucoma Assessment Comprehensive eye exam at least once by age 18-22. Follow up eye
Comprehensive eye exam every 1-2 years, with more frequent eye exams for higher risk patients.
exam every 2-3 years, with more frequent eye exams for higher risk
Skin cancer
Additional Recommended Screening
Body Mass Index (BMI) Screen for overweight and eating disorders. Consult the CDCs growth and BMI charts (www.cdc.gov/nccdphp/dnpa/bmi/index.htm). Ask about body image and diet patterns. Counsel on benefits of physical activity and
Cancer Screening
Breast Cancer:
Mammography
Clinical breast exam and self examination instruction as Clinical breast exam and self
appropriate. Annual mammography at discretion of
examination instruction as
clinician/patient.
appropriate. Annual mammography
Health Maintenance Visit Annually for all ages. Includes initial/interval history, age-appropriate physical exam; height and weight measurement; preventive screenings and counseling; screening for ocular disease or injury; assessment and
Procedure
Infectious Disease
Screening
Sexually Transmitted
Infections
HIV
Hepatitis B
Hepatitis C
Tuberculosis (TB)
Immunizations
Influenza
Pneumococcal
Hepatitis B
Hepatitis A
Tetanus, Diphtheria, Pertussis
(TdaP)
Measles, Mumps, and
Rubella (MMR)
HPV Vaccine**
Varicella (Chicken Pox)
Zoster (shingles) Vaccine**
19-29 Years
40-49 Years
50-64 Years
30-39 Years
Annually
65 Years +
Annually
Once, even if vaccinated before
For chlamydia and gonorrhea: Sexually active patients under age 25: Screen annually. Patients age 25 and over: Screen annually, if at risk. Screen pregnant women at the first prenatal visit and in the third trimester,
for all STIs if at risk.
Periodic testing if at risk and testing of pregnant women at increased risk.
Periodic testing if risk factors present.
Periodic testing of all patients at high risk. Risk factors include: illicit injection use; receipt of blood product for clotting problems before 1987 and/or receipt of a blood transfusion or solid organ transplant before July,
1992 (if not previously tested); long term kidney dialysis; evidence of liver disease; a tattoo or body piercing by nonsterile needle; risky sex practices.
Tuberculin skin testing every 1-2 years when risk factors present. Risk factors include residents or employees of congregate setting, close contact with persons known or suspected to have TB.
Annually
Annually
Annually
Once and a booster after 5 years if chronic renal failure; sickle cell disease or splenectomy; immunocompromised
Once. Reevaluate antibody status every 5 years.
If at high risk and not previously immunized. (2 doses)
3 doses if not previously immunized. Booster every 10 years.
If born after 1956 and have not been immunized or have laboratory evidence of immunity. Receive a second dose of measles-containing vaccine if at risk. Ages 50+: Not routine.
Three injections given over a 6-month period to females 9-26 yrs old.
2 doses recommended for those who do not have documentation of age-appropriate immunization or a reliable history of chicken pox (varicella)
Annually counsel regarding prevention of accidents related to falls, fire/burns, choking and screen for at-risk sexual behavior.
Prevention counseling
Annually monitor for behavioral signs of abuse and neglect.
Abuse or neglect
As appropriate, including genetic counseling, folic acid supplementation, discussion of parenting capability.
Preconception counseling
At an appropriate age, counsel women on the changes that occur at menopause and their options for the symptom management.
Menopause management
Annually counsel regarding diet/nutrition, incorporating regular physical activity into daily routines, substance abuse.
Healthy Lifestyle
Notes: 1
Based on review of the following primary guidelines/resources.
i.
Massachusetts Health Quality Partnership (MHQP) Adult Preventive Care Recommendations 2007/81 and
ii.
Consensus Guidelines for primary health care of adults with developmental disabilities, Canadian Family Physician, Vol.52 2006
iii.
US Preventive Services Task Force Guidelines
2 Items that are indicated in Large Bold are specific recommendations that differ from the MHQP recommendations in order to reflect particular health concerns of the population with intellectual disability.
3 Vaccines are recommended, but may not be covered by MassHealth or Medicare in all cases
Massachusetts DDS Health Screening Recommendations Updated February 2010
200
HEALTH RECORD
Massachusetts Department of Developmental
Services
(3) Name:
(5) Gender:
(6) SSN:
(14) Religion:
Health Insurance (type & numbers)
(15A) Ins. #1:
(15B) #:
(16A) Ins. #2:
(16B) #:
(17A) Ins. #3:
(17B) #:
(18A) Ins. #4:
(18B) #:
(10) State:
(11) Zip:
(12) Telephone:
(19) Agency Responsible for Provider Care? No Yes (19A)
(To be completed or updated at the ISP and brought to all new medical contacts)
BASIC INFORMATION
(4) D.O.B:
(19B) Tel. #:
(22B) Tel.#:
CONTACTS EMERGENCY AND PHARMACY (Repeat 24A 24H for additional emergency/pharmacy contacts on separate sheet)
(24A) Type
Select One
Emergency
Pharmacy
Emergency
Pharmacy
Emergency
Pharmacy
Emergency
Pharmacy
MEDICATIONS LIST
(24B)
Name
(24C)
Street Address
(24D)
City
Frequency Options:
x 4 x day
x 1 x day
x Once every other day
x 2 x day
x 1 x week
x 3 x day
(24E)
State
(24F)
Zip
x 2 x week
x Once every 28 days
x Every 2 Months
(25C) Frequency
(24G)
Telephone
x Every 3 Months
x Every 6 Months
x Annually
(25D)
Date Started
(24H)
Fax
x PRN
x Unknown
(25E)
Date Stopped
(26B)
To What?
(26C)
Type of Reaction
Page 1 of 6
201
Individuals Name:
Insects Other
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202
Page 2 of 6
Individuals Name:
CURRENT MEDICAL PROBLEMS AND DIAGNOSES (Select all that apply)
(27) Neurologic:
Cerebral Palsy
(28) Cardiovascular:
(29) Respiratory:
Pneumonia
Asthma
(30) Gastrointestinal:
GERD
Dysphagia
COPD
Osteoporosis
Lung Cancer
Prostate Cancer
Stomach Cancer
Urinary Retention
(34) Metabolic/Endocrine:
Diabetes
Hyperlipidemia
Autistic Disorder
Down Syndrome
Prader-Willi
Angelman syndrome
Aspiration
Recurrent Infection
Liver Cancer
Blood Cancer
Breast Cancer
Hyperthyroidism
Brain Cancer
Other
If Other, specify:
Hypothyroidism
(36) Psychiatric:
Colon Cancer
Esophageal Cancer
Pancreatic Cancer
(35) Syndromes:
(32) Kidney/Urinary:
(33) Cancer/Neoplasm:
Hypertension
Recurrent Infection
Constipation
(31) Musculoskeletal:
Arthritis
Alzheimer's Disease
Rett Syndrome
Smith-Magenis syndrome
Tuberous Sclerosis
Turner's Syndrome
Sexual disorders
Substance use disorder
Other
If Other, specify:
Normal
Low Vision
Normal
Braces
Continent
Regular
Deaf
Needs Assistance
Ground
None
Unknown
Incontinent
Totally Dependent
Chopped
Unknown
Hearing Aid
Independent/Self Medicates
Needs Assistance
Wears Glasses
Helmet
Hard of Hearing
Blind
Catheterized
Other
Unknown
Unknown
Unknown
Puree
Thicken Liquid
Other
Unknown
Independent
Independent
Yes
Unknown
Unknown
No
Special Needs
Special Needs
Yes
No
Page 3 of 6
203
Individuals Name:
SPECIAL NEEDS (Select one)
(52) Usual response to Medical Exams: Cooperates Partially Cooperates Resistant Fearful Unknown
(53) Sedation for clinical visits: Yes No Unknown
(53B) If Yes, type of sedation used:
(54) Special positioning required for examination: Yes No Unknown (54A) If Yes, Explain:
(55) Double staffing required for assistance with exams: Yes No Unknown (55A) If Yes, Explain:
(56) Requires limited waiting periods for exams: Yes No Unknown
(57) Appointment Schedule Preference: Early day
Unique Unknown
No
No Preference
CONTACTS - HEALTHCARE PROVIDERS (Repeat 61A 61H for additional healthcare providers contacts on separate sheet)
(61B)
Name
(61C)
Street Address
(61D)
City
(61E)
State
(61F)
Zip
(61G)
Telephone
(61H)
Fax
DEMOGRAPHICS
(62) Living Status:
(Select one)
Single
Married
Other-Widow
Divorced
Legally Separated
Regular job
Sheltered
Healthcare Coordination
Unknown
Unknown
IMMUNIZATIONS / TB TESTING
(66) Date of most recent TETANUS:
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Series Complete
(69B) Booster:
(70) Dates most recent MEASLES/MUMPS/RUBELLA (MMR):
(71) List any other vaccinations and dates (e.g., Lyme Hepatitis A, Varicella, etc.):
Tuberculosis Skin Test (PPD):
(72) Has the individual ever had a positive skin test for tuberculosis?
(72A) If Yes, was any treatment given?
Yes
No
Yes
No
Unknown
Unknown
(72B) If Yes, please describe. If No, please explain why treatment was not given:
(73) Date of last PPD:
Version: hcsis_hcr_form
204
Page 4 of 6
(61A)
Type/Specialty
Individuals Name:
PAST MEDICAL HISTORY DDS RELEASE CONTACT
(74) Medical History not released by parent/guardian
For information, contact: (Repeat 74A 74G for additional contacts on separate sheet)
(74A)
Name
(74B)
Relationship
(74C)
Street Address
(74D)
City
(74E)
State
(74F)
Zip
(74G)
Telephone
(75B)
Type of
Hospitalization
(75A)
Type of Event
(Select one)
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
(75C)
Hospital Name
(75D)
Description of Event
(75E)
Date/Year
of Event
Unknown
Yes
Unknown
No Unknown
Never conducted
Never conducted
Unknown
Unknown
(81) Any history of abnormal PAP smear? Yes No (81A) If Yes, please describe:
(82) Mammogram Status: Administered Date:
Never conducted
Unknown
(84) Cardiovascular:
(85) Respiratory:
Pneumonia
(86) Gastrointestinal:
GERD
Aspiration
Dysphagia
(89) Cancer/Neoplasm:
Lung Cancer
Prostate Cancer
Stomach Cancer
Colon Cancer
Esophageal Cancer
Pancreatic Cancer
(90) Metabolic/Endocrine:
Diabetes
Hyperlipidemia
(91) Psychiatric:
Version: hcsis_hcr_form
Hyperthyroidism
Urinary Retention
Liver Cancer
Blood Cancer
Breast Cancer
Hypothyroidism
Recurrent Infection
Brain Cancer
Other - If Other, specify:
Sexual disorders
Substance use disorder
Other
If Other, specify:
Page 5 of 6
205
Individuals Name:
PAST MEDICAL HISTORY EVALUATIONS
(92) AUDIOLOGICAL EXAM Status:
Administered Date:
Never
Unknown
Administered Date:
Never
Unknown
Administered Date:
Never
Unknown
Administered Date:
Never
Unknown
Never
Unknown
Administered Date:
Never
Unknown
Administered Date:
Never
Unknown
Yes
No
Yes
No
Unknown
(103) List all brothers and sisters with information about their
age and health:
Yes
No
Yes
No
Unknown
Yes No Unknown
Yes No Unknown
(106) OSTEOPOROSIS:
Yes No Unknown
Yes No Unknown
(107) CANCER:
Yes No Unknown
Version: hcsis_hcr_form
206
Page 6 of 6
Contacts e-mail
Facility Information
Facility Name ______________________________________________________________________________________
Address ___________________________________________________________________________________________
City_______________________________________________
Facility Type
Hospital
Clinic
MAP (DDS)
MAP (DMH)
Prison/House of Correction/Jail
School
Date of Loss
Incident Type
Diversion
Ambulance
Manufacturer/Distributor
Practitioners Office
Loss
Theft
Tampering
Documentation
Quantity
Strength
Dosage Form
__________________________________
_____________________
_____________________
_____________________
__________________________________
_____________________
_____________________
_____________________
__________________________________
_____________________
_____________________
_____________________
Narrative (Please explain what happened, what factors may have contributed to loss, and any other relevant information.
Please indicate if patient harm was involved. Please use additional sheets if necessary.)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
For office use only
Received by Drug Unit
Staff initials
Intake number
R20120209-01
207
MEDICATION OCCURRENCES
Page 1 of 3
v.04212009
*Last Name:
(* = Required Field)
* (9) Time:
*(10) Did the Medication Occurrence Happen Over Multiple Consecutive Administrations?
YES
NO
*(11) If Yes in #10, over what number of doses did the medication occurrence happen?
*(12) Staff Position of Person Giving Medication: Choose from Dictionary #1
*(13) Medication Occurrence: Choose from Dictionary #2
*(14) MAP Consultants Title:
Registered Nurse
Yes
No
Clinic Visit
Registered Pharmacist
YES
NO
Hospitalization
*(20) Did any of the following situations or conditions result from the medication occurrence (Check All That Apply)?
Illness
Injury
Death
YES
NO
(21) Was DPH Notified?
According to MAP Policy, DPH must be notified if any medical intervention occurred as a result of the medication
occurrence. Such medication occurrences are called HOTLINES. Answering Yes to Question
# 18 and selecting
any of the choices in Question #20 requires that DPH be notified immediately. Submit HOTLINES within 24 hours of
discovery.
(22) Date DPH was Notified:
208
(23) Time:
MEDICATION OCCURRENCES
Page 2 of 3
Last Name:
YES
NO
(29) Dosage:
(30) Frequency/Time:
(31) Route
(33) Dosage:
(34) Frequency/Time:
(35) Route
Choose from Dictionary #4
Choose from Dictionary #4
Choose from Dictionary #4
*(36) Number of medications supposed to be given at same time as the medication occurrence including the medication(s)
involved in the medication occurrence (check one): 0
(0, 1, 2, 3, 4, 5, 6-10, 11-15)
*(37) Was there a recent change in the medication order for the medication(s) involved in the MOR?
YES
NO
YES
NO
YES
NO
(43) Was the person who caused the medication occurrence working their regular shift?
YES
NO Different Shift
NO Overtime Shift
(44) Was the person who caused the medication occurrence working at their routine site?
YES
NO
209
MEDICATION OCCURRENCES
Page 3 of 3
Last Name:
Approved
Not Approved
Referred to Provider for follow-up
Other
210
Name:
Allergies:
Reason for Visit/Symptoms:
Results/Diagnosis:
Tests/Treatment Ordered:
Special Instructions
Date/Time:
Date/Time:
If vital signs are indicated, please give parameters and when to call the health care practitioner.
Staff Follow-up:
Yes
No
N/A
Posted
Date
Provider Staff Signature
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Verified Date
Provider Staff Signature
Time
FORM HC-3 v2
211
Date:
Ht
Wt
Tq
BP
General Appearance:
Skin:
HEENT:
Head
Eyes/Vision Screen
Ears/Hearing Screen
Mouth/Throat
Neck:
Chest:
Breast:
Heart:
Lungs:
Abdomen:
Genitalia:
GYN/Testicular Exam
Rectum:
Musculoskeletal:
Back/Spine
Extremities
Lymph Nodes:
Circulatory:
Neurologic:
Cranial Nerves
Reflexes
Sensory
Motor
Cognitive
Other:
HC Provider Signature:
212
FORM HC-4 v2
Individuals Name:
Cognitive Skills
0
1
2
3
0
1
2
3
D
0
1
2
3
E
0
1
2
3
F
0
1
2
3
G
0
1
2
3
213
1
2
3
Individuals Name:
Shapes
0
1
2
3
Numbers
0
1
2
3
K
0
1
2
3
L
0
1
2
3
M
0
1
2
3
0
1
2
3
0
1
2
3
214
2
3
Identifies one or more side effects to specific medications and how to respond to
side effects after training.
Identifies side effects to specific medications and how to respond to side effects
after training.
Individuals Name:
Ability to reorder
0
1
2
Total score
Add up the number responses (Lines A-O) for the total Score.
Average
Score
Based on this Observation Evaluation Tool, I have determined that the Individual named below appears to be appropriate to
learn to self-administer medications.
Staff Persons Printed
Name
Individuals Printed
Name
Staff Persons
Signature
Date
Based on this Observation Evaluation Tool, I have determined that the individual named below does not appear to be
appropriate to learn to self-administer medications at this time because:
Individuals Printed
Name
Staff Persons
Signature
Date
As the above named individuals Health Care Provider, I concur that this individual demonstrated the ability to self-administer.
Health Care Provider
Printed Name
HCPs Signature
Date
215
2.
3.
4.
DURING THE APPOINTMENT, HELP THE PERSON AND HEALTH CARE PROFESSIONAL
If needed, assist the individual during the appointment. Provide information to the health care professional
when asked and/or help the individual to answer questions. If you do not know the answers to the questions,
refer the health care professional to the other contact people on the Health Record
6. BRING BACK ALL FORMS, ANY PRESCRIPTIONS, DOCTORS ORDERS, AND THE
APPOINTMENT CARD TO THE APPROPRIATE PERSON.
form.
Be prepared to tell Emergency Room staff why you are bringing the person to the ER.
If you have any concerns about taking the person home (or to work/day program) after
the visit, tell the emergency room staff and contact your supervisor before leaving the
hospital.
216
LEAVE OF ABSENCE
Name: ________________________Allergies: _________________________
Date of Departure: ______________ Expected Date of Return: ____________
Destination: _____________________________________________________
Medication
Strength
Amount
___________________________
Staff who prepared medications
Frequency
Route
Special Instructions
# of
Pills
__________________________
Staff who checked medications
217
Medication Occurrence
Report Forms
Communication Book
Medication Progress Notes
Controlled Substance
Disposal Record
Telephone / Fax Order Forms
Leave of Absence Form
Other
Emergency Telephone Numbers
Local Poison Control Number
Supervisor Contact Information
____
MAP Consultant Contact Information
218
Bibliography
American Pharmacists Association. Avoiding Medication Occurrences.
http://www.pharmacyandyou.org/about medicine.med.html.
Board of Registration in Nursing. Advisory ruling.
http://www.state.ma.us/reg/boards/rn/advrul/ruldmr.htm.
Brynes G. Why does my medication give me so many side effects?
http://www.ncpamd.com/side effects.htm.
2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions
Bibliography
219
220
Bibliography
Web MD Health. How to get the most benefits with the fewest risks. May 16, 2003.
http://www.webmd.com/content/article/6/1680_5160.htm.
Web MD Health. Imodium. August 2, 2003.
http://www.my.webmd .com/search/searchresults?query=Imodium&filter==mywe
bmdallfilter.
Web MD Health: Medication monitoring. February 14, 2001.
http://www.webmd.com/content/healthwise/140/34842.htm.
Web MD Health. Medications used to treat mental disorders. November 2002.
http://www.webmd.com/content/article/60/671.50/htm.
Bibliography
221