Running head: LMM MEDICATION DISTRIBUTION 1

Lighthouse Mission Ministries Medication Distribution

Harpinder Cheema, Brittani Fiscus, and Katherine Sellards

Western Washington University

NURS 432 Community-Based Care for Vulnerable Populations

William Lonneman, DNP, RN

31 May 2017
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Lighthouse Mission Ministries Medication Distribution

Lighthouse Mission Ministries (LMM) approached Western Washington University

(WWU) RN-to-BSN students for their expertise to enhance the medication distribution process

and reduce errors. The current procedure requires Agape House guests to release their

medications to staff and Mens Ministries guests to release only particular medications to staff

for safekeeping. The guests retrieve 24 hours worth of medications once a day from staff during

a medication distribution period. Through interviews with multiple staff, first-hand experience,

and review of surveys complete by guests and staff (see Appendices A, B, & C), students were

able to identify the specific problems. Among staff, there is a lack of continuity with distribution

procedures and lack of knowledge in best practices in distributing medications. Handling

discrepancies was a major issuehow can staff best prevent these and what is the best course of

action when the recorded number of medications does not align with the guests reported

number? A goal of LMM staff is to empower guests to regain their independence, but staff need

to maintain a safe environment and discourage poor medication habits. With these factors in

mind, suitable interventions can be categorized by either improving organization or improving

safety and accountability.

Assessment

An assessment was conducted to understand the issues pertaining to LMM medication

distribution system. First, the time of distribution was observed both in the Agape House and the

main mission building where men receive their medications. To be clear, LMM is not licensed

to dispense medications, so staff can only handle medications when counting in during check-

in. When dispensing times were observed, only one staff was present with multiple guests in the

lobby in both facilities. During mens medication distribution time, there was not enough room
LMM MEDICATION DISTRIBUTION 3

for the guests to record medications in the log binder--the staff member had to fill this

out. Guests were required to state what they were taking so the staff member could record them

in the binders. Further, one staff member was unfamiliar with the medication process and had

trouble locating each guests medications. That staff member also did not know everyone by

face and relied on the guest stating their name to find their medications. There was no means of

identification to refer to. The major issue was guests constantly entering and leaving the facility

and milling about in the lobby. Some guests stayed close enough to the dispensing area to

overhear what others were prescribed.

Interviews were conducted with four key informants: three who handle medication and

one who oversees the process. Informants agreed on two major problems: medication times

were busy and only one staff member was available for help, and there was an inconsistent

system that lent itself to things being overlooked. Guests are required to report how many pills

they are taking and display what they have in their hands, but it is an inconsistent practice so

staff were concerned that guests were not taking their medications as prescribed. Further, guests

take out 24 hours-worth of pills, meaning they do not necessarily take those pills in front of

staff. Staff members have been accused of taking or misplacing medications, though most of the

process is done in front of a camera.

LMM has a document called Procedures Regarding Medications (see Appendix E),

developed by past managers in the Agape House (there is no known document for the Mens

Ministries). The document has a step-by-step process of checking in medications, making

medications available during medication time, accountability, disposal, as well as a copy of the

medication forms to be filled out for each guest. Of note, checking in medications requires only

one staff members presence and should be in front of the camera as much as possible. Checking
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in medications is the only time when pills are required to be counted. Under 8.4.7 in Appendix

E, there is a privacy clause stating staff should not ask the guests to say the prescriptionthis is

the purpose of giving the guests section in the medication binder to them and having the guest

show the prescription as well as the number of pills they took. Under 8.4.10, there is short

direction on when discrepancies arise, with greater explanation under 8.5.

A literature review was conducted about the best practices of medication distribution in a

community setting with no license to administer medication. There was very little written in

regard to a community setting because most locations that distribute medications are health

facilities licenses. The group utilized knowledge obtained from nursing practice and reviewed

literature about the best practices for nursing medication administration and ways to decrease

errors, which would adapt to be more appropriate in a community setting with a less controlled

environment that has different goals of giving out medications than treating illness. These

practices are well-established, though evolving with technology and extensive research has been

conducted as to decrease medications errors. According to Hughes and Blegen (2008):

Threats to medication safety include miscommunication among health care

providers, drug information that is not accessible or up to date, confusing directions, poor
technique, inadequate patient information, lack of drug knowledge, incomplete patient
medication history, lack of redundant safety checks, lack of evidence-based protocols,
and staff assuming roles for which they are not prepared.

Noted during assessment: technique was inconsistent in distributing medications, lending

itself to errors and decrease in privacy; some staff were unfamiliar with all guests and not enough

guest information was available to verify identity; staff have limited knowledge on identifying

high-risk medications; safety checks are either nonexistent or followed inconsistently; safety

protocols are also inconsistent; and some staff are unfamiliar with the policy and

procedure(P&P) regarding medications.

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The team developed a survey to evaluate how both staff and guests thought about the

medication process. This will be described in greater detail below in Deliverable.

Deliverable

A survey of the guests and staff at Agape House and the Main Mission were performed to

learn their thoughts about the current medication distribution process. Results show that guests

are mostly satisfied with the process with the exception of independence with medications. The

results from Agape House revealed that the current process does not facilitate for the guests

independence in managing their own medications and state that they would like to be more self-

sufficient in this area. The staff, however, seemed less satisfied with the medication distribution

process, stating there are inconsistencies among staff, a lack of privacy for guests, and frequent

errors on the log sheet. Results of both surveys can be viewed in Appendix B and C.

The group modified the medication log sheet because, after reviewing, it was determined

that there were categories that could be added which would assist in decreasing the time of

medication distribution and reduce discrepancies with medications. To decrease distribution

times, a predated column was added so that guests would only have to sign on that line and then

add the check-out time.

To improve staff-guest relations, more frequent audit checks were suggested so that

inaccurate medication counts could be investigated in a timely manner. The column, Amount

Remaining, was also added to keep a running total of remaining medications on the log

sheet. Additionally, a section was included on the bottom of the log sheet to chart audit dates

and signature line for the guest and staff member. By keeping a running total and performing

more audits with the guest will reduce medication discrepancies and alleviate mistrust between

guest and staff.

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Interventions

At the time of the initial assessment, it was discovered that the LMMs organization and

structure needed attention, particularly the storage of medications. The Agape House stored

medications in foam pipe insulation that were kept in a locked cabinet organized by the guests

last name. This system worked, but it lacked a professional appearance. At the Main Mission

building, medications were stored in plastic zip-lock bags that were kept in locked drawers. It

was unclear how the zip-lock bags were organized, but it was not organized by last name or

room number. The system of how medications were stored by staff differed from building to

building. One possible solution is to purchase a nice tool storage device with individual

drawers. Each drawer would contain a guests medications, organized by last name or room

number. Another possible intervention is to buy lockers that would be accessible by

guests. This would also involve the use of a point system. Points would be given for good

behavior and deducted for poor behavior. For example, following the rules and taking the

correct amount of medications would constitute as good behavior, resulting in more control for

the guests over their medications. Guests with fewer points would have less control over their

medications.

It was determined that the Agape House and Main Mission building did not follow the

same P&P. In fact, further investigation revealed the main mission building did not have a

formal set of written P&P. The first recommendation is to develop a set of P&P that both

buildings would follow and to place a copy in each medication log binder. Having staff adhere

to P&P would be essential in providing structure for the guests as each staff member would be

following the same set of guidelines. Medication log sheets differed slightly from one building

to the next. The group recreated the medication log sheet and recommended that each building
LMM MEDICATION DISTRIBUTION 7

utilize the same log sheet. Additions that were made to the medication log sheet include quantity

taken, prescribing physician name, a pre-written date, and two medication audit sections with a

place for the guest and staff to sign following the audit. Having a location to document that an

audit or count of medications has taken place would decrease the likelihood of discrepancies and

would strengthen the guest-staff relationship. Along with the log sheet, a very brief and simple

face sheet was created to be placed in front of each guests set of medication sheets. It would

contain a picture of the guest, name, and date of birth. The face sheet would help the staff

members verify that correct medication was given to the correct guest.

The Main Mission buildings storage of medications needed attention. The

recommendation was made to use small storage bins or containers to store medications rather

that plastic zip-lock bags. The small storage containers could easily be organized in alphabetical

order going by last name. This would decrease the amount of time spent looking for medications

as well as decrease the chance of medications being misplaced or lost.

Finally, the last issue addressed the constant amount of distractions and interruptions the

staff member would face during medications times. A solution would be to set up a quiet zone, a

simple and effective way to decrease distractions and increase privacy for the guest. To set up a

quiet zone, mark a perimeter with red tape or something similar around the counter or desk

where the medication process takes place. Another intervention to decrease the amount of

interruptions would be to add a staff member or volunteer during the medication time. The

second individual would supervise the door, as guests frequently come and go as they please. He

or she would also be the go-to person for questions or concerns during the medication times. To

assist with cost containment, it is recommended that the second individual working during

medication times be a volunteer.

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Evaluation

In order to evaluate any changes that have been implemented related to the

recommendations, the group suggests repeating a survey inquiring about the effectiveness. The

goal is to see an improvement with staff concerns related to the previous survey and that an

atmosphere of trust has been maintained or increased between the staff and guests. Also, an

evaluation as to the effectiveness of an updated medication log sheet, if it is introduced, in

regards to number of discrepancy errors.

Summary

Medication errors have the potential to cause harm. It is important to take necessary

steps and have systems in place to prevent medication errors. LMM staff realized that their

medication distribution process needed to be revamped and reached out to students from the

WWU RN-to-BSN program to utilize their expertise with medication administration. The

current process lacks structure, organization, continuity, and safety. Through our assessment and

research, recommendations include creating a set of P&P for both buildings, using the same

medication log sheet, and adding a face sheet to streamline the distribution process while

enhancing the safety and accountability for all parties. Other recommendations include

recruiting the help from either another staff member or volunteer to watch the door during

mediation times, the implementation of a quiet zone, and improving the organization of stored

medications to cut down on distractions and interruptions during the medication pass

times. With the implementation of these recommendations, the medication process can be safer

and more structured, benefiting both staff and guests.

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Katherine

It was a pleasure working on this project with the Lighthouse Mission Ministries. The

staff and guest were very welcoming and open to any new ideas to assist in improving the

medication distribution process. I believe that the LMM staff has an unwavering desire to

support this particular population of people by offering support through food, shelter and life-

building skills to facilitate their recovery and reentry to an independent living and working

lifestyle. The guests at LMM are there for a variety of reasons such as addiction, homelessness

due to loss of job and income and domestic violence. I believe that anyone can find themselves

under the same circumstances of financial or domestic hardships that lead to the services of

agencies such as this one. LMM exhibits a true dedication and support for the community and

people of Bellingham to promote for a safe and healthy environment.

Brittani

All staff at LMM were hospitable in allowing us to invade their space in order to improve

the processes for the guests. It was apparent that all staff put guests needs first. What I learned

from the experience had more to do with the people I met rather than learning about medication

procedures outside of skilled health facilities. I was surprised by the population of gueststhey

were wary of us, but friendly for the most part. Their ages were far more varied than I had

expected. There were many young men and women who were dressed and groomed nicely, not

looking like your stereotypical homeless person. One flaw of mine is being judgmental,

something Im working on. Working with LMM staff and guests especially gave me a better

perspective on the situation homeless are found in, showing me my judgments are more often

than not incorrect.

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Harp

The LMM is a wonderful asset to our community. In the beginning, it was difficult for

myself to entertain the idea that licensed individuals were not involved in the medication

process. As I learned more of the LMM and their processes it became difficult for myself to

come up with feasible recommendations of improvement. I wanted to recreate how hospitals or

nursing facilities handled medications, but that was not the goal for this experience. For this

experience, we needed to focus on what the staff at the LMM could do with their skill

level. Once I could understand this, I was finally able to come up with creative

recommendations the LMM could adapt. I hope the recommendations we came up with can help

improve the way medications are handled at the LMM.

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References

Hughes, R. G., and Blegen, M. A. (2008) Patient Safety and Quality: An Evidence-Based

Handbook for Nurses. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2656

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Appendix A

Guest Survey

Western Washington University nursing students are assessing the procedures for medication
dispensing at Lighthouse Mission Ministries. We would like your feedback to improve the
current system. Your answers will be kept confidential and will only be used for the
improvement process. You may leave your name for follow-up (see the bottom of the page), but
this will not be shared. Your privacy is important to us. Thank you!

1. Are you satisfied with current medication dispensing process?

YES SOMEWHAT NO (please explain)

2. Do you feel your privacy is protected while receiving medications?

YES SOMETIMES NO (please explain)

3. Do you feel judged about what medications youre taking?

YES SOMETIMES NO

4. If you answered yes to #3, who do you feel judged by?

STAFF GUESTS OTHER (please explain)

5. Do you feel your medications are safe the way they are stored right now?
YES SOMEWHAT NO (please explain)

6. Is the current medication process helping you become more independent in managing
your own medications?

YES SOMEWHAT NO (please explain)

7. Would you like more independence in taking your medications?

I NEED MORE INDEPEDENCE THIS AMOUNT IS GOOD

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I NEED MORE HELP WITH MEDICATIONS

8. Do you feel you have to wait long times to get your medications?

YES SOMETIMES NO

9. When do you normally get your medications?

6:15-7:15 am 9:00-9:30 am 6:45 pm Other

10. Do you feel more staff need to be available at medication dispensing times?
YES SOMETIMES NO

Optional: Other questions/comments/concerns:

If you would like to participate in follow-up questions, please leave your name and staff will
arrange a follow-up meeting:
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Appendix B

Guest Survey Results

Questions (Mens) Main Mission Building

1. Are you satisfied with current medication dispensing process?
2. Do you feel your privacy is protected while receiving medications?
3. Do you feel judged about what medications youre taking?
4. If you answered yes to #3, who do you feel judged by?
5. Do you feel your medications are safe the way they are stored right now?
6. Is the current medication process helping you become more independent in managing your own medications?
7. Would you like more independence in taking your medications?
8. Do you feel you have to wait long times to get your medications?
9. When do you normally get your medications?
10. Do you feel more staff need to be available at medication dispensing times?

Question Yes Sometimes/somewhat No More IND No Change More Help 615-715am 900-930am 645pm Other Staff Guests
1 5 3 1
2 6 3
3 _ 1 8
4 _
5 7 2
6 2 6 1
7 _ 2 5 1
8 _ 2 7
9 _ 2 2 6
10 3 6
Other questions/comments/concerns:
I would be happier filling my meds for the week with staff and follow up with them during one-on-ones; successes or short comings
I think medications should be poured into a cup then given, I could take as many pills as I wanted
have another line for those usually wait, have 2 medication lines
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Appendix C

Staff Survey with Answers

Western Washington University nursing students are assessing the procedures for medication
dispensing at Lighthouse Mission Ministries. We would like your feedback to improve the
current system. Your answers will be kept confidential and will only be used for the
improvement process. You may leave your name for follow-up (see the bottom of the page), but
this will not be shared. Your privacy is important to us. Thank you!
AGAPE HOUSE: answers A-F MENS MINISTRIES: answers G-I
11. What is your role with the medication dispensing process?
a. I receive, count-in, log in/out with guests, and lock up guests prescriptions
medications
b. Upon occasion, I count in and dispense
c. Guests turn them in to me in the evenings when they have a refill or new script. I
also will count in medication at night when I work a night (overnight) shift, but
this is NOT often. I also work during med times as well sometimes and make
meds available to guests
d. Receive meds, count in meds, maintain meds safety, security, provide meds to
guest to self dispense. Documentation, usual accountability, guest privacy
e. I am a staff person who occasionally dispenses and counts in medications
f. Dispense (on occasion); counting in (rarely)
g. I dispense them
h. I dispense and oversee
i. One, we do not dispense meds (no license) we just med monitor and log and lock
up for guestI occasionally will take in meds and occasionally hand guests their
meds to take

12. Are you satisfied with current medication dispensing process?

a. SomewhatI see the benefits of it for safe community living, but ultimately think
it is not equipping our guests for future independence
b. No, there are lots of (too many) errors by staff it seems. Inconsistent process;
training/retraining needed.
c. Improvements could be made
d. Yes
e. Not really. It is slow and lacks privacy.
f. In general, yes
g. No, I think there could be a better process
h. No
i. No, too many staff are involved or dont monitor correctly or write down
correctly
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13. Do you feel the privacy of the guests is protected during the medication pass times?
a. Not completely, because though we request guests to stay away from the counter
where someone is checking out meds, it is still an open space with people coming
and going
b. Mostlydepends on individual staff and their process. If our process is followed,
then I think its private enough. Turning to correct page, not handing them the
binder. Not saying meds; maintain safe distance
c. No. The lobby is an open room where meds are given during med times. Often
guests overhear another guest talking about what med theyre getting/taking
d. No
e. Not really
f. Sometimesbut often not depending who is presentsome guests/staff have
more discretion than others
g. No, no privacy
h. No
i. No, but I do feel we do the best we can under our current situationwe do done
person at a time and have the others wait in the staircase

14. Do you feel the guests are judged about what medications theyre taking?
a. I believe our staff culture is one to not judgethat being said I dont have the
privilege of working with every staff member, let alone observe their execution of
the med time procedures
b. By staffno? Mostly not; not often do we know what everything is for.
Potentially by other guestsDoes this person have 3 sleeves of meds vs 1 sleeve?
c. Yes, sometimes. Not by staff, but by other guests
d. Not by staff
e. By staff? No, absolutely not
f. No
g. At times, or how many they take
h. No
i. No not the least bit

15. Do you feel rushed during medication pass times?

a. When I first was hired I did, but then realized that ultimately I would rather have
it take slightly longer for guests so that we all achieve accuracyI aim to take my
time while also respecting theirs
b. No, I take charge and dont let guests rush me. I think its fair to give each guest
my undivided attentionand however long it takes, so be it
c. YES!!!
d. No
e. Guests attempt to rush other guests, but I hold to boundaries with this.
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f. No
g. Yes, too many distraction
h. Yes
i. I rarely do it but when I did definitely rushed

16. Do you feel medications are safe the way they are kept right now?
a. I do feel medications are safe when the procedures are followed correctly
b. Mostly. Camera could be adjusted better? Although more than once cabinet left
unlocked. I think meds in office should be disposed of ASAP.
c. Anyone could pick these locks! So, no! also, the camera is NOT fully on the meds
going into the cabinet, so theres no real verification of them going in the cabinet,
its more faith/trust based than anything
d. No
e. Yes
f. Yes
g. Yes, it is hard to monitor what is actually being taken though
h. I think we could do better. Too much room for error.
i. No too many staff w/ access and sometimes they are rushed and forget to lock the
drawers when finished

17. Is the current medication process helping the guests reach their goal of becoming
independent with managing their own medications?
a. No, I believe that when someone takes care of something for you (almost
completely), you start to lose your sense of responsibility in that area in some
cases take on a victim mentality
b. Mostly. I think we still overseemeds skipping, preventing abuse. I dont know
what some guests wouldnt abuse pain meds, for example, if we didnt keep theirs
c. In certain ways, it makes them realize the correct dosages they should take, when
to take them, etc.standing in a long line though does NOT help this, though!
d. I hope so
e. Those who want to manage their meds well, will. I feel our scheduled med time
is more about saving staff time
f. Noit controls too much
g. Yes and noyesthey are responsible for taking the proper amount. Nothey
have to report what they are taking
h. Again, I think we could do better
i. Yes, but only when we are tracking correctly by taking the extra seconds/minutes
to watch and ask questions w/ the guests

18. Would you like to see more independence with guests taking their medications?
a. I think we should at least be giving guests the independence to decide if they are
not going to take a medication or take a lower dose than is prescribed. I dont feel
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were equipped/trained to tell someone how much of a med they have to take and
ultimately if it effects their ability to living in the community, that will play out in
their behavior and our accountability system
b. Maybe except narcotics, etc. we could have a list of the exceptions that we
dispense (20%?)
c. YES!
d. No
e. Yes and no. some guests have a habit of leaving pills everywhere. I worry about
theft and the misuse of certain meds, but it is really an honor system. What
actually stops guests from keeping meds on their person anyway?
f. Yes
g. For some, yes.I would have concerns with some guests.
h. Yes
i. No we only currently hold onto narcotics and psychotropic medsNorco can be
easily sold or stolen and we want to make sure they are not overtaking or
undertaking psychotropics

19. Do you feel that medications should by audited or counted more frequently?
a. Yes
b. Yes. Could this prevent the missing meds? I hate it when staff are accused.
We lose respect and credibility.
c. They should be counted in/audited at least 2x monthly for everyone!
d. No
e. Yes. If we maintain our system is designed for accountability then we should be
auditing our system
f. Maybedepending on what consequences would be if we found discrepancies.
would guests move along the accountability process when there are discrepancies
in that case? Would we able them to leave for that?
g. If we are going to hold them, then yes. This will help w/ accountability, but not
independence.
h. Yes, let the guest control their own meds and staff has periodic pill counts
i. Yes, once a week

20. Do you feel more staff need to be available at medication dispensing times?
a. I dont think this is necessary, at least with the current method.
b. In case there are issues? Accountability? Not necessarily. For speed?maybe.
But average wait time10-15 min? I think thats acceptable
c. YES!
d. No
e. No. I feel we trip over each other when two people are in that tiny space.
f. No
g. Yes, one to handle it all is a lot
h. No
LMM MEDICATION DISTRIBUTION 20

i. I believe 2 people should be presentone to hand out meds. The other to help
keep lobby empty for privacy

21. Do you feel that medication discrepancies are handled appropriately?

a. I dont see all of them being followed up on and completely resolved, but it could
be that it is just not getting logged for other staffgenerally though I think these
things should be logged to completion so that staff are on the same page
b. No. But maybe I dont know all the infoor need to. Mostly I hear It been
handled but I dont feel confident in this answer
c. I THINK we TRY our best to handle them well, but mistakes can happen and
theres always room for improvement!
d. Yes
e. Not always. We review camera footage and count meds, but this rarely offers any
explanation
f. Seems like they are not really addressed because we dont have the facts on what
happened
g. Yes
h. Yes
i. For the most part

22. Do you have any other suggestions to improve the medication process?
a. I dont know that this is the right option but it could be good for staff to discuss
what it would look like to only lock up narcotics and opioid medications. Maybe
GAs could still be made aware of what other prescriptions guests are takingnot
positive how we would enforce thisjust a couple of thoughts.
b. Training! And more training! I am baffled when people, for example, give more
meds than whats allowed per dayjust bc a guest says Another staff let me or
something. We should know the rules and feel confident in enforcing them. (no
matter what guests say).
c. *Having guests come one at a time for med time and having set times each day
would be very helpful. *Better documentation of meds/check in/check out/etc
would be good. *Better privacymaybe bring guests to office one at a time
d. More secure lock up
e. Maybe doing away with med system and trusting our guests, as adults, to navigate
their meds on their own and with their Dr. or offering med lock-up as a chosen
recovery path? Optional accountability
f. Allowing guests to keep their own insulin and needles (stored appropriately)
g. For guests with numerous medsrequire a mediset
h.
i. Just to have 2 people present at hand out time/this can be a volunteer as well
Optional: Other questions/comments/concerns:
LMM MEDICATION DISTRIBUTION 21

a. My hope would be that there would be a high-level of consistency among staff in our
procedures, including the dispensing of medications. That being said, I have heard from
multiple guests that there is not always consistency amongst staff, which can bring up
concerns of inaccuracy or a questioning of the rules from both staff and guests
b. In a perfect worldI would love it if Gas could have more influence and the freedom to
address issues of narcotic/prescribed meds abuse. I think its rampant here, and we seem
to turn a blind eye to it
c.
d.
e.
f.
g.
h.
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Appendix D

Updated Medication Sheet

Name: Check-In Date: .

Medication: mg/mL: Pills in bottle: Refilled amt.: .

Refills: By Date: Directions: .

Rx #: Prescribing Physician: Daily Max: ..

Month: .Year: .
Date Time Amount taken Amount Remaining Guest Initials Staff Initials
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

Medication Audit Date: Guest Verification (signature): Staff Initials: .

Correct Count: Yes No If count is off, who was notified: ______________________________

Medication Audit Date: Guest Verification (signature): Staff Initials: .

Correct Count: Yes No If count is off, who was notified: ______________________________
LMM MEDICATION DISTRIBUTION 23

Appendix E

8 Procedures Regarding Medications

8.1 Purpose:
To provide support and accountability to women and children staying at Agape through
the safe-keeping, monitoring and encouraging of healthy medication practices.

8.2 Categories of Medication

Over-the-Counter Medications.
Guests that have over-the-counter medications can maintain possession of these
medications while on the Mission campus. Staff does not check in over-the-
counter medications. Though, when administering a urinalysis staff should ask if
the guest is taking any over-the-counter medications to cross-check for a false
positive.
Prescription Medications.
Guests that have prescription medications need to check in their prescriptions
when entering Agape, unless given other permission by staff (ex: an inhaler).
Guests can have enough of a prescription on their person while on Mission
campus that they need for one 24 hour period. This check in is done at intake, at
each prescription refill or filling of a new prescription, or when coming back from
overnights. If a guest has prescriptions on them it is suggested that their first
stop back to Agape be the office with the prescriptions.

8.3 Check-in of Prescription Medications

When a guest turns in prescription medication to staff as per the Rights and Responsibilities (It
is your responsibility to turn in all prescription medications to staff upon admission and
throughout your stay at Agape upon entering the building. They will be made available daily for
check out at 6:30am-7:50am and 8:30am-9:00am, you may check out sufficient medication for
24 hours. Medications are returned upon check-out. Excerpt from the Rights and
Responsibilities. The following steps apply to checking in the prescription medication.
1. The first staff person with time to check-in medication needs to do so. If the staff
person that received the prescription medication from a guest is unable to check that
medication in at that time, the medication needs to be kept with the staff person or in a
locked office or cabinet at all times.
2. When staff do have time to check in a prescription they need to first assess if it is a new
prescription or a refill of one already in the medicine cabinet or office filing cabinet.
3. If the prescription medication is a new prescription or a change in dosage or a change in
pill type then the staff person needs to begin using a new medicine check-in sheet.
These blank sheets can usually be found with the medication binders at the front desk
(for medications that will be placed in the front desk filing cabinet) or the medication
LMM MEDICATION DISTRIBUTION 24

files inside the downstairs office (for medications that will be placed in the downstairs
office filing cabinet). Please see step #13 for refill prescriptions.
4. As much as possible, all check-in of prescription medication should happen at the front
desk in view of the camera.
5. The staff person needs to then legibly fill out this medication check-in form completely.
Please see the example med sheet following this procedure as well as the below list for
more information.
For name: please write the full name of the guest
Date of Check-In: write the date you are checking in the prescription
Medication: Name of medication (Check spelling)
Mg/ml (or other measurement): Write mg/ml as listed on the label
Number of Pills: please write the number of pills in the bottle after counting
them (please see steps #6-10).
Refill Date: Either none or number of refills and date (Ex: 5x by 10/20/2014)
Directions: please write the directions for taking the prescription (ex: once in
the morning and once at night or as needed for pain or two times per day)
6. After filling out as much as possible on the form, put on laytex gloves and pull out the
plastic pill sorter from the front desk drawer.
7. Open the pill bottle and pour the pills carefully onto the pill counter, being careful not to
spill the pills.
8. Using the plastic pill sorter (this looks like a clear plastic knife attached into the side of
the pill counter) then begin counting the pills into the side compartment of the plastic
pill sorter.
9. Once the pills are counted they can be poured carefully back in the pill bottle.
10. Record the number of pills in the bottle on the medication sheet.
11. Take particular note if the number of pills in the bottle do not match the number listed
on the outside of the bottle. Discuss this discrepancy with the guest and make note for
other staff if the difference has not already been explained upon handing in the
prescription medication.
12. Place the form in the medication binder at the front desk or in the medication binder in
the downstairs office in the respective alphabetized spot for that guest.
13. If the prescription is a refill of the same dosage then find the medication sheet already
written up for that prescription medication.
14. The next step is to count the number of pills in the bottle. Please refer to steps 6-11.
Except at step #9 record the number of pills in the bottle on the next row on the
medication sheet. Please write in the next row:
Date: Date prescription is counted in
Time: Write Refill
Amount: Amount of pills turned in/the refilled amount as on the bottles label
Ex: 120/125 [If the number turned in is significantly different than the number
listed on the pill bottles label, please address this discrepancy with the guest at
the earliest convenience.]
Guest: Leave blank
LMM MEDICATION DISTRIBUTION 25

Staff: Your initials

15. Place the prescription medication in the guests respective sleeve of medications that
aligns with the bed the guest is assigned. If the guests prescriptions will be in the
downstairs office then the guests prescription needs to go in the top drawer of the
filing cabinet or the office refrigerator if needed.

8.4 Making Medications available during Med Time

Med Time is the previously scheduled daily time that staff make medications available for
guests to check out sufficient medication for a 24 hour period.
1. Med Time should be posted on the white board in the lobby area as well as on the
daily schedule.
2. Guests can arrive at any time during Med Time. When a guest arrives staff, barring a
more urgent matter, meet the guest in the front lobby area. If a guest has medications
in the downstairs office the guest and staff person can arrange for when during med
time it is appropriate to check those out.
3. When meeting a guest in the front lobby area to make medication available the first
step is to hand that guest the medication binder that aligns with their last name and
open it to their first page of medication. There is no need for a guest to search for their
name and possibly look through other peoples medication sheets.
4. The guest then fills out a line for medication check out. **
5. Open the medicine cabinet behind the front lobby desk and take out the sleeves of
medications or loose prescriptions that pertain to the guest first in line and filling out
information in the medication binder.
6. Once a guest is done filling out the medication sheets, take the binder and give the
guest the bottles of pills in the sleeve or their loose bottles.
7. As the guest goes one by one through their bottles to check out what they need for a 24
hour period staff need to make sure the guest shows them the label on the bottle, and
how many pills they are taking out. To protect privacy, please do not ask the guest to
state the name of the prescription allowed.
8. As guests show the prescription label on the bottle compare with the medication sheet.
When looking at the bottle, number of pills taken out and the medication sheet, staff
need to be asking the following:
a. Does the number of pills this person is taking out of the bottle match the dosage
written down on the medication sheet?
b. Does the number of pills this person is taking out of the bottle match what they
said they will be taking for that 24 hour period?
9. If in comparing the pills taken out, medication sheet and prescription label, everything
seems to match, then sign the medication sheet, signifying that you witnessed the guest
removing that many pills from the bottle.
10. If in comparing the pills taken out, medication sheet and prescription label, something
does not line up, gently let the guest know what the discrepancy is you are seeing.
Allow them to explain or fix it. Depending on the discrepancy, and frequency of the
discrepancy, further consequences may be needed, though most often that can be
addressed outside of Med Time.
LMM MEDICATION DISTRIBUTION 26

11. It is the guests responsibility to place the pills in an appropriate container. As available
staff can offer ziplock bags to guests for this purpose.

Exceptions to the above medication check-out procedure:

1. If a guest is going on an overnight and needs to check-out more medication than would
be needed in a 24 hour period.
If a guest is going on an authorized overnight and needs to check-out more
medication than would be needed in a single 24 hour period because they will
not be back in time for the next Med Time, they can do so at the normal
morning Med Time.
Unless the guest is leaving for their overnight before Med Time this check-out
can happen during the last Med Time before they leave.
Instead of checking to ensure no more is checked out than needed for a 24 hour
period, staff would verify that no more is checked out than needed for the
number of days the individual will be gone for.
2. If a guest is moving out.
If a guest is moving out, staff can check out their prescriptions in the bottles to
them as close to their time of checking out of Agape as possible.
For the safety of others in the house, we want to minimize the amount of time
prescriptions are on-campus but not checked-in.
Medication sheets are shredded after six months of someone moving out.

Things to remember during Med Time

Though both Medication binders can be out with guests, being filled out; only one
persons prescriptions should be out of the medicine cabinet at a time.
Help protect guests privacy by advocating for a couple feet of space for the person
taking medication and filling out the medication binders.
Staff does not count out pills nor pour them into guests hands. Staff should not except
for extreme situations open pill bottles.

8.5 Medication Accountability

Why does Agape provide Medication Accountability?
So medications are not abused.
For the safety and overall well-being of our guests.
To promote emotional and physical health of guests.
For the safety of children and the greater community.
To encourage safe, legal use of medication.

In what ways does Agape provide Medication Accountability?

Locked check-in of prescriptions.
Monitored daily check-out of prescriptions.
Ask for explanation regarding discontinuation or discrepancy of usage.
LMM MEDICATION DISTRIBUTION 27

When necessary for the safety of a guestparticularly with the concern of suicide
staff may ask for the medications to be taken in front of a staff person.

In what ways does Agape not provide Medication Accountability?

Agape staff does not count out pills for daily check-out.
Agape staff does not prescribe medications or change a dosage.
Agape staff does not call doctors offices for guests regarding prescriptions. Exceptions
made when absolutely necessary.
With few exceptions, Agape staff does not require guests to take prescriptions in front
of a staff person.
Agape staff does not distribute any medication, including over-the-counter medication.

Types of prescription abuse or misuse:

Not taking prescriptions as prescribed.
Checking out more medication than needed for a 24 hour period.
Sharing or selling prescriptions.
Not taking prescriptions.
Not checking in prescription medications and storing them on-campus.

Please refer to the Progressive Discipline Guidelines with regards to consequences for
prescription abuse or misuse. A copy of the Progressive Discipline Guidelines can be found in
Procedure #7 regarding discipline and consequences.

Valid verification of prescription change/discontinuation:

If a prescription has changed or been discontinued staff ask guests for verification of this
change in prescription. This would entail a professionals note regarding the change,
faxed, sent in on letterhead or other legitimate paper source.
All verification needs to be asked for in a timely manner.
If a guest gets a refill of a prescription with new doctors instructions on the label, and
says that the doctor would like them to finish the old bottle with the new instructions,
no verification is needed. The guest may finish the old bottle with the new bottles
instructions.
If a prescription has no refills and the guest finishes the bottle of pills there is no
verification needed.

8.6 Medication Disposal

For unlabeled pill or capsule or tablet forms of medication:
1. Situations where staff would be disposing of medication:
A pill was found on the ground and is unidentified by a guest as being theirs.
Medications are left behind by a past guest for a significant amount of time
(approximately a month). Calls can be made if appropriate and helpful to check
in with the past guest regarding prescription pick-up or disposal.
LMM MEDICATION DISTRIBUTION 28

Guest has brought in a doctors note stating that they are discontinuing a
particular prescription.
2. If one of the two situations is identified, then the decision can be made to dispose of the
medication.
3. All medication disposals must be done with two staff persons present and inside the
office.
4. Put used coffee grounds and filter into a plastic ziplock bag.
5. Pour medication to be disposed of inside the bag onto the coffee grounds.
6. Mix pills into the coffee grounds.
7. If there is still space within the coffee grounds you can pour more pills in, though be
careful not to overload the grounds because the pills will not dissolve if the grounds are
oversaturated.
8. Continue mixing the pills with the bag closed by squishing the bag with your hands until
the pills have begun to dissolve.
9. Once you know the pills have begun to dissolve, throw the ziplock bag into the
downstairs office trash can.
10. Note in the daily log that pills were disposed of and by whom.
For labeled pill, liquid or non-pill forms of medication:
1. Situations where staff would be disposing of medication:
Medications are left behind by a past guest for a significant amount of time
(approximately a month). Calls can be made if appropriate and helpful to check
in with the past guest regarding prescription pick-up or disposal.
Guest has brought in a doctors note stating that they are discontinuing a
particular prescription.
2. Once a medication is identified as needing to be disposed of, then the medication is put
in the top drawer of the filing cabinet in the box designated for medication disposal.
3. Once a few medications have accumulated in the box to be disposed of, the Womens
Ministries Manager and one staff person takes a bag with the medications inside to
Hoaglands pharmacy for proper disposal. Always have two staff persons transporting
the medications.
For sharp disposal:
1. Guests that use syringes, needles or laplets to inject medication, dispose of the used
needles and syringes in a designated sharps container provided by staff at the Agape
Home unless the guest desires to provide a personal small sharps container to stay in
the office.
The container can be a 2 liter soda bottle or some other plastic, rigid container
that is unlikely to puncture.
The container must be labeled clearly on the outside as a SHARPS container.
The container should be kept in the downstairs office for ease of access and use.
2. Once the sharps container is three quarters of the way full, staff will seal the container
with the lid, and tape it shut, and then dispose of the container in the regular garbage
bin at Agape.