STATE OF CONNECTICUT Department of Children and Families

STATE OF CONNECTICUT

Department of Children and Families

Medication Administration Certification Training

Based on the Basic Medication Administration Curriculum2010 Edition

2Recertification Review Guide, Unit 1

3

RIGHTSRIGHTSof

MedicationAdministration

1.1. Right Right ChildChild

2.2. Right Right

MedicationMedication

3.3. Right Right DoseDose

4.4. Right Right RouteRoute

5.5. Right Right TimeTime

Recertification Review Guide, Unit 1 3

4

Three Documents Necessary for Three Documents Necessary for Safe Medication AdministrationSafe Medication Administration

Licensed Practitioner’s Order

Pharmacy Label

Medication Administration Record (MAR)


5

The Rule of Three is:The Rule of Three is:

Comparing the licensed practitioner’s order, MAR and the pharmacy label for the five rights three times every time you administer the medication

DocumentsDocumentsLicensed Practitioner’s OrderLicensed Practitioner’s OrderMARMARPharmacy LabelPharmacy Label

RightsRightsChildChildMedicationMedicationDoseDoseRouteRouteTimeTime

TimesTimeseveryevery timetimeyou administeryou administerthe medicationthe medication


6

Roles of LP, Pharmacist, Roles of LP, Pharmacist, Medication Certified Staff and Medication Certified Staff and

NurseNurse

Licensed PractitionerLicensed Practitioner:: may diagnose and prescribe treatment/medications. May dispense medication.

PharmacistPharmacist:: dispenses medications according to a licensed practitioner’s order.

Medication Certified StaffMedication Certified Staff:: may administer medications according to a licensed practitioner’s order to children in any DCF licensed or operated child-caring facility or extended day program.

Nurse (RN, LPN or APRN)Nurse (RN, LPN or APRN):: provides ongoing supervision of medication administration program/staff.


7

Responsibilities of the DCF Responsibilities of the DCF Medication Administration StaffMedication Administration Staff

AlwaysAlways follow DCF Med Admin Procedure

AlwaysAlways use the Five Rights and the Rule of Three before medication administration

Know the desired effects of a medication and report any side effects

Adhere to any precautions

Follow instructions from the LP

Contact the Chain of Command whenever you Contact the Chain of Command whenever you have a question or concernhave a question or concern


8

When you have a question about a LP’s order, a pharmacy

label or MAR

There is change in the condition of a

child

A child does not receivehis medications as

ordered

Any incident where medication is not properly

safeguarded

Any time you have a question or

concern

When toContact

theChain of

Command


9

Unit 1 QuizUnit 1 Quiz

1. What are the Five Rights of Medication Administration?

2. What are the three documents you must have to assure safe medication administration?

3. True or False: You only need to check the Five Rights and the Rule of Three the first time you give the medication.


10

Answers to Unit 1 QuizAnswers to Unit 1 Quiz

1. What are the Five Rights of Medication Administration?

The right child, right medication, right dose, right route and right time

2. What are the three documents you must have to assure safe medication administration?

Licensed practitioner’s order, pharmacy label, MAR

3. True or False: You only need to check the Five Rights and the Rule of Three the first time you give the medication.

False – You need to check the Five Rights and the Rule of Three every time you administer a child’s medication. Recertification Review Guide, Unit 1 10

13

Define the terms trade name Define the terms trade name and generic name for and generic name for

medicationsmedications

Trade name:Trade name: marketing namefor example: Tylenol

Generic Generic name:name:

chemical namefor example: acetaminophen


14

Define active ingredientsDefine active ingredientsand inactive ingredientsand inactive ingredients

Active Active ingredientingredient::

chemical that actually causes the medication’s desired effect

Inactive Inactive ingredientingredient::

dyes, water and other additives to form a tablet, add flavor or color


15

Define controlled medicationDefine controlled medication

Controlled medications

have the potential to be

abused or addictive


16

Define unlabeled (off-labeled)Define unlabeled (off-labeled)use of medicationuse of medication

Unlabeled/Off-labeled Unlabeled/Off-labeled use of a medicationuse of a medication is the use of a medication for a purpose that has not been approved of by the FDA


17

Describe the different routesDescribe the different routesof administrationof administration

Oral medication

Eye drops and ointments

Ear drops

Nasal sprays

Inhaled medication

Topical medication


18

List the steps of the DCF List the steps of the DCF Medication Administration Medication Administration

ProcedureProcedure

Approach the task in a calm manner allowing no distractions

Wash hands before and after medication administration

Assemble appropriate equipment


19


Procedure Procedure (Cont.)(Cont.)

Perform the rule of three:

1. Compare the LP’s order with the pharmacy label

2. Compare the pharmacy label with the MAR

3. Compare the MAR with the LP’s order to see if the five rights match


20

Pour the correct dose of medication

Identify the correct child

Administer the medication utilizing the proper techniques

Perform a mouth check

Document

Return the medication to the locked area and clean up


ProcedureProcedure (Cont.)(Cont.)


21


1. True or False: Unlabeled use means the medication is being used for a purpose that has not been approved by the FDA.

2. What is the description of controlled medication?

3. List the steps of the DCF Medication Administration Procedure.


22


1. True or False: Unlabeled use means the medication is being used for a purpose that has not been approved by the FDA.

True – Unlabeled/Off-labeled use of a medication is the use of a medication for a purpose that has not been approved by the FDA.

2. What is the description of controlled medication?

Controlled medications have the potential to be abused or addictive


23

Answers to Unit 2 Quiz Answers to Unit 2 Quiz (Cont.)(Cont.)

List the steps of the DCF Medication Administration Procedure.

1. Approach the task in a calm manner allowing no distractions

2. Wash hands before and after medication administration

3. Assemble appropriate equipment

4. Perform the Rule of Three

5. Pour the correct dose of medication

6. Identify the correct child

7. Administer the medication utilizing the proper techniques

8. Perform a mouth check

9. Document

10.

Return the medication to the locked area and clean up


26

Identify what you must know about a Identify what you must know about a medication before you administer itmedication before you administer it

Medication’s name

Medication’s use

Medication's action

Controlled or non-controlled

Usual dose

Precautions and considerations

Side effects

Recertification Review Guide, Unit 3

27

Describe the process that must occur Describe the process that must occur in thein the

body for a medication to have an effectbody for a medication to have an effect

Enter

Absorb

Distribute

Metabolize

Eliminate


28

List and describe the effects List and describe the effects a child may have to a medicationa child may have to a medication

Individual effect

Desired/Therapeutic effect

No effect

Side effect

Allergic effect


29

Define the term “side effects”Define the term “side effects”and give examplesand give examples

A response to a medication that is not the desired effect; may be mild to severe and includes:

nauseaheadachedifficulty sleepingfevermuscle twitching and tics


30

Identify the correct steps to take if Identify the correct steps to take if a child experiences a side effecta child experiences a side effect

1. Hold the medication

2. Contact Chain of Command

3. Document


31

Describe anaphylaxis and the Describe anaphylaxis and the appropriate steps to followappropriate steps to follow

Severe potentiallyfatal allergic reaction

CALL 911911(Follow your facility’s

Policies and Proceduresre: medical emergencies)


32

List factors that affect a child’s List factors that affect a child’s response to medicationresponse to medication

Age

Weight

Route of Administration

Drug and Food Interactions

Size

Gender

General Health Status

Genetics


33

Define drug to drug Define drug to drug interactioninteraction

The effects of one medication are changed by the presence of another medication.

May occur whenever there is more than one medication in the child’s system.


34

Describe drug to food Describe drug to food interactioninteraction

The presence of food in the stomach affects how medication is absorbed


35

Factors that affect a child’s Factors that affect a child’s compliance with taking medicationcompliance with taking medication

Taste

Smell

Color

Consistency of the medication

Parental approval


36

Define commonly usedDefine commonly usedmedical abbreviationsmedical abbreviations

Q Day

every day

BID twice a day

TID three times a day

HS at bedtime (Hour of Sleep)

Q#H every # hours

PRN as needed

AC before meals

PC after meals


37

Define commonly usedDefine commonly usedmedical abbreviations medical abbreviations (Cont.)(Cont.)

mg milligrams

ml milliliters

cc Cubic centimeters

Tab tablet

Cap capsule

tsp teaspoon

Tbsp tablespoon

NTE Not to Exceed


38


PO by mouth

OU both eyes

NKA No Known Allergies

NKDA No Known Drug Allergies

SR Sustained Release

CR Controlled Release

DR Delayed Release

XL Extra Long Release


39


MDI Metered Dose Inhaler

NPO Nothing by mouth

c with

s without

One tsp 5ml or 5 cc

One Tbsp

15ml or 15cc or 3 tsp


40


1. Translate: Depakote 250mg PO TID

2. Identify the correct steps to take if a child experiences a side effect

3. Describe the process that must occur in the body for a medication to have an effect


41


1. Translate: Depakote 250mg PO TID

Depakote 250 milligrams, by mouth, three times a day

2. Identify the correct steps to take if a child experiences a side effect

Hold the medicationContact Chain of CommandDocument

3. Describe the process that must occur in the body for a medication to have an effect

Enter, Absorb, Distribute, Metabolize, Eliminate


44

Identify the componentsIdentify the componentsof a licensed practitioner’s orderof a licensed practitioner’s order

Five Rights

Signature

Date (within the last 90 days)

Special instructions


45

LP’s order must be renewed …LP’s order must be renewed …

Every 90 days(per DCF regulations)


46

Documentation necessaryDocumentation necessaryfor OTC medicationfor OTC medication

CT statutes and regulations require a LP’s order for any medication to be administered to a child. That includes OTC medications.

Orders must include the Five Rights, be dated within the last 90 days and signed by a LP.


47

Define “Define “standing ordersstanding orders””

Standing orders are licensed practitioner’s orders that include PRN OTC medications used to help treat or manage routine, minor childhood illnesses or symptoms


48

General rules of documentationGeneral rules of documentation

Use permanent ink – no pencils or erasable pens

Write legibly

Only approved abbreviations

No white-out

Do not obliterate a documentation error – draw a single line through the mistake, write your initials and date above it

Use full, proper names and titles

Do not use one child’s full name in another child’s record

The time and date should be noted in all documentation


49

DocumentingDocumentingNon-controlled medicationsNon-controlled medications

Every child who is prescribed medication must have his own MAR for each medication he is prescribed


50

Documenting Controlled Documenting Controlled MedicationsMedications

When you administer a controlled medication you must document how much of that medication remains

All controlled medications must be counted and the count documented at the beginning of each shift or whenever responsibility for the controlled medication is transferred from one staff member to another


51

Documenting PRN medicationsDocumenting PRN medications

The time, dose, reason and outcome for the PRN medication must be documented in an objective manner


52


1. Identify the components of a licensed practitioner’s order

2. Define “standing orders”

3. When should controlled medications be counted?


53


1. Identify the components of a licensed practitioner’s order

Five Rights, Signature, Date (within the last 90 days), Special Instructions

2. Define “standing orders”

Standing orders are licensed practitioner’s orders that include PRN OTC medications used to help treat or manage routine, minor childhood illnesses or symptoms

3. When should controlled medications be counted?

All controlled medications must be counted and the count documented at the beginning of each shift or whenever responsibility for the controlled medication is transferred from one staff member to another.


56

Household vs. metric termsHousehold vs. metric terms

5ml = 1 tsp

5cc = 1 tsp

15ml = 1 Tbsp

15cc = 1 Tbsp

1ml = 1cc

“ml” and “cc” are used interchangeably


57

Identify how weight is measured Identify how weight is measured for medication administrationfor medication administration

Milligrams (mg) indicate the weight of the medication in a:

Pill

Capsule

Tablet

In a certain amount of liquid


58

Units for measuringUnits for measuringliquid medicationliquid medication

Liquid medication must be carefully measured using only standardized or calibrated measuring tools

Measured in metric (“ml” or “cc”) or household (tsp or Tbsp) units


59

Using decimalsUsing decimals

Write a “0” in front of the decimal point for doses less than 1:

Correct: 0.25 mg0.5 mg

Incorrect:

.25mg

.5mg

Do not write a “0” after last number:Correct: 0.25 mg

1 mgIncorrect

:0.250mg1.0mg

Write the decimal point clearly so that it is clearly visible


60

Verify that the dose on the LP’s order Verify that the dose on the LP’s order matches the pharmacy label and the matches the pharmacy label and the

MARMAR

Is this a liquid medication?Do I need to convert mm/cc to tsp/Tbsp?4

What dose does the MAR or pharmacy label say to give?3

What is the concentration?2What dose is prescribed? 1To verify To verify

thatthatdoses all doses all matchmatchyou will you will needneedto ask:to ask:


61

Practice math for medication administration(click on the link below)

Unit 5 Quiz

Answers to: Unit 5 Quiz


64

The physical changes in theThe physical changes in thelungs of people with asthmalungs of people with asthma

Bronchial constriction

Inflammation

Increased mucous


65

Common asthma triggers are:Common asthma triggers are:

Smoke Dust Pollen Fumes Strong odors Strong emotions Exercise Cold air


66

Common symptomsCommon symptomsof an asthma attack are:of an asthma attack are:

Shortness of breath

Cough

Wheezing

Chest tightness

Difficulty breathing

Chest and neck retractions


67

Two general types ofTwo general types ofasthma medications are:asthma medications are:

RescueRescue – inhaled bronchodilator – will quickly open constricted airways during an asthma attack

Maintenance or PreventionMaintenance or Prevention – inhaled steroids, cromolyn sodium, Leukotriene antagonists, oral steroids – taken daily to keep asthma under control and prevent attacks


68

Know how to administer an MDIKnow how to administer an MDI

Hold the inhaler upright and shake it

Exhale completely

Hold the inhaler 1 to 2 inches from the mouth

or Place the mouth piece of

the inhaler in the mouth forming a tight seal


69

Know how to administer an MDI Know how to administer an MDI (Cont.)(Cont.)

Depress the canister once while inhaling for 2–5 seconds

Hold breath for up to 10 seconds or as long as possible

Wait 1 minute and repeat the entire process if a second puff is ordered


70


1. What are the three physical changes that occur in the body during an asthma attack?

2. True or False: Inhaled bronchodilators (rescue medications) are typically used to treat an asthma attack.

3. True or False: Chest and neck retractions and cough are two symptoms of an asthma attack.


71


1. What are the three physical changes that occur in the body during an asthma attack?

Bronchial constrictionInflammationIncreased mucous

2. True or False: Inhaled bronchodilators (rescue medications) are typically used to treat an asthma attack.

True

3. True or False: Chest and neck retractions and cough are two symptoms of an asthma attack.

True


Medications for Medical ConditionsMedications for Medical Conditions


74

AntibioticsAntibiotics

May reduce theeffectiveness of birth controlmedications

5

Follow specific instructions about administration with food

4Do not give double doseto make up for a misseddose

3

Watch forallergies1

Finish entireprescription2TreatTreat

BacterialBacterialInfectionInfection

ss


75

Anti-viral medicationsAnti-viral medications

Treat viral infections

1. Reduces symptoms – will not cure viral infection

2. Must start at the earliest sign of viral infection


76

ScabicidesScabicides

Treat scabies infestation of the skin

1. Follow orders and directions exactly

2. May cause serious adverse effects if overused

3. Potentially toxic to the Central Nervous System

4. LP’s order required for administration

5. Contact the chain of command if child is re-infected


77

PediculocidesPediculocides

Treat lice infection

1. Follow orders and directions exactly

2. May cause serious adverse effects if overused

3. Potentially toxic to the Central Nervous System

4. LP’s order required for administration

5. Contact the chain of command if child is re-infected


78

Antifungal medicationAntifungal medication

Treat fungal infection

1. Treatment may take a long time

2. Keep infected area clean and dry

3. Good hygiene prevents spread of infection

4. Report any side effects to chain of command


79

AnalgesicsAnalgesics

Relieve pain

1. Frequent, unusual, or pain that interferes with child’s usual activity must be reported to the chain of command


80

AntipyreticsAntipyretics

Reduce fever

1. Monitor child’s temperature before and 1 hour after administering antipyretic

2. Fever is a change of condition that must be reported to the chain of command


81

ExpectorantsExpectorants

Promote coughing up mucous

1. Report any persistent cough to the child’s physician

2. Increased fluid intake will help to loosen secretions


82

AntitussivesAntitussives

Suppress cough

1. May mask signs of infection such as pneumonia or bronchitis

2. May be ordered at night to quiet a cough that interrupts sleep

3. Narcotic antitussives should be used cautiously with clients who have a history of drug or alcohol abuse


83

DecongestantsDecongestants

Reduce congestion in the sinuses and nasal passages

1. May cause excitability and insomnia

2. Avoid administering at bedtime


84

AntihistamineAntihistamine

Reduce symptoms of allergic reactions

1. May cause drowsiness – use with caution

2. May cause decreased ability to urinate


85

Cardiovascular medicationsCardiovascular medications

Affect the heart and circulatory system

1. BP and pulse must be checked routinely

2. Do not stop abruptly

3. Doses should not be missed

4. Unlabeled use: Anxiety and ADHD


86

AnticonvulsantsAnticonvulsants

Reduce or prevent seizures

1. Give consistently on time

2. May require periodic blood work

3. Unlabeled use: mood disorders


87

LaxativesLaxatives

Promote bowel movements; treat constipation

1. Increased fluids, fiber, and activity may reduce the need for laxative medication


88

AntacidsAntacids

Control or reduce acid in stomach

1. Check with pharmacist or licensed practitioner before administering at the same time as another medication: may interfere with absorption of other meds

2. Frequent complaints of heartburn or stomach upset should be evaluated by a physician


89

Birth control / contraceptivesBirth control / contraceptives

Prevent pregnancy

1. Must be administered as ordered for maximum effectiveness

2. Follow LP’s order re: missed doses

3. May be prescribed to regulate menstrual cycle


90

Unit 7 Quiz Unit 7 Quiz (click on the link below and print)(click on the link below and print)

Medications to treat medical conditions

Answers to: Medications to treat medical conditions


Medications for Psychiatric ConditionsMedications for Psychiatric Conditions


93

AntipsychoticAntipsychotic

Treat psychotic conditions/symptoms

1. For suspected side effects: hold the medication, hold the medication, contact the chain of command, and documentcontact the chain of command, and document

2. Difficulty swallowing, drooling, facial tics, twitches, and change in gate may be the first sign of a serious side effect

3. Fever is also a possible side effect

4. Call 911 if appropriate

5.5. Certified staff must directly consult with a LP Certified staff must directly consult with a LP before administering any psychotropic PRNbefore administering any psychotropic PRN


94

AnticholinergicAnticholinergic

Treat muscle movement disorders associated with antipsychotic meds

1. Adequate fluid intake is essential, especially in hot weather

2. Contact the chain of command if symptoms don’t improve/get worse


95

AntidepressantAntidepressant

Treat depression

1. Watch for signs of worsening depression or thoughts of suicide


96

Mood stabilizer Mood stabilizer – – LithiumLithium

Treats mood disorders

1. Encourage adequate fluid intake

2. Routine blood test may be ordered

3. Ibuprofen should not be administered to patients treated with Lithium


97

Mood stabilizer Mood stabilizer – – AnticonvulsantAnticonvulsant

“Off-labeled” use to treat mood disorders

1. Must be given on time as ordered

2. Take as prescribed

3. Routine blood test may be ordered


98

Anti-anxietyAnti-anxiety

Treats anxiety, tension and nervousness

1. May be controlled medication

2.2. Med certified staff must Med certified staff must directly consult with a LP directly consult with a LP before administering a PRN before administering a PRN anti-anxietyanti-anxiety

3. Overdose can be fatal


99

StimulantsStimulants – ADHD medications– ADHD medications

Treat attention deficit hyperactivity disorder

1. Usually not administered late in the day

2. Monitor weight and food intake

3. May be controlled medication

4. May delay growth


100

HypnoticsHypnotics – sleep medication– sleep medication

Promotes sleep

1. Offer non-medication interventions first

2. Report insomnia or poor sleeping to the LP


101

Serious side effectsSerious side effects(adverse reactions)(adverse reactions)

Some serious side effects are potentially life-threatening or may become permanent.

If you notice or the child complains of any of these side effects, hold the medication, contact your chain of command and document.


102

Serious side effects (adverse reactions) Serious side effects (adverse reactions) (Cont.)(Cont.)

If you notice or the child complains of any of these side effects:

hold the medication

contact your chain of command &

document

Fever or complaint of sore throat

Drooling or difficulty swallowing

Changes in gait (walking)

Confusion or increased sedation

Muscle stiffness, esp. in the neck or mouth area

Eyes rolling back involuntarily

Complaint of stomach pain


103

Other side effectsOther side effects(Must report to chain of command)(Must report to chain of command)

Sensitivity to Sensitivity to sunsun

Apply sunscreen

Sensitivity to Sensitivity to heatheat

Encourage increased fluid intake

ConstipationConstipation Encourage fluids, fiber, exercise

Appetite Appetite changeschanges

Monitor food intake, encourage healthy food choices

Weight gainWeight gain Follow nutritional recommendations

Sleep Sleep disturbancesdisturbances

Allow for relaxing bedtime routine

Dry mouthDry mouth Encourage fluids to relieve dry mouth


104

Unit 8 Quiz Unit 8 Quiz (click on the link below and print)(click on the link below and print)

Medications to treat psychiatric conditions

Answers to: Medications to treat psychiatric conditions


Medication Administration TechniquesMedication Administration Techniques


107

General InformationGeneral Information

Follow the steps of the Medication Administration Procedure every time you administer any medication to any child. You must perform the Five Rights and the Rule of Three making sure that the five rights match on all three documents

Thoroughly wash your hands before and after you administer medication

Use Standard Precautions whenever necessary


108

Standard PrecautionsStandard Precautions(aka: Universal Precautions)(aka: Universal Precautions)

A set of practices that prevent the spread of infection including the use of personal protective equipment such as gloves, gowns, masks and goggles

Frequent hand washing is the best way to prevent the spread of infection


109

Forms of oral medicationForms of oral medication

Liquid medications

Tablets

Capsules

Gel caps

Chewable tablets

Quick dissolving tablets


110

Forms of oral medicationForms of oral medication (Cont.)(Cont.)

EntericEntericcoated tabletscoated tablets

have a special coating so that the tablet will not be absorbed until it reaches the small intestine

SustainedSustainedRelease tabletsRelease tablets

designed to be absorbed over a long period of time so that the child may not need to take the medication several times daily

XR, XL, CR, or XR, XL, CR, or SRSR

after the medication name indicate a sustained release medication


111

Scored tabletsScored tablets

Scored tablets – a scored tablet has a groove(s) dividing the pill in equal parts (half, third, etc.)

A groove across the center of the tablet indicates that the tablet may be cut exactly in half


112

General guidelines forGeneral guidelines foradministering oral medicationadministering oral medication

Ask the child to remove gum, candy or food from his mouth before you administer medication to him

Always give oral medication with fluids; water is usually the best choice

A mouth check should be done to make sure that the child swallowed the medications

If you must directly touch a tablet, wear gloves


113

Forms of oral medicationsForms of oral medicationsthat should not be crushedthat should not be crushed

Enteric coated tablets

Sustained release tablet

Gel caps

Other liquid filled capsules


114

How to crush a tabletHow to crush a tablet

Use a clean, dry mortar and pestle, a pill crusher or place the tablet between the bowls of two spoons

Wrap the tablet in waxed paper or in a paper med cup to prevent the crushed medication from spilling

Mix the crushed medication with a small amount of food (applesauce, yogurt, pudding, etc.) Use no more than a tablespoon or two to mix with the medication

Offer glass of water after administering the medication


115

LiquidsLiquids

Liquid medications are often prescribed for young children or for children who cannot swallow pills

Any dose of medication that is less than 5cc/ml must be measured in an oral syringe or calibrated dropper


116

Measuring liquid medicationsMeasuring liquid medications

The medication cup must be placed on a flat surface at eye level

While pouring medication from the bottle hold the label facing upward to avoid spilling the medication onto the label


117

Technique forTechnique foradministering oral medicationsadministering oral medications

1. Follow the medication administration procedure

2. Pour the accurate dose: place the prescribed number of pills or pour the correct amount of liquid into a medication cup

3. Administer the medication to the client with water or juice

4. After administering the medication, perform a mouth check to ensure that the child swallowed the medication


118

Eye medicationsEye medications

1. Wash hands and wear gloves when administering eye medication

2. Ask the child the following questions: Does the eye feel worse? Does the eye hurt?

3. If the child answers yes to either of these questions: Hold the medication Contact the chain of command Document and follow instructions


119

Eye medications Eye medications (Cont.)(Cont.)

4. After administering an eye medication, have the child remain in a safe environment until medication is completely absorbed and the client’s vision is cleared

5. Never bandage an eye unless there is a specific order to do so


120

How to clean an infected eyeHow to clean an infected eye

Wash hands and wear gloves

Moisten a washcloth, gauze, or cotton ball with warm water

Wipe the infected eye gently from the inner to outer corner

To prevent spreading the infection, never use the same area of the washcloth for more than one wipe AND use separate washcloth for each eye

Remove your gloves and wash hands when the eye is clean

Put on clean gloves before handling the medication


121

Technique forTechnique foradministering eye ointmentadministering eye ointment

1. Follow the DCF Med Admin procedure

2. Prepare medication correctly: place the cover of the medication on its side to avoid contamination. Warm the medication to room temperature.

3. Clean the child’s eye if necessary

4. Wear gloves. Squeeze a small amount of medication out of the tube onto a tissue before administering

5. Have the child tilt his head slightly backward, resting it against a hard surface if possible. Ask the child to look up and away


122

Technique forTechnique foradministering eye ointment administering eye ointment (Cont.)(Cont.)

6. Do not touch the eye with the medication container

7. Gently pull down the lower eyelid using the side of a finger. Beginning at the inner corner of the eye, place a thin ribbon of medication into the lower lid

8. Instruct the child to close his eyes for 1-2 minutes so the medication may be absorbed

9. Gently wipe away any excess medication that may have dripped out of the eye.


123

Technique forTechnique foradministering eye dropsadministering eye drops


2. Have tissues available; place the cover of the medication on its side to avoid contamination. Warm the medication to room temperature.

3. Clean the child’s eye if necessary


124

Technique forTechnique foradministering eye dropsadministering eye drops

4. Wear gloves. Have the child tilt his head slightly backward, resting against a hard surface if possible. Ask the child to look up and away.

5. Do not touch the medication dropper to the eye or eyelashes

6. Gently pull down the lower eyelid using the side of your finger. Form a small pocket and place the prescribed number of drops into pocket.


125

Technique forTechnique foradministering ear dropsadministering ear drops


2. Wash hands and wear gloves

3. Remove the cover and place on its side to avoid contamination; warm the medication to room temperature

4. Position the child with the ear to be treated upward


126

Technique forTechnique foradministering ear drops administering ear drops (Cont.)(Cont.)

5. Straighten the ear canal by the following methods:

3 years old or younger:3 years old or younger: gently pull ear lobe down and back

Over 3 years old:Over 3 years old: gently pull upper part of the ear up and back

6. Place the prescribed number of drops against the side of the ear near the ear canal opening to allow the medication to roll in

7. Have the child remain with affected ear upward for 3-5 minutes


127

Technique forTechnique foradministering nasal sprayadministering nasal spray


2. Have the child gently blow his nose. Have tissues available.

3. Wear gloves. While plugging one nostril, place the tip of the sprayer 1cm (3/8 inch) into the other nostril

4. Ask the child to breathe in through his nose as the spray is administered

5. Have the child exhale through his mouth after the spray is administered, repeat the procedure if prescribed

6. Discourage him from blowing his nose for 5 minutes


128

Types of inhaler devicesTypes of inhaler devices

Metered Dose Metered Dose Inhaler (MDI)Inhaler (MDI)

use chemical propellants to push out the medication from the inhaler. A spacer or aero-chamber may be prescribed to use with the MDI to make proper use easier and the medication more effective.

Dry powder or Dry powder or Rotary Rotary Inhalers Inhalers (Turbuhaler, (Turbuhaler, Discus)Discus)

dry powder inhalers are activated through breathing; they release the medication through rapid inhalation instead of using propellants

NebulizersNebulizers

convert liquid medication into a fine mist and deliver the mist through a face mask or mouth piece that is connected to the nebulizer machine with plastic tubing. Your program nurse should teach you the correct way to use a particular child’s nebulizer before you use it.


129

AdministeringAdministeringtopical medicationtopical medication

1. Allow for client privacy

2. Clean the skin if necessary per LP’s directions

3. Wear disposable gloves

4. The skin should be dry prior to applying topical medication

5. Apply enough medication to cover the area to be treated, unless otherwise directed


130

AdministeringAdministeringtopical medicationtopical medication

6. Except for powders, never apply a topical medication directly from the container onto the skin. Place a small amount of medication onto clean gauze then apply to the skin. This prevents contamination of the medication container.

7. Observe the client for any rashes that are new or that get worse


131

The correct method for applying and The correct method for applying and removing transdermal medication removing transdermal medication

patchespatches

Gloves should be worn to apply or remove transdermal patches

The patch should be applied to clean, intact, dry skin that is not infected, scarred, callused or tattooed

Wash the skin with soap and water both where the new patch will be placed and where the old patch was removed

Remove the old patch before applying the new one. Check the skin under the patch for redness or rash


132

The correct method for applying and The correct method for applying and removing transdermal medication patchesremoving transdermal medication patches

(Cont.)(Cont.)

Change application sites to avoid skin irritation

Peel backing off the patch, press onto the skin and apply pressure to assure that it sticks to the skin

Document in the child’s record the site where you applied the patch (for example: 6/18/2010, upper right arm)

Read package instructions for any further information


133

The role of DCF Med Admin certified The role of DCF Med Admin certified staff in administering rectal and staff in administering rectal and

vaginal medicationvaginal medication

Do not directly administerDo not directly administer to any child

DCF Med Admin certified personnel are not trained nor certified to administer any rectal or vaginal medications

The children who have these types of medication ordered must be able to self administer the medication or have a nurse available to administer the medication


134

The role of DCF Med Admin certified staff in The role of DCF Med Admin certified staff in administering rectal and vaginal administering rectal and vaginal

medicationmedication (Cont.)(Cont.)

Medication certified staff may provide the child with instructions on self administration. This information may be found on the package information.

Review of instructions may be done by a staff member of the same sex as the child and in the presence of another staff member as witness. This review should be documented.


135


1.

True or False: After administering oral medication you must always perform a mouth check.

2.

True or False: Hand washing is the most effective way of preventing the spread of infection.

3.

True or False: To administer ear drops to a 2year old child you straighten the ear canal by gently pulling the ear lobe down and back.


136


1. True or False: After administering oral medication you must always perform a mouth check.

True

2. True or False: Hand washing is the most effective way of preventing the spread of infection.

True

3. True or False: To administer ear drops to a 2year old child you straighten the ear canal by gently pulling the ear lobe down and back.

True


139

RegulationsRegulations re: safeguarding the re: safeguarding the medications and the medication storage medications and the medication storage

keyskeys

The medication storage keys must be carried by the medication certified staff person or licensed medical person on duty


140

Storage requirement forStorage requirement fornon-controlled medicationsnon-controlled medications

Non-controlled medications must be stored in a locked, immobile container that is accessible only to med certified or licensed medical staff


141

Storage requirement forStorage requirement forcontrolled medicationscontrolled medications

Controlled medications must be stored in a locked, immobile container that is inside another locked, immobile container accessible only to medication certified staff or licensed medical staff


142

Controlled medication countControlled medication count

Must be performed at the change of shift or whenever the responsibility for the medications changes


143

IncorrectIncorrectControlled medication countControlled medication count


Forward the incident report to theDept. of Consumer Protection Drug Control Division and to DCF

3

Complete an incident report2Contact your chain of command 1If the If the

controlled controlled medication medication count is count is wrongwrong(there is a (there is a discrepancy)discrepancy)

144

Refrigerated medicationsRefrigerated medications

The medication refrigerator must be kept at 36° - 46°F. Medications stored in the refrigerator must be accessible only to med certified or licensed medical staff


145

Storage of external, internal Storage of external, internal and emergency medicationsand emergency medications

Internal medications and external (topical) medications must be stored separately from each other

EmergencyEmergency medications (Epi-pens and rescue asthma inhalers) must be stored where all trained staff may have easy access to them. They should not be locked with other medications.


146

Guidelines for destroying non-Guidelines for destroying non-controlled and controlled controlled and controlled

medicationsmedications

2 DCF med certified staff may destroy non-controlled medications

Contact Drug Control Division of Consumer Protection if controlled medications need to be destroyed

Follow your facility’s policy and procedure for destroying medications


147


1.

Who may legally dispense medication?

a) licensed practitioners, RN’s, med admin certified staff

b) pharmacists, licensed practitioners, RN’s

c) pharmacists, licensed practitioners

d) pharmacists, med admin certified staff

2.

True or False: The controlled medication count must be performed at the change of shift or whenever the responsibility for the medications changes

3.

True or False: 2 DCF med certified staff may destroy non-controlled medications


148


1. Who may legally dispense medication?

c) pharmacists, licensed practitioners

2. True or False: The controlled medication count must be performed at the change of shift or whenever the responsibility for the medications changes

True

3. True or False: 2 DCF med certified staff may destroy non-controlled medications

True


151

Types of medication errorsTypes of medication errors

Error in communication

Error in documentation

Error in storage and control

Error in ordering or dispensing medications

Error in administration


152

1. Check on the child and follow your facility’s policy and procedures

2. Inform your supervisor and chain of command and follow any directions

3. Document the error; use objective description


Steps to take if an error occursSteps to take if an error occurs


Documenting Documenting a medication errora medication error

Note the child’s name, medication, the date and time, staff involved

Write an objective description of the error: what happened, action taken, and status of the child

Documentation must be completed before the end of the shift by the person who made or discover the error

Follow facility policy and procedure on submitting required documentation to DCF Risk Management


Reporting medication error that Reporting medication error that leadsleads

to the child needing medical to the child needing medical attentionattention

1. Notify child’s guardian, social worker

2. Call DCF Careline if after hours

3. Send copy of incident report to the DCF Medical Director within one business day

In additionto the

documentationalready

discussed

155

When to contact the Dept. of When to contact the Dept. of Consumer Protection Drug Control Consumer Protection Drug Control

DivisionDivision

When controlled medications appear to be missing

If controlled medications need to be destroyed


156



1.

True or False: Documenting a medication error must be completed before the end of the shift by the person who made or discover the error

2.

Who must be contacted when controlled medication appears to be missing or needs to be destroyed?

157


1. True or False: Documenting a medication error must be completed before the end of the shift by the person who made or discover the error

True

2. Who must be contacted when controlled medication appears to be missing or needs to be destroyed?

The Department of Consumer Protection, Drug Control Division


160

A LP’s orderA LP’s ordershould be questioned when:should be questioned when:

You do not understand the order

Unusual quantities or doses are prescribed

The medication is ordered to be given at unusual times


161

Medication should Medication should not be administered when:not be administered when:

You have a question about the order

A child has a sudden change in physical or mental state

The pharmacy label is illegible

The child refuses to take medication

Any of the five rights is violated

If there is no LP’s order or you cannot perform the Rule of Three

If storage practices are questionable

Medication looks unfamiliar to you or the child


162

Steps to take whenSteps to take whenquestioning an order or a questioning an order or a

medicationmedication

Do not administer the medication (hold the medication)

Contact the chain of command and follow directions

Document contacts and directions

Follow up on directions


163

Why borrowing medicationWhy borrowing medicationis is not permittednot permitted

Med admin certification permits you to administer medications only when the Five Rights match on the order, pharmacy label and MAR.

If you are borrowing on child’s medication for another child, the Five Rights will not match on all three documents.


164

Criteria for administering Criteria for administering medicationmedication

at the right timeat the right time

Medications may be administered one hour before until one hour after the scheduled administration time unless the LP has ordered the medication to be given at a specific time.


165

DispensingDispensing

The act of placing a medication into a container, labeling the container and giving the container for someone else to administer

Medication certified staff may not dispense

Only LP’s and pharmacists may dispense medications


166


1.

When would you not administer a medication?

a) if there is no change in status of the client

b) if the client refuses

c) if the medication is stored in a locked and immobile container

d) if the licensed practitioner's order is present


167


1. When would you not administer a medication?

b) if the client refuses


STATE OF CONNECTICUT Department of Children and Families

Documents

Transcript of STATE OF CONNECTICUT Department of Children and Families