Microsoft Word Responsibilities in Action Massachusetts Curriculum FINAL 7 28 17.docx

Transcript

1 Responsibilities in Action Understanding the Connections The Massachusetts Medication Administration Program Certification Training

2 To the Reader - The state or fact of being accountable or answerable for Re·spon·si·bil·i·ty something. ‘Responsibilities in Action’ is of responsibilities must be based on the concept that a set the outcome of ‘Safe Medicati on Administration’. carried out accurately to produce r picture as a ‘Responsibility’. Each gear is dependent Consider each ‘gear’ on the cove ildren and Families unction; if one gear fails, the after it for the system to f on the gear before it and the gear entire system fails. When all gear s are functioning together, the result is a system that runs smoothly. Think of yourself as one of the gears; you will play an important role in the outcome of the medication sy stem in your work location! Learning about each responsibil ity in class and then applying w hat you have learned at your work location helps to promo people you support as well te the quality of life for the as a safe work environment for you. Services, Mental Health and Ch f: The following are your responsibili ties as a MAP Certified staf Observe and Report  Assist with visits to the HCP  Obtain medication from the pharmacy   Transcription Medication security  Medication administration  of Public Health, Developmental Documentation  ility. It will continue to be h the details of each responsib This curriculum provides you wit ole as a MAP Certified staff. Refer back to this a resource for you in your new r curriculum often and practice w hat you are taught every day! chusetts Departments 2017 The Massa 2 Massachusetts | Responsibilities in Action

3 ‘Responsibilities in Action’ Content Writers: Gina Hunt, RN and Carolyn Whittemore, RN Content Developers: res, RN; and Sharon Oxx, RN Susan Canuel, RN; Mary Desp ildren and Families Case Studies: Brock) Mary Dewar, RN (Scott Green) and Carminda Jimenez, RN (Jonathan Editors: Marie Brunelle, RN; Bob Boyer, RN; Mary Dewar, RN; Lisa Kaliton, RN; Jo-Anne Shea, RN and Joanna Thomas, RN Contributors: Claude Augustin, RN Services, Mental Health and Ch Evelyn Brezniak, RN David Bruno, RN Pat Coupal, RN Lori Gross, RN Jackie Heard, RN Tanya Jenkins, RN Denise McGrath, RN Denice Vignali, RN Theresa Wolk, RN of Public Health, Developmental Michele L. Deck, RN-use of a blank 12 box ‘grid’ as a teaching strategy chusetts Departments 2017 The Massa Health Reviewed and Approved by the Massachusetts Department of Public All images are for training purpos of the designers. es only. The rights are those 3 Massachusetts | Responsibilities in Action

4 Contents Introduction ... 8  MAP Certification ... 8  MAP Recertification ... 9 Where MAP Certification is Not Valid ... 10   MAP Policy Manual ... 10 ildren and Families  Symbols and their Meanings... 11  Case Studies ... 12 Unit 1 Working at a MAP Reg istered Program ...14  Health Care Provider ... 14  MAP Consultants ... 14  Emergency Contacts ... 15  Learning about the Peopl e You Support ... 16 Services, Mental Health and Ch Principles of Medication Administration ... 17  o Mindfulness ... 17 o Supporting Abilities ... 17 o Communication ...17 velopmental ... 19 Respecting Rights ...  ealth, De Unit 2 Observing and Reporting... ... 22  Observation... 22 bjective Observation... 22 o O nts of Public H o Subjective Observation... 23  Reporting ... 23 o Everyday Reporting ... 24 epartme o Immediate Reporting... 25  Documentation ... 28 chusetts D o How to Document ... 28 o 29 How to Correct a Documentation Error ... Unit 3 Medications ... 31 What are they? ... 31  Brand and Generic ... 31  2017 The Massa Medication Categories ... 33  Controlled ... 33 o o Countable Controlled ... 34 o Over-the-Counter (OTC) ... 36 4 Massachusetts | Responsibilities in Action

5  Dietary Supplements ... 37  Nutritional Supplements ... 37  Medication Outcomes ... 40 Desired Effect ... 40 o No Effect Noted ... 40 o Side Effects ...40 o  Medication Interactions ... 41 ildren and Families  Alcohol, Nicotine and Caffeine ... 42 43 Sensitivity to Medication ...   Medication Information ... ...43 Unit 4 Interacting with a Health Care Provider ...46  Before the Appointment ... 46 o Preparing the Person... 46 Services, Mental Health and Ch Before Leaving the Program... o 46  When You Get to the A ppointment ... 48 o During the Appointment... 48 o Advocate-Encourage Partici pation-Support Abilities... 48 o Obtain Signed/Dated HCP Order... 48  Valid Orders... 49 DMH/DCF Psychotropic Medication Orders ... 49  49 o Obtain Prescription ... o Sample Medication... 49 of Public Health, Developmental  After the Appointment ... 50  People Who Manage Appoin tments Independently... 53 Medication Reconciliation ... 53  Fax Health Care Provider Orders... 55   Telephone Health Care Prov ider Orders ... 55 chusetts Departments  Exhausting a Current Supp ly of Medication... 58 Unit 5 Obtaining, Storing and Securing Medication ... 61  Obtaining Medication... 61  Rogers Decision... 64 2017 The Massa  Pharmacy Label Requirements... 65  Ensure the Pharmacy Provi ded the Correct Medication ... . 68 Tracking Medication ...69   Medication Storage and Security ...70 5 Massachusetts | Responsibilities in Action

6 Unit 6 Recording Information... 73  Abbreviations ... 75  The Medication Book... 75  Medication Sheet... 76 Transcribing a New HCP Order... 88   Discontinuing a Medication... 89  Posting and Verifying...96 ildren and Families Medication Information Sheet ... 102  Unit 7 Administering Medications ...103  Regularly Scheduled Medications...103  PRN Medications...104 5 Rights... 108  o Right Person... 108 Services, Mental Health and Ch  Emergency Fact Sheet... 109 o Right Medication... 110  Brand and Generic... 110 o Right Dose...112  Dose = Strength X Amount ...113 o Right Time...115 o Right Route... 115  Routes Other than Oral... 116 of Public Health, Developmental 3 Checks ... 118  Special Instructions... 124  Medication Administration Process ... 126  Prepare ... 126 o  Handwashing...126 o Administer...127 chusetts Departments Complete... 128 o Medication Administration Process Checklist... 129  Medication Administration Process Visual... 130  Glove Use... 131  edications If... 132  Do Not Administer M  Liquid Medication ... 133 2017 The Massa Measuring Devices ... 138 o  Medication Refusals ...144 Parameters ... 148  Medication Ordered to be Held 150  Before a Medical Test... 6 Massachusetts | Responsibilities in Action

7  Medication is Not Available to Administer...151 ... 155 Unit 8 Chain of Custody What ‘Chain of Custody’ Means ...155   Tracking Documents ... 156 Medication Ordering and o Receiving Log ...157 o Pharmacy Receipts ... 158 ildren and Families Countable Controlled Subst o ance Book ...159  Index ...160  Count Sheets... 162 Count Signature Sheets... 165  ‘Shoulder to Shoulder’ Count Procedure... 166  are Required ... 171 When and Why Two Signatures  o Medication Sheets ... 173 Acceptable Codes... 173  o Medication Release Documents ... 175 Services, Mental Health and Ch  Medication Transfer Form... 176  Day Program Medication... 177 179  Leave of Absence... Disposal ...184 o Medication Supply Discrepancy...190  Unit 9 Medication Occurrences ... 196 Definition of a Medication Occurrence ...196  of Public Health, Developmental Definition of a Hotline M edication Occurrence...196   Procedure Following a Medication Occurrence ... 197 How to Help Prevent Medica  202 tion Occurrences ... Words You Should Know ... 209 chusetts Departments Answer Key ... 217 Questions to Ask Your Supervisor ... 238 2017 The Massa 7 Massachusetts | Responsibilities in Action

8 Introduction (DPH) serves as the lead agency for the Medication The Department of Public Health ch is carried out jointly with the Department of Administration Program (MAP) whi Developmental Services (DDS), the Department of Mental Health ( DMH) and the Department of Children and Families (DCF). The overall goal of MAP is to ensure that there are appropriate policies and procedures their medication while tion. This helps people receive for safe medication administra ildren and Families ties. The program makes it ing on their day to day activi living in the community and carry possible for direct support staff and concerns of each , who knows the specific needs y routine. as a part of the person’s dail person, to administer medication upport staff who has a current MAP Certificate to The Departments allow direct s administer medication in: rograms and short term respite and DDS adult residential, day p  and day programs ntial programs DMH/DCF adult and youth reside  Services, Mental Health and Ch is transferrable These programs are registered with DPH. The MAP Certification between DPH MAP regist ered programs only. The MAP Certificatio n training program:  Is a minimum of 16 hours in length Is taught by approved MAP Trainers   Includes 3 pretest components 1. Computer Based Test (CBT) or written format (MAP Trainer dis cretion) of Public Health, Developmental Accessed at www.hdmaster.com o  Click on ‘Massachusetts M AP Testing and Registry’  Click on ‘Online Comp uter Based Pretest’ ty number (with no dashes) Enter your social securi  Select an answer to each of the 30 questions in 35 minutes or less   Click on ‘Stop Exam’ to see your score report showing  Percentage (%) of questi ons you answered correctly chusetts Departments  Topic of any question missed Provide the score report to your MAP Trainer o o A score report of 80% or higher is ‘passing’ 2. Medication Administration Demonstration of process   Applying the 5 Rights as you complete the 3 Checks in 10 minutes or less 2017 The Massa Feedback by MAP Trainer or Peer (MAP Trainer discretion)  3. Transcription transcribe a new medication  Discontinue a medication and 100% accuracy in 15 minutes or less  8 Massachusetts | Responsibilities in Action

9 After you meet the CBT pretest ouraged to continue requirement you are strongly enc retaking the pretest as many time s as possible prior to your D& S Diversified mes you take it or the Technologies CBT test date. N o one but you can see how many ti score you receive each time. There are over 200 questions for you to answer. Retaking the CBT many times al ong with reading the curriculum and reviewing all you l set you up for test success. will learn in your training wil In preparation for the skills portions of the test, continue practicing transcriptions, paying ractice the medication admini stration process using the close attention to the details. P ildren and Families medication administration demonstration video as a guide; avail able at www.hdmaster.com Upon successful completion of t he training program, you are eligible to schedule to test for a limited period of time. MAP Certification is: esults are posted on the D&S Effective on the date that test r  Diversified Services, Mental Health and Ch Technologies website a t www.hdmaster.com passed the test. t day of the month in which you Valid for 2 years until the las  ation date is July For example, if you passed the test on July 6, 2017, your expir 31, 2019. required to maintain acceptable proof All DDS/DMH/DCF MAP registered programs are of staff MAP Certification. A p MAP Certification is rint out of your Massachusetts available at: www.hdmaster.com of Public Health, Developmental MAP Online Registry Click Public Verification You are responsible for ensuring that your MAP Certification re mains current. medication. You have If your MAP Certification expire s, you may no longer administer , you must complete the full one year to recertify. If you do not recertify within one year chusetts Departments MAP Certification training pr skills tests. ogram again and retake the CBT and Recertification must be completed every 2 years. To become recertified you must pass the recertification skills test. If you do not pass the recertification test you may no longer administer medication. If you fail any combination of the recertification skills test (transcription or medication 2017 The Massa ete the full MAP administration demonstration) components 3 times you must compl Certification training program again and retake the CBT and ski lls tests. 9 Massachusetts | Responsibilities in Action

10 for administration of medication to people who are: MAP Certification Is Not Valid in DDS programs  Under the age of 18  Residing in nursing homes centers and programs  In crisis intervention, stabilization or hospital diversion  In hospitals  In Intensive Residential Treatment Programs (IRTP)  departments such as the Departme nt of Youth In programs licensed by other ildren and Families Services In DDS, DMH and DCF programs not possessing a Massachusetts Co ntrolled  Substance Registration (MAP MC Health SR) from the Department of Public The MAP Policy Manual Throughout the training curriculu m you will see references to MAP Policy. The MAP rs, trainers, staff and Policy Manual is a resource int ended to provide service provide other interested parti rce for MAP policies. es with a single, topically organized sou Services, Mental Health and Ch a copy of the policy Each program registered with DPH must have manual as part of the required reference materials for MAP Certified st aff. The MAP policy manual is available at: www.mass.gov/dph/map of Public Health, Developmental chusetts Departments 2017 The Massa 10 Massachusetts | Responsibilities in Action

11 Let’s Begin! Throughout the training curriculu of a date on Health Care m you will see ‘yr’ at the end , medication administration sheets and medication Provider orders, pharmacy labels progress notes. For training and epresents the current year. testing purposes only, ‘yr’ r In addition you will find sever nt facts, indicate the need al symbols that identify importa work location or review information regarding to seek more information about your ee the symbols you will know: policy and practice. When you s ildren and Families nd Ch There is information specific to your work location that you must ask your Supervisor Services, Mental Health a l tanopme There is additional information about the topic located in the MAP Policy Manual Devel The information is important lth,a f Public He There is an exercise to complete o The information that follows are important things to remember in the unit you just read ssachusetts Departments aM 2017 The 11 Massachusetts | Responsibilities in Action

12 Case Studies Juanita Gomez is a 36 year old woman who uses facial expressions and nods her as a seizure disorder head yes or no when communicating her likes and dislikes. She h that causes her to have uncontrolled, involuntary movements. Sh e also has chronic muscle pain (contractures) cu rrently managed with physical therapy and pain is managed by keeping medication twice daily. She also has chronic constipation that track of her bowel movements (B ng bowel medic M) and administeri ation PRN (as lowing (dysphagia) and requires supervision when needed.) She has difficulty swal ildren and Families res full assistance with activ ities of daily living (ADLs) eating or drinking. Juanita requi including medication administration. Ellen Tracey is a 42 year old woman who comm unicates using simple words and short sentences. Her health issues inc tension) and high pressure (hyper lude high blood cholesterol (hyperlipidemia). Both are well controlled through diet and medication. Ellen becomes self-injurious by bit also has an anxiety disorder; she ing her hands and slapping her head when anxious. E llen’s anxiety is managed with Ativan taken twice staff is preparing her medicat ions, Ellen will fill her daily and once daily PRN. While Services, Mental Health and Ch glass with water. Tanisha Johnson is a 22 year old woman with a history of seizures following an ith medication. Although acquired brain injury (ABI). Her seizures are well controlled w she has an interest in learning about her medications and their possible side effects, she often refuses her medication. She enjoys going to her loca l health club and working local florist and goes to her family’s home on weekends. with a trainer. She works at the David Cook is a 52 year old man with Down with Syndrome. David is independent ADLs and receives community based day supports. During day program hours, he of Public Health, Developmental e evening David enjoys unteers in the community. In th participates in outings and vol continuous positive spending time with friends and family. At night David wears a to sleep apnea (a airway pressure device (C-PAP) to help keep his airway open due der in which breathing repeatedl potentially serious sleep disor y stops and starts). He is t high blood pressure, gastroesop hageal reflux disease on several medications to trea (osteoarthritis) and a seizure disorder. (GERD), swollen, painful joints chusetts Departments 2017 The Massa 12 Massachusetts | Responsibilities in Action

13 is a 48 year old man who has had multiple psychiatric hospital izations. He Scott Green is on several medications to tr eat schizophrenia, a mood disorder, high blood pressure, He also takes PRN high cholesterol and non-insulin dependent diabetes (Type 2). cott was interested in n and difficulty sleeping. S medication for headaches, heartbur becoming more independent with hi s medications and in the past packed medication , he recently started not under staff supervision for up to two weeks at a time. However taking some of his medications o n a regular basis. Staff have increased their support on. At his last psychiatric appointment staff reported and now administers his medicati that Scott preferred to take hi s medication in the evening. His doctor changed the timing ildren and Families of his medication from the morning to the evening. is 6 year old boy, with poor c oncentration and irritable behav ior with Jonathan Brock t support at school. His angry outbursts. He is in kindergarten and receives significan ule system with built in ince ntives. It was reported that school utilizes a first/then sched his interest in activities suc h as play groups and structured school activities had decreased. He has post-traumatic stress disorder (PTSD) and at tention- deficit/hyperactivity disorder (ADHD); managed with Methylpheni date CD and Methylphenidate. Services, Mental Health and Ch When Jonathan began thes nistration time e medications he struggled during admi and would either spit it out or refuse it. Staff would encourage and prompt him to take it, including putting the medicati on in applesauce and yogurt at th e doctor’s request. Jonathan told staff that he was refusing the medication because he was not able to the medication to a hoking. The psychiatrist changed swallow the tablets without c p with sleep, it was started on Melatonin to hel chewable form. Later when Jonathan staff support and prompts. ing skills with etes daily liv ordered in liquid form. He compl of Public Health, Developmental chusetts Departments 2017 The Massa 13 Massachusetts | Responsibilities in Action

14 Unit 1 Working at a MAP Registered Program Responsibilities you will learn  Who will answer your medicati on and health related questions  How you will get to know the people you support Medication administration principles  ildren and Families Rights in relation to medication  Getting Your Medication and Health Related Questions Answered A MAP Consultant is a valuable medication information resource. A MAP Consultant is: a registered nurse  a registered pharmacist  Services, Mental Health and Ch a Health Care Provider (authorized prescriber)  state of one who is registered with the An authorized prescriber is some cation. See MAP Policy Section Massachusetts to prescribe medi 13. Examples of authorized prescriber s are a Health Care Provider ( HCP), doctor, dentist, horized prescriber is the nurse practitioner, etc. For purposes of this training, an aut of Public Health, Developmental same as a person’s HCP. ed questions contact the person’s Health Care Provider. Anytime you have health relat n procedures or MAP Consultants will help answer your questions about medicatio . specific medication issues ant with your question, make When you call a MAP Consult chusetts Departments sure you have the HCP order, the medication and the medication sheet available for reference; you may need to read them to the MAP Consultant. Examples of when you may need to contact a MAP Consultant inclu de if: too much or too little of a m  edication was administered  itted (not given) the medication was om 2017 The Massa  the medication was refused o if refused, the MAP consultant c ontacted must be the prescribi ng HCP  the HCP order, pharmacy label or medication sheet do not agree 14 Massachusetts | Responsibilities in Action

15 PH requires available 24 hours a day, 7 days a week. D MAP Consultants are rol and other MAP Consultants, poison cont that the telephone numbers for the emergency numbers (911, fire, police) be clearly posted near th e telephone in all ction 05 and Section 10. programs. See MAP Policy Se ildren and Families cy contact list in David Cook’ s home located near the This is an example of the emergen phone for quick and easy staff reference. Emergency Contact List Rescue + Fire + Police Services, Mental Health and Ch 911 Poison Control 800-222-1222 MAP Consultants Greenleaf Pharmacy 111-222-3434 of Public Health, Developmental Monday-Friday Registered Nurse Rebecca Long 781-000-4500 Saturday-Sunday chusetts Departments Health Care Provider(s) ack 617-332-0000 Dr. Richard Bl Jones 617-332-0001 Dr. David Dr. Shirley Glass 508-123-1234 Dr. Chen Lee 617-332-0002 2017 The Massa Administrator on Duty 617-000-0000 Program Supervisor Linda White 780-000-2222 15 Massachusetts | Responsibilities in Action

16 ther Ask your Supervisor where MAP Consultants, poison control and o emergency numbers are located in the program where you work. ildren and Families Answer True (T) or False (F) if the person listed may act as a MAP Consultant. 1. Licensed Practical Nurse (LPN) 2. Pharmacy Technician Registered Nurse (RN) 3. st at the HCP office 4. Receptioni 5. Health Care Provider (HCP) Services, Mental Health and Ch 6. MAP Certified Super visor or Program Director Registered Pharmacist 7. Learning about the People You Support d reporting changes in Two of your most important responsibilities are watching for an be physical or behavioral. In order to recognize the people you support. A change may of Public Health, Developmental a change, you must first get to know the person by learning about their personality, bout a person who is new medications. You can learn a physical conditions, abilities and to you by: Observing (watching) the person  Talking with the person  chusetts Departments  Listening to the person  Communicating with o the person’s family o your co-workers  life and health history Reading about the person’s ensure the people you Recognizing changes and reporti ng them to the right person will 2017 The Massa best care possible. support will receive the 16 Massachusetts | Responsibilities in Action

17 Principles of Medicat ion Administration By following the principles of m edication administration you will help to ensure medications are administered safely. The principles of medicati on administration are mindfulness, supporting abilities and communication.  Mindfulness o ation ed during medication administr Always remaining alert and focus Thinking about what you are doing and not something else o ildren and Families  As you begin administering medication, you will very quickly become familiar with which pers on receives what medication at what time, etc. and even the size, shape, color and markings on the medication itself, because of this  tration to become routine Never allow medication adminis o Consider changing the order of who you administer medications to first to help yourself to remain mindful.  Supporting abilities Helping the person to functi on as independently as possible o Services, Mental Health and Ch encouraging a person to participate fully in the medication  based on their abilities administration process Communication  o cy label and medication sheet Reading the HCP order, pharma ensuring they agree  contacting a MAP Consultant as needed  Talking and listening to the per son while you are administerin g their o medication of Public Health, Developmental our job. To communicate is to s Communicating is a big part of y hare or exchange information. In your role as a M AP Certified st aff, you will c ommunicate with the people s, supervisors, family members, you support, with your co-worker the HCP, pharmacist, nurse and many others. In addition to talking, communication also includes: chusetts Departments Listening   Documenting Body language   Facial expression  Tone of voice 2017 The Massa 17 Massachusetts | Responsibilities in Action

18 effective, remember: For communication to be Speak clearly and slowly   on you are speaking to Look directly at the pers Listen carefully   Take notes during your shift if needed, this will help you wit h accurate documentation  o be sure you If information is given to you, repeat it back to the person t ildren and Families understood it correctly  Ask questions if you do not understand something he case studies, and then write the related Answer each question based on t tration (mindfulness, supporting abilities and principle of medication adminis Services, Mental Health and Ch communication). whole in pudding or applesauce. How would you 1. Juanita takes her medication know if she did not like a ce _____________ rtain pudding flavor? ____________ What is the related prin ciple? ____________ ____________________ ________ lities during medication admin 2. How do you support Ellen’s abi istration? ________________________ _____________________ __________________ _ ________ What is the related prin ciple? ____________ ____________________ of Public Health, Developmental he refusal to? medication. Who do you report t 3. Tanisha refused her morning _____________________ _ __________________ ________________________ ciple? ____________ ____________________ What is the related prin ________ 4. Typically, you administer medications to the people in your work location in the same order each day. How can y ou ensure the medication administ ration chusetts Departments process does not become ______ __________________ routine? ____________ What is the related prin ____________________ ciple? ____________ ________ 2017 The Massa 18 Massachusetts | Responsibilities in Action

19 Respecting Rights ith both dignity and Like you, the people you support have the right to be treated w respect. Everyone also has the ty means keeping right to privacy. Confidentiali information private. Informa ust only be shared with tion about the people you support m others if involved in their care. istration, people have the right In relation to medication admin to ildren and Families know what their medications are and the reasons they are taken   taking the medication know the risks associated with  h taking the medication know the benefits associated wit refuse medication   be given medication onl y as ordered by the HCP medication, the first thing y If a person refuses to take their ou should do is ask them why they do not want to take i the prescribing HCP and t and report that information to g HCP in this situation also ac your supervisor. (The prescribin ts as the MAP Services, Mental Health and Ch ceive their medications Consultant.) Ultimately, you want the people you support to re as ordered by the HCP. Until you ng their medications know why the person is refusi and report the issue, the pr oblem cannot be solved. The meaning of, a person has the right to be given medication o nly as ordered by the HCP, is shown in this example: Ellen Tracey has an order for a PRN medica tion to manage her anxiety. You will only he displays symptoms of anxiety, as described in her administer the medication when s of Public Health, Developmental A Support Plan, if needed, is a HCP order and/or Support Plan. n extension of a HCP order. Although Ellen communicates using simple words and short sentences, she ail what you will observe us. Her plan describes in det cannot tell you when she is anxio to administer the o that you will know exactly when when she experiences anxiety s medication. Administering PRN anti-anxiety medication for symp toms other than those described in her HCP order and/ or Support Plan is not allowed. chusetts Departments At times, the instructions inclu ded in a HCP order regarding ho w and/or when to administer a medication are so lengthy that the order is wri tten in the format of a Protocol or a Support Plan. A P rotocol is typically seen when the reason the medication 2017 The Massa is ordered is to lessen a physical symptom, such as a seizure p rotocol which gives anti-seizure medication when a p instructions for the use of an erson experiences a edication is ordered is seizure. A Support Plan is typically seen when the reason the m to help lessen a behavior. 19 Massachusetts | Responsibilities in Action

20 Ellen Tracey Support Plan Anxiety Management Specific behaviors that show us Ellen is anxious: 1. Biting hands for more than 4 minutes s in 4 minutes 2. Head slapping for longer than 30 seconds or more than 5 time ildren and Families A. Staff will attempt to talk to Ellen in one on one conversati on regarding current feelings and difficulties B. Staff will attempt to direct and involve Ellen in a familiar activity such as laundry, meal preparation, etc. he Ativan may be administered. If unsuccessful with A and B, t Ativan 0.5mg once daily as needed 4 hours apart from regularly by mouth; must give at least scheduled Ativan doses. (Refer to HCP order) If anxiety continues after the addi tional dose, notify HCP. Services, Mental Health and Ch HCP signature: Shirley Glass MD 2/1/yr Posted: Sam Dowd 2-1-yr 4pm Verified: Linda White 2-1-yr 4pm of Public Health, Developmental Review the support plan and answer the following questions. 1. What is the reason the PRN Ativan is ordered? __________________________ chusetts Departments If Ellen was crying and atte 2. mpted to hit you, could you administer the PRN ____________________ Ativan? ___________________________________ ___ ed, Ellen PRN medication was administer 3. What would you do if after the __________ ? _____________ continued slapping her head and biting her hands 2017 The Massa 20 Massachusetts | Responsibilities in Action

21 Let’s Review questions Contact a person’s HCP for health related issues, concerns or  answer 24 hours a day, 7 days a week to MAP Consultants are available  de technical assistance regard medication questions and/or provi ing medication ildren and Families MAP Consultants are a  HCP o o Registered Pharmacist Registered Nurse o  Your Supervisor must be informed anytime the MAP consultant ha s been contacted To recognize changes staff mus pport  t learn about the people they su Medication Administration Principles include  Mindfulness o Services, Mental Health and Ch o Supporting abilities Communication o Everyone has the right to be treated with dignity and respect  of Public Health, Developmental chusetts Departments 2017 The Massa 21 Massachusetts | Responsibilities in Action

22 Unit 2 Observing and Reporting Responsibilities you will learn The difference between objective and subjective observations   When changes observed in a person should be reported  How to accurately report the changes you observe ildren and Families How to correct a documentation error  atching someone carefully in order to obtain information. Observation is the process of w You have such close day to day contact with the people you support; you will quickly become familiar with a person’ s daily routine, their habits; th eir likes and dislikes and may be the first staff to observe a change. ting physical and behavioral ch anges are your Observing, reporting and documen responsibility. These responsibil ities are essential to the healthcare a person receives. Services, Mental Health and Ch Observations are either objective or subjective. see, hear, feel, smell or meas is factual information you will Objective observation ure.  See o Examples  Redness  Bruising  Scratch of Public Health, Developmental  Swelling and bump their head  Seeing a person fall  Hear o Examples  Crying  Coughing chusetts Departments  Sneezing Moaning  Feel  o Examples  Warmth Coolness  2017 The Massa  Dryness  Moist  Smell Examples o 22 Massachusetts | Responsibilities in Action

23 Body odor   Measure o Examples Number of hours a person sleeps   How long a seizure lasts How much liquid a person drinks   How many pounds a person weighs  erature, pulse, respiration) Vital Signs (blood pressure, temp ildren and Families Subjective observation who speaks or signs and they is when you work with a person tell you how they are feeling. Examples o ‘I have a headache’   ‘My throat hurts’ ‘I’m sad’   ‘I’m tired’ Services, Mental Health and Ch tive (O) or subjective (S): Label each observation as objec 1. ___ Frowns getting off the van 2. ___ Limping 3. ___ David states he has ‘sharp pain’ of Public Health, Developmental llen, red and warm to touch 4. ___ Right knee is swo David states ‘My knee still hurts’ 5. ___ Reporting chusetts Departments Reporting is to give spoken or wri tten information of something observed or told. You are responsible for reporting any changes, physical or behavioral, you notice. Report you think the issue might be. The more details you the facts. Do not guess at what ive observation) in eel, smell or measure (object report about what you see, hear, f addition to how the person says t hey are feeling (subjective ob servation) the better the HCP can determine the most appropriate treatment. The quality of healthcare a pers the information you on receives is only as good as 2017 The Massa report to the HCP. When you r eport changes, follow up the next time you are working to see what action was taken. 23 Massachusetts | Responsibilities in Action

24 nges the expectation of who contacts the When reporting physical and behavioral cha HCP varies from Provider to Provider, do you  Call your Supervisor first for further directions?  t the change, make an appointment if needed, Contact the HCP directly, repor and then call your Supervisor after?  Contact someone else bef ore your Supervisor? ildren and Families Ask your Supervisor who is res ponsible for contacting the HCP to report n. support at your work locatio changes observed in the people you There are two types of reporting: Services, Mental Health and Ch  Everyday reporting  Immediate reporting Everyday reporting typically occurs between staf f present at shift change. Outgoing n regard to basic staff are expected to provide in coming staff with information i ry list has been started as well as ongoing medication household details such as a groce administration details they should be aware of on such as: and/or follow up ‘PRN Ativan was administered  to Ellen Tracey 30 minutes ago. Later in the shift, o the a medication progress note is needed documenting the response t of Public Health, Developmental medication.’ dentist today. Look at her HCP o ‘Tanisha Johnson went to the  rders. An t dose will be at 4pm. The me dication is a liquid antibiotic was ordered. Her firs and is locked in the refrigerator.’ chusetts Departments Ask your Supervisor how informa uch as how tion is shared between shifts, s if there is no staff present when you arrive for your new HCP orders are communicated shift. 2017 The Massa 24 Massachusetts | Responsibilities in Action

25 is reporting without delay as soon as possible after a change is Immediate reporting observed. Immediate reporting may prevent a small change observed from becoming a major health issue and allows t he appropriate treat ment to be ordered as quickly as possible. Examples: a symptom of allergie s or a symptom of a sinus infection. A runny nose could be A slight cough could be a symptom umonia (severe lung of a cold or a symptom of pne infection). ildren and Families immediately, such as: There are many people you will speak with to report information  911 when a o person falls and cannot get up o , has difficulty breathing or is person complains of chest pain choking o person is unresponsive o MAP Consultant recommends you hang up and call 911 Services, Mental Health and Ch  Poison control when a ance such as laundry detergent person ingests a forei o gn subst hang up and call poison control MAP Consultant recommends you o  A MAP Consultant when when administering medication an occurrence (error) is made o For example:  of Public Health, Developmental  Tegretol 400mg is ordered and Tegretol 600mg is administered o the HCP the medication received from the pharmacy seems different from order have administered it  Even if other staff you notice the medication is di fferent in color, size, shape and/or markings o from the last time it was obtained chusetts Departments you are not able to administer o the medication based on the str ength of medication received from the pharmacy For example:  The dose ordered is 50mg and you receive a 100mg  strength tablet from the pharmacy  The HCP who prescribed medication when 2017 The Massa o medication is refused medication is not available from the pharmacy o there are no refills left o a medication parameter (guidelin e) for HCP notification has be en met o 25 Massachusetts | Responsibilities in Action

26 For example:   is below 56, do not give the A HCP order states, ‘If pulse medication and contact the HCP.’ o you hang up and call the HCP a MAP Consultant recommends an order is missing the person’ s name, medication, dose, frequency, route o or the date and the HCP signature Your Supervisor when  ildren and Families o there is a math error in the C ountable Controlled Substance Bo ok  typically known as a Count Book o the shift count pages in a Count Book are almost full o the Count Book binding is loose a medication seems to be tampered with o are unsure if a refill has been o the medication is low and you ordered you cannot locate a medication to administer o Services, Mental Health and Ch A Countable Controlled Substanc e Book, a method used to track certain rred to as a Count Book. For tra ining purposes, the term medications, is typically refe Count Book will be used. contacted and Make sure all of your questions are answered by the person you of Public Health, Developmental document the conversation including  your question or concern the response given to you  the name of the person you contacted   date, time and your full name chusetts Departments 2017 The Massa 26 Massachusetts | Responsibilities in Action

27 regarding David’s knee pain. Review the narrative note NARRATIVE NOTES Name of David Cook Individual ildren and Families NARRATIVE Include observations, communications, information STAFF TIME DATE sharing, HCP visits, medication changes, changes SIGNATURE from the familiar, etc. 3PM 3/3/yr y, is limping and states he has David frowns getting off the van toda ‘sharp pain’ when bending his knee. His right knee is now swollen, red and warm to touch. John Craig 3:15PM 3/3/yr i h ee pain’. Call Ibuprofen 400mg was given for compla int of ‘sharp kn John Craig made to Dr. Black and message left. 4:15pm 3/3/yr David received Ibuprofen 400mg at 3:15 PM and still Services, Mental Health and Ch complains of right knee pain. Even though Ibuprofen has been given as ordered, his symptoms continue. Sam Dowd 4:45pm 3/3/yr Dr. Black returned call, no medication changes but would like to see David tomorrow, appointment made for 2 PM. Sam Dowd of Public Health, Developmental Place a checkmark next to the most complete information to report to the HCP. 1. ___ David’s osteoarthritis has been bothering him. His knee is red, swollen and painful. He has received Ibuprofen for the pain. chusetts Departments 2. ___ David has injured his k nee. He is limping becaus e his k nee hurts; it is red, swollen and warm to touch. ofen and states his right knee s till hurts. It is warm 3. ___ David has received Ibupr to touch, red and swollen. He is limping. 4. ___ David states he has, ‘ sharp pain’ when he bends his righ t knee. He frowns 2017 The Massa getting off the van and is limping warm to touch and . His right knee is now red, swollen. He has received Ibupr ofen 400mg for right knee pain an d his symptoms continue. 27 Massachusetts | Responsibilities in Action

28 Documentation an issue takes a day, ng to end whether y from beginni Documentation should tell a stor many days or weeks to resolve. When documenting: Use ink   Write ildren and Families o Clearly In complete sentences o Include  o Date Time o Your full name o You will be documenting medication administration on the front side of a medication administration sheet; however, t documentation is here are times when additional Services, Mental Health and Ch required. Additional medication related documentation is typically written on a medication progress note form; usually on the backside of a medication adm inistration sheet. Medication progress notes are kept in a medication book. When documenting using a se as many lines as needed. medication progress note, u Name Juanita Gomez MEDICATION PROGRESS NOTE of Public Health, Developmental Not Given Re G O Reason fused iven ther (for giving/not Results and/or Response Staff Signature Time Medication Dose Date giving) 1200mg Magnesium Hydroxide 8pm Third day with no BM 3/3/yr See 3/3/yr 11pm entry below Serena Wilson X 11pm 3/3/yr __ e to monitor. ______ tinu con Night staff No BM as of 11pm. will _ _____ _ _ ___________________ _ Serena Wilson chusetts Departments 3/4/yr 8am No BM overnig droxide ht. Dr. Jo nes n otif ied. Telephone o rder taken to give magnesium hy tion is a re is still no BM, M by is still n 8pm. If the medica tonight if there o B dministered and the __ Timothy Miller ______________ . mo See HCP order omorrow rning. _______ call Dr. Jones t 3:30pm 3/4/yr ent. ___________ _ m Had a large bowl ( ve wel bo error SW) mo _______________________________ Serena Wilson 2017 The Massa 28 Massachusetts | Responsibilities in Action

29 which there is a PRN If a health issue is chronic (ongoing) such as constipation for medication prescribed, documentat ion in the medication progress notes helps keep track of how often the PRN medication is needed and if it has a ny effect. , for example, if the HCP knows that Juanita is This is key information for a HCP receiving PRN magnesium hydroxide on an ongoing ba sis over a period of time, a daily in an effort to reduce PRN m agnesium hydroxide bowel medication may be considered use. ildren and Families t additional t uses a separate form to documen You may work in a location tha medication information instead of rm. In this situation, a medication progress note fo elated documentation may be wr itten on progress additional medication or health r person’s confidential notes, sometimes called narrative notes, which are filed in the record. NARRATIVE NOTES Name of Juanita Gomez Individual Services, Mental Health and Ch NARRATIVE Include observations, communications, HCP visits, STAFF DATE TIME medication changes, changes from the familiar, SIGNATURE reportable events, etc. 3-3-yr 8pm Magnesium hydroxide 1200mg administered at 8pm since third day with no BM. S erena Wilson Serena Wilson 3-3-yr 11pm No results as of 11pm. Night s taff will continue to monitor. 3-4-yr 8am der taken to No bowel movement overnight. D r. Jones notified. Telephone or o BM by 8pm. If give magnesium hydroxide again just tonight if there is still n and there is still no BM, call Dr. Jones tomorrow the medication is administered of Public Health, Developmental Miller Timothy morning. See HCP order. 3-4-yr 3:30pm Serena Wilson rror SW) bowel movement. Large bowl (e Medication sheets, medical progr ess notes, narrative notes and HCP orders, etc. are documentation error, never use legal documents. If you make a ‘white-out’, mark over or erase the error; th mething. is can be viewed as an attempt to hide so chusetts Departments To correct a documentation error:  Draw a single line through the error  Write ‘error’  Write your initials o Then document what you meant t o write the first time tive  For example, see the medication progress note and/or the narra 2017 The Massa 3-4-yr at 3:30pm note entries dated 29 Massachusetts | Responsibilities in Action

30 Let’s Review will help you recognize when there is a change  Knowing the people you support  Subjective information is what a person tells you  seen, heard, felt, smelled or measured Objective information can be ildren and Families  All changes must be reported Reporting immediately decreases  become worse the chances a health issue may reatment and A HCP uses the information reported by staff to determine if t  medication are needed  umented from beginning to end Health related issues are doc Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 30 Massachusetts | Responsibilities in Action

31 Unit 3 Medications Responsibilities you will learn The purpose of medications   Medication categories Medication outcomes  ildren and Families  Medication information resources will change one or more Medications are substances that when put into or onto the body ways the body works. Medications are used to treat illness, dis ease, pain or behavior. the goal is that the person’s symptoms will lessen and When a medication is prescribed life will improve. their quality of the same steps each time medications safely, following You will learn how to administer ister medication to the you administer a medication; this will help you to safely admin Services, Mental Health and Ch people you support. Brand and Generic Medications are known by their brand name and/or generic name. Typically, all medications have a brand and a generic name. name medications are created and made by a specific pharmaceutical company. Brand When a pharmaceutical company creates a medication they are all owed to name it. of Public Health, Developmental Examples of brand name medications are Tylenol, Advil and Proza c. ed by many chemical name and are manufactur medications are known by their Generic ar to its brand name different pharmaceutical compani es. Generic medication is simil ; the name is different and may have a different color, medication but is less expensive marking, shape and/or size. Examples of generic name medications are acetaminophen, ibuprofen and fluoxetine. chusetts Departments When the HCP writes a prescrip tion for a brand name medication and the generic pharmacy, you will see the generi c name of the medication is supplied by the medication and the letters ‘I C’ near the brand name of the medication printed on the pharmacy label. eric name medication was ‘IC’ is an abbreviation for ‘interchange’. This means the gen 2017 The Massa supplied by the pharmacy in place of the brand name medication. 31 Massachusetts | Responsibilities in Action

32 Review the pharmacy labels. Fill in the generic medication sup plied. Zestril _____________ Pr ilosec _____________ Motrin _____________ ildren and Families Rx#138 Greenleaf Pharmacy 111-222-3434 20 Main Street 1/31/yr Treetop, MA 00000 David Cook Lisinopril 20 mg Qty. 60 IC Zestril Take 2 tablets by mouth one time a day in the morning. Hold if systolic blood pressure is below 100 and notify HCP. Services, Mental Health and Ch Dr. Black Refills: 2 ED: 1/31/yr Lot# 269 Rx#174 111-222-3434 Greenleaf Pharmacy 20 Main Street 6/30/yr Treetop, MA 00000 David Cook Omeprazole 20 mg Qty. 30 IC Prilosec of Public Health, Developmental once a day before supper Take 1 tablet by mouth Dr. Black yr Refills: 2 Lot# 1436 ED: 6/30/ chusetts Departments Rx#140 Greenleaf Pharmacy 111-222-3434 20 Main Street Treetop, MA 00000 8/31/yr David Cook Qty. 90 Ibuprofen 400 mg IC Motrin ee pain. Take 1 tablet by mouth every eight hours as needed for right kn 2017 The Massa ore than 48 hours notify HCP. If symptoms continue for m Dr. Black Lot# 745 ED: 8/31/yr Refills: 2 32 Massachusetts | Responsibilities in Action

33 Medication Schedules All prescription medications are known as controlled substances . This means a red to obtain the medication from a pharmacy. prescription from a HCP is requi are numbered; II, III, Controlled substances are placed into schedules. The schedules n its abuse potential, tance is placed in is based o IV, V and VI. The schedule a subs and when abused, its chance of causing dependence. ildren and Families Medication Categories There are three categor ies of medications:  Controlled (Schedule VI)  Countable Controlled (Schedule II-V) Over-the-Counter (OTC)  Services, Mental Health and Ch Controlled (Schedule VI) Medication , order to obtain the require a prescription Controlled medications written by the HCP, in on the prescription to pharmacist uses the information medication from a pharmacy. The tions include prepare and label the medication. Examples of controlled medica chotics (Haldol). depressants (Prozac) and antipsy antibiotics (amoxicillin), anti requirements include: Controlled medication of Public Health, Developmental  A HCP order for administration d by the pharmacy  Labeled and package In a bottle or o o May be in a tamper resistant package  Secured in a locked area  Tracked using a chusetts Departments Receiving log and Medication Ordering/ o o Medication sheet  Where the medication is docum ented after administration o Transfer Document DPH Disposal Record o 2017 The Massa Additional training is required specific to certain ‘high alert ’ controlled and s as identified by DPH. High al ert medications include countable controlled medication Coumadin, Clozaril (schedule VI) and Suboxone (schedule II-V). See MAP Policy Section 08. 33 Massachusetts | Responsibilities in Action

34 HCP orders for ‘high alert’ medication at Ask your supervisor if anyone has your work location. ildren and Families D ing a high PH periodically identifies some Schedule VI medications as hav risk of abuse potential, with the expectation they be tracked c losely as if they were a countable controlled medication. Ask your supervisor if anyone ha r abuse s HCP orders for ‘high risk’ fo Services, Mental Health and Ch k location and if so, how they are tracked. Schedule VI medication at your wor Countable Controlled Medication (Schedule II-V) n by the HCP, in order to s require a prescription, writte Countable controlled medication pharmacy. The pharmacist uses the obtain the medication from a information on the prescription to prepare and label the medication. The pharmacy must also add an ‘i dentifier’ on the package of the countable controlled of Public Health, Developmental rolled medication, such as a fact that it is a countable cont medication to alert you to the (prescription) number that ma ‘C’ stamped on the package, an Rx y start with a ‘C’ or an ‘N’ or the package itself may be color coded.* *Pharmacy “identifier” examples: chusetts Departments 2017 The Massa 34 | Responsibilities in Action Massachusetts

35 les of countable etimes called narcotics. Examp Schedule II-V substances are som cocet, Vicodin) or controlled medications include pr escription pain relievers (Per antianxiety medication (Ativan). Due to the high risk olen and abused, countable controlled for these medications to be st medications have additional sec urity measures in place. tion requirements include: Countable controlled medica ildren and Families  A HCP order for administration Labeled and packaged by the pharmacy in a  Tamper resistant package o  The reason for this type of packaging is to decrease the chanc e that the medication insi ion de is r eplaced with a different medicat  With an identifier double locked area Secured in a  A lock within a lock o  The reason for a double locked storage area is to maintain Services, Mental Health and Ch medication security  Tracked using a o Medication Ordering/Receiving log Count Book o Added into a Count Book as medications come into the program  ons are removed from a Count Book as medicati  Subtracted from the package or transferred Medication sheet o  ted after administration en Where the medication is docum of Public Health, Developmental o Transfer Document DPH Disposal Record o  Counted every time the medica tion storage keys change hands medications are secure and o Counting this frequently ensures Protects you from being accused of mishandling or misusing  medication  Assists you in adhering to laws, regulations and policies chusetts Departments If controlled substances, countable controlled substances or th e paper copy probable police involvement. of prescriptions are stolen, an investigation will follow with 2017 The Massa cy identifies countable contr olled Ask your supervisor how the pharma medication at your work location. 35 Massachusetts | Responsibilities in Action

36 Over-the-Counter (OTC) Medication Over-the-Counter (OTC) or nonpre scription medication may be pur chased from a pharmacy without a prescription fr om the HCP; however, MAP requires that all OTC medications be labeled by the pha rmacy, with some possible exce ptions*. This means that you must ask the HCP to write a prescription for all OTC medications so that the pharmacy will prepare and label the medications include medication. Examples of OTC nonprescription pain relievers (Ty lenol, Advil) or allergy medi cation (Benadryl). ildren and Families OTC medication requirements include: A HCP order for administration  Packaged by the pharmacy  In a bottle or may be in a o o Tamper resistant package Labeled by the pharmacy*  Secured in a locked area   Tracked using a o Medication Ordering/ Receiving log and Services, Mental Health and Ch o Medication sheet  umented after administration Where the medication is doc o Transfer Document uirements and counter medication labeling req *For details regarding over-the- any additional training requirem ents, see MAP Policy Section 06. of Public Health, Developmental chusetts Departments lant require a HCP order. Neither sunscreen nor insect repel etary Supplements. In addition to the three categories of medications there are Di 2017 The Massa 36 Massachusetts | Responsibilities in Action

37 Dietary Supplements ingredients such as vitamins, Dietary supplements are products that contain dietary minerals, herbs or other substances. Unlike medication, dietary supplements are not pre-approved by the gov Dietary or effectiveness before marketing. ernment for safety tion from the HCP om a pharmacy without a prescrip supplements may be purchased fr etary supplement s be labeled b y the pharmacy, with however; MAP requires that all di some possible exceptions*. Th is means that you must ask the HC P to write a supplements so that the pharmacy will prepare and label the prescription for all dietary ildren and Families supplement. Examples include multivitamins, fish oil and shark cartilage. Dietary supplement requirements include:  A HCP order for administration Packaged by the pharmacy  In a bottle or may be in a o Tamper resistant package o  Labeled by the pharmacy* Services, Mental Health and Ch Secured in a locked area  Tracked using a  o Medication Ordering/ Receiving log and Medication sheet o umented after administration  Where the medication is doc o Transfer Document of Public Health, Developmental and any *For details regarding dietary supplement labeling requirements additional training requirement s, see MAP Policy Section 06. chusetts Departments Nutritional Supplements nsure, gastric tube Nutritional supplements are ‘conv entional’ food items such as E ns and do not fall under feedings or Carnation Instant Breakfast; they are not medicatio MAP. 2017 The Massa 37 Massachusetts | Responsibilities in Action

38 For your general information, to know if a product is an OTC medication, a dietary supplement or a nutritional supplement, look at the manufacturer’s label. Over-the-counter medications have a Drug Facts label. ildren and Families Services, Mental Health and Ch Dietary Supplements have a Supplement Facts label. of Public Health, Developmental chusetts Departments label. ‘Conventional’ Foods hav e a Nutrition Facts 2017 The Massa 38 Massachusetts | Responsibilities in Action

39 the product is Look at the manufacturer’s label for each product. Determine if ement or nutritional supplement an OTC medication, dietary suppl and answer the corresponding questions. ildren and Families 1. This product is a(n) a. Dietary Supplement b. OTC Medication c. Nutritional S upplement 2. Is a HCP order required for administration? ________ ed for administration? ____ 3. Is a pharmacy label requir Services, Mental Health and Ch onto a medication sheet? __ 4. Is the product transcribed elopmental 1. This product is a(n) a. Dietary Supplement of Public Health, Dev b. OTC Medication c. N utritional Supplement 2. Is a HCP order required for administration? ________ ed for administration? _____ 3. Is a pharmacy label requir chusetts Departments 4. Is the product transcribed onto a medication sheet? __ 2017 The Massa 39 Massachusetts | Responsibilities in Action

40 Medication Outcomes r a medication is administe red is known as a What happens or does not happen afte medication outcome. When a medica of the following tion is given it may cause any outcomes:  Desired Effect No Effect Noted   Side Effects ildren and Families the Desired effect ly what it was intended to do; is when a medication does exact results of the medication. Fo r example: Tylenol is person experiences the beneficial administered for a headache an tin is administered to d the headache goes away or Dilan control seizures and the person is seizure free. is when a medication is taken fo r a specific reason and the sy mptoms No effect noted continue; no effects are noted from the medication. This could occur for one of two reasons. Services, Mental Health and Ch medication and a different 1. The body will not respond to the medication will need to be ordered. For example, eryth romycin is ordered for an ear infection; the e medication for 2 ure of 100.2, after taking th person has ear pain and a temperat symptoms; ear pain and a tem days the person still has the same perature of 100.2. No effect was noted from inues to the medication, the person cont HCP must be notified. experience symptoms and the 2. The medication has not had enough time to work. For example, a person was of Public Health, Developmental ill experiencing started on a new antid epressant medication a week ago and is st symptoms of depression. Some m edications take longer to work th an other medications; in this case several weeks may be necessary for th e person’s symptoms to improve. When a new medication is start ed, you should document what you observe, even if there are no effects noted. This will help the HCP in determini ng if the medication is chusetts Departments working as intended. hat were not wanted or intended even if the Side effects are results from a medication t desired effect is achieved. Side effects are usually mild, and while they may be t severe enough for the HCP to dis uncomfortable, are usually no continue the medication. For example, an antib iotic may cure an ear infection but it may also cause mild nausea, or a cold medicine may reduce a cough and runny nose but may also 2017 The Massa cause sleepiness. Side effects range from minor to severe. If the side effect is more severe, it is called an adverse response to the medication. For example, if an antibio tic caused diarrhea and 40 Massachusetts | Responsibilities in Action

41 d ordering a different vomiting, the HCP may consider d hat medication an iscontinuing t one. (severe side effects) to observe for include: Adverse responses  the body’s immune system reacts to the medication as if it Allergic reaction: acterized by a rash were a foreign substance. An allergic reaction is usually char spreads to the back, arms and then down the body, which starts on the chest and to the legs. An allergic reac tion may happen at any time, even if the person has ildren and Families taken the medication in the past. Anaphylactic reaction: a severe, very dangerous, lif e threatening allergic  uires immediate tion happens very quickly and req reaction. An anaphylactic reac medical attention, such as c alling 911. An anaphylactic reaction is usually characterized by difficulty breathing, rash and changes in vita l signs. Paradoxical reaction: when the response the person experiences is opposite of  dication is to produce. For example, a me what the medication was intended Services, Mental Health and Ch ordered to help a person relax estless. and instead the person becomes r when a medication bui body lds up in the body to the point where the  Toxicity: cannot handle it anymore; this c an be life threatening. Toxici ty is more common with certain medications than others. For example, even a very common edications also be toxic. Many anti-seizure m medication, such as Tylenol, can have the ability to build up in the body causing toxicity. Typically, a person’s cation levels to ensure they ar blood will be monitored for medi e not toxic. of Public Health, Developmental Medication Interactions ixing of medications in the body which will either increase A medication interaction is a m ide effects of one or both of t he medications; the more or decrease the effects and/or s greater the possi teraction occurring. In bility of an in medications a person takes the s can also interact with ing with each other, medication addition to medications interact chusetts Departments tances and certain foods. dietary supplements, other subs Examples of medication interactions:  with the antibiotic If an antibiotic is taken with calcium, the calcium interacts will not get the decreasing the effects of the antibiotic; this means the person beneficial result from the antibiotic.  Vitamin K, often found in leafy green vegetables, interacts wi th warfarin sodium 2017 The Massa effects of the warfarin sodium (a blood thinner) decreasing the ; this means the person will not get the beneficial result (for the blood to be thinned) from the warfarin sodium.  If more than one pain medication is taken at a time, they can interact increasing s of either pain medication. the effects and/or side effect 41 Massachusetts | Responsibilities in Action

42 Alcohol, Nicotine and Caffeine ity to interact or interfere Substances such as alcohol, nicotine and caffeine have the abil with the absorption of medication in the body. You must inform the HCP if any of the people you support use these substances. ildren and Families tion sheet. f the Tramadol medication informa Read the interaction section o drink. Circle what could happen if Tramadol is taken with an alcoholic Sample Medication Information Sheet Tramadol: pain. Brand names for is an analgesic used to treat moderate to severe pain, chronic Services, Mental Health and Ch Tramadol are Conzip, Rybix, Ryzolt, Ultram, and Zytram How to take: Oral tablets, take with or without food. What to do if you miss a dose: dose. If s it is one hour before the next Take as soon as possible unles so, skip the missed dose. Never double up on dose. blurred vision, nasal Side Effects: Vertigo, depression, seizures, headache, fatigue, hypotension, congestion, nausea, anorexia, c rhea, pruritus and urinary retention. onstipation, GI irritation, diar Interactions: Tell your HCP of all the medicati ons you are taking. Do not use with St. John’s Wort. Using of Public Health, Developmental ay increase side effects such a tramadol together with alcohol m s dizziness, drowsiness, confusion, and difficulty concentrating. Contraindications: ation with any CNS depressant, Hypersensitivity, acute intoxic alcohol, asthma, respiratory depression. Special Precautions: Monitor vital signs, if respira tions are less than 12 withhold , track bowels, and chusetts Departments check urinary output. Serotonin syndrome, neuroleptic malignant syndrome: increased heart rate, Overdose reaction: , high B/P, hyperthermia, head sweating, dilated pupils, tremors ache, and confusion. 2017 The Massa 42 Massachusetts | Responsibilities in Action

43 Sensitivity to Medication Each person may respond differ ently to the same medication. How a person responds depends on how sensitive they may o on. There are several r may not be to the medicati son’s sensitivity to medicatio n. factors which contribute to a per These factors include:  Age ildren and Families  Weight  General health  Medical history  Use of other medications or dietary supplements ion or dose of For example, a HCP would not necessarily order the same medicat as he would for a 275 pound man or a healthy 25 medication for a 100 pound woman year old and an 85 year old with many health issues. Services, Mental Health and Ch Medication Information the medications you administ You are responsible to learn about er and know the reason tion you must for administration. To monitor the person for effects of medica  ncluding their medical con ditions and learn about the people you support i medications prescribed on before administering read about each new medicati  of Public Health, Developmental know where to find or how to contact medication information re  sources Resources for medication information include  the MAP Consultant  the medication information sheet chusetts Departments o supplied by the pharmacy for each medication dispensed a reputable online source   a drug reference book 2017 The Massa Ask your supervisor where the dr ug reference book is located or how to access the reputable online resour ce used at your work location . 43 Massachusetts | Responsibilities in Action

44 Match the terms to the correspondi ed. ng examples or actions requir Controlled Mild itching and rash occur after taking a new 1. A __ Medication medication A prescription is required to obtain it but does not Medication ildren and Families 2. B __ Sensitivity require counting; schedule VI medication Anaphylactic A 100 pound person becomes very sleepy after 3. C __ receiving a normal dose of ibuprofen Reaction Coumadin and Aspirin taken together cause a person’s 4. No Effect Noted D __ gums to bleed Dietary Medication is ordered to help calm a person, 5. E __ Supplement instead the person becomes restless Services, Mental Health and Ch Paradoxical 6. F Must be counted every time the keys change hands __ Effect Countable 7. G Immediate 911 call required __ Medication Toxicity 8. Mild upset stomach after receiving an antibiotic H __ Tylenol is taken for back pain and the back pain goes 9. Side Effect I __ away of Public Health, Developmental 10. handle Desired Effect J The body stores up more medication than it can __ K Allergic Reaction 11. Multivitamin __ Medication An antibiotic is ordered for bronchitis; after 2 days the chusetts Departments 12. L __ Interaction person is still coughing and has a fever 2017 The Massa 44 Massachusetts | Responsibilities in Action

45 Let’s Review change one or more ways the bo dy works  A medication has the ability to or generic name Medications are known by thei  r brand name and/ Categories of medications are:  ildren and Families Controlled (Schedule VI) o o Countable Controlled (Schedule II-V) o Over-the-Counter (OTC) Medication outcomes include:  desired effect o o no effect noted o side effects  Adverse responses are severe side effects ents have the ability to intera Medications and dietary supplem ct with each  Services, Mental Health and Ch other, alcohol, nicotine, caffeine and certain foods, either in creasing or decreasing the effect of the m edication or dietary supplement o r both  y supplements a person takes th The more medications and dietar e greater the possibility of an interaction ister all medications and diet  ary A HCP order is required to admin supplements ter  You are responsible to learn about the medications you adminis You are responsible to know the r  eason a medication is ordered of Public Health, Developmental chusetts Departments 2017 The Massa 45 Massachusetts | Responsibilities in Action

46 Unit 4 Interacting with a Health Care Provider Responsibilities you will learn  A procedure to help ensure a successful HCP visit  When medication reconciliation is required  The process of taking a telephone order ildren and Families there is a dose  What is required to use an existing supply of medication when change and report result in a HCP visit. There will be Sometimes the changes you observe times when you will go with a person for a particular problem, issue or concern that you, other staff or the person want to heir routine yearly physical discuss with the HCP or for t examination. Services, Mental Health and Ch ation and forms needed A procedure to ensure that you are prepared with all the inform when accompanying a person to a medical appointment is as follo ws: Prepare the Person for the Appointment e and time, when appropriate Tell the person the dat  Discuss what is going  to happen at the visit Follow any instructions ordered to prepare for the visit  o For example Pre-medications ordered prior to the appointment  of Public Health, Developmental Fasting, such as no food or fl uid prior to the appointment  Think About  o Items to keep the person occupied in the Encouraging the person to wear l o oose and comfortable clothing event the HCP needs to physically examine the person sure you have the following: Before leaving the program, make chusetts Departments Person’s insurance card   Copy of current medication sheet s or a list of medications  HCP Encounter/Consult/Order Form The top portion is completed by program staff o  Name of person Date  2017 The Massa  Allergies Reason(s) for visit  PRNs  List of current medication, including dietary supplements and  Name of HCP  Signature of staff pers on completing the form 46 Massachusetts | Responsibilities in Action

47 HEALTH CARE PROVIDER ORDER Name: June 1, yr Date: David Cook Staff Complete Top of Form Allergies: No Known Allergies Health Care Provider: Dr. Black Reason for Visit: ildren and Families David states that he has burning in his throat after eating. Current Medications: ressure Zestril 40 mg by mouth once a day in the morning. Check blood p before administering medication. If systolic reading is less than 100, hold medication and notify HCP. ain. Motrin 400 mg by mouth as needed every 8 hours for right knee p Notify HCP if right knee pain continues for more than 48 hours. Date: June 1, yr Staff Signature: Sam Dowd Services, Mental Health and Ch Health Care Provider Findings: HCP Completes Bottom of Form Medication/Treatment Orders: Instructions: Follow-up visit: Lab work or Tests: of Public Health, Developmental Date: Signature: chusetts Departments Date: Time: Verified by: Date: Time: Posted by: Each department, DDS, DMH and DCF uses standardized forms and/o r tools or the forms used have required informa tion that must be included rela ting to a HCP visit. 2017 The Massa Ask your Supervisor what HCP visit forms are required specific to the people you support. 47 Massachusetts | Responsibilities in Action

48 paperwork, make sure you read it before leaving so you If another staff completes the as needed when you are asked. can tell the HCP why the visit w Make sure you also have: Driving directions   Money for parking, gas, food or drink n case you need to contact someone) Provider on-call information (i   Family/Guardian information ildren and Families  Name of the pharmacy, telephone number and directions  A charged cell phone When You Get to the Appointment  First, check in with the receptionist person you are accompanying Introduce yourself and the o o State the reason that you are there i.e. ‘David Cook has a 2pm Services, Mental Health and Ch appointment to see Dr. Black’ Discuss any accommodations the person may need in the waiting room o During the Appointment Assist the person, if needed  Advocate, encourage participation and support abilities  o Provide HCP Encounter/Consult/Order and other forms to the HCP when asked Provide information o of Public Health, Developmental Communicate the reason for the visit o  t when the person does not speak This is especially importan o so If the person can speak about their health encourage them to d o ou are assisting when the HCP asks Redirect the HCP to the person y o questions so that they may answer whenever possible chusetts Departments  Help the person to answer questions, if needed Ask the HCP for answers to any questions the person or you hav o e o Write down any information tha t is given to you that is not on the forms so that it can be communicated to o thers after the appointment nt including: Recommendations of the Appointme Obtain the Written Results and 2017 The Massa  HCP Encounter/Consult/Order Form o Make sure the HCP’s portion of the form is completed  HCP orders must include:  The 5 rights of medication administration 48 Massachusetts | Responsibilities in Action

49 Person’s name o Medication name o Dose o Frequency o Route o  Allergies HCP findings  ildren and Families Special Instructions, if any  Target signs and symptoms, ins  tructions and/or parameters for PRN medication  HCP signature If there are more than one page of orders, each page o is signed and dated An electronic signature is acceptable o  Date of the order, including the year Services, Mental Health and Ch opic HCP orders are valid for 1 year . In DMH and DCF only, psychotr medication orders must be updated at clinically appropriate int ervals as determined by the prescribing HCP. See MAP Policy Section 13. mptoms and PRN medication orders must incl ude specific target signs and sy instructions for use including w hat to do if the medication is given and is not effective. See MAP Policy Sect ions 06 and 13. of Public Health, Developmental  Prescription o ree before If given a written prescription ensure it and the HCP order ag leaving  Both must include the 5 right s of medication administration chusetts Departments The HCP may o send the prescription by fax or electronic prescription (e-  prescribing) to the pharmacy call the prescription into the pharmacy  give the prescription to   you to bring to the pharmacy 2017 The Massa rmacy, if self-administering  the person to bring to the pha  if the HCP Sample medication may be received from a HCP and administered pharmacy label labels the sample medication with the same information as on a name and writes a HCP order for the samp le medication and includes the HCP’s 49 Massachusetts | Responsibilities in Action

50 h the receptionist, if needed Set up another appointment wit  Prescriptions may not be used in place of a HCP order. See MAP Policy Section 13. ildren and Families After the Medical Appointment  Ensure the pharmacy received the prescription Pick up new medications at the pharmacy or check on when the pharmacy will  deliver the medication  Bring back all forms, any prescriptions, HCP orders, and the next appointment card to give to the appropriate person Services, Mental Health and Ch  Transcribe all medication orders on to the medication administ ration sheet o Post and Verify all orders  Secure the medication  Document the visit  Communicate changes to all staff of Public Health, Developmental chusetts Departments 2017 The Massa 50 Massachusetts | Responsibilities in Action

51 and fill in the blanks. Review the HCP order below HEALTH CARE PROVIDER ORDER Date: June 1, yr Name: David Cook ildren and Families Allergies: No Known Allergies Health Care Provider: Dr. Black Reason for Visit: David states that he has burning in his throat after eating. Current Medications: Zestril 40 mg by mouth once a day in the morning. Check blood p ressure before administering medication. If systolic reading is less than 100, hold Services, Mental Health and Ch medication and notify HCP. ain. Motrin 400 mg by mouth as needed every 8 hours for right knee p Notify HCP if right knee pain continues for more than 48 hours. Date: June 1, yr Staff Signature: Sam Dowd Health Care Provider Findings: Gastroesophageal reflux disease (GERD) Medication/Treatment Orders: of Public Health, Developmental Prilosec 20 mg by mouth once a day before supper Instructions: remain upright 30 minutes after eating Follow-up visit: Lab work or Tests: 1 month None today chusetts Departments Date: June 1, yr Signature: Richard Black, MD Date: Time: Verified by: Posted by: Date: Time: 1. HCP name _____________________ 2017 The Massa _____________________ 2. Reason for visit 3. Staff completing form _____________________ 4. Allergies _____________________ _____________________ 5. HCP findings ______ 6. New medication or dered _______________ _____________________ 7. HCP instructi ons 51 Massachusetts | Responsibilities in Action

52 Tanisha went to the dentist today. an antibiotic. She received a new order for You return to Tanisha’s home with a signed HCP order. Review th e HCP order and complete the following exercise. ildren and Families HEALTH CARE PROVIDER ORDER Feb. 2, yr Date: Name: Tanisha Johnson Health Care Provider: Allergies: Dr. Chen Lee No known medication allergies Reason for Visit: Complaining of soreness in back of mouth. Services, Mental Health and Ch Current Medications: Phenobarbital 64.8mg once daily in the evening by mouth Clonazepam 1mg twice daily at 8am and 4pm by mouth Date: Feb. 2, yr Staff Signature: Sam Dowd Health Care Provider Findings: Inflammation of gum-line on left side of mouth of Public Health, Developmental Medication/Treatment Orders: Amoxil Suspension 500mg every 12 hours for seven days by mouth Instructions: fter 72 complain of mouth soreness a Notify HCP if Tanisha continues to hours. chusetts Departments Lab work or Tests: Follow-up visit: None Feb. 16, yr Date: Feb. 2, yr Signature: Dr. Chen Lee Verified by: Date: Time: Posted by: Date: Time: 2017 The Massa 1. Circle the new medication order. __________________ 2. What is the dose ordered? 3. What is the frequency ordered? __________________ 4. Place a checkmark next to Tanisha’s current medications 5. Does Tanisha have any m edication allergies? _________ 52 Massachusetts | Responsibilities in Action

53 People Who Manage Appointments Independently your responsibilities s independently When a person manages their medical appointment will vary depending on the person. Your responsibilities may include:  Reminding the person of the upcoming appointment date and time order form essary documents, such as a HCP Ensuring the person has all nec  pointment Reviewing with the person w hat needs to be discussed at the ap  ildren and Families Arranging transportation   ain prescription refills Reminding the person to obt new valid orders and prescrip tions, it is If the person does not bring back your responsibility to obtain them. Services, Mental Health and Ch If going to the Emergency Room and/or Hospital  Take the person’s current medication list o insurance card o o HCP Encounter/Consult/Order form Be prepared to tell Emergency Room (ER) and/or hospital staff why you are  bringing the person to the ER and/or hospital.  If you have any concerns about taking the person home (or to work/day program) of Public Health, Developmental your supervisor before after the visit, tell the ER and/ or hospital staff and contact leaving the hospital. chusetts Departments k to the ore the person is discharged bac After a hospital admission, bef program, medication reconciliati on is required. Medication reco nciliation is comparing the hospital discharge orders to the orders prior to admission; any discrepancies must be clarified with the HCP. An ER visit is not considered a hosp ital admission. See MAP Policy Section 13. 2017 The Massa Medication reconciliation ensures new medication ordered during a hospital stay is not omitted when the per son returns home. It also ensures medication that was discontinued during a hospital stay is not administered when the person returns home. 53 Massachusetts | Responsibilities in Action

54 Discharge Orders/Medication Reconciliation (Sample Guide) Medication reconciliation is the process of comparing an individual’s new medication orders to all of the medication orders that were in place prior to the new orders. This must be done during every transition of care (e.g., transferred to/from a health-ca re facility, hospital, nursing home, crisis stabilization unit or rehabilitation center, etc.). Discharge (new) orders from the Health Care facility supersede (take the place of) prior existing orders. Any discrepancies identified must be immediately brought to the attention of the ildren and Families cribing HCP has been notified. prescribing Health Care Provider (HPC). Document that the pres Checklist 1. Before the individual is discharged from the Health Care Fac ility: O btain all HCP orders that were in place prior to the admissio n (from the individual’s home). Obtain the new HCP medication orders being prescribed (using t he Health Care Facility discharge orders.) Services, Mental Health and Ch prior); bear in Compare the medications on the two sets of HCP orders (new and mind the 5 rights. Pay particular attention to dose and/or fre quency changes for medications that appear on both sets of orders. If there are discrepancies between the two sets of orders; rev iew these with the HCP prior to discharge. Be sure to obtain signed, dated, HCP orders. If there is more than one page of HCP orders, each page must be signed and dated by the HCP. Electronic ts. An Health Care Provider signatures are acceptable by the Departmen electronic signature is a signature from a DEA compliant Electr onic Medical Record (EMR) System or an image of the providers’ signature. of Public Health, Developmental een notified by pharmacy has b Obtain any new prescriptions or ensure that the the HCP of any new medication prescriptions. 2. Once the individual has returned home: Notify the Primary Care Physician (PCP), and any other prescri bing HCP, that the individual had a transfer of care. chusetts Departments hanged Notify the PCP, and any other prescribing HCP, of any new or c mitted from the medication/treatment orders or previously ordered medications o Health Care Facility discharge orders. Obtain from the PCP and any other prescribing HCP, orders to r esume any previously scheduled medications /treatments that they want reor dered (and are not on the new Health Care Facility discharge orders). medication from the pharmacy. Obtain any newly prescribed ders and newly Transcribe, Post, and Verify Health Care Facility Discharge Or 2017 The Massa transcribed medications. Communicate the changes to other involved in supporting the individual (e.g., coworkers, supervisor, day program staff, family members, etc.) according to agency policy. 54 Massachusetts | Responsibilities in Action

55 Fax Health Care Provider Orders rders. A fax order is a legal s be used in place of telephone o It is preferred that fax order order. Ask the HCP to fax you a copy of the order (if your agency’s confidentiality policy the person’s permits this) to save time and hel p prevent errors. To protect confidentiality, wait at the fax machine for the transmission. Telephone Health Care Provider Orders ildren and Families HCP orders by telephone are allowed. A telephone order is docu mentation of instructions given by a HCP ove ns may include a newly r the telephone. The instructio ordered medication, a change to an existing medication order, o r a non-medication order such as, to begin monitori . ng a person’s weight every week Telephone orders are sometimes necessary. For example, blood work results become sults the HCP available 3 hours after the HCP appointment. Based on those re determines a new medication or a medication change is needed an d calls to give you a Services, Mental Health and Ch telephone order for th e new medication. When you take a telephone order: on a HCP Telephone Order form Record the order word-for-word   Read back the information given to you by the HCP to confirm you recorded it accurately If you're having trouble underst anding the HCP, ask another st aff to listen in as  you take the order of Public Health, Developmental o then have that staff read it back and sign the order too If you do not know how to spell a spoken word, ask the HCP to  spell it Draw lines through any bl ank spaces in the order  Make sure the HCP signs the original order within 72 hours  e for the You may administer a medication while waiting for the signatur o first 72 hours chusetts Departments aking to, so the HCP Provide the pharmacy contact information to the HCP you are spe orresponds with the telephone or der. Call the pharmacy to will send a prescription that c see if the prescription was re ceived and when the medication wi ll be ready for pick up or when it will be delivered. Telephone orders are post ed and verified twice: First when the order i s initially obtained  2017 The Massa  Again after the HCP has signed the order, ensuring there were no changes 55 Massachusetts | Responsibilities in Action

56 some aff to take a telephone order, Although MAP allows Certified st for allows you to take a visor if the provider you work providers do not. Ask your super e the telephone order forms are telephone order, if so, ask wher kept at your work location. Sample HCP Telephone/Fax Order Form ildren and Families Telephone/Fax: Program address: Time of telephone/fax order: Date of telephone/fax order: Name of person: Allergies : Discontinue: New order: Services, Mental Health and Ch Generic Name: Brand Name: Dose: Frequency: : Route Reason for Medication/Change: of Public Health, Developmental Special Instructions/Precautions ( include instruc on side effects): tions for comm If vital signs are requir ed, list guidelines: Date of next lab work (if any): Physician Name (print): chusetts Departments Physician telephone number: Physician fax number: Date: Staff Signature/Title: Time: Date: Posted by: by: Date: Time: Verified 2017 The Massa Physician Signature: Date: Posted Time: by: Date: Verified by: Date: Time: 56 Massachusetts | Responsibilities in Action

57 Answer the following HCP Telephone Order questions. ________________ 1. Are MAP Certified staff allo wed to take a telephone order? _ r correctly? ou have taken the telephone orde 2. What must you do to ensure y ildren and Families _____________________ __________________________________________ _ 3. A telephone order must be si gned by the HCP within how many hours? _______ 4. May this medication be adminis tered before the HCP signs the order? ________ Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 57 | Responsibilities in Action Massachusetts

58 Exhausting a Current Supply of Medication If there is a new order to c hange the dose or frequency of a medication a person is currently on, it is acceptable to exhaust (use) the current supply of medication until the ections change sticker may on ly be used for a maximum new prescription is filled. A dir of 30 days. You must verify wit h the pharmacist that the suppl y of medication on hand may be used according to the new prescription directions. In a ddition, the following must be in place: ildren and Families  A new HCP order reflecting the change sheet The old order will be marked as discontinued on the medication o The new order is transcribed on to a medication sheet o The medication strength on hand allows for easy administration  o For Example:  A 10mg dose is increased to a 20mg dose  ‘directions change’ sticker The medication container has a A brightly colored sticker may s change be used in place of a direction o sticker Services, Mental Health and Ch The sticker is placed close to but does not cover the pharmacy  label directions of Public Health, Developmental chusetts Departments 2017 The Massa 58 Massachusetts | Responsibilities in Action

59 If you see a ‘directions change’ or brightly colored sticker on a medication container, you will know there is a new HCP order. This means the information between the new HCP order and the information on the old pharma cy label will not licy Section 13. agree until a new label is applie d by the pharmacy. See MAP Po ildren and Families ned, the pharmacy label must refle When the next refill is obtai ct the new HCP order. Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 59 Massachusetts | Responsibilities in Action

60 Let’s Review  Preparation before a HCP visi t will help to ensure a successful appointment During a HCP appointment make sure  o appointment and/or you advocate , as The person participates in the ildren and Families needed New HCP orders o  edication administration include the 5 rights of m  are signed and dated by the HCP  electronic HCP signatures are acceptable agree with prescriptions written  if a paper prescription is obtained  o the HCP sent new prescriptions or prescription refill requests to the correct Services, Mental Health and Ch pharmacy dications are obtained from the pharmacy After the appointment ensure me o  bring back new it without your help and does not If a person attends a HCP vis tain them t is your responsibility to ob valid orders and prescriptions, i Prescriptions may not be used in place of a HCP order   Changes are communicated to all staff involved in the person’s care al admission Basic information needed for an emergency room visit or hospit  reason for visit o of Public Health, Developmental o current medication list insurance card o HCP Encounter/Consult/Order form o e a hospital discharge is required Medication reconciliation befor  ed instead of telephone orders  Fax orders are preferr o Telephone orders chusetts Departments  must be posted and verified twice  may be administered without the HCP signature for 72 hours  HCP within 72 hours must be signed by the A current supply of medication may be exhausted if there is a  dose change and the strength of the tablet a llows for easy administration n a medication If you see a ‘directions change’ or brightly colored sticker o  2017 The Massa container, you will know there is a new HCP order and you canno t rely on the information printed on the pharmacy label. 60 Massachusetts | Responsibilities in Action

61 Unit 5 Obtaining, Storing and Securing Medication Responsibilities you will learn order and a prescription The difference between a HCP   What you do if the medication lo oks different from the last time it was obtained ildren and Families  n not in use Where the medication storage keys are kept when in use and whe  How to access the back-up set of medication keys Obtaining Medication A HCP order is required to admin ister medications and dietary s upplements to people ed programs. If there u may not administer the living at MAP register is no HCP order yo medication. Services, Mental Health and Ch The HCP order is a set of inst ructions, from the HCP to the staff at the program, instructing the staff what medi cation the person is to receive and how it is to be administered. by the HCP for every medication A prescription must be written ordered; this includes upplements. A controlled, countable controlled , OTC medications and dietary s macist, instructing the ructions, from the HCP to the phar prescription is a set of inst pharmacist what medication to p repare and how it is to be admin istered to the person. t a pharmacy label. on on the prescription to prin The pharmacist uses the informati of Public Health, Developmental send the prescription to the ph There are many ways the HCP can armacy, such as:  E-prescribe Fax   Telephone chusetts Departments written for (if A paper prescription can be hand  ed to you or the person it is self-administering), to bring to the pharmacy. the brand name of the medication on the order and the Typically, the HCP will write medication. upply the generic form of the prescription. The pharmacy will s To ensure that the HCP order and pharmacy label agree, if the p harmacy supplies the generic form of the medication, the label must also include the brand name. 2017 The Massa he brand name medication that is circled. The generic Review the HCP order and note t medication is substitued by the pharmacy. The corresponding pharmacy label has both the generic and brand names circled. 61 Massachusetts | Responsibilities in Action

62 HEALTH CARE PROVIDER ORDER David Cook Date: June 1, yr Name: No Known Allergies Allergies: Health Care Provider: Dr. Black Reason for Visit: David states that he has burning in his throat after eating. ildren and Families Current Medications: ressure Zestril 40 mg by mouth once a day in the morning. Check blood p before administering medication. If systolic reading is less than 100, hold medication and notify HCP. Motrin 400 mg by mouth as needed every 8 hours for right knee p ain. Notify HCP if right knee pain continues for more than 48 hours. June 1, yr Date: Staff Signature: Sam Dowd Services, Mental Health and Ch Health Care Provider Findings: Gastroesophageal reflux disease (GERD) Medication/Treatment Orders: Prilosec 20 mg by mouth once a day before supper Instructions: remain upright 30 minutes after eating Follow-up visit: Lab work or Tests: of Public Health, Developmental None today 1 month June 1, yr Date: Signature: Richard Black, MD Posted by: Verified by: Date: Time: Date: Time: chusetts Departments 222-3434 Rx#174 Greenleaf Pharmacy 111- 20 Main Street 6/1/yr Treetop, MA 00000 David Cook Omeprazole 20 mg Qty. 30 IC Prilosec 2017 The Massa Take one tablet by mouth once a day before supper Dr. Black Lot# 1436 ED: 6/1/yr Refills: 2 62 Massachusetts | Responsibilities in Action

63 y, no medication and writes “brand onl If the HCP orders a brand name tion, the pharmacist will prepare the brand name substitutions” on the prescrip medication and not the generic form. Once the HCP orders a medicati on, the expectation is, the perso n will receive the ildren and Families t be a system in place to ensure the medication is medication as ordered. There mus obtained from the pharmacy in a timely manner. For example:  eceived. Once You must contact the pharmacy to ensure the prescription was r the medication has been prepar ed by the pharmacy, you must o pick up the medication at the pharmacy or o ication to confirm a date and time that the pharmacy will deliver the med the program Services, Mental Health and Ch Every program must have a method the pharmacy. for obtaining medication from For example: edication from the pharmacy You pick up new or refilled m   illed medication to the home The pharmacy delivers new or ref  The pharmacy supplies automatic refills of Public Health, Developmental used to obtain medication from the Ask your Supervisor what method is pharmacy at your work location. chusetts Departments If a new medication is ordered by the HCP and there is a delay in obtaining the medication from the pharmacy for any reason, such as when prior authorization is , if guardian consent is requir ed or if an needed from an insurance company 2017 The Massa antipsychotic medication prescri bed requires court approval und er a Rogers Decision; you must contact the HCP immediately and obtain orders stating what should be done until the medication is obtained. 63 Massachusetts | Responsibilities in Action

64 ed to decrease symptoms of mental illness. Antipsychotic medications are us These medications cause side effects. In November 1983, the Massachusetts Supreme Judicial Court issued a decision that is called the ‘Rogers Decision’. This gave persons who take antipsychotic medications ildren and Families these medications and new rights. These rights help pr otect them from the overuse of are limited to a required maximum daily dose that a HCP can ord er. Ask your Supervisor if there are HCP orders for antipsychotic medications Services, Mental Health and Ch at your work location. requiring a Rogers Decision of Public Health, Developmental chusetts Departments 2017 The Massa 64 Massachusetts | Responsibilities in Action

65 Pharmacy Label Requirements rmacy may be packaged in a plas tic container, bottle Medication received from the pha or tamper resistant package, such as a blister pack. Whatever t he packaging, it must be labeled by the pharmacy. The pharmacy label must contain the following information: 1. Prescription Rx number (Rx is an abbreviation for medical pr escriptions. It is ildren and Families used to obtain refills.) 2. Pharmacy name 3. Pharmacy telephone number (It is used to contact the pharmac y or a pharmacist.) 4. Name of the person 5. Date the medication was dispensed 6. Name of the medication a. Generic Services, Mental Health and Ch b. Brand 7. Strength of medication supplied ach tablet, capsule (how much medication is in e or mL supplied) 8. Total amount of medication dispensed (# of tablets, capsules or mLs in the container) 9. Amount of tablets, capsules or mLs to be administered 10.Route to administer the medication 11.Frequency to administer the medication of Public Health, Developmental 12.Special instructions 13.The HCP’s name 14.Lot number* (used to track medication in the event a medica tion is recalled or taken off the market f or safety reasons) 15.Expiration date (the last dat e the medication may be admini stered). Typically, the words, expirati Exp. Examples of ED or on date are abbreviated on a label as chusetts Departments other words that may be printed on a pharmacy label instead of ‘expiration ed to, ‘Discard After’ or ‘Use date’, include but are not limit By’ followed by the date. may be obtained 16.Number of refills (how many remaining times the medication from the pharmacy) 2017 The Massa 65 Massachusetts | Responsibilities in Action

66 mbered below with the corresponding nu Number the pharmacy label items (1-16) pharmacy label requirement s listed on the previous page. Rx # C201 111-222-3434 Greenleaf Pharmacy ildren and Families 20 Main Street 3/4/yr Tr eetop, MA 00000 David Cook 50mg Tramadol Qty. 21 IC Ultram Services, Mental Health and Ch Take by mouth every 8 hours fo r 7 days 1 tablet Take with water Dr. Black Lot # 776-5433 ED: 3/4/yr Refills: 0 of Public Health, Developmental recalls on the news, if you do, contact the *Often you learn about medication sts’ pharmacy with the medication lot number and follow the pharmaci chusetts Departments recommendations. 2017 The Massa 66 Massachusetts | Responsibilities in Action

67 Answer the following questions by choosing the best response. 1. The expiration date on a pharmacy label is the A. ___ Date the pharmacy las t filled the prescription ildren and Families B. ___ Date the prescription was purchased at the pharmacy C. ___ Last date the medication may be administered D. ___ Last date to call in a refill 2. The Rx # (number) is used to obtain a A. ___ New HCP order B. ___ Renewal of the prescription C. ___ Medication refill ibed medication D. ___ Newly prescr Services, Mental Health and Ch 3. There is a 7 day supply of medication available for a person ; you need what information to refill this medi it runs out? cation before A. ___ Lot # B. ___ Generic name C. ___ Expiration date D. ___ Rx # of Public Health, Developmental 4. The pharmacy phone number can be used for many reasons. Che ck all that apply: A. ___ Determine when a medicati on will be delivered to the program B. ___ Call in refills will be available for pick up C. ___ Determine when a medication D. ___ Ask about possible medication interactions and/or side e ffects chusetts Departments hand may be used with a change in a E. ___ Ask if the st rength of tablet on medication order 2017 The Massa Remember, it is your responsibil ity to learn about a medication before you administer it. The pharmacist and the medication information sh eet are both excellent resources for medication information. 67 Massachusetts | Responsibilities in Action

68 Ensuring the Pharmacy Provides the Correct Medication armacy has supplied the ortant responsibilitie One of your most imp s is to ensure the ph medication as ordered by the HCP . As soon as the medication is obtained, compare the der; both must agree. pharmacy label to the HCP or s, the pharmacy will purchase th e same medication from Look at the medication. At time es; depending on the pharmaceut ical company used, different pharmaceutical compani the same medication might look different. If the medication is different in color, shape, ildren and Families size or markings from the las t time it was filled you must cont act the MAP Consultant before administering it. allow the correct dose to If the strength of the tablet supplied by the pharmacy will not st return the medication to the pharmacy to obtain the correct be administered you mu cy provides 50 mg is 75mg and the pharma ple, the dose ordered strength. For exam tablets. ntal Services, Mental Health and Ch the Some pharmacy labels include a de scription of the medication on and compare it to the description of the medication container. If included, read the medication in the container. Also, you must check the strengt h of tablet supplied; it may have changed from the last time the medication was obtained. of Public Health, Developme A person has a HCP order for t pharmacy opiramate 100mg twice daily. The chusetts Departments h instructions to give 4 had been supplying topiramate 25mg tablet (round and white) wit tablets twice daily. When the fo obtained, the pharmacy llowing month’s refill was supplied topiramate 100mg tablet (round and pink), with instructions to give 1 tablet twice daily. t read the label closely to see the strength and 1. What could happen if you did no 2017 The Massa amount had changed? ___________________________ _____________ ections changing, what is differ ent about the 2. In addition to the label dir _____________ ________________________ appearance of the tablet? ___ 68 Responsibilities in Action | Massachusetts

69 When the pharmacy label direction s change, for example, a diffe rent strength tablet was supplied; the current t ranscription on the medication sheet must be marked cription was rewritten to ref lect the pharmacy label through to indicate that the trans changes. See example below: Start ildren and Families 30 21 8 27 26 25 c Lisinopril 24 23 22 Generi 9 10 28 31 29 11 12 13 14 15 Hour 1 2 3 4 5 6 7 20 19 18 17 16 r 8/31/y AS WS WS JC Brand Zestril 8am 30mg Dose 10mg Strength Amoun t 3 tabs Route mouth Stop Cont. Frequency Daily in the morning high BP Special instructions: Reason: 18 19 20 21 22 23 24 25 26 27 28 29 Generic 31 Lisinopril 30 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Start Zestril 8am X X X X 8/31/yr Brand Strength Dose 30mg 30mg Stop 1 tab mouth Route t Amoun Services, Mental Health and Ch Daily in the morning Frequency Cont. high BP Special instructions: Reason: Tracking Medication After medication has been obtain ed from the pharmacy it must be documented as in a record of when a cked. All programs must mainta received into the program and tra by the pharmacy; this is prescription is filled and the quantity of medication dispensed of Public Health, Developmental Ordering and Receiving Log. Medi cations are also documented using a Medication documented and tracked using: Pharmacy receipts  Count Book  Medication sheets  chusetts Departments Medication release documents such as  Leave of Absence (LOA) form o when medication is administe red away from a program  o Transfer Form  when medication is moved from one location to another Disposal record  2017 The Massa 69 Responsibilities in Action | Massachusetts

70 Medication Storage and Security quid and refrigerated orage requirements, including li The following are medication st medication: All medication is locked  Countable medication must be  double locked o ildren and Families a lock within a lock  o packaged in tamper resistant packaging , the liquid countable medication must be packaged so that once used o se a multi-dose bottle of a liquid countable container is empty; you may not u medication  er in Some liquid countable medication is packaged by the manufactur the specific dose ordered; if not the pharmacy must prepare a sing  le dose of liquid countable Services, Mental Health and Ch syringe and close with a tamper medication into an oral dosing resistant seal. of Public Health, Developmental  Only items required for medicati on administration may be store d in the locked medication area Medication must remain in the original, labeled, packaging rec  eived from the pharmacy Each person should have their  own medication storage container with their name chusetts Departments taken by other d be separated from medication Medication taken by mouth shoul  being administered by routes; this will help decrease the possibility of a medication the wrong route The medication storage/preparati  on area should have minimal distractions; this will istration help you to remain focused whil e preparing medication for admin Store medication away from  2017 The Massa uch as household cleaners food and/or toxic substances s o o excessive heat, moisture and/or light; these factors can resul t in the medication becoming less effective 70 Massachusetts | Responsibilities in Action

71 re stored at Ask your Supervisor where medica tions requiring refrigeration a your work location. ildren and Families The medication storage keys must be carried by you if you are a ssigned medication administration duties for the shift. There must also be a back-up set of keys accessed through contact with adm inistrative staff in the event there is an issue with the first set. See MAP Policy Section 10. For example: Services, Mental Health and Ch There are two combination locke  d boxes located in the program o Each ‘box’ contains a set of medication keys st  ified staff in the program The combination to the 1 box is known only to MAP Cert nd known only to administrative staff box is The combination to the 2  st In the event there is an issue with the 1  set of keys inistrative staff for the combination o MAP Certified staff calls the adm The combination must be changed a taff o fterwards by administrative s of Public Health, Developmental Ask your Supervisor how you acce ss the backup set of keys at y our work location, if needed. chusetts Departments 2017 The Massa 71 Massachusetts | Responsibilities in Action

72 Let’s Review  A HCP order is required to admin ister all medication and dieta ry supplements ietary  on for each medication and/or d The HCP must write a prescripti supplement ordered ildren and Families The pharmacist uses the prescr iption to prepare and label med ication   macy Medication must remain in the packaging received from the phar You must compare what is rece  ived from the pharmacy ensuring i t agrees with what the HCP ordered  When medication is received from the pharmacy, you must check the color, shape, size and/or markings of the medication; if different from the last time it was obtained a MAP Consultant must be contacted Check to see if the strength of the tablet received changed fr  om the last refill Services, Mental Health and Ch  All medications must be locked All countable medications must be  o double locked in tamper resistant packaging o tracked o o counted  ain on the person assigned medication Medication storage keys must rem s for the shift administration dutie of Public Health, Developmental tive staff through contact with administra Back up keys are accessed only  chusetts Departments 2017 The Massa 72 Massachusetts | Responsibilities in Action

73 Unit 6 Recording Information Responsibilities you will learn  The purpose of a medication sheet How to transcribe information from a HCP order and pharmacy la bel onto a  ildren and Families medication sheet Acceptable abbreviations for use on a medication sheet   How to “Post and Verify” a HCP order To transcribe is to copy information from one document and record it onto another document, the completed document is a . When a HCP order is written transcription the pharmacy, the information from the HCP order and and medication is obtained from heet. (copied) onto a medication s pharmacy label must be transcribed Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 73 Massachusetts | Responsibilities in Action

74 HEALTH CARE PROVIDER ORDER March 3, yr David Cook Name: Date: Health Care Provider: No Known Allergies Allergies: Dr. Black Label Pharmacy Reason for Visit: days, David states his ‘head hurts’ and he has had a runny nose for 2 Greenleaf Pharmacy 111-222 -3434 Rx # 156 temperature is 100.3 20 Main Street Treetop, MA 09111 3/3/yr Current Medications: Amoxil 500mg three times daily for 10 days by mouth David Cook Also, see attached medication list. Erythromycin 333mg ildren and Families IC EES Take 2 Qty.60 Staff Signature: Date: March 3, yr tablets by mouth three times daily for 10 days Kay Mathers Dr. Black Health Care Provider Findings: Refills: 0 Lot # 14239 ED: 3/3/yr Sinus infection Medication/Treatment Orders: DC Amoxil EES 666mg three times daily for 10 days by mouth Instructions: han 48 hours Call HCP if temperature remains elevated above 100.3 for more t Follow-up visit: Lab work or Tests: None today March 3, yr Date: Signature: Richard Black, MD Services, Mental Health and Ch Verified by: Date: Time : Posted by: Date: Time: MEDICATION ADMINISTRATION SHEET Month and Year: month yr Al lergies: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour Start Generic Brand Strength Dose Route Amount Stop Frequency Special instructions: Reason: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Start Generic Brand of Public Health, Developmental Dose Strength Stop Route Amount Frequency Special instructions: Reason: 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Start Generic Brand Dose Strength Route Amount Stop Frequency Special instructions: Reason: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour Generic Start chusetts Departments Brand Strength Dose Stop Route Amount Frequency Reason: Special instructions: CODES Signature Signature Name: DP-day program/day hab LOA-leave of absence Site: P-packaged W-work H-hospital, nursing home, rehab center S-school 2017 The Massa Accuracy Check 1 __________________ Date ___________ Time __________ Accuracy Check 2 __________________ Date __________ Time __________ To transcribe a new medication using the HCP order, the pharmacy order, you will be label and the medication sheet. 74 Massachusetts | Responsibilities in Action

75 Abbreviations are many abbreviations rm of a word or phrase. There An abbreviation is a shortened fo on however there are only a few abbreviations you are used in the health care professi allowed to use in a MAP program . When transcribing onto a medi cation sheet, the following abbreviations ar e acceptable for use:  Cont.- continue ildren and Families  DC - discontinue  am - morning pm - afternoon or evening   cap - capsule tab - tablet   gm - gram IU - international unit  mcg - microgram  Services, Mental Health and Ch  mg - milligram  mL - milliliter  PRN - as needed True (T) or False (F) of Public Health, Developmental 1. ___ Only acceptable abbreviations may be used on the medicat ion sheet reviations their own list of acceptable abb 2. ___ Each program may create ning ndicate either afternoon or eve 3. ___ The abbreviation pm can i for milligram is mL 4. ___ The abbreviation 5. ___ PRN is the abbrev iation for as needed chusetts Departments The Medication Book A medication book typically contains: 2017 The Massa  Emergency Fact Sheets (EFS) HCP Orders   Medication Sheets  Medication Information Sheets 75 Massachusetts | Responsibilities in Action

76 Medication Sheets All HCP medication orders mus t be transcribed onto a medication sheet. The medication sheet is a document which tracks the administration of medications, for each monthly basis. person who has medication order ed. This is typically done on a als on the medication Each time you administer a medication, you will sign your initi sheet, documenting you have admini stered the medication as orde red. At the end of each month, the completed medica tion sheets are removed from th e medication book ildren and Families and the new month’s medication s nth’s medication heets are inserted; the past mo sheets are kept and filed. ication administration Other terms used for a medication sheet include: med sheet, med sheet, medication administration record (MAR) and/or medication log. MEDICATION ADMINISTRATION SHEET Al lergies: Month and Year: month yr Services, Mental Health and Ch Start 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic Brand Dose Strength Route t Amoun Stop Frequency Sp ecial instructions: Reason: 1 2 3 4 5 6 7 8 9 Start Generic Hour 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Strength Dose Route t Amoun Stop Frequency Reason: Sp ecial instructions: 1 2 3 4 5 6 7 8 9 Start Generic 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour of Public Health, Developmental Brand Strength Dose t Stop Amoun Route Frequency Sp ecial instructions: Reason: 1 2 3 4 5 6 7 8 9 Hour 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Generic Start Brand Strength Dose Route Stop Amoun t chusetts Departments Frequency Sp ecial instructions: Reason: Signature CODES Signature DP-day program/day hab Name: LOA-leave of absence Site: P-packaged W-work H-hospital, nursing home, rehab center S-school 2017 The Massa __________ Accuracy Check 1 __________________ Date ___________ Time __________ Accuracy Check 2 __________________ Date __________ Time 76 Massachusetts | Responsibilities in Action

77 the Medication Sheet A Detailed View of The top of the medication sheet includes the: current month and year and   allergies Al lergies: Month and Year: month yr MEDICATION ADMINISTRATION SHEET 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic Start Brand ildren and Families Dose Strength Amoun t Route Stop Frequency sheet has an area to write: The left side of the medication Generic and brand medication names   Strength of the medication  Amount of medication to administer Services, Mental Health and Ch  Frequency or how often the medication is to be administered Dose of the medication   Route by which the medication is to be administered  Start date Stop date  Brand names Generic and MEDICATION ADMINISTRATION SHEET Month and Year: month yr Al lergies: of Public Health, Developmental 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 6 7 Start Generic 5 4 3 2 1 Hour Brand Strength Dose Route Amoun t Stop Frequency chusetts Departments Dose Strength Route Amount Frequency 2017 The Massa 77 Massachusetts | Responsibilities in Action

78 Start and Stop Dates e the person receives the first dose of a medication. Start dates A start date is the dat person has been receiving a medication without any are used to monitor how long a changes to the HCP order. If a person has been receiving a medi cation for a long time, ears old. without the HCP order changing, the start date may be several y A stop date is used to i dentify the date when: medication is administered; such as an antibiotic  The last dose of a time limited ildren and Families that is administered for only 7 days or ongoing basis, the If the medication is not time limited and wil l be given on an  ‘cont.’ (continue). stop date is documented as Start date Al lergies: Month and Year: month yr MEDICATION ADMINISTRATION SHEET 1 2 3 4 5 6 7 8 9 Start Generic Hour 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Strength Dose Services, Mental Health and Ch t Stop Amoun Route Frequency Stop date of Public Health, Developmental chusetts Departments 2017 The Massa 78 Massachusetts | Responsibilities in Action

79 Medication Grid The right side of the medication sheet is called the ‘grid’; each box in the grid is a ‘medication box’. The medication box is where you will documen t your initials after means you have nitials in a medication box administering a medication. Your i administered the medication as ordered. the numbers 1-31; these are the days of the month. Across the top of the grid are hen the medication is to be in the hour column to indicate w Specific times will be written ildren and Families administered. (as noted in the HCP order) and/or any special The reason for the medication instructions are written, under the medication grid. Days of the month Medication box Hour column Month and Year: month, yr MEDICATION ADMINISTRATION SHEET Allergies: no known 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic Start Brand Services, Mental Health and Ch Strength Dose Route t Amoun Stop Frequency Reason: Special instructions: Reason the medication is prescribed rs for use of the medication Special instructions or paramete of Public Health, Developmental chusetts Departments 2017 The Massa 79 Responsibilities in Action Massachusetts |

80 The bottom of the medication sheet includes the:  Person’s name  Address List of acceptable ‘codes’ for use on the medication sheet  Signature list  o signature list Each staff administering medications must initial and sign the ill only need to ls with their full name. You w as a way to identify their initia initial and sign the si er a medication gnature list the first time you administ ildren and Families located on the medication sheet.  Accuracy Checks o Before the start of a new month 2 staff (preferably together) check the new ccuracy using the HCP orders and month’s medication sheets for a pharmacy labels. Also review the current month’s l  medication sheets to ensure al transcriptions were copied ont o the new medication sheets. Staff signature Acceptable codes Name and address Staff initials Services, Mental Health and Ch Signature Signature CODES DP-day program/day hab Name: LOA-leave of absence Site: P-packaged W-work H-hospital, nursing home, rehab center S-school Accuracy Check 1 __________________ Date ___________ Time __________ Accuracy Check 2 __________________ Date __________ Time __________ of Public Health, Developmental 2 1 check Accuracy check Accuracy Acceptable Codes on a Medication Sheet  DP-day program/day hab  OA-leave of absence L chusetts Departments  P -packaged (used when a person packs their own pill organizer under staff supervision as part of a learning to self-administer medication program) W-work  H-hospital, nursing home, rehab center   S-school 2017 The Massa Only acceptable codes may be us ed on the medication sheet to id entify ed at a location other than the person’s home or if the when a medication is administer person is learning to self-adm inister their medication. 80 Massachusetts | Responsibilities in Action

81 dication Sheet: Transcription Recorded Information on a Me Before you are able to administe r a medication, the information from the HCP order and ibed onto the medication shee the pharmacy label must be transcr t. The following information must be transcribed onto the medicati on sheet: 1. The month and year 2. The person’s name ildren and Families 3. Any known allergies or if none, write ‘none’ or ‘no known allergies’ 4. Generic medication name 5. Brand medication name 6. Dose of the medication (copied from the HCP order) opied from the pharmacy label) 7. Strength of the medication (c 8. Amount to be administered (copied from the pharmacy label) on is to be administered 9. Frequency the medicati to be administered by 10.Route the medication is Services, Mental Health and Ch 11.Start date 12.Stop date ons or parameters for use 13.Any special instructi 14.Reason for the medication of Public Health, Developmental The allergy information on a medication sheet must be completed. Whether he allergy section on the medica tion sheet must be or not a person has allergies t completed so that HCP’s and other staff will know this section was not overlooked. chusetts Departments 2017 The Massa 81 Massachusetts | Responsibilities in Action

82 vious page the medication sheet of the term on the pre Write the number on numbers 1-14. to be transcribed, listed as that corresponds with information Month and Year: month, yr MEDICATION ADMINISTRATION SHEET Al lergies: Start Hour 1 2 3 4 5 6 7 8 9 Generic 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand ildren and Families Strength Dose Route Amount Stop Frequency ecial instructions: Sp Reason: 1 2 3 4 5 6 7 8 9 Hour Generic Start 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Dose Strength Route Stop Amoun t Frequency Sp ecial instructions: Reason: Start Generic Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Strength Dose Services, Mental Health and Ch Route Stop Amoun t Frequency Reason: ecial instructions: Sp 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic Start Brand Dose Strength Stop Amoun t Route Frequency ecial instructions: Reason: Sp CODES Signature Signature DP-day program/day hab Name: LOA-leave of absence P-packaged Site: of Public Health, Developmental W-work H-hospital, nursing home, rehab center S-school Accuracy Check 2 ______________ Date_______ Ti Accuracy Check 1______________ Date_______ Time________ me________ chusetts Departments 2017 The Massa 82 Massachusetts | Responsibilities in Action

83 Depending on the pharmacy used at your work location, you may s ee sheets’. Pharmacy generated medication sheets have ‘pharmacy generated medication all of the information from the HCP order and the pharmacy labe l already recorded on it by the pharmacy. ildren and Families are still responsible If your program uses pharmacy generated medication sheets, you for verifying that all informati on is accurate by comparing the HCP order and the ication sheet. ed on the pharmacy generated med pharmacy label to what is print are part way through When pharmacy generated medication sheets are utilized, if you scribe the new HCP the month and a new HCP order is written, you will need to tran heet and cannot rely order onto a blank space on t he pharmacy generated medication s on the pharmacy to complete the pr ocess. See MAP Policy Section 13. Services, Mental Health and Ch Frequency ‘Frequency’ and the word ‘time’ HCPs will not order an are used interchangeably. Most medication but instead will order actual time to administer the how many times per day ered or the time between doses, for example: a medication is to be administ Twice daily   Three times daily Once daily before bedtime  of Public Health, Developmental Three times daily after meals   Every 6 hours  Every 12 hours PRN every 12 hours  chusetts Departments HCP orders are written this way so that specific medication adm inistration times may be chosen by your program based on a person’s daily schedule. Time s will vary from program to program or person to a medication person. Each program must have administration time schedule. In general, unless otherwise ind icated by the HCP, medication dose times should t. be scheduled at least 4 hours apar 2017 The Massa Ask your supervisor what the medication administration time schedule is specific to your work location. 83 Massachusetts | Responsibilities in Action

84 HCP orders for ‘once daily’ medi ed to include which portion cations must be further clarifi d be administered, such as: of the day the medication shoul Once daily in the am (morning)  Once daily after lunch   Once daily before bedtime noon or evening) Once daily in the pm (after  ildren and Families cations are given at an appropria te time of day. For This ensures ‘once daily’ medi ause sleepiness. Administering a medication that example, some medications may c ng is a safer option than administering it in the may cause sleepiness in the eveni morning. Except for medications ordered P tten underneath the RN, a specific time must be wri word “Hour” in the hour column use references to time , on the medication sheet. Do not such as breakfast, lunch, dinner or bedtime. Services, Mental Health and Ch When writing times in the hour column, it is important to write the time in the appropriate hour box. It is best practice to wri te ‘am’ times in the top tw o boxes and ‘pm’ times in the bottom two boxes. Four times daily PRN every 12 hours Three times daily ce daily Once daily at 4pm Twi Hour Hour Hour Hour Hour 8am 8am 8am P 12pm R 4pm 4pm 4pm N of Public Health, Developmental 8pm 8pm 8pm For example: Sally’s HCP writes an order for Depakote 250 mg daily at bedtim e by mouth. Sally's chusetts Departments anscribing the HCP order, remember that you must typical bedtime is 9 pm. When tr ation time. The time is document assign the medication administr ed in the hour column on the medication admin istration record. In this example 9 pm is documented in the preferred bedtime using the bot tom ‘pm’ hour box. hour column to indicate Sally’s Hour 2017 The Massa 9pm 84 Massachusetts | Responsibilities in Action

85 r Depakote 500 mg daily at bedti 1. Tim’s HCP writes an order fo me by mouth. You will be transcribing the HCP order. Tim's typical bedtime is 10pm. Document the using the appropriate hour box. time chosen in the hour column ildren and Families Hour for Omeprazole 20 mg daily thir 2. Andrew’s HCP writes an order ty minutes before be transcribing the HCP order. A ndrew's typical breakfast by mouth. You will lumn using the breakfast time is 8 am. Document the time chosen in the hour co Services, Mental Health and Ch appropriate hour box. Hour of Public Health, Developmental at a specific time, Occasionally, the HCP may want a medication to be administered ill order the specific time, such as: when this is the case, the HCP w Once daily at 4pm  Twice daily at 8am and 8pm  specific time, the specific time When the HCP order indicates a written in the HCP order chusetts Departments is transcribed in the hour colum n on the medication sheet. 2017 The Massa 85 Massachusetts | Responsibilities in Action

86 mouth. You will r Aspirin 81mg daily at 4pm by 1. Kevin’s HCP writes an order fo Document the time in the be transcribing the order. hour column using the appropriate hour box. Hour ildren and Families ily, at 8am and 2. Mary Alice’s HCP writes an order for Depakote 250mg twice da anscribing the order. 8pm by mouth. You will be tr Document the times in the hour column using the appr opriate hour boxes. Services, Mental Health and Ch Hour is an exception when transcrib ing in the hour Remember, medication ordered PRN of Public Health, Developmental column. chusetts Departments RN headache 1. Joe’s HCP writes an order for Tylenol 650mg every 6 hours P by mouth. You will be transcribing the order. What will you d ocument in the hour column? Hour 2017 The Massa 86 Massachusetts | Responsibilities in Action

87 Match the term(s) to the corresponding definition. Used when a person is not home when the medication is 1. Start Date A scheduled to be given or if the person is learning to self- __ administer their medication ildren and Families Special Placed in a medication box to indicate you have administered 2. B __ the medication as ordered Instructions Hour Column C The days of the month 3. __ Numbers 1-31 4. D Why the medication was ordered __ The date the person is scheduled to receive the first dose of a Reason 5. E __ medication Services, Mental Health and Ch Location of the specific time a medication is to be Stop Date 6. F __ administered Guidelines or parameters specific to administration of the Staff Initials 7. G __ medication The date when the last dose of a time limited medication is Acceptable scheduled to be administered or if given continuously listed 8. H __ Codes as ‘cont.’ of Public Health, Developmental chusetts Departments 2017 The Massa 87 Massachusetts | Responsibilities in Action

88 Transcribing a New HCP Order When transcribing a new HCP order onto the medication sheet, al ways start with the first order written. Complete each new order without skipping o rders in the process; this orders are transcribed. will help to ensure all HCP, orders have been written a nd medication David Cook has been seen by the obtained from the pharmacy; and the date is March 3rd, yr. at 1 pm. Review the the information from the HCP order and pharmacy label following demonstration of how ildren and Families is transcribed onto medication sheet. HEALTH CARE PROVIDER ORDER Date: David Cook March 3, yr Name: Allergies: No Known Allergies Health Care Provider: Dr. Black Services, Mental Health and Ch Reason for Visit: days, David states his ‘head hurts’ and he has had a runny nose for 2 temperature is 100.3 Current Medications: Amoxil 500mg three times daily for 10 days by mouth Also, see attached medication list. Date: March 3, yr Staff Signature: of Public Health, Developmental Sam Dowd Health Care Provider Findings: Sinus infection Medication/Treatment Orders: DC Amoxil EES 666mg three times daily for 10 days by mouth chusetts Departments Instructions: han 48 Call HCP if temperature remains elevated above 100.3 for more t hours Follow-up visit: Lab work or Tests: None today 2017 The Massa March 3, yr Date: Signature: Richard Black, MD Date: Time: Verified by: Date: Time: Posted by: 88 Massachusetts | Responsibilities in Action

89 The first HCP order written states “DC Amoxil”. Discontinuing a Medication ree step process: on the medication sheet is a th Discontinuing (DC) a medication 1. Cross out all open boxes on t he medication sheet, next to wh ere the medication or a straight line may be used. is scheduled to be given; xxxxx’s ildren and Families MEDICATION ADMINISTRATION SHEET A llergies: none Month and Year: March, yr Amoxicillin 23 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Start 22 Generic 24 25 26 27 28 29 30 31 21 SW SW A S Amoxil 2/28/yr 8 am Brand X XXX X X X X X X X X X X X X X X X X X Strength 250mg Dose 500mg Stop Amoun t 2 tabs Route mouth 4pm TM JS X X XXX X X X X X X X X X X X X X X X X X 3/10/yr Frequency Three times daily 8pm TM JS X XXX X X X X X X X X X X X X X X X X X X Special instructions: for 10 days Reason: sinus infection Services, Mental Health and Ch 2. Draw a diagonal line through the left side, written portion, of the medication sheet and document: DC, the date and your initials. MEDICATION ADMINISTRATION SHEET A llergies: none Month and Year: March, yr Start Generic 11 Hour 1 2 3 4 5 6 7 8 9 10 Amoxicillin 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 DC 3/3/yr SD SW SW A S Brand Amoxil 2/28/yr 8 am X X X X X X X XXX X X X X X X X X X X X Dose 500mg 250mg Strength Amoun t 2 tabs Route mouth 4pm TM Stop JS X XXX X X X X X X X X X X X X X X X X X X 3/10/yr Frequency Three times daily 8pm TM JS X X X X XXX X X X X X X X X X X X X X X X sinus infection Special instructions: for 10 days Reason: of Public Health, Developmental 3. Draw a diagonal line through t he right side, grid section, o f the medication sheet and document: DC, the date and your initials. Month and Year: March, yr MEDICATION ADMINISTRATION SHEET A llergies: none chusetts Departments Start Generic Amoxicillin 20 30 29 28 21 31 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 27 22 23 24 25 26 DC 3/3/yr SD SW SW A S 8 am 2/28/yr Amoxil Brand X X X X XXX X X X X X X X X X X X X X X Strength 250mg Dose 500mg DC 3/3/yr SD TM Stop Amoun t 2 tabs Route mouth 4pm JS X XXX X X X X X X X X X X X X X X X X X X Frequency Three times daily 8pm TM 3/10/yr JS X X XXX X X X X X X X X X X X X X X X X X sinus infection Special instructions: for 10 days Reason: 2017 The Massa 89 Massachusetts | Responsibilities in Action

90 The next order you transcribe is the new medication, EES. HEALTH CARE PROVIDER ORDER Name: David Cook Date: March 3, yr Allergies: No Known Allergies Health Care Provider: Dr. Black ildren and Families Reason for Visit: David states his ‘head hurts’ and he has had a runny nose for 2 days, temperature is 100.3 Current Medications: Amoxil 500mg three times daily for 10 days by mouth Also, see attached complete medication list. Date: March 3, yr Staff Signature: Services, Mental Health and Ch Sam Dowd Health Care Provider Findings: Sinus infection Medication/Treatment Orders: √ DC Amoxil EES 666mg three times daily for 10 days by mouth Instructions: han 48 Call HCP if temperature remains elevated above 100.3 for more t of Public Health, Developmental hours Follow-up visit: Lab work or Tests: None today March 3, yr Date: Signature: Richard Black, MD chusetts Departments Verified by: Date: Time: Posted by: Date: Time: Rx # 156 2-3434 Greenleaf Pharmacy 111-22 20 Main Street 3/3/yr Treetop, MA 09111 David Cook 2017 The Massa Generic Erythromycin 333mg Brand IC EES Qty.60 ee times daily for 10 days Take 2 tablets by mouth thr Dr. Black Refills: 0 /yr ED: 3/3 Lot # 14239 90 Responsibilities in Action | Massachusetts

91 When transcribing information onto the medication sheet it is important to dose from the HCP order and s understand that you must copy the trength and amount must be copied from the pharmacy label. word dose on the The dose is copied from the HCP order and is copied next to the ildren and Families medication sheet. HEALTH CARE PROVIDER ORDER March 3, yr Date: David Cook Name: Allergies: No Known Health Care Provider: Dr. Black Allergies Reason for Visit: s’ and he has had a runny David states his ‘head hurt nose for 2 days, temperature is 100.3 Services, Mental Health and Ch Current Medications: Amoxil 500mg three times daily for 10 days by mouth Also, see attached complete medication list. March 3, yr Date: Staff Signature: Sam Dowd Health Care Provider Findings: Sinus infection Medication/Treatment Orders: √ DC Amoxil of Public Health, Developmental s daily for 10 days by mouth Start EES 666mg three time Follow-up visit: Lab work or Tests: None today Date: March 3, yr Signature: Richard Black, MD Date: Time Posted by: Date: Time: Verified by: chusetts Departments 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic Start Brand Dose 666mg Strength t Route Stop Amoun Frequency Special instructions: Reason: 2017 The Massa 91 Massachusetts | Responsibilities in Action

92 The strength and amount are copied from the pharmacy label. The strength on a pharmacy label is usually next to or underneath the name of the medication, and is copied next to the word strength on the medication sheet. Greenleaf Pharm acy 111-22 2-3434 Rx # 156 20 Main Street 3/3/yr Treetop, MA 09111 ildren and Families David Cook Erythromycin 333mg IC EES Qty.60 ee times daily for 10 days Take 2 tablets by mouth thr Dr. Black Refills: 0 Lot # 14239 ED: 3/3 /yr 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 Start Generic Hour Brand Services, Mental Health and Ch Dose 666mg Strength 333mg Stop Amoun Route t Frequency Reason: Special instructions: in the label directions and i s copied next to the word The amount on a pharmacy label is amount on the medication sheet. 2-3434 acy 111-22 Greenleaf Pharm Rx # 156 20 Main Street of Public Health, Developmental Treetop, MA 09111 3/3/yr David Cook Erythromycin 333mg Qty.60 IC EES ee times daily for 10 days Take 2 tablets by mouth thr Dr. Black Refills: 0 /yr ED: 3/3 Lot # 14239 chusetts Departments Start Hour 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Generic 1 2 3 4 5 6 7 8 9 Brand Strength 333mg Dose 666mg Route Amoun Stop t 2 tabs Frequency 2017 The Massa Special instructions: Reason: 92 Massachusetts | Responsibilities in Action

93 The medication name(s), frequency, route and any special instru ctions or parameters rder and/or the pharmacy label and copied onto the for use may be found on the HCP o left side of the medication sheet. Generic Erythromycin Start Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand EES Dose 333m 666mg g Strength Route 2 tabs t Amoun Stop mouth ildren and Families Frequency Three times daily for 10 days Reason: Sinus infection Special instructions: If the medication name on the HCP order is written as a ation then only generic medication and the pharmacy supplies the generic medic  Services, Mental Health and Ch the generic name of the d onto the medication is required to be transcribe medication sheet brand name medication and the HCP itutions” on the writes “brand only, no subst  prescription, the pharmacist will prepare the br and name medication and not the generic form. In this situation there will only be a brand nam e listed on the (as listed on the HCP orde r and pharmacy pharmacy label. Only the brand name label) will be transcribed onto the medication sheet. To complete the grid , follow these steps: of Public Health, Developmental Assign times in the hour column ; times assigned should be at l east 4 hours apart  o For David, the HCP ordered the frequency as Three times a day for 10 days.  4pm and he hour column; 8am, Three ‘times’ are chosen and written in t o 8pm are examples of times often chosen. chusetts Departments 2017 The Massa 93 Massachusetts | Responsibilities in Action

94 Think about the date and time to determine when the first dose can be  administered o at 1pm: time, March 3, yr For David, based on the date and rd rd  The March 3 8am dose cannot be administered. The March 3 8am medication box is crossed (X ) out; as are all boxes before it. rd at 4pm, this  administered March 3 The medication can be boxes before it are crossed (X) medication box is left open and all out. ildren and Families rd administered March 3  The medication can be at 8pm, this medication box is left open and all boxes before it are crossed (X) out. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Erythromycin Generic Start Brand EES 8am X X X 666mg Dose g 333m Strength Route t 2 tabs 4pm Amoun Stop mouth X X Three times daily Frequency 8pm Services, Mental Health and Ch X X Special instructions: Sinus infection Reason: for 10 days Next, be administered for a certain  If the medication is ordered to number of days, the days must be counted o For David, the HCP ordered the medication to be administered f or 10 days 4pm and 8pm), ten medication For each scheduled time (8am,  boxes are counted and left open; the remaining medication boxes of Public Health, Developmental are crossed (X) out.  Write the “start” and “stop” dates: o A start date is the date the first dose is scheduled to be administered o A stop date is the date the la st dose is scheduled to be administered Start Erythromycin 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Generic chusetts Departments 3/3/yr Brand EES 8am X X X X X X X X X X X X X X X X X X X X X 666mg Dose g 333m Strength Route 2 tabs t Amoun mouth 4pm Stop X X X X X X X X X X X X X X X X X X X X X Frequency 3/13/yr 8pm Three times daily X X X X X X X X X X X X X X X X X X X X X Special instructions: Sinus infection Reason: for 10 days 2017 The Massa 94 Massachusetts | Responsibilities in Action

95 This is the completed transcrip tion of David Cook’s HCP order and pharmacy label onto tion sheet: a medica MEDICATION ADMINISTRATION SHEET Month and Year: March, yr lergies: none Al Start Generic 25 30 Amoxicillin Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 31 26 27 28 29 SW SW AS Amoxil 8am Brand 2/28/yr X XXX X X X X X X X X X X X X X X X X X DC 3/3/yr SD Strength 250mg Dose 500mg DC 3/3 /yr SD LW JS Amoun t 2 tabs Route mouth 4pm Stop XXX X X X X X X X X X X X X X X X X X X X LW JS 3/10/yr Three times daily 8pm Frequency XXX X X X X X X X X X X X X X X X X X X X ildren and Families Sp ecial instructions: for 10 da ys Reason: Sinus infection Generic Erythromycin 14 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 Start 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 3/3/yr EES 8am Brand X X X XXX X X X X X X X X X X X X X X X Strength 333mg Dose 666mg mouth 4pm Stop Amoun t 2 tabs Route X X X X XXX X X X X X X X X X X X X X X 3/13/yr 8pm Three times daily Frequency X XXX X X X X X X X X X X X X X X X X X ecial instructions: for 10 da ys Reason: Sinus infection Sp Generic Hour 1 2 3 4 5 6 7 8 9 10 11 12 14 Start 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 13 Brand Strength Dose Amoun t Route Stop Frequency Sp ecial instructions: Reason: Services, Mental Health and Ch 13 15 Hour 1 2 3 4 5 6 7 8 9 10 11 12 Start 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Generic Brand Strength Dose Amoun Route Stop t Frequency Reason: Sp ecial instructions: Signature CODES Signature SD Name: David Cook DP-day program/day hab Sam Dowd LOA-leave of absence AS Amanda Smith Site: 45 Shade Street LW P-packaged Linda White SW Serena Wilson W-work H-hospital, nursing home, rehab center JS Jenna Sherman S-school of Public Health, Developmental Linda White Date 2/28/yr Time 8pm Accuracy Check 2 Jenna Sherman Date 2/28/yr Time 8pm Accuracy Check 1 chusetts Departments 2017 The Massa 95 | Massachusetts Responsibilities in Action

96 questions. iption and answer the following Review the completed EES transcr 1. What is the date and time of the first scheduled dose of EES ? ____________ ________ _____________________ 2. What is the “start date”? _____________ ildren and Families the last scheduled dose of EES? ____________ 3. What is the date and time of e”? ________________ 4. What is the “stop dat _______ ___________________ 5. What is the frequency? ______________________ _______________ ______ tion is scheduled to be adminis 6. What are the times the medica tered? _______ _________ ____________________ new medication? dose of the 7. What is the Services, Mental Health and Ch ___________________ amount to adm ________ 8. What is the inister? _______ ____________ he tablet suppl ied? _______________ 9. What is the strength of t of Public Health, Developmental If anything about an existing HCP order changes (frequency, dose, parameters HCP order must be to be a new HCP order. The old for use etc.), it is considered heet and the new HCP order transcribed. See MAP discontinued on the medication s Policy Section 13. chusetts Departments Posting and Verifying CP order is Posted and After a HCP order is transcribed onto a medication sheet, the H Verified. Posting and Verifying is completed by two Certified a nd/or licensed staff. The first staff who transcribes the HCP order onto the medication sheet, places a check must be done for each mark, on the HCP order, near the order being transcribed; this order as it is transcribed onto the medication sheet. Posting i s documentation of the 2017 The Massa staff who completed the transcription. 96 Massachusetts | Responsibilities in Action

97 bed, the first staff documents: After all orders are transcri “Posted”  on the HCP order form o o under the HCP’s signature  Date  Time Staff signature  ildren and Families aff must review the transcript To verify an order, the second st ion completed by the first s accurately and pharmacy label information wa staff, ensuring the HCP order transcribed onto the medication sheet. The second staff documents: “Verified”  on the HCP order form o o under the HCP’s signature Services, Mental Health and Ch  Date Time  Staff signature  ensure all medication orders are transcribed accurately Posting and verifying helps to onto medication sheets so that medi dered. cation is administered as or of Public Health, Developmental All HCP orders must be posted and verified including when the H CP notes, ‘no new orders’ or ‘no medication changes’. chusetts Departments he medication is If two Certified and/or licensed staff are not available when t tion and posts the HCP staff completes the transcrip due to be administered, the first 2017 The Massa order. After posting, the medication may be administered. The next staff on duty must verify the order befor e administering any further doses. See MA P Policy Section 13. 97 Massachusetts | Responsibilities in Action

98 that once the medication is r eceived from the Telephone orders are different in d twice: orders are post ed and verifie pharmacy, after transcribing, the s initially obtained First when the order i   Again after the HCP has signed the order, ensuring there were no changes ildren and Families sted and verified under the HCP s ignature. Note the HCP order has been po HEALTH CARE PROVIDER ORDER David Cook Name: March 3, yr Date: Allergies: No Known Allergies Health Care Provider: Dr. Black Services, Mental Health and Ch Reason for Visit: days, David states his ‘head hurts’ and he has had a runny nose for 2 temperature is 100.3 Current Medications: Amoxil 500mg three times daily for 10 days by mouth Also, see attached complete medication list. Date: March 3, yr Staff Signature: of Public Health, Developmental Sam Dowd Health Care Provider Findings: Sinus infection Medication/Treatment Orders: DC Amoxil √ chusetts Departments EES 666mg three times daily for 10 days by mouth √ Instructions: han 48 Call HCP if temperature remains elevated above 100.3 for more t hours Lab work or Tests: Follow-up visit: None today 2017 The Massa Date: March 3, yr Signature: Richard Black, MD Posted by: Sam Dowd Date: 3/3/yr Time: 1:15pm Verified by: Linda White Date: 3/3/yr Time: 2pm 98 Massachusetts | Responsibilities in Action

99 medication has Tanisha has returned from a HCP appointment and been time is 1pm. Use the obtained from the pharmacy. The date is February 5th, yr. The e new orders. cation sheet to transcribe th HCP order, pharmacy label and medi on. fter completing the transcripti Remember to post the HCP order a ildren and Families HEALTH CARE PROVIDER ORDER Date: Name: Tanisha Johnson Feb. 5, yr Health Care Provider: Allergies: No known medication allergies Dr. Chen Lee Reason for Visit: Services, Mental Health and Ch Continues to complain of soreness in back of mouth Current Medications: Phenobarbital 64.8mg once daily in the evening by mouth Clonazepam 1mg twice daily at 8am and 4pm by mouth Amoxil Suspension 500mg every 12 hours for seven days by mouth Staff Signature: Date: Feb. 5, yr Sam Dowd Health Care Provider Findings: of Public Health, Developmental Increased inflammation of gum-line on left side of mouth Medication/Treatment Orders: DC Amoxil Suspension by mouth Cleocin HCL 300mg three times a day for 10 days Instructions: Notify HCP if Tanisha continues to complain of mouth soreness a fter 72 chusetts Departments hours. Follow-up visit: Lab work or Tests: February 16, yr None Signature: Date: Feb. 5, yr Dr. Chen Lee 2017 The Massa Date: Time: Verified by: Posted by: Date: Time: 99 | Responsibilities in Action Massachusetts

100 Greenleaf Pharmacy 111-222-3434 Rx #178 20 Main Street Treetop, MA 00000 2/5/yr Tanisha Johnson Qty. 90 Clindamycin 100mg IC Cleocin HCL Take 3 tablets by mouth 3 times a day for 10 days ildren and Families Take with 8 ounces of water Dr. Lee Lot# 352 ED: 2/5/yr Refills: 0 Allergies: none MEDICATION ADMINISTRATION SHEET Month and Year: February, yr Generic Phenobarbital 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Start Services, Mental Health and Ch 8/31/yr Brand Luminal Dose 64.8mg Strength 32.4mg Stop Route mouth t 2 tabs Amoun TMTM TM Cont. Frequency Once daily in evening 8pm JS Reason: ecial instructions: Sp seizures Start Generic Clonazepam Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 KM KM KM AS AS 8am 8/31/yr Brand Klonopin Strength 1mg Dose 1mg TMTM TM 4pm Stop JS t 1 tab Amoun Route mouth Cont. Frequency Twice daily 8am and 4pm Reason: seizures Sp ecial instructions: 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Amoxicillin suspension Start Generic KM KM AS 2/2/yr Brand Amoxil suspension 8am X X X X X X X X X X X X X X X X X X X X X X X X Strength 250mg/5mL Dose 500mg of Public Health, Developmental Route mouth Amoun Stop t 10mL TM TM 8pm 2/9/yr Frequency every 12 hours for 7 days JS X X X X X X X X X X X X X X X X X X X X X X X X Reason: Sp gum inflammation ecial instructions: Generic Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Start Brand Strength Dose Route Amoun Stop t Frequency Sp Reason: ecial instructions: chusetts Departments Signature Signature CODES JC John Craig Name: Tanisha Johnson DP-day program/day hab KM Kay Mathers LOA-leave of absence AS Amanda Smith Site: 45 Shade Street TM P-packaged ller Timo thy Mi Treetop MA 00000 SW Serena Wilson W-work H-hospital, nursing home, rehab center JS Jenna Sherman SD S-school Sam Dowd Accuracy Check 2 Date 1/31/yr Time 9pm Date 1/31/yr Time 9pm John Craig Accuracy Check 1 Sam Dowd 2017 The Massa 100 Massachusetts | Responsibilities in Action

101 Answer the following questions b y choosing the best response. n the signature list of a 1. Sam Dowd has written his initials and signed his full name o person’s medication sheet. This is done ildren and Families A. __ every time he administers a medication ame y his initials with his full n B. __ once each month to identif C. __ at the beginning of each shift isters a PRN medication D. __ only when he admin ion sheet. This a medication box on the medicat 2. Sam Dowd documented “DP”, in indicates that the person A. __ received their daily pills Services, Mental Health and Ch B. __ refused all afternoon medications when the medication was due C. __ was at the day program D. __ is at a doctor’s appointment and is unable to take medic ation 3. When transcribing the dose onto the medication sheet A. __ copy it from the pharmacy label B. __ multiply the am ount sent by the pharmacy C. __ look at the HCP order to find the dose of Public Health, Developmental D. __ divide the strength of t he tablet by the amount to give 4. The start date for a medication the medication was ordered A. __ will always be the date B. __ is located on the HCP order chusetts Departments C. __ is the date a person re ceives the first scheduled dose D. __ is listed on the pharmacy label 5. The allergy information on a medication sheet A. __ only needs to be filled in if a person has an allergy none” B. __ must be completed; if t he person has no allergies list “ 2017 The Massa C. __ must be written in red, h ighlighted and in itialed by the supervisor D. __ can be written under special instructions 101 Massachusetts | Responsibilities in Action

102 new month’s Before the start of each new month, two staff must review the that all HCP orders are medication sheets for accuracy. Accuracy checks help to ensure sheets. Both staff signs the bottom of the transcribed onto the new month’s medication orrect. new medication sheet(s) indicati ng that they are complete and c ildren and Families Medication Information Sheets The last section of the medication book typically contains the medication information sheets. Medication information sheets can be obtained from the pharmacy, printed from can be found packaged with the medication as an insert. a reputable online resource or t be available for each medic A medication information sheet mus ation ordered for a person. Remember you must learn about a medication before administering it. Services, Mental Health and Ch Let’s Review t used to track the administrat A medication sheet is a documen  ion of a person’s medication  The HCP order and pharmacy label a scription re needed to complete a tran The dose is copied from the HCP order o of Public Health, Developmental o opied from the pharmacy label The strength and amount are c  A specific time must be transcr ibed in the hour column on the medication sheet son is scheduled to receive th The start date is the date a per e first dose of a  medication last dose of a  The stop date is the date a person is scheduled to receive the medication chusetts Departments Transcriptions must be completed accurately to ensure safe med  ication administration  All HCP orders must be posted and verified to ensure HCP order s are accurately transcribed onto the medication sheet ers or o be posted and verified even if no new ord All HCP orders must medication changes have been written. This is documentation that staff 2017 The Massa are aware that no changes have been made.  Accuracy checks must be complet ed, by two staff, prior to the start of the new month’s medication sheets ation resource  Medication information sheets are a valuable medication inform 102 Massachusetts | Responsibilities in Action

103 Unit 7 Administering Medications Responsibilities you will learn  medications ly scheduled and as needed (PRN) The difference between regular  The medication administration process How to use liquid medica tion measuring devices  ildren and Families tered  How to manage various scenarios i f a medication is not adminis It is important to know the differe nce between which medication s you will administer regularly and which medications you will administ er only if nee ded. Regularly us health conditions stered due to vario scheduled medications are ordered and admini ally taken every day at high cholesterol. They are typic such as high blood pressure or routine time(s) in order to work as intended. Services, Mental Health and Ch However, other medications are ordered and are only administered as needed for specific health issues if they occur such as chest pain, season al allergies, cold symptoms or constipation. These medications are only administe red on an ‘as needed’ or ‘PRN’ basis. Regularly Scheduled Medications Regularly scheduled medi cations are administe red routinely, on a continuing basis. of Public Health, Developmental For Example: Colace 100mg twice daily by mouth In the example, the medication will be administered twice daily at two specific times, as listed under the hour column on the medication sheet. Generic Docusate Sodium Start Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 AS WS WS JC Colace Brand 8/31/yr 8am chusetts Departments Dose 100mg Strength 100mg t Stop Amoun mouth Route 1 tab KM KM SD 8pm SD Twice daily Cont. Frequency Reason: Special instructions: constipation 2017 The Massa When data collection is required , such as vital for medication administration signs or bowel tracking, the data must be recorded on the medic ation sheet, above or below the medication to be administered. 103 Massachusetts | Responsibilities in Action

104 Review the medication sheet. What is the data being recorded? _______ 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 20 21 22 23 1 2 3 4 5 6 7 8 9 Start Generic Hour AS WS WS JC Check blood pressure (BP) 8am 8/31/yr Brand 134 130 132 120 BP Dose Strength /64 /66 /62 /60 Stop Amount Route ildren and Families Frequency Cont. Daily in the morning Reason: lood pressure (BP) reading is below 100 and notify Hold Zestril if systolic (top) b Special instructions: HCP 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 20 21 22 23 1 2 3 4 5 6 7 8 9 Hour Start Generic Lisinopril AS WS WS JC 8am 8/31/yr Brand Zestril 40mg Dose 20mg Strength mouth Route Amount Stop 2 tabs Cont. Frequency Daily in the morning Hold Zestril if systolic (top) b HCP Reason: Special instructions: lood pressure (BP) reading is below 100 and notify high BP Services, Mental Health and Ch PRN Medications Medications that are administered only ‘as needed d abbreviated as ’ are known an ‘PRN’. In addition to including nistration, PRN medication the 5 rights of medication admi the following details: orders must also include  symptoms for use such as The specific target signs and o complaint of ‘headache’ no bowel movement in 3 days o of Public Health, Developmental o complaint of right knee discomfort  Measurable objective criteria, if needed, such as head slapping for more than 5 minutes o o seizure lasting more than 1 minute temperature of 101 or more o chusetts Departments  A PRN frequency How many hours apart the doses may be administered such as o  ‘every 8 hours PRN’ or  how many hours apart the PRN dose may be given to a regularly scheduled dose of the same medication, such as  ‘Do not giv e within 4 hours of a regularly scheduled dose’ 2017 The Massa  Parameters for use o How many doses of medication may be administered before the HC P must be notified such as  ‘If 4 doses are administered within 24 hours, notify the HCP’ What to do if the medication is administered and is not effect ive such as o 104 Massachusetts | Responsibilities in Action

105 s after onger than 2 hour ‘If complaints of right knee pain continues l  PRN medication is adminis tered, notify the HCP’ A PRN medication may and only be administered for the target signs symptoms ordered by the HCP. ildren and Families PRN medication orders must incl ude specific target signs and s ymptoms and instructions for use including w hat to do if the medication is given and is not effective. See MAP Policy Sections 06 and 13. Services, Mental Health and Ch For example, Tanisha has an order for: rd Milk of Magnesia 1200mg by mouth PRN every 3 evening if no bowel movement (BM). Contact HCP if no BM by the next morning. On the medication sheet under the hour column you will see the abbreviation ‘PRN’. Specific to this example, to follo w the order as written, BM data must be cross referenced; this includes during day program or work hours. You will look for the BM data documented on the medication sheet to determine whether or not the medication of Public Health, Developmental must be administered. entered (which includes day pr ogram data), Based on the bowel data tracking th chusetts Departments ? _________ does the Milk of Magnesia require of the 5 administration on the evening Start Generic Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Monitor and record number 6/1/yr Brand 7-3 of bowel movements (BM) 0 1 0 0 0 3-11 Dose Strength 1 1 0 0 0 Route 11-7 Stop Amount 0 0 0 0 0 Every shift Frequency Cont. Special instructions: Reason: Check daily Monday-Friday with day program and record 2017 The Massa 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Magnesium hydroxide Generic Start Brand P Milk of Magnesia 6/1/yr Strength 400mg/5mL Dose 1200mg R N mouth Stop Amount 15mL Route rd PRN every 3 evening Frequency Cont. if no BM Contact HCP if no bowel movement by the next morning. Constipation Reason: Special instructions: 105 Massachusetts | Responsibilities in Action

106 A PRN medication is documented on a medication sheet by in the same medication box dministered, writing your initials a nd the time a  across from the medication administered, o  under the correct date. o If the medication is administe red in the morning, use one of t he top two medication grid boxes on the medication sheet. or evening (as ordered in the o If administered in the afternoon example ildren and Families above); document using one of the tw o bottom medication grid bo xes. ng medication progress note including You will also write a correspondi  o the date and time o medication and dose administered o the reason administered o your signature After enough time has passed, typically 1 hour after administr ation,  esponse to the medication document the results and/or r Services, Mental Health and Ch  Use a new line in the progress notes, if needed Example of PRN medication documentation: Ibuprofen Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Generic Start Motrin 8/31/yr Brand P Strength 400mg Dose 400mg R 3pm Stop t mouth Route Amoun 1 tab N AS Every 8 hours as needed Frequency Cont. for complaint of right knee pain. Notify HCP if pain continues right knee pain Reason: Special instructions: after 48 hours of Public Health, Developmental Name David Cook MEDICATION P ROGRESS NOTE March, yr Not Given Refused Given Other Reason Results and/or Response (for giving/not Staff Signature Time Medication Date Dose chusetts Departments giving) 400mg 3pm Ibuprofen 3/1/yr X Amanda Smith David states, ‘m y right knee hurts’. 3/1/yr 4pm Amanda Smith At 4pm David says, ‘It still hurts to bend my knee.’ 2017 The Massa 106 Responsibilities in Action | Massachusetts

107 Review the HCP order for David Cook and answer the questions. Health Care Provider Order ildren and Families Motrin 400mg every 8 hours as n right knee pain eeded by mouth for complaints of inue for more than 48 hours. Notify HCP if symptoms cont tion? ___________ 1. Is the Motrin ordered as a regularly scheduled or PRN medica 2. What is the reason the medication is _____________ ordered? ______________ Services, Mental Health and Ch a headache? ______ the Motrin if he complains of 3. Are you allowed to administer 4. If administered at 9am; wha administered again? __ t is the earliest time it may be 5. If the medication has been adm urs and David still inistered as ordered for 48 ho ___________ complains of right knee pai n, what should you do? _____________ of Public Health, Developmental chusetts Departments 2017 The Massa 107 Massachusetts | Responsibilities in Action

108 cation Administration The 5 Rights of Medi minister medication are administered safely, each time you ad To ensure medications administration betw 5 rights of medication you will compare the een the HCP order, the tion administration are on sheet. The 5 rights of medica pharmacy label and the medicati the: Right Person  ildren and Families  Right Medication  Right Dose  Right Time  Right Route Right Person To be sure you have the right per son the person’s name on the HCP order, the Services, Mental Health and Ch on sheet must agree. If you are pharmacy label and the medicati not sure who the person is never ask their name as a way of identification, such as ‘Are you David pond. Cook?’ The reason is because, someone other than David may res Know that you can identify the right person by  o Asking a staff who is familiar with the person or o Looking at a current picture of the person itten on the HCP order, Once you identify the right person, locate the person’s name wr he pharmacy label and the person’ the person’s name printed on t s name transcribed on of Public Health, Developmental tact a MAP Consultant. the medication sheet. If the names are different, you will con organized to include a person’s Many times medication books are chusetts Departments Emergency Fact Sheet, which incl at can be used to udes a picture of the person th identify the right person; followed by the HCP order, medication sheet and medication information sheet. 2017 The Massa 108 Massachusetts | Responsibilities in Action

109 Nickname Name Dave David Cook Current Address 45 Shade Street, Treetop MA 00000 Former Address 25 Smith Street, Oldtown MA 00000 D.O.B. Age* Height* Weight* Build Hair Eyes Race Sex 52 6’1” 196 Bl Br M Cauc 3-15-64 Distinguishing Marks Mole on right shoulder ildren and Families Legal Competency Status Presumed Competent If Legal Guardian, Name Phone NA Address Work Phone Family Address (if different) 25 Smith Street 617-000-0000 Oldtown MA 00000 Services, Mental Health and Ch Training / Work Program Phone Address Amercare Services 617-000-0000 eet Treetop MA 00000 13 Main Str ation: (Allergies, Medication s, etc.) Relevant Emergency Medical Inform Allergies-none Diagnoses-High blood pressure, ost Down Syndrome, Sleep Apnea and Constipation eoarthritis right knee, GERD, Address Phone Physician’s Name 617-000-0000 Dr. Richard Black 504 Lyman Street, Treetop MA 00000 Language / Communication A bility to protect self w/o assistance Speaks and understands English Minimal ability to read and write yes Significant Behavior Characteristics Likely Response To Search Efforts of Public Health, Developmental none good Places Frequented Pattern of Movement (if lost previously) Preferences: Limitations: Relevant Capabilities: Enjoys riding on buses Independent with ADLs Probable Dress* chusetts Departments Where and When the person was last seen Date* Time* Emergency Contacts DDS FAMILY / GUARDIAN David Cook, Sr. (father) Sky Johnson, Service Coordinator RESIDENCE Linda White, Program Manager ge, height, and weight which must be recorded at all times on t he form. Note: Asterisked (*) items are left blank on the original and filled in on copy if and when the individual is lost. Except a 2017 The Massa A NAME REA COMMONWEALTH OF MASSACHUSETTS Anywhere Area Office David Cook RECORD LOCATION EMERGENCY 45 Shade Street FACT SHEET Treetop MA 00000 109 Massachusetts | Responsibilities in Action

110 Right Medication To be sure you have the right med ication, the medication name on the HCP order, the pharmacy label and the medicati on sheet must agree. Read each medication name to as a brand and a generic ensure it matches letter for le tter. Each medication usually h name.  Know that when identifying the right medication ildren and Families o l typically be ritten on the HCP order, it wil if a brand name medication is w substituted by the pharmacy wit h the generic medication. You will see  o the brand name on the HCP order o both the brand and generic names on the pharmacy label both the brand and ge o neric names on the medication sheet Once you identify the right medication, locate the medication n ame(s) written on the printed on the pharmacy label and the medication HCP order, the medication name(s) Services, Mental Health and Ch names are different, cation sheet. If the medication name(s) transcribed on the medi you will contact a MAP Consultant. of Public Health, Developmental chusetts Departments 2017 The Massa 110 Massachusetts | Responsibilities in Action

111 Compare the 5 rights between t he HCP order and the pharmacy label. Do the 5 rights agree? ___ If no, why ________ ____________________ _____________ HEALTH CARE PROVIDER ORDER Scott Green Name: Date: March 3, yr ildren and Families No Known Allergies Allergies: Health Care Provider: Dr. Glass Reason for Visit: Annual physical exam Current Medications: See attached medication list. Services, Mental Health and Ch Date: March 3, yr Staff Signature: Tom Salowsky Health Care Provider Findings: Start aspirin as preventive measure secondary to diabetes Medication/Treatment Orders: Aspirin EC 81mg by mouth once daily in the morning of Public Health, Developmental Instructions: Follow-up visit: Lab work or Tests: CMP and CBC March 3, yr Date: Signature: chusetts Departments Shirley Glass MD 111-222-3434 Greenleaf Pharmacy Rx #555 20 Main Street Treetop, MA 00000 3/3/yr Scott Green 2017 The Massa Qty. 30 Aspirin 81mg Take 1 tablet by mouth once daily in the morning Dr. Glass Lot# 777 ED: 3/3/yr Refills: 5 111 Massachusetts | Responsibilities in Action

112 Right Dose To be sure you have the right dose, the dose written on the HCP order, the pharmacy medication the HCP label and the medication sheet m ust agree. The dose is how much each time it is scheduled to be administered. orders the person to receive Know that when identifying the right dose you will see the  dose on the HCP order o ildren and Families written in milligrams, ‘mg’. The number is most often  o strength of the tablet and the amount of tablets to administer on the pharmacy label on the medication sheet dose, strength and amount o The dose ordered by the HCP will equal the strengt h of a tablet, multiplied by the amount to administer, as printed in the pharmacy label directio ns. tion you will notice the stren As you begin to administer medica gth of the tablet supplied by the pharmacy can be Services, Mental Health and Ch  the same as the dose ordered or ster will equal the  iplied by the amount to admini a different number and when mult dose ordered. of Public Health, Developmental chusetts Departments 2017 The Massa 112 Massachusetts | Responsibilities in Action

113 Dose = Strength X Amount se of a medication. The HCP orders the do Health Care Provider Order Name: Date: Allergies: Health Care Provider: Reason for Visit: Current Medications: ildren and Families Staff Signature: Date: Dose ordered is 100mg Health Care Provider Findings: Medication/Treatment Orders: Instructions: Lab work or Tests: Follow-up visit: Signature: Date: Services, Mental Health and Ch The pharmacy supplies the strengt h of the tablet and label directions for the amount to give to equal the dose ordered. The strength supplied and the amount to give can change; the dose ordered remains the same. Dose Strength Amount 100mg = of Public Health, Developmental 4 tablets 25mg 25mg 25mg 25mg = 100mg chusetts Departments tablets 50mg 50mg 2 = 100mg 1 tablet 100mg 2017 The Massa = 100mg 200mg, ½ tablet tablet ½ 113 | Massachusetts Responsibilities in Action

114 of the tablet Review the dose of medication ordered by the HCP, the strength capsule(s) to adm n the amount of tablet(s) or supplied by the pharmacy and fill i inister ed in the pharmacy label direction you would expect to see print s. ildren and Families Dose Strength Amount 100mg 50mg tablet 150mg 75mg tablet 500mg 250mg capsule 375mg 125mg tablet Services, Mental Health and Ch 500mg capsule 500mg 4mg 1mg tablet 10mg 2mg tablet 30mg capsule 60mg 300/100mg tablet 600/200mg of Public Health, Developmental 25mg 12.5mg tablet 25mg tablet 12.5mg chusetts Departments Once you identify the right dose, locate the dose written on th e HCP order, the strength of the tablet and the amount to a acy label and the dose, dminister printed on the pharm strength and amount transcribed on the medication sheet. If the dose does not agree, you will contact a MA P Consultant. 2017 The Massa 114 Massachusetts | Responsibilities in Action

115 Right Time me, the time written on the HCP order, the pharmacy To be sure you have the right ti label and medication sheet must agree. The words frequency and time are used interchangeably.  Know that when identifying the right time the HCP will order how many times throughout a day a medication is to be o ildren and Families administered. pharmacy label directions will include the frequency o o equency as ordered by the HCP medication sheet includes the fr and The specific times chosen are wr the itten under the hour column on  medication sheet. in the HCP order, the , locate the frequency written Once you identify the right time cribed on the label and the frequency trans frequency printed on the pharmacy medication sheet. If the frequencies are different, you will c ontact a MAP Consultant. Services, Mental Health and Ch All medications must be administered ‘on time’. On time is defined as one hour column on the medication she et up to one hour after before the time chosen in the hour the time chosen in the hour col umn on the medication sheet. If you are unsure, contact a MAP Consultant. Right Route of Public Health, Developmental To be sure you have the right rout e, the route wr itten on the H CP order, the pharmacy medication enters the ust agree. The route is the way label and the medication sheet m body. Know that the  chusetts Departments HCP order will in o clude the route pharmacy label directions o will include the route o medication sheet will include the route Once you identify the right route, the HCP order, the route locate the route written in the route transcribed on the medication sheet. If the printed on the pharmacy label and 2017 The Massa routes are different, you wil l contact a MAP Consultant. Medication administer ed orally (by mouth) is the focus of this training. If a person is unable to take medications by mouth or if the medication is not available in oral form 115 Massachusetts | Responsibilities in Action

116 other routes. Other (tablets, capsules, liquids), medications can enter the body by routes include, but are not limited to: Route Definition Buccal P laced in the cheek ildren and Families Enteral Administration into the stomach or intestines Admini Intramuscular stration in a muscle Intravenous Administration in a vein Nasal Administration in the nose h, usually into the stomac Administration th Nasogastric rough the nose and through a tube Services, Mental Health and Ch Ophthalmic Administration in the eye Otic Administration in the ear Rectal Administration to or in the rectum Respiratory Inhaled orally or nasally Subcutaneous Administration bet ween the skin and the muscle of Public Health, Developmental Sublingual Placed under the tongue Applied directly to the skin Topical Transdermal Administration through the skin chusetts Departments Vaginal Administration to or in the vagina 2017 The Massa Never administer a medication by a route for which you have not received training. r a licensed staff to conduct ad ditional route Your supervisor will arrange fo during a staff meeting. training, if needed, typically 116 Massachusetts | Responsibilities in Action

117 Specialized training is requir ed if a person receives: jejunostomy (g/j) tube. es, i.e., a gastrostomy or Medication through enteral rout  h as an EpiPen® or an Avui-Q®  Auto injectable epinephrine, suc through the MAP Policy Section 14. intramuscular route. See ildren and Families on has an You are newly Certified. You know a person in your work locati order for an EpiPen®. Before you are assigned medication admin istration duties you should Services, Mental Health and Ch 1. ___ Ask a coworker to show you how it is administered 2. ___ Call the pharmacy and ask for instructions 3. ___ Read the medication inform ow to use it ation sheet so you will know h 4. rrange a specialized training for EpiPen® use ___ Ask your Supervisor to a ill receive training on all other routes Ask your Supervisor when you w of Public Health, Developmental medications are administered in your work location. chusetts Departments You will be comparing the 5 ri harmacy ghts between the HCP order, the p label and the medication sheet as you complete 3 checks to ensu re safe medication administration. 2017 The Massa 117 Massachusetts | Responsibilities in Action

118 The 3 Checks of Medicat ion Administration tration are a comparison of t he 5 rights. Compare The 3 checks of medication adminis the (Check 1) 1. HCP order and the pharmacy label edication sheet (Check 2) 2. Pharmacy label and the m 3. Pharmacy label and the medication sheet (Check 3) ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 118 Massachusetts | Responsibilities in Action

119 Check 1 is a comparison of the 5 right s between the HCP order and the pharmacy label: Health Care Provider Order Date: Name: Health Care Allergies: Provider: Reason for Visit: ildren and Families Current Medications: Staff Signature: Date: Health Care Provider Findings: Pharmac y Label Medication/Treatment Orders: Instructions: Lab work or Tests: Follow-up visit: Date: Signature: Services, Mental Health and Ch  The reason(s) for check 1 is to make sure ister o there is a HCP order for the medication you are going to admin o what the HCP ordered is w hat the pharmacy supplied and the order has not changed since the last time you administered o medication of Public Health, Developmental chusetts Departments 2017 The Massa 119 Massachusetts | Responsibilities in Action

120 is a comparison of the 5 rights between the pharmacy label and the medication Check 2 sheet: Medication Sheet Generic 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour Start 1 2 3 4 5 6 7 8 Brand Dose Strength Stop Amount Route Frequency Reason: Special instructions: 1 2 3 4 5 6 7 8 Hour Generic Start 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand ildren and Families Strength Dose Route Stop Amount Frequency Reason: Special instructions: 1 2 3 4 5 6 7 8 Hour Generic Start 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Strength Dose Stop Amount Route Frequency Reason: Special instructions: 1 2 3 4 5 6 7 8 Hour Generic 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Start Brand Strength Dose Label y Pharmac Stop Amount Route Frequency Reason: Special instructions: Signature Signature CODES Services, Mental Health and Ch DP-day program/day hab LOA-leave of absence Name: P-packaged Site: W-work H-hospital, nursing home, r rehab cente S-school  The reason(s) for check 2 is to make sure o the strength of each tablet s upplied and the amount of tablets to cy label agree with what is tra nscribed on administer printed on the pharma the medication sheet and of Public Health, Developmental that you focus on the number of tablets needed o After check 2 you place the correct number of tablets in the medication cup  chusetts Departments 2017 The Massa 120 Massachusetts | Responsibilities in Action

121 is a comparison of the 5 rights between the pharmacy label and the medication Check 3 sheet: Medication Sheet Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Generic Start Brand Strength Dose Stop Route Amount Frequency Reason: Special instructions: Generic Start 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 Hour Brand ildren and Families Strength Dose Amount Route Stop Frequency Special instructions: Reason: Hour 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 Generic Start Brand Dose Strength Route Amount Stop Frequency Reason: Special instructions: Generic 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 Start Brand Strength Dose Label y Pharmac Route Amount Stop Frequency Reason: Special instructions: CODES Signature Signature Services, Mental Health and Ch DP-day program/day hab LOA-leave of absence Name: Site: P-packaged W-work H-hospital, nursing home, r rehab cente S-school  number of tablets e sure you placed the correct The reason for check 3 is to mak s and the in the medication cup according to the pharmacy label direction amount transcribed on the medication sheet of Public Health, Developmental  ister the medication After check 3 you admin chusetts Departments ole tablets The standard when administering medication is to administer wh or capsules with water. 2017 The Massa 121 Massachusetts | Responsibilities in Action

122 ’ and/or Fill in the blanks using the terms ‘HCP order’, ‘pharmacy label ‘medication sheet’. the___________. 5 rights between the _________ and 1. Check 1 is comparing the ildren and Families 5 rights between the _________ and 2. Check 2 is comparing the the___________. 5 rights between the _________ and 3. Check 3 is comparing the the___________. s on administration process to it Match each check in the medicati Services, Mental Health and Ch corresponding reason. ructions and amount to administer on the A. To ensure the inst Check 1____ label agree with what is transcr ibed onto the medication sheet Check 2____ u prepared is he amount of medication that yo B. To verify that t dication sheet instruct what the pharmacy label and me as ordered by C. To ensure the pharmacy supplied the medication Check 3____ of Public Health, Developmental the HCP chusetts Departments 2017 The Massa 122 Massachusetts | Responsibilities in Action

123 el. Compare the 5 rights between the HCP order and the pharmacy lab Do the ______________ ____________________ hy not? _______ 5 rights agree? ___ If no, w HEALTH CARE PROVIDER ORDER Date: March 3, yr Name: David Cook ildren and Families Allergies: No Known Allergies Health Care Provider: Dr. Black Reason for Visit: . David states he ’has to push hard’ when having a bowel movement Current Medications: See attached medication list. Services, Mental Health and Ch Date: March 3, yr Staff Signature: Sam Dowd Health Care Provider Findings: constipation Medication/Treatment Orders: Colace 200mg by mouth once daily in evening of Public Health, Developmental Instructions: Follow-up visit: Lab work or Tests: None Date: March 3, yr Signature: chusetts Departments Richard Black, MD Greenleaf Pharmacy 111-222-3434 Rx #201 20 Main Street Treetop, MA 00000 3/3/yr David Cook 2017 The Massa Qty. 60 Docusate sodi um 100mg IC Colace Take 2 tablets by mouth every evening at 8pm Dr. Black ED: 3/3/yr Lot# 463 Refills: 5 123 Massachusetts | Responsibilities in Action

124 Special Instructions Look at the entire pharmacy labeled container to see if there a re special instructions you must follow when preparing, admin tion, such as, ‘do not istering or storing the medica crush’, ‘shake well’ or ‘refrigerate’. There are people who have difficult with water. In these y swallowing a whole tablet the HCP. The HCP will determine cases, you must report this to if it is acceptable for ildren and Families you to change the form of a medication. A HCP order is required to  place the whole tablet or caps ule in applesauce, yogurt or pud ding, etc. tc. crush the tablet and mix with applesauce, yogurt or pudding, e   open the contents of a capsule and mix with applesauce, yogurt or pudding, etc. mix two liquid medications together   liquid medication together mix crushed medication and Services, Mental Health and Ch dissolve the medication in water   give the medication with a liquid other than water If a tablet must be halved or qua rtered in order to administer the correct of Public Health, Developmental dose, it must be done by the pharmacy. You are not allowed to break, split or cut a tablet. chusetts Departments 2017 The Massa 124 Massachusetts | Responsibilities in Action

125 True (T) or False (F) 1. ____ You must contact the HCP to obtain an order if a person requests apple juice with their medication. ildren and Families 2. ____ A tablet may only be hal ved or quartered by the pharma cy ing without an lls in applesauce, yogurt or pudd 3. ____ You may place whole pi HCP order 4. ____ Liquid medications may be the HCP mixed together if ordered by 5. ____ A HCP order is not requir ed to open a capsule and mix t he contents with Services, Mental Health and Ch applesauce of Public Health, Developmental chusetts Departments 2017 The Massa 125 Massachusetts | Responsibilities in Action

126 Medication Administration Process t of a larger process called the Medication Administering medication is par Administration Process. Medication is prepared and administered to one person at a time. The medication administrat ion process includes what happ ens before; during and of the 5 rights. The process includes what you will do after you complete the 3 checks to: ildren and Families  Prepare Administer  Complete  Prepare  Wash the area o Services, Mental Health and Ch  If a tabletop surface is used as you prepare medication make s ure you wipe it clean before starting. your hands o  Proper handwashing includes w etting your hands with clean, Lather your hands by rubbing running water and applying soap. sure to lather the backs of you them together with the soap. Be r under your nails. Rub your han hands, between your fingers, and ds for at least 20 seconds. Rinse thoroughly and dry. of Public Health, Developmental  Unlock the storage area ication due to be Review the medication adminis tration sheet specific to any med  administered chusetts Departments o Take out the medication(s) to be administered o Locate the corresponding HCP order(s) 2017 The Massa 126 Massachusetts | Responsibilities in Action

127 Administer Check 1  Compare the 5 rights on the HCP harmacy order to the 5 rights on the p o label Check 2  the pharmacy label to the 5 rights on Compare the 5 rights on the o medication sheet ildren and Families ablets in the medication cup Place the correct number of t  When removing a tablet from a o  blister pack always start with the highest numbered ‘bubble’; place the  medication cup underneath firmly and push the tablet into the medication cup through the backing directly bottle,  ons to push down then turn or  the cap may have instructi Services, Mental Health and Ch line up to remove the cap. there may be arrows you must Tap the number of tablets neede d into the bottle cap then place directly into the medication cup Check 3  o Compare the 5 rights on the pharmacy label to the 5 rights on the medication sheet Administer the medication  o swallowed Stay with the person until t he medication is of Public Health, Developmental set the medication cup down  Never  The medication is given directly from you to the person Look Back  edication sheet to make sure th o Review the pharmacy label and m at what the person just swallowed is w hat you intended to administer chusetts Departments If you realize you made a mistake   Notify a MAP Consultant immediately 2017 The Massa 127 Massachusetts | Responsibilities in Action

128 Complete Document  In the medication book o place your initials on the medication sheet  across from the medication administered  next to the correct time  under the correct date  ildren and Families o for the month, administering the medication, if it is the first time you are sign and initial t he signature list. medication is countable) o In the count book (if the  nt ct person, medication and cou use the index to locate the corre sheet page number, then,  turn to the corresponding count sheet  subtract the number of tablet s you removed from the Services, Mental Health and Ch package  Secure the medication  Wash your hands effects of the medication Observe the person for the  of Public Health, Developmental If you are administering multipl e medications due at the same time, to one chusetts Departments person, complete Checks 1 throu gh 3 for each medication. All medication due at the d in the same same time, for the same person, may be given together and place medication cup; liquid medication is measured and placed in a s eparate medication cup. 2017 The Massa 128 Massachusetts | Responsibilities in Action

129 Medication Administration Process Prepare Wash the area and your hands Look at the medication sheet to i inister dentify the medication to adm Unlock and remove the medication you are administering Administer ildren and Families ompare the 5 Rights (HCP order Check 1-verbalize and point to c and pharmacy label) label and med sheet) compare the 5 Rights (pharmacy Check 2-verbalize and point to Prepare the medication label and med sheet) Check 3-verbalize and point to compare the 5 Rights (pharmacy Give the med Look back (silent comparison bet eet) ween pharmacy label and med sh Services, Mental Health and Ch Complete Document 1. Medication Book evelopmental 2. Count Book, if needed Secure the medicati on and wash your hands Observe of Public Health, D chusetts Departments 2017 The Massa 129 Responsibilities in | n Massachusetts Actio

130 Medication Administration Process WASH LOOK FOR UNLOCK Area & Hands Medication Medication Prepare Book Area ildren and Families PREPARE 1 2 HCP Order Pharmacy Label Services, Mental Health and Ch to to Medication Sheet Pharmacy Label Administer SILENT GIVE Look Back 3 Pharmacy Label of Public Health, Developmental to Medication Sheet WASH HANDS DOCUMENT LOCK chusetts Departments 1. Medication Complete Medication Sheet Area 2. Count Sheet, OBSERVE if needed 2017 The Massa 130 Responsibilities in Action Massachusetts |

131 In addition to hand washing, ther e may be times when wearing gl oves is hen administering a ointment to a skin rash or w necessary such as when applying an rectal suppository. To put the gloves on: ildren and Families edication the ‘Prepare’ section of the m  wash your hands as described in administration process, then put on each glove to cov  er your entire hand and wrist. To take the gloves off: t of the other glove at the wris With one gloved hand, take hold  Services, Mental Health and Ch Turn the glove inside ou  t as you peel it off your hand Roll the removed glove in your hand still wear ing a glove   With your ungloved hand, insert your index finger down the wrist of your still ed glove wn and inside out over the roll gloved hand pulling the glove do the other o ff with one glove tucked inside At this point both gloves are o glove of Public Health, Developmental  Throw away the used gloves into the trash  Wash your hands chusetts Departments 2017 The Massa 131 Massachusetts | Responsibilities in Action

132 Do not administer medication if  you cannot read the HCP order  there is no HCP order  you cannot read the pharmacy label ildren and Families  there is no pharmacy label you have any concern that the  e 5 Rights do not agree between th o HCP order o pharmacy label o medication sheet a medication seems to be tampered (altered)  epared by someone else the medication was pr   the person Services, Mental Health and Ch has a serious change o has difficulty swallowing o refuses to take the medication o form of medication, you have been giving the  the pharmacy supplied a liquid tablet form and there is no change in the HCP order the medication was ‘pre-poured’  omeone else for any son’s medication to give to s In addition, never use another per of Public Health, Developmental reason, even if they have the same medication and dose ordered. chusetts Departments 2017 The Massa 132 Massachusetts | Responsibilities in Action

133 Liquid Medication on administration process id form, the identical medicati When the medication is in a liqu is followed as described earlier . Liquid medications are products you may see labeled s are only available as or an elixir. Some medication as a solution, suspension, syrup ons must be measured. liquids. Liquid medicati Liquid medications are usually measured in milliliters, teaspoo ns, or tablespoons. If ildren and Families macy label read them carefully. Abbreviations for abbreviations are used on the phar teaspoons and tablespoons are similar. n a three times over- or ablespoons, this could result i If teaspoons are confused with t under-dose. If milliliters are confused with teaspoons, this could result in a five times over- or under-dose. trength of the medication id medication includes the s You will notice the label on a liqu based on how many milligrams (mg) red. per milliliters (mL) is measu Services, Mental Health and Ch of Public Health, Developmental L of liquid measured there label tells you that for every 5m The strength on the Dilantin® is an equivalent of 125mg of the medication. chusetts Departments If you measure 10mL, how many milligrams of medication do you have? ____ 2017 The Massa 133 Massachusetts | Responsibilities in Action

134 acist will Remember, whenever a medication has a pharmacy label, the pharm the label. and the amount to administer on indicate the strength supplied nd For purposes of this exercise, review the manufacturers label a write the strength of each medication. ildren and Families trength _______mg/______mL 1. Milk of Magnesia s Services, Mental Health and Ch of Public Health, Developmental chusetts Departments If the dose ordered by the HCP is 2400mg, using the measuring d evice below, the strength r based on the dose ordered and shade in the amount to administe suppled. 2017 The Massa 134 Massachusetts | Responsibilities in Action

135 h _______mg/______mL 2. Tussin strengt ildren and Families Services, Mental Health and Ch If the dose ordered by the HCP is 200mg, using the measuring de vice below, shade in the amount to administe r based on the dose ordered and the strength supplied. of Public Health, Developmental chusetts Departments 2017 The Massa 135 Massachusetts | Responsibilities in Action

136 ength _______mg/______mL 3. Pepto-Bismol str ildren and Families Services, Mental Health and Ch Developmental If the dose ordered by the HCP is vice below, 262mg, using the measuring de shade in the amount to administe the strength r based on the dose ordered and supplied. of Public Health, partments chusetts De 2017 The Massa 136 Massachusetts | Responsibilities in Action

137 ength _______mcg/______spray 4. Flonase inhaler str ildren and Families Services, Mental Health and Ch with the medication. vice. Use the device that comes Always use a proper measuring de If one is not provided, you must ask the pharmacist for an appr opriate measuring cup, oral syringe, ng devices include a medication device. Types of liquid measuri dropper and dosing spoon. of Public Health, Developmental chusetts Departments kings es include a combination of mar Some oral liquid measuring devic (measurements) such as, milliliter (mL), teaspoon, or tablespoo n. If you are unsure of which marking to use, contact the MAP Consultant. 2017 The Massa 137 Massachusetts | Responsibilities in Action

138 Medication Cup Find the marking on the cup that agrees with the amount you need for the dose ordered. When preparing a liquid medicati on, once you determine the amou nt of liquid to measure into the medication c up based on the dose ordered, make sure you: Shake the medication, if needed  Remove the cap and place it upside down  ildren and Families medication free of germs this will help to keep the o  Place the medication cup on a flat surface, at eye level o do not hold it in your hand  Locate the correct measurement on the medication cup Hold the bottle so that your hand covers the pharmacy label  om becoming soiled this keeps the label fr o Pour slowly  If you pour too much, do not pour back into the bottle o Services, Mental Health and Ch Use a second medication cup to pour into and measure again o o Extra medication must be disposed per MAP Policy  e after pouring, if needed Wipe the top of the bottl  After use, wash the medication cup if reusing o with dish soap and water of Public Health, Developmental medication is If two liquid medications are due at the same time, each liquid measured using a different medication cup. chusetts Departments Sometimes the amount of liquid medication to be administered is so small; the medication can only be measured accurately using an oral syring e or a dropper or a dosing spoon. 2017 The Massa 138 Massachusetts | Responsibilities in Action

139 Oral Syringe e 1mL, 2.5mL and 5mL Oral syringes come in different sizes. The most common sizes ar syringes, but there are 10mL and la urement on the oral rger syringes. Find the meas ount you need for the correct do syringe that agrees with the am se. an adapter that fits on de an alternative bottle cap or Many times a pharmacy will provi he liquid to be withdrawn direc the top of the bottle to allow t tly from the container with ildren and Families an oral syringe. on, once you know the amount of liquid to be When preparing a liquid medicati Services, Mental Health and Ch measured into the oral syringe based on the dose ordered, make sure you: Shake the medication, if needed.   Remove the lid and the top of the bottle or push the adapter firmly into o screw the alternative cap on the bottle o al syringe into the hole  Push the tip of the or o in the adapter or an o alternative cap of Public Health, Developmental  Turn the bottle upside down o back so that the medicine is d rawn from the Pull the plunger of the syringe bottle into the syringe. ck to the marking that corresponds to the o Continue to pull the plunger ba dose. If you are unsure about how much  medication to draw into the s yringe, contact chusetts Departments the MAP Consultant. Remove any large air  bubbles from the syringe. Air bubbles within an o urement. oral syringe can give an inaccurate meas o If there are air bubbles, empty the syringe back into the bott le and try again.  Turn the bottle back the right way up. 2017 The Massa  Remove the syringe.  o dry. After use wash with warm wate r and dish soap and leave apart t 139 Massachusetts | Responsibilities in Action

140 Dropper and has a rubber end at A dropper is a glass or plastic tube that is narrow at one end, order to measure and sometime the other end that is squeezed in s administer kings and are used for rent sizes with different mar medication. Droppers come in diffe quid oral medication, eye droppers used to administer li different reasons. There are droppers and ear droppers. If a dropper comes with the medicat ion, always use the dropper included. ildren and Families When preparing a liquid medicati on, once you know the amount of liquid to be Services, Mental Health and Ch measured into the dro you: ordered, make sure pper based on the dose  Hold the dropper upright into the rubber end (bulb) of a dropper or o Do not to pull the medication up o turn the dropper upside down. Squeeze the bulb of the dropper  out of the dropper and prepare the dropper to o This will squeeze excess air suck up the medication. of Public Health, Developmental  Place the dropper into the bottle.  Slowly let pressure off of the bulb. You will see the medication being pulled up into the dropper. o  ed up to the mark of the amount needed When you get the medication pull Measure at eye level o  Squeeze the bulb to either remove extra medication or to pull up chusetts Departments more medication if needed. Let go of the rubber end.  cation is off o This will cause an air bubble to pop up and look like the medi measurement, but you have the correct amount in the dropper. Some droppers are made to be ta ken apart and cleaned after use. If you are using this type of dropper, remove the bulb from the dropper and wash both pieces with warm 2017 The Massa water and dish soap, rinse wel l and let the parts air dry. 140 Massachusetts | Responsibilities in Action

141 Dosing Spoon Dosing spoons come in different sizes with different markings. ildren and Families on, once you know the amount of liquid to be When preparing a liquid medicati measured into the dosing spoon based on the dose ordered, make sure you: Hold the dosing spoon upright   ed Find the marking for the amount needed based on the dose order om the bottle into the spoon at e ye level Slowly pour the medication fr  Services, Mental Health and Ch  After use, wash the spoon with warm water and dish soap, rinse and let it air dry suring s with household utensils or mea Never measure liquid medication spoons. They are not consistent in their size and will result in either too much or too little of Public Health, Developmental medication administered. chusetts Departments 2017 The Massa 141 Massachusetts | Responsibilities in Action

142 medication Look at the dose ordered by the HCP, the strength of the liquid n the amount to administer you would expect to see supplied by the pharmacy and fill i printed in the pharmacy label directions. ildren and Families Dose Amount Strength 150mg 75mg/10mL 50mg/6mL 100mg 100mg 50mg/2mL 150mg 75mg/4mL Services, Mental Health and Ch 200mg 100mg/5mL 50mg/3mL 150mg 25mg/2mL 100mg 250mg/10mL 500mg 100mg/15mL 100mg of Public Health, Developmental 500mg/30mL 500mg 500mg 125mg/5mL chusetts Departments 2017 The Massa 142 Massachusetts | Responsibilities in Action

143 id medication. After completing your first two You are preparing Tanisha’s liqu checks in the medication administr ation process, you are now ready to measure the medication. The amount is listed as 4 mL and to use a special dropper. You cannot locate the dropper. Check what you should do next. ildren and Families he kitchen drawer and pour just 1. ___ Obtain a teaspoon from t a little less since a teaspoon is 5mL. uid that comes with Juanita’s liq 2. ___ Borrow the special dropper medication since it would have 4mL clearly mar ked for administration. evice. 3. ___ Call the pharmacy and request an appropriate measuring d 4. ___ Use a medication cup that L and pour just under has markings for 2.5mL and 5 m Services, Mental Health and Ch the 5 mL marking. Match the following terms with the corresponding letter. A. Must be held upright and at eye level for measuring 1. ___ Medication cup e the bulb to draw up medication 2. ___ Oral syringe B. Squeez of Public Health, Developmental 3. ___ Dropper C. Place on a fl at surface at eye level surement plunger back to the correct mea D. Pull the 4. ___ Dosing spoon True (T) or False (F) chusetts Departments vice this could result in 1. ___ If a household teaspoon is u sed as a liquid measuring de an over- or under-dose. 2. ___ Whether preparing liquids or tablets, the same medication administration process is followed. 3. ___ When pouring liquid medication from a bottle, your hand should cover the label. 4. ___ Two different liquid medi same medication cup. cations may be measured in the 2017 The Massa 5. ___ Air bubbles within an oral syringe can give an inaccurat e measurement. 6. ___ An oral syringe may be wa shed and reused for the same person. 143 Massachusetts | Responsibilities in Action

144 cation is Not Administered How to Document if a Medi e to document that a medication There are times when you may hav was not administered, such as when a medication: is refused   ion ers of when to hold (not give) a medicat order includes paramet  is held prior to testing ildren and Families  is not available to administer Medication Refusals Sometimes a person may not want to take their medication. This is called a medication refusal. When a person refuses, ask them why. Their answer is important. If the not speak, notice if they keep their lips sealed and person you are working with does medication before wn as they try to swallow the turn away from you or seem to fro Services, Mental Health and Ch spitting it out, etc. eporting the refusal to Your subjective and objective observations are important when r the prescribing HCP. When you speak to the HCP, the HCP may write a new order for the medication to be crushed and m ixed in applesauce so that it is easier to swallow. If a person refuses frequently, the HCP may choose to discontinue the medication since not taken exactly as prescribed . The HCP may prefer to the medication will not work if list as well as other team members and develop a plan to consult with a Behavior Specia manage refusals. of Public Health, Developmental Medication refusals are defined as when the person:  says ‘No’  spits the medication right back out or never takes the medicat ion from you  spits the medication out later , even though when you administe red it, the person chusetts Departments seemed to swallow it king it  intentionally vomits the medi cation within one half hour of ta ecure it, wait 15-20 kes the medication from you, s If the person says no or never ta minutes and offer the medication again. When offered a second t ime if the person still 15-20 minutes and offer the me refuses, secure it, wait another dication a third time. 2017 The Massa ation, this is considered a person still refuses the medic When offered a third time if the three times to refuse a medi cation before you are to final refusal. A person has up to consider it a final refusal. 144 Massachusetts | Responsibilities in Action

145 All refusals must be reported im mediately to the prescribing HC P. It is very important that the prescribing HCP be notified that the person is refusing to take the medication as to do next, if anything. ordered. You will ask the HCP fo r their recommendation of what In practice, any MAP Consultant may be contacted and their ildren and Families recommendation followed; however specific to a refusal, the prescribing HCP must also be made aware. ent this on the medication she When medication is refused, docum et by:  circling your initials rogress note including writing a medication p  the date, time o the medication involved o Services, Mental Health and Ch o why the medication was not administered o your observations o who was notified  the prescribing HCP your Supervisor   include first and last names what you were instructed to do o o your signature of Public Health, Developmental chusetts Departments 2017 The Massa 145 Massachusetts | Responsibilities in Action

146 Documentation example of a refus ed medication; on the medicatio n sheet and corresponding medication progress note: MEDICATION ADMINISTRATION SHEET Allergies: none Month and Year: February, yr Generic Clonazepam Hour 1 2 3 4 5 6 7 8 9 Start 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 8am 8/31/yr Brand Klonopin JS JS JS Strength 1mg Dose 1mg Stop Route mouth Amount 1 tab TMTM Frequency twice daily 8am and 4pm 8pm cont Reason: seizures Special instructions: ildren and Families ohnson ary, yr Febru MEDICATION PROGRESS NOTE Name Tanisha J Not Given Refused Given Other Reason Staff Signature Results and/or Response (for giving/not Dose Date Time Medication giving) 2-3-yr 8:30am Tanisha refused her morning clonazepam 1mg. I attempted to Services, Mental Health and Ch notifi was ed. He recommended to skip thi e s dose and it 3 times. Dr. Le administer to administer the n hite, supervisor was also notified. ext dose e. Linda W wh t is du en i ____________________________________________________________________________ Jenna Sherman of Public Health, Developmental You are responsible for medicati You on administration on March 4, y r. prepare David’s 4pm medication. As you enter the room with his Prilosec, he is pacing back and forth and states, “I don’ t want that medication”. You should: chusetts Departments 1. ___ Tell David he has to take his medication 2. ___ Dispose of the medica tion since he doesn’t want it 3. ___ Ask David why he doesn’ t want to take the medication 4. ___ Consider the medication refused David tells you he doesn’t like the purple color of the tablet. You should: 2017 The Massa 1. ___ Hide the pill in his food so he cannot see the color pur ple e doctor 2. ___ Insist he take the medication because it’s ordered by th ___ Leave the pill with Davi d and hope that he will take it 3. 4. ___ Secure the medication, ret urn in 15 minutes and offer it again 146 Massachusetts | Responsibilities in Action

147 After 3 attempts, David still r efuses the medication. You shou ld first: 1. ___ Notify your Supervisor and coworkers of the refusal e 2. ___ Wait one more hour and offer the medication a fourth tim 3. ___ Save the medication for t he next scheduled administ ratio n time 4. ___ Notify Dr. Black of the refusal ildren and Families Using the medication sheet and corresponding progress note, doc ument the medication refusal. Generic 10 11 12 13 14 15 16 17 18 19 20 21 22 23 1 2 3 4 5 6 7 8 9 Hour 24 25 26 27 28 29 30 31 Omeprazole Start Brand Prilosec 8/31/yr 20mg Dose Strength 20mg Services, Mental Health and Ch WD JC WS Amount mouth 4pm Route 1 tab Stop supper Once daily before Frequency Cont. Reason: Special instructions: GERD MEDICATION PROGRESS NOTE March, yr N R o Given Other e Reason fused Time /not Medication Dose Date Staff Signature Results and/or Response (for giving it G ven giving) of Public Health, Developmental chusetts Departments 2017 The Massa 147 Massachusetts | Responsibilities in Action

148 Parameters d be done. Another Parameters are a set of rules that tell you how something shoul nistration, HCP orders . Specific to medication admi word for parameters is guidelines or after you administer a may include parameters that tell you exactly what to do before medication and when to notify the HCP, if needed. This is an example of a HCP ord er that includes a parameter telling you when to give a ildren and Families medication: rd evening if no bowel by mouth as needed every 3  give Milk of Magnesia 1200mg movement This is an example of a HCP ord er that includes a parameter telling you when to hold (or not give) a medication:  less than 60 do not pril administration, if pulse is take pulse daily before Lisino Services, Mental Health and Ch give Lisinopril These are examples of HCP order s that include a parameter telling you when to notify the HCP:  hours after PRN Milk of Magnesi a is if no bowel movement within 24 administered, notify the HCP  ify the HCP d Lisinopril and not if pulse is less than 60, hol  throat, notify the HCP if complaints of a sore of Public Health, Developmental  reater, notify the HCP if temperature is 100 or g When parameters are me t and the medication is not administered, document this on the medication sheet by: chusetts Departments  circling your initials and rogress note including writing a medication p  o the date, time and o the medication involved o why the medication was not administered o your observations o if required, who was notified 2017 The Massa  MAP Consultant  typically the HCP your Supervisor   include first and last names 148 Massachusetts | Responsibilities in Action

149 what you were instructed to do o o your signature The parameters in a person’s HC P order (written on the medication sheet next ildren and Families tolic (top) blood pressure (BP) to special instructions) states to hold Zestril if the sys th at 8am the BP reading you ify the HCP. On March 5 reading is below 100 and not obtain is 90/50. Use the medica tion sheet to document the BP r eading and the held dose. Use the medication progres s note to document what happen ed and who you notified. 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 20 21 22 23 1 2 3 4 5 6 7 8 9 Hour Generic Start AS WS WS JC 8am Check blood pressure (BP) Brand 8/31/yr Strength Dose BP Services, Mental Health and Ch 130 132 134 120 Stop S Amount Route 64 62 60 66 Cont. Frequency Daily in the morning D Reason: Special instructions: HCP Hold Zestril if systolic (top) b lood pressure (BP) reading is below 100 and notify 1 2 3 4 5 6 7 8 9 24 25 26 27 28 29 30 31 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Start Generic Lisinopril Hour AS WS WS JC 8am Brand 8/31/yr Zestril Strength 20mg 40mg Dose Stop Amount 2 tabs Route mouth Daily in the morning Frequency Cont. HCP Reason: high BP lood pressure (BP) reading is below 100 and notify Hold Zestril if systolic (top) b Special instructions: of Public Health, Developmental MEDICATION PROGRESS NOTE March, yr N R o Given Other e Reason fused no iv Dose Date Time Medication (for g ing/ t Results and/or Response Staff Signature it G ven giving) chusetts Departments 2017 The Massa 149 Massachusetts | Responsibilities in Action

150 Medication ordered to be held before a medical test that require restrictions of food, drink and/or medication There are some medical tests prior to tes ting. A HCP order will specify if medication is to be held before a medical test pleted or to resume the and whether or not to give the m edication after the test is com next regularly scheduled dose as ordered. to a medical test, When medication is ordered to be held (not administered) prior ildren and Families document this on the medication sheet by:  circling your initials and writing a medication p rogress note including  the date, time and o the medication involved o o why the medication was not administered the dose of medication prior to reference the HCP order to hold  Services, Mental Health and Ch testing your signature o prazole on The instructions in a person’s HCP order state to hold the ome March 4, yr at 4pm prior to a scheduled test and to resume the next dose when it is due. rite a medication Document the held medication dose on the medication sheet and w of Public Health, Developmental progress note. Generic 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 Hour Omeprazole Start Brand 8/31/yr Prilosec Dose 20mg 20mg Strength WD JC WS mouth 4pm 1 tabs Stop Amount Route Once daily before supper Frequency Cont. chusetts Departments Special instructions: Reason: GERD March, yr MEDICATION PROGRESS NOTE Not Given Refused Given Other Reason Staff Signature Results and/or Response (for giving/not Medication Time Date Dose giving) 2017 The Massa 150 Massachusetts | Responsibilities in Action

151 If a medication is not available to administer hough you have At times a medication may not be available to administer even t tion from the pharmacy such as when attempted to obtain the medica prior authorization is required  insurance company from the person’s prescription ting the prescribing HCP and ob Follow up by immediately contac o tain a n be recommendation about what you are to do until the medication ca ildren and Families obtained the medication is ‘too soon to refill’  macist and asking when the medication o Follow up by contacting the phar will be available and what you ar e to do until the medication is obtained no refills remain on the prescription  ting the prescribing HCP and request a Follow up by immediately contac o new prescription be sent to the pharmacy follow up with the pharmacy to ens  ure the prescription is received Services, Mental Health and Ch he medication will be obtained confirm a date and a time t  if you cannot obtain the medication for the dose that is due  obtain a recommendation about what you should do Prior authorization is when the HCP must obtain approval from the health specific medication for a person. insurance company to prescribe a of Public Health, Developmental When medication is not available to be administered, document t his on the medication sheet by: circling your initials and   writing a medication p rogress note including the date, time and o chusetts Departments the medication involved o why the medication was not administered o o what you have done to obtain the medication your observations o who was notified o  MAP Consultant 2017 The Massa  your Supervisor  include first and last names o what you were instructed to do o your signature 151 Massachusetts | Responsibilities in Action

152 th, yr There is no Prilosec available fo r you to administer at 4pm on March 4 . leaf Pharmacy. You You call and speak to Forrest G reenleaf the pharmacist at Green ask the pharmacist were told the medication will be delivered by 7:30pm. You then what to do about the 4pm dose that will be missed. The pharmac ist’s recommendation th, yr is to omit the 4pm dose on March 4 and to give the next regularly scheduled dose ildren and Families when due. Document the missed dose on the medication sheet and write a medication progress note. Hour Start Generic Omeprazole 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 8/31/yr Brand Prilosec Dose 20mg 20mg Strength WD JC WS Amount 1 tab Route Stop mouth 4pm Once daily before supper Cont. Frequency Special instructions: Reason: GERD Services, Mental Health and Ch MEDICATION PROGRESS NOTE March, yr Not Given Refused Given Other Reason Results and/or Response (for giving/not Staff Signature Dose Medication Date Time giving) of Public Health, Developmental chusetts Departments 2017 The Massa 152 Massachusetts | Responsibilities in Action

153 le and as a result is omitted ( not given), it is a When a medication is not availab t immediately and you to contact a MAP Consultan medication occurrence; requiring complete a medication occurrenc e report form. See MAP Policy Se ction 09. ildren and Families mes, should On the medication sheet, all medication boxes, for scheduled ti onth; if documentation has been be filled in by the end of the m completed accurately, there will be no blank spaces. hould be a set of initials, If there is a blank space on the medication sheet where there s Services, Mental Health and Ch ant immediately and follow the re you must contact a MAP consult commendation given. Do not assume that the medication was not administered because the space was left blank. If there is a blank space on the medication sheet and the medic ation is determined to , write a late entry on the have been administered, do not fill in your initials. Instead ting the date and time the medication was administered. medication progress note indica of Public Health, Developmental chusetts Departments 2017 The Massa 153 Massachusetts | Responsibilities in Action

154 Let’s Review Some medications are administered on a continuous basis   Some medications are administered on a PRN, as needed basis PRN medication orders must have o ildren and Families  a specific reason for use  parameters or instructions edication is given and does not including what to do if the m  work  There are 5 Rights of Medication Administration o Person o Medication Dose o Services, Mental Health and Ch o Time Route o The 5 Rights must agree between the  HCP order o Pharmacy label o Medication sheet o times before any medication is administered The 5 Rights must be checked 3  o Check 1 - HCP order and pharmacy label of Public Health, Developmental - Check 2 o medication sheet Pharmacy label and Pharmacy label and - Check 3 o medication sheet  Liquid medication strength will usually have a ‘mg’ per ‘mL’  Liquid measuring devices must a lways be used to prepare liquid medication stered by  There are many different rout es that medications can be admini Routes other than oral require additional training o chusetts Departments  hange the form of a medication (such as crushing) A HCP order is required to c If a person refuses their medication try to determine why  refused ore considering the medication Offer the medication 3 times bef  Documentation of a medication not administered includes  o Your initials circled on the medication sheet o A progress note indicating 2017 The Massa  why the medication was not administered  recommendations given who was notified Supervisor)  (HCP and 154 Massachusetts | Responsibilities in Action

155 Unit 8 Chain of Custody Responsibilities you will learn What the ‘Chain of Custody’ means   Why the Chain of Custody is necessary  What can happen if the Chain of Custody is broken ildren and Families Your role in the Chain of Custody  assigned to administer Access to the medication storage area must be limited to staff medication. Only MAP Certified staff may know the combination to access the medication storage keys. Once you are assigned medication administration duties you are responsible for the inventory (supply) of medication during your assigned shift. Ev ery time the medication Services, Mental Health and Ch storage keys change hands conduct a oulder’, count of the two person, ‘Shoulder to Sh off-going responsible staff. medication with the on-coming and nly you should have t and have accepted the keys, o Once you have conducted the coun area. The medication keys are kept with you as long access to the medication storage conduct a two person count as you are in the program. At t he end of your shift, you will with the on-coming staff that will be responsible for the medication before handing the keys over. of Public Health, Developmental If the Certified staff assigned to administer medication and/or maintain medication nd the keys are passed, a count must be completed at security changes during a shift a that time. If there will be no Certif ied staff in the pr ogram during the n ext shift, the keys must be kept locked in the program. M edication storage keys are typica lly secured in a chusetts Departments g the keys into the ust be completed before placin combination locked box. A count m locked box and/or after removing the keys from the locked box. MAP requires all medications be passed directly to and from only MAP Certified or is an unbroken documentation trail of licensed staff. The Chain of Custody . Every tablet, capsule, ysical security of medication accountability that ensures the ph mL, etc. of medication, from the time the medication is request ed from the pharmacy, 2017 The Massa me the medication no longer either as a new medication or a medication refill, until the ti tered, disposed, transferred etc. ), the medication must be exists in the program (adminis tracked. 155 Massachusetts | Responsibilities in Action

156 The Chain of Custody ensures the integrity of t he medication is not compromised and all medication is accounted for. Maintaining the Chain of Custody minimizes the opportunity for medication to be stolen. Tracking hods used to track medications. There are many documents and met documents include: A Medication Ordering and Receiving Log  ildren and Families o Documentation of medication t hat is ordered by a program and w hen received from the pharmacy Pharmacy receipts  of all medication dispensed to Documentation from the pharmacy o a program; whether delivered to the program or picked up from the pharmacy by Certified staff. Services, Mental Health and Ch Count Book  cation that is added into the c Documentation of countable medi ount book o and/or subtracted from a count book. Medication sheet  hat is administered and (if) not o Documentation of medication t administered. of Public Health, Developmental Medication release document (Transfer form)  o hat is transferred from one locat ion to Documentation of medication t another location.  Disposal Record o Documentation of medication that is disposed. chusetts Departments  Blister Pack Monitoring o Although not a MAP requirement, if used at your program you wi ll  r Document medication removed from a blister pack by writing you initials, date and time on the back of the blister pack for eac h tablet removed. 2017 The Massa  Periodically the documentatio n on the back of the blister pack is reviewed to ensure medication was given as prescribed. 156 Massachusetts | Responsibilities in Action

157 our work Ask your Supervisor if blister pack monitoring is required at y location. ildren and Families Medication Ordering and Receiving Log All programs must mai ntain a record of when a prescription is requested to be filled by the pharmacy with the correspond ing quantity of medication rece ived. This process is typically documented using a Medication Ordering and Receiving Log. You must document in the Medication Ordering and Receiving Log each time you:  request a medication refill from the pharmacy, document the o person’s name Services, Mental Health and Ch o name of medication and strength o ets, capsules, mLs, etc.) quantity (total number of tabl o Health Care Provider d medication refill was requeste o Your signature and the date the  receive a medication refill fr om the pharmacy, document the prescription (Rx) number o strength of medication received o double check that the ngth strength ordered is the same as the stre  of Public Health, Developmental received o d) s, capsules, mLs, etc. receive quantity (total number of tablet o remaining refills  t to if “0”, contact the HCP to request another prescription be sen the pharmacy o your signature and the date the medication refill was received chusetts Departments rrive with the pharmacy delivery, make sure If the ordered refill does not a you immediately contact the phar macy to determine when the medi cation will be 2017 The Massa obtained. 157 Massachusetts | Responsibilities in Action

158 Sample Medication Ordering and Receiving Log Provider Program Address Pharmacy Quantity Health Care Strength Ordered by- Quantity Remaining Received by- Strength Name Medication Rx# Signature/Date Provider Ordered Ordered Signature/Date Refills Received Received ildren and Families Pharmacy Receipts The pharmacy will provide a rece ipt for every medication dispensed. The pharmacy receipt will typically include the:  person’s name  medication name Services, Mental Health and Ch  strength of medication  total number of tablets, capsules or mLs dispensed  Rx (prescription) number When medication is received from the pharmacy you must compare the: pharmacy to the pha medication received from the  rmacy receipt o ensuring you received what the pharmacy documented they sent of Public Health, Developmental Medication Ordering and Receivi  ng Log to the medication obtained o ensuring you received what was ordered by your program chusetts Departments kept at the f medication dispensed) must be The pharmacy manifest (receipt o program for a minimum of 90 da ys. See MAP Policy Section 10. Ask your Supervisor if the pharmacy where you work supplies automatic 2017 The Massa refills. If the answer is yes, ask what system is used to cross check the medication you are expecting to receive to what the pharmacy delivers. 158 Massachusetts | Responsibilities in Action

159 Countable Controlled Substance Book e Book is typically known as the Count Book. All The Countable Controlled Substanc countable controlled (schedule II- ted and tracked in a V) medication must be documen count book. There are many requ irements surrounding countable m edication because these medications may be stolen and abused. The count book must have a bind ing with no loose pages. The binding is the cover of a ildren and Families and protects them. The book book that holds the pages together must be preprinted with consecutively numbered pages. A count book has 3 basic sections, including the  Index Count Sheets   Count Signature Sheets Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 159 Massachusetts | Responsibilities in Action

160 Index ill identify the The beginning of the count book c ontains the index. The index w name of each person prescr  ibed a countable medication medication name and strength  count sheet page number of the countable medication  signature space if the medication is removed from count  ildren and Families but not a medication from count including only a supervisor may remove o limited to, any of the following reasons: scontinued and disposed  the medication was di  the medication was dispos ed after a person passed  the person moved and medication was transferred to a new home  the ‘amount left column’ of the corresponding count sheet Services, Mental Health and Ch page in any of the above exampl es will be marked as ‘0’, since that medication is physica lly no longer in the program to count Index Person responsible for removing medication from Medication and Strength Name Page Number count of Public Health, Developmental 1 2 David Cook Phenobarbital 32.4mg 3 Tanisha Johnson Clonazepam 1mg Tanisha Johnson Phenobarbital 32.4mg 4 chusetts Departments Lorazepam 0.5mg Ellen Tracey 5 Tramadol 50mg Juanita Gomez 6 David Cook Tramadol 25mg 7 2017 The Massa 160 Responsibilities in Action | Massachusetts

161 A count book index also identif ies the count sheet pages that a re currently in use. The index must be updated when transfe rring from an old count sheet page to a new count sheet page. A ‘Shoulder to Shoul der’ count of all medication i s conducted using the index as a guide. Looking at the sample index below, you know that bital is no longer in the double locked area to count  Sarah Brown’s phenobar because Linda White, the superviso r, signed as removing it from count. If the ildren and Families medication was discontinued, it would have remained on count an d double locked until disposed. Only after its disposal would a supervisor sign as ‘Person Responsible for Removing Medica tion from Count’. If you turned to the corresponding count sheet page 7, t d have a ‘0’ as he ‘amount left’ column woul there is no longer m edication physically present to count. ause page 2 ets to be coun Mike Stone has Ativan 1mg tabl  ted on page 5 (bec became full.) Services, Mental Health and Ch  supervisor wrote eph Smith’s Ativan were full, a When the four boxes next to Jos ted on a new row in ‘see below’ with their initials to indicate the Ativan was star ivan is currently found on count sheet page 11. the index. Joseph Smith’s At be counted on count sheet pag e 8. William Mitchell has Percocet to  According to the index below, there are three count sheet pages currently in use, count sheet page numbers 5, 8 and 11. of Public Health, Developmental Sample Index Person responsible for Name removing medication from Page Number Medication and Strength count chusetts Departments Linda White 1 4 Phenobarbital 97.2mg Sarah Brown 7 2 5 Ativan 1mg Mike Stone See below LW 9 Joseph Smith Ativan 0.5mg 3 6 10 8 Percocet 5mg/325mg William Mitchell 2017 The Massa Joseph Smith 11 Ativan 0.5mg 161 Massachusetts | Responsibilities in Action

162 Count Sheets medication is ount or the balance of is added into the c When a new medication transferred from a completed co eet page, the heading unt sheet page to a new count sh of the new count sheet page must be completed. The heading of e ach count sheet must on from the pharmacy label, incl uding the be completed with the informati  person’s name ildren and Families  medication name  strength of medication directions to administer the medication   HCP’s name  pharmacy name  prescription (Rx) number The first line of the count sheet must indicate the Services, Mental Health and Ch  date and time o ed from the pharmacy and added into the amount of medication receiv count, or ed from a completed count sheet page to a o amount of medication transferr new count sheet page new medication  signatures of the two Certifi ed staff verifying the amount of t of medication transferred to the new page. added into the count or the amoun of Public Health, Developmental The count sheet tracks the amount of each countable medication when  added as o a new medication a medication refill o chusetts Departments o transferred from a previous page o received from another program r repackaging and/ o received from the pharmacy afte or relabeling  subtracted as administered, including the o  date and time 2017 The Massa  route by which the medication was administered  amount on hand (the amount you started with)  amount used 162 Massachusetts | Responsibilities in Action

163 ng are left with after subtracti amount remaining (the amount you  what you removed from the package) your signature  transferred o to another program, suc  h as the day program  on a LOA packaging or relabeling  to the pharmacy for re disposed o ildren and Families  if the medication is refused   expired  discontinued  dropped on floor, etc. Each tablet, capsule or mL of m edication must be accounted for. Services, Mental Health and Ch The amount used column must be documented in word form, not the numerical form. For example, “one” must be written and not documented as the number “1”. This will help prevent someone from altering your document ation. of Public Health, Developmental chusetts Departments 2017 The Massa 163 Massachusetts | Responsibilities in Action

164 1| Pa ge Name: David Cook X Original Entry or Doctor: Dr. Black ______Transferred from page___ Greenleaf N671 Number: Pharmacy: Prescription Phenobarbital 32.4mg Feb. 17, yr Prescription Date: Medication and Strength: Take 3 tablets by mouth once daily in evening Directions: ildren and Families Amount Amount Amount Time Route Date Signature Used Left on Hand 9am 2/17/yr 42 y Recei ved from Pharmac Dowd / Linda White Sam 2/17/yr three mouth 8pm 42 39 Jenna Sherman 2/18/yr three mouth 8pm 39 36 Jenna Sherman Services, Mental Health and Ch 2/19/yr mouth 8pm three 33 36 Amanda Smith 2/20/yr mouth 8pm three 30 33 Amanda Smith 2/21/yr 8pm mouth three 30 27 Amanda Smith 2/22/yr 8pm mouth three 24 27 Jenna Sherman 2/23/yr 8pm mouth three 24 21 Jenna Sherman of Public Health, Developmental 2/24/yr mouth 8pm three 21 18 Amanda Smith 2/25/yr 8pm mouth three 18 15 Amanda Smith 2/26/yr 8pm mouth three 12 15 Amanda Smith 2/27/yr chusetts Departments 8pm mouth three 9 12 Jenna Sherman 2/28/yr 8pm mouth three 6 9 Jenna Sherman 3/1/yr 8pm mouth three 6 3 Amanda Smith Amanda Smith 8pm mouth three 3/2/yr 0 3 2017 The Massa Amount left _0__ transferred to page __2___ Amanda Smith __ Signature _________ Signature ____________ Jenna Sherman ___ 164 Massachusetts | Responsibilities in Action

165 Count Signature Sheets sheets. Countable The last section of the count book contains the count signature controlled medication must be counted  with two Certified staff  on storage keys change hands every time the medicati o moving including, when placing the medication storage keys into or re ildren and Families them from the combination lock box This can happen when   there is no staff coming on duty as you are leaving or there is no staff present when you arrive  Count Signature Sheet Count correct Date Time Incoming Staff Outgoing Staff Services, Mental Health and Ch yes/no 3:10pm Amanda Smith yes Sam Dowd 3/1/yr 11:06pm 3/1/yr Jenna Sherman Amanda Smith yes 3/2/yr 8:56am single person count yes Jenna Sherman * 10:12am 3/2/yr yes ** Linda White Sam Dowd of Public Health, Developmental 3/2/yr 3:04pm Amanda Smith yes Sam Dowd chusetts Departments * an was the only MAP Certified On 3-2-yr at 8:56am, Jenna Sherm staff on duty. When it was time for her to leave, t here was no MAP Ce rtified staff coming on duty. Jenna conducted a single pers on count before securing the medication storage keys. 2017 The Massa ** On 3-2-yr at 10:12am , Sam Dowd and his supervisor, Linda White , both MAP Certified, conducted a 2 person c ount before Sam accepted respo nsibility for the medication storage keys. 165 Massachusetts | Responsibilities in Action

166 ‘Shoulder to Shoulder’ Count Procedure When conducting a 2 person coun t of the countable controlled medication follow the ‘Shoulder to Shoulder’ count procedure: and leads the count.  The off-going staff (giving up the keys) holds the count book information of Using the index as their guide , the off-going staff reads the o the first medication to be count ed including the person’s name, medication ildren and Families name and strength, and then turns t page. to the appropriate count shee ding tamper  The on-coming staff (receiving the keys) locates the correspon resistant pack of medication. the label information aloud; th o e person’s The on-coming staff then reads name, medication name, strength unts and and directions for use. Then co states the number of pills, syr inges, etc. seen in the package. Services, Mental Health and Ch he keys) verifies that the dir ections listed on the The off-going staff (giving up t  hat the number of pills, syringes e count page is accurate and t tc. in the ‘amount ing staff. left’ column is the same as the number as count ed by the on-com  etc. remaining in the fies the number of pills, syringes Both staff looks at and veri tamper resistant package and in the ‘amount left’ column are the same. r each countable medication.  This process is completed fo of Public Health, Developmental  After all countable medications , both staff have been counted must sign the and all count signature sheet documenti ng that the count was conducted countable medication is accounted for. The medication storage k eys are now transferred to the on-coming staff. chusetts Departments Countable medications must be counted each time the medication storage by the person keys change hands. The medication storage keys must be carried 2017 The Massa assigned medication administrat ion duties for the shift. See MA P Policy Section 10. 166 Massachusetts | Responsibilities in Action

167 DPH recognizes that there are some situations when only one Certified and/or licensed staff is available at the change of shift/assignment. In this instance only, the single Certified and/or licens person count’ and sign the ed staff should conduct a ‘single count indicating a ‘single count’ was conducted. At the first o pportunity for a two person count, the count must be conducted. Under no circumstances should a two person ildren and Families count be conducted less than once y Section 10. every 24 hours. See MAP Polic True (T) or False (F) Services, Mental Health and Ch f on medication count, it is acceptable for one staf 1. __ When conducting a two pers . to conduct the count and then have a second staff verify the count at a later time e medication storag must be counted every time the 2. __ All countable medications keys change hands. on storage keys, 3. __ After counting the medications and accepting the medicati for the security of the medication. you are accepting responsibility 4. __ The medication storage ke ys are carried by the Certified staff assigned medication administration duties for the shift. of Public Health, Developmental 5. __ Maintaining the Chain o f Custody makes it harder for medi cation to be stolen chusetts Departments 2017 The Massa 167 Massachusetts | Responsibilities in Action

168 Review the scenario and select the best action. uties for the shift. A gned medication administration d You arrive at work and are assi keys are handed to Shoulder to Shoulder count is completed, the medication storage ring your shift, another you and you have accepted responsibility for the medication. Du the drug reference book Certified staff asks for the medication storage keys to obtain ildren and Families from the medication storage area. You must: 1. __ Give the keys to the Certif return them as soon as ied staff with instructions to they have what they need. 2. __ Unlock the medication stor age area for the Certified staff and instruct them to lock it back up when they are done. 3. __ Unlock the medication stor ence book for the age area, obtain the drug refer Certified staff and relock. Services, Mental Health and Ch Mark yes (Y) or no (N) if you ma y give the medication keys to: 1. __ The VNA nurse who needs to access the insulin stored in t he medication area 2. __ Administrator or superviso uesting to do an audit r that is not MAP Certified req n closet 3. __ Maintenance personnel fo r needed repairs to the medicatio of Public Health, Developmental Answer the following questions: 1. What happens to the ‘Chain of C have access to the ustody’ if unauthorized staff chusetts Departments _______________ ______ medication storage area? ___________________ ge keys? 2. When and to who are y ou allowed to give the medication stora _ __________________________________________ ____________________ 2017 The Massa 168 Massachusetts | Responsibilities in Action

169 oulder’ count. You are one of two Certified st aff conducting a ‘Shoulder to Sh ack (see next page). and the corresponding blister p Review count sheet page 9 below Is the count correct? _______ ildren and Families 9| Pa ge Scott Green _ X_ Original Entry or Name: Doctor: ____Transferred from page__ Dr. S. Pratt N588 Number: Prescription Greenleaf Pharmacy: Prescription Date: Mar. 3, yr Zolpidem 5mg Medication and Strength: Directions: Take 1 tablet by mouth once daily PRN at bedtime per Scott’s request for difficulty sleeping Services, Mental Health and Ch Amount Amount Amount Time Date Signature Route Left Used on Hand Received 30 from pharmacy 3/3/yr 9am 30 Linda White/Sam Dowd 3/3/yr 9pm mouth 0ne 30 29 Jenna Sherman 3/4/yr one 9pm mouth 28 29 Jenna Sherman of Public Health, Developmental 3/8/yr one mouth 9:30pm 27 28 Amanda Smith 3/10/yr 9pm mouth one 26 27 Amanda Smith 3/11/yr mouth 9:15pm one 25 26 Jenna Sherman chusetts Departments 3/13/yr 9pm mouth one 25 24 Jenna Sherman 3/14/yr 10pm mouth one 23 24 Jenna Sherman 3/18/yr mouth 10pm one 22 23 Amanda Smith 3/22/yr 9:30pm mouth one 22 21 Amanda Smith 2017 The Massa 169 Massachusetts | Responsibilities in Action

170 ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa t of order, you If the tablets in a blister pack age are accidentally removed ou ch tablet. cannot rely on the numbered blisters; instead you must count ea 170 Massachusetts | Responsibilities in Action

171 e Required in the Count Book When and Why Two Signatures ar the count book when aff signatures are required in Two Certified and/or licensed st  adding a newly prescribed medication into the count Why? o new medication received from the To verify the total amount of  pharmacy is correct, is added to the count and is not stolen. ildren and Families adding a medication refill from the pharmacy into the count  Why? o f medication received from the To verify the total amount o  pharmacy is correct, is added to the count and is not stolen.  disposing medication o Why? Services, Mental Health and Ch  To verify the total amount of m edication to be disposed is ren dered be used or stolen. useless and cannot  f the completed a count sheet page is transferred, including both the bottom o page and the top of the newly transferred page Why? o f tabs, caps, mL’s etc.) of To verify the amount (number o  medication at the bottom of the co he mpleted page is the same as t n op of the new page and has not bee amount of medication at the t of Public Health, Developmental tion can be stolen. changed so that the medica the medications are counted each time the medication storage k  eys change hands o Why? chusetts Departments  To verify all medication is se cure, accounted for and is not s tolen. 2017 The Massa 171 Massachusetts | Responsibilities in Action

172 8| Pa ge Tanisha Johnson Name: Original Entry or __ Doctor: from page_ Transferred _X_ Dr. C. Lee 4 N347 Greenleaf Pharmacy: Number: Prescription Prescription Date: Phenobarbital 32.4mg Mar. 3, yr Medication and Strength: Take 2 tablets by mouth once daily in evening Directions: ildren and Families Amount Amount Amount Date Route Time Signature Left Used on Hand 32 3/17/yr 9pm Jenna Sherman/ Amanda Smith sferred from Tran . 4 p 30 two 32 mouth 8pm Jenna Sherman 3/18/yr mouth 30 two 28 8pm Jenna Sherman 3/19/yr Services, Mental Health and Ch two 8pm mouth 26 28 Amanda Smith 3/20/yr two 8pm 26 mouth 24 Amanda Smith 3/21/yr 22 two 24 mouth 8pm Amanda Smith 3/22/yr 22 two mouth 8pm 20 Jenna Sherman 3/23/yr two 20 mouth 8pm 18 Jenna Sherman of Public Health, Developmental 3/24/yr chusetts Departments 2017 The Massa The 3/17/yr 9:00pm entry is an example a count sheet page transfer. If you looked back m, you would see 32 in the am at count sheet page 4 at the botto ount left column and the signatures of Jenna Sherman and Amanda Smith. 172 Massachusetts | Responsibilities in Action

173 Medication Sheets Medication sheets are tracking fo rms. All HCP medication orders must be transcribed onto a medication sheet. After a medication is administered you write your initials in the medication box on the medication sheet documenting you have administered the medication. Your initials in a medication box means that you administered the he medication was not administe red at the program medication at the program. If t location, an acceptable code because the person was at another is used such as: ildren and Families LOA - leave of absence  H - hospital, nursing home, rehab center  DP - day program/day hab  W - work   S - school  /her medication rning to self-administer his P - packaged, if the person is lea Services, Mental Health and Ch owever, the medication is not administered, document If the person is at the program, h this on the medication sheet by  circling your initials and o writing a progress note explaining why the medication was  not administered and who was notified  of Public Health, Developmental chusetts Departments 2017 The Massa 173 Massachusetts | Responsibilities in Action

174 Documentation example of a refus ed medication; on the medication sheet and corresponding medication progress note: Allergies: Bactrim MEDICATION ADMINISTRATION SHEET Month and Year: February, yr 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 Generic Phenytoin Start 2/1/yr Brand Dilantin 8am JS JS JS Dose 200mg Strength 100mg Stop Route mouth t 2 tabs Amoun TMTM 8pm cont. Frequency twice daily ildren and Families Reason: seizures Special instructions: y, yr Name Juanita Gomez MEDICATION PROGRESS NOTE Februar Not Given Refused Given Other Reason Staff Signature Results and/or Response (for giving/not Medication Date Dose Time giving) Services, Mental Health and Ch 8:30am 2/3/yr ytoin 200mg. I attempted to Juanita refused her morning phen administer it 3 times. Dr. Jones was notified. He recommended to skip this dose and to administer the next dose when it is due. Linda White, supervisor was also notified. Jenna Sherman of Public Health, Developmental chusetts Departments 2017 The Massa 174 Responsibilities in Action | Massachusetts

175 Medication Release Documents In the event a also known as a transfer form. A medication release document is n, such as ferred to a different locatio medication is required to be trans  the day program/day hab  on a LOA  a different residential program ildren and Families  to the pharmacy for repackaging or re-labeling  ic medication prescribed for t to the hospital because a specif he person is not supplied by the hospitals pharmacy a dated medication release documen t (transfer or LOA form) must be completed. The medication release document must include: Services, Mental Health and Ch being transferred from  Where the medication is Where the medication is being transferred to  Medication name and strength   Total amount of medication (tablets, capsules, mLs etc.) transferred Signature of person transferring medication  Signature of person receiving medication  of Public Health, Developmental chusetts Departments 2017 The Massa 175 Massachusetts | Responsibilities in Action

176 Sample Medication Transfer Form tion I, ______________________, am transferri ng the following medica From ___________________________________________________ To ___________________________________________________ Date ______________________ ___________ __________________ Strength Quantity Medication ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments medications ___ Signature of staff receiving ________________ Date _________ Date ________ ng medications __________________ Signature of staff transferri 2017 The Massa aff. See MAP Medications must be transported by MAP Certified or licensed st Policy Section 10. 176 Massachusetts | Responsibilities in Action

177 Day Program Medication residential program. tion to be administered in the Whenever possible schedule medica more than one location, However, if a person will routinely be receiving medications at such as the day program, ask t he pharmacy to ‘split-package’ th e medication. For example, if Juanita attends day program five days a week, the pharmacy will prepare and package her day program medica tion separately from medicati on she receives at ion is delivered in full to her residential program. If Juanita’s monthly supply of medicat ildren and Families the residential program, before you send i t to the day program,  eived into the residential progr  document the medication as rec am’s Medication Ordering and Receiving Log o if the medication is a countable medication add it to the coun t book he split-packag complete a transfer form for t ed day program o medication including Services, Mental Health and Ch  medication name and strength amount of tablets, capsules or mLs transferred  if the medication is a countable medication, it must be  subtracted from the resident ial program’s count book is being transferred from  location the medication  location the medication is being transferred to  your signature, as the person transferring the medication  date of Public Health, Developmental  at the day program obtain signature and date, of person accepting the medication o  if the medication is a countable medication, day program staff must add it to the count book  make a copy of the signed and dated transfer form chusetts Departments  a copy as documentation the residential program needs of medication transferred and  the day program needs a c opy as documentation of medication received 2017 The Massa 177 Massachusetts | Responsibilities in Action

178 Day programs typically receive t om the heir supply of medication(s) fr residential programs. In this ins tance, the day program will no t be able to meet the MAP orth of pharmacy receipts on site; instead, the day requirement of having 90 days’ w program will have transfer forms w hich are kept indefinitely. ildren and Families communication opies of Juanita’s HCP orders; The day program will also need c aff and day program staff is essential fo between residential st r safe medication ensure the day program staff residential staff’s responsibility to administration. It is the opy of the HCP order and medication administration (a c has all required information for pharmacy labeled medication). Services, Mental Health and Ch Class Discussion Juanita has a medication ordered four times daily, scheduled for 8am, 12pm, 4pm and week. At Juanita’s 8pm; the 12pm dose is administered at the day program 5 days a inued the medication. The residential staff discontinued last HCP visit Dr. Jones discont the order on the medication sheet, posted and verified the HCP order and disposed of notified the day the discontinued medication, per agency policy. However, no one of Public Health, Developmental program. What do you thin k happened? What should have happened? e day Ask your supervisor what the co mmunication system is between th chusetts Departments program and your work location. 2017 The Massa 178 Massachusetts | Responsibilities in Action

179 Leave of Absence administered outside of the p In the event a medication will be erson’s home, such as a staffed outing or during a visit with family, medication must b e sent with the person for you or the family mem ber to administer. For any leave of absence contac t the pharmacy to package the LOA medication. ce if the LOA is edication for any leave of absen The pharmacy must prepare the m ildren and Families scheduled ahead of time or  greater than 72 hours  If the pharmacy is contacted and is unable to prepare the medic ation you may prepare it only if the LOA is  ad of time) and is unplanned (not scheduled ahe Services, Mental Health and Ch less than 72 hours  ing on the LOA son will be leav Knowing the date and time the per and the date and time the person will be returning from the LOA will he lp to determine the amount of medication to prepare. of Public Health, Developmental chusetts Departments tion administrat If you are responsible for medica ion while on t he LOA, you s prepared by the cation unless the medication wa must be the preparer of the medi pharmacy. 2017 The Massa 179 Massachusetts | Responsibilities in Action

180 ed by or will be administered by staff, each medication If the LOA medication is prepar strength must be in a separate container*  o original marked directly on the container with the information from the pharmacy label including the  person’s name medication name  ildren and Families strength of medication  amount to administer  name of ordering HCP  directions for medication administration   date prepared amount of medication in the c  ontainer (number of tablets, caps ules or mLs) Services, Mental Health and Ch each medication you prepare. *A coin envelope may be used for of Public Health, Developmental mplete leave of absence details including See MAP Policy Section 11 for co vacation LOAs. chusetts Departments 2017 The Massa 180 Massachusetts | Responsibilities in Action

181 of absence when you are admini stering medication, If the person is away on a leave heet by writing ‘LOA’ in the m document this on the medication s edication box. In addition, all medication sent on the LOA must be documented on a Leave of Absence form. The Leave of Absence form should include the person’s name   destination date and time of departure  ildren and Families estimated date and time of return  allergies  medication name  o strength of tablet, capsule or mL o frequency amount to administer o o route o directions or special instructions, if any Services, Mental Health and Ch amount of medication placed into the container   who prepared the medication pharmacy name or o o staff name  signature(s) of the the prepared LO o A ho double checked second staff, if available, w medication staff releasing medication and t o he person accepting medication of Public Health, Developmental  if the medication was released to a family member will be administeri the LOA ng the medication on staff who prepared and o available to the person Written instructions and medica tion information should also be administration during the LOA . who is responsible for medication chusetts Departments 2017 The Massa 181 Massachusetts | Responsibilities in Action

182 If the LOA medication is a count able controlled medication it must be subtracted in the count book as a LOA medication. anda Smith subtracted *On 2-24-yr at 10am, Am nine tablets from the count sheet, that n those medications a leave of absence (LOA) whe were prepared by the pharmacy, for ildren and Families were released to David’s sister. 1| Pa ge Name: X Original Entry or David Cook ______Transferred from page___ Dr. Black Doctor: Prescription Pharmacy: Greenleaf Number: N671 Feb. 17, yr Prescription Date: Phenobarbital 32.4mg Medication and Strength: Take 3 tablets by mouth once daily in evening Directions: Services, Mental Health and Ch Amount Amount Amount Time Route Date Signature Used Left on Hand 42 2/17/yr 9am Linda White Sam Dowd / Received from Pharmacy 2/17/yr three 8pm mouth 42 39 Jenna Sherman 2/18/yr 8pm mouth 39 36 three Jenna Sherman of Public Health, Developmental 2/19/yr 33 8pm mouth 36 three Amanda Smith 2/20/yr 8pm mouth 33 three 30 Amanda Smith 2/21/yr three 8pm mouth 30 27 Amanda Smith chusetts Departments 2/22/yr 8pm mouth 27 three 24 Jenna Sherman 2/23/yr 21 8pm mouth 24 three Jenna Sherman 2/24/yr 12 * 21 nine/LOA 10am _____ Amanda Smith 2/27/yr 9 three 8pm mouth 12 Amanda Smith 2017 The Massa 182 Massachusetts | Responsibilities in Action

183 Sample Leave of Absence Form te ______________ Name _________________________ Allergies ___________________ Da ________________ Program address ___________________________ Program Phone _____ Destination address ___________________________________________ _________________ Date and time of departure ____________________________________ __________________ ____________________ Date and time of expected return ______________________________ # Pills Medication Strength Amount Frequency Route Special Instruction s Provided ildren and Families Services, Mental Health and Ch of Public Health, Developmental Medications Packaged By: Check one c Name of Pharma Pharmacy y ____________________________ Date ____ chusetts Departments Name of Staff ____________________________ Date ____ Staff Name of Staff who double checked* ** (if available) * preparation of medication: ____________________________ Date ____ dministration. My questions I understand the above information regarding medication and its a urther questions. have been answered. I understand I may call the staff if any f 2017 The Massa Name of Person entrusted with medication _____________________ _____ ____ Date ____ Signature _____________________________________________________ Name of Staff releasing medica tion ________ ___________ _________ ________ ___ Date ____ Signature _____________________________________________________ 183 Massachusetts | Responsibilities in Action

184 may not be returned to the progr Any unused oral LOA medication am for use; instead, it must be disposed acco rding to policy and documented . See MAP Policy Sections 10 and 11. ildren and Families Disposal All controlled and countable cont ed must be documented rolled medication to be dispos on the DPH Disposal Record Form. Services, Mental Health and Ch Disposals of OTC medication and di etary supplements may also be documented using the DPH Disposal Record Form. on of medications utive, chronological documentati The disposal record is a consec disposed. This means, each time a medication is disposed, it is assigned an ‘item’ number and dated. For example, the first disposal to take place in a new program would , followed by item #2 (year), it be documented as item #1 (year) em #3 (year) etc. each new calendar year with ite m #1 and the current year. Typically, a program will start of Public Health, Developmental When documenting a medication dis o not leave blank posal on the Disposal Record d spaces. Complete the  heading of the form including the o agency name o program address chusetts Departments o DPH MAP Registration number  item #  date of disposal person’s name   date the prescription was last filled medication name  2017 The Massa  strength of medication  amount disposed  reason for disposal* count book information  o If the medication was a count able medication include the 184 Massachusetts | Responsibilities in Action

185 count book number and   count book page number t a countable medication o If the medication was no  Write ‘n/a’ (not applicable) in the space  Rx number  pharmacy name signature of MAP Ce  rtified supervisor ildren and Families  your signature *When countable medications are d isposed, the Disposal Record and Count Book documentation must agree i l was needed; ncluding; the reason why disposa documented in both places. Services, Mental Health and Ch Possible reasons for medication disposal include  the medication o was refused dropped on the floor o o was discontinued expired (outdated) o o medication was prepared incorrectly the person died  of Public Health, Developmental program is more than allowed  the supply of medicine in the s returned to the program  unused LOA oral medication wa Medication disposals must be completed with two Certified staff , one of which is a MAP chusetts Departments Certified Supervisor ex cept as noted below. on if the medication was Two Certified staff (no supervisor) may dispose of the medicati refused  dropped   prepared incorrectly 2017 The Massa o your supervisor is unavailable and  your agency allows it 185 Massachusetts | Responsibilities in Action

186 Ask your Supervisor if he/she is required for all medication disposals or if two pped dose of medication, Certified staff (no supervisor) may dispose of a refused or dro at your work location. ildren and Families on to be disposed is rendered unu DPH requires that the medicati sable, meaning once you have prepared the medication for disposal; no one is able t o still use it. Look for any the medication information sheet; if there are any, specific disposal instructions on follow them. While there are m ation unusable, any methods for rendering a medic typically, you will om the pharmacy packaging remove the medication fr   put the medication into a sealable bag Services, Mental Health and Ch  crush the medication in the sealable bag add dish detergent to the crushed medication  you can also use o  moistened kitty litter  hand sanitizer used coffee grounds   seal the bag and put it into an airtight, non-descript container place it in the trash  of Public Health, Developmental onal information (pharmacy label) is removed from the Make sure all identifying pers placing it in the trash. empty pharmacy packaging before chusetts Departments ee MAP Policy Medication may not be retur ned to the pharmacy for disposal. S Section 10. 2017 The Massa 186 Massachusetts | Responsibilities in Action

187 On March 3, yr, Amanda Smith accidently dropped one tablet of Tanisha Johnson’s clonazepam 1mg on the floor and di sposed of the tablet with Lin da White. In this was completed in the count book example, disposal documentation and on the disposal ) Notice the entry d to complete a disposal form. form. (The pharmacy label is use tablet was removed for admin istration. fifteen minutes later when another 3| Pa ge ildren and Families X Original Entry or Tanisha Johnson Name: Dr. Chen Lee ______Transferred from page__ Doctor: Pharmacy: N236 Number: Prescription Greenleaf Prescription Date: Medication and Strength: Clonazepam 1mg March 3, yr Directions: Take 1 tablet by mouth twice daily at 8am and 4pm Amount Amount Time Date Amount Used Signature Route Left on Hand 3/3/yr Services, Mental Health and Ch 9am 60 John Craig Sam Dowd / Received from Pharmacy one 4pm ____ 59 60 Linda White Amanda Smith/ dropped/disposed 3/3/yr 4:15pm mouth 58 one 59 Amanda Smith 3/3/yr of Public Health, Developmental chusetts Departments Rx # N236 Greenleaf Pharmacy 111-222-3434 20 Main Street Treetop, MA 00000 3/3 /yr Tanisha Johnson Qty. 60 Clonazepam 1mg 2017 The Massa IC Klonopin Take 1 tablet by mouth twice daily at 8am and 4pm Dr. Lee ED: 3/3/yr Refills: 3 Lot # 365-792 187 Massachusetts | Responsibilities in Action

188 Controlled Substance Disposal Record Form DPH Registration #: ProgramSite: Agency: Amercare MAP 00000 45 Shade St. Date: Item #: Item #: 02/18/yr Date: 1-yr Date Last Individual’s Individual’s David Cook Date Last Filled: Name: Filled: 05/5/yr Name: Strength: Medication: 50mg Medication: Strength: Tramadol Amount Take Amount Take twenty Reason: Reason: DC’d tabs Back Disposed: Back Disposed: ildren and Families Countable Countable Page Page Rx Number: Rx Number: N125 Number: Controlled Number: Controlled Substance Substance Pharmacy: 7 Pharmacy: Greenleaf 1 Book Number: Book Number: Signatures: Signatures: Supervisor: Supervisor: Sam Dowd Linda White Staff: Staff: 2-yr Date: Date: 03/3/yr Item #: Item #: Date Last Individual’s Individual’s Tanisha Date Last Filled: Filled: Johnson Name: Name: 03/3/yr clonazepam Strength: Medication: Medication: 1mg Strength: Services, Mental Health and Ch Take Take Amount Amount one Reason: Reason: tab fell on floor Back Disposed: Back Disposed: Countable Countable Page Page Rx Number: Rx Number: N236 Controlled Number: Number: Controlled Substance Substance Pharmacy: 3 Pharmacy: Book Number: 1 Greenleaf Book Number: Signatures: Signatures: Supervisor: Amanda Smith Supervisor: Linda White Staff: Staff: Date: Item #: Item #: Date: Individual’s Individual’s Date Last Date Last Filled: Name: Filled: Name: of Public Health, Developmental Strength: Medica tion: Medication: Strength: Take Amount Take Amount Reason: Reason: Back Disposed: Back Disposed: Countable Page Page Countable Rx Number: Rx Number: Controlled Number: Controlled Number: Substance Substance Pharmacy: Pharmacy: Book Number: Book Number: chusetts Departments Signatures: Signatures: Supervisor: Supervisor: Staff: Staff: d due to on medications in Schedules II -VI that are either outdated, spoiled or have not been administere Destruction of all prescripti ecord. According to regulations a change in the prescription or a stop order shall be documente d on the DPH approved disposal r at 105CMR 700.003(f)(3)(c): “Dispos al occurs in the presence of at least two witnesses and in accordance with any policies at the Department of Public Health”. DPH policy requires disposal to o ccur in the presence of two Certified or licensed staff of whic h one of en an individual refuses a prepared medication, or a pill is inadvertently the two is supervisory staff. If a s upervisor is unavailable wh dropped then two Certified staff may render these medications u nusable in accordance with acceptable DPH disposal practices. on of your Controlled Substance Failure to maintain complete and accurate records of drug destr uction could result in revocati ender the medication unusable and must be in accordance with acceptable DPH disposal practices. Registration. Disposal must r 2017 The Massa Unless prohibited by local ordin ance, acceptable practices incl ude, but are not limited to, flushing (flushing should be restr icted to those medications so labeled), c rushing the medication and/or d issolving in water put into a sealable bag and mixing with an then be put into an impermeable unpalatable substance (such as liquid soap, used coffee grounds , kitty litter). Mixture should , non- h. Medications are not permitted to be returned to the pharmac y for descript container, (e.g., detergent bottle) and placed in tras destruction. Medications retur ned to the program site (e.g., L OAs) must be destroyed as per DPH regulation. They cannot be reused by the program. Page # 1 188 Massachusetts | Responsibilities in Action

189 If the medication to be disposed is a countable medication, the countable . medication must remain on count until the disposal is completed ildren and Families This means, if you subtracted the medication in the count book and then the person refused the medication, if a sec ond certified or licensed staff is not available; keep the l process. count until a second staff is available to complete the disposa medication on After the medication is disposed you may subtract the medicatio n from the count. Services, Mental Health and Ch Fill in the blanks 1. Medication disposal must take p Certified sta ff. lace with _____ ed on a disposal 2. When a countable medication is disposed, it must be document ________________ record and in the __________ _________________ ___ 3. On a disposal record, the ________ _________ is the chronological numbering of Public Health, Developmental of medications disposed. 4. A MAP Certified ____________________ mus t be present when disposing of expired or discontin ued medications. chusetts Departments 2017 The Massa 189 Massachusetts | Responsibilities in Action

190 Medication Supply Discrepancy Suspicious A suspicious count discrepancy is re is suspicion of when the count is off and the tampering, theft or unauthorized use of medication; known as a medication or drug loss. ed to the Drug Control (schedules II-VI) must be report Prescription medication losses hours after discovery of the medication Program (DCP) within 24 loss using the ildren and Families DPH/DCP Drug Incident Report (DIR) Form. Remember, documentation tells a story from beginning to end. If a suspicious ccurately, using as discrepancy is noted in the Coun t Book, it must be documented a e sure your many lines as needed, to ‘tell the story’ of what happened. Mak DPH/DCP and your discrepancy was reported to the documentation includes that the supervisor. Count Signature Sheet Services, Mental Health and Ch Count correct Date Time Incoming Staff Outgoing Staff yes/no 3:10pm Amanda Smith yes Sam Dowd 3/1/yr 3/1/yr 11:06pm Jenna Sherman Amanda Smith yes 3/2/yr 8:56am single person count Jenna Sherman yes of Public Health, Developmental 3/2/yr 10:12am yes Linda White Sam Dowd 3:04pm 3/2/yr Amanda Smith yes Sam Dowd 11:00pm 3/2/yr Amanda Smith single person count no chusetts Departments y’s Ativan 0.5mg tab is missing. When I counted, one of Ellen Trace unt sheet pag See c left says 9 and there are 8 tabs e 5. The amount o ompleted for the last e packa ge. Blister pack moni in th toring is c dose due. There is one empty bubble after that dose with no moni docum ented. Linda White, Supervisor notified. Drug toring ort for Incident rep m completed an d faxed to DPH. Amanda Smith 2017 The Massa 190 Responsibilities in Action Massachusetts |

191 re sheet will cation loss, the count signatu In the event of a countable medi reflect that the count is incorre hen noting that the count is ct; you will document ‘no’. W umber where the loss incorrect, you may include the corresponding count sheet page n was discovered. ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 191 Massachusetts | Responsibilities in Action

192 Department of Public Health Drug Control Program Drug Incident Report Pursuant to the Department’s regulations at 105 CMR 700.005(D), registrants are required to report the loss of any ncident report and fax it to very. When a drug loss of disco controlled substances upon disco vered, kindly fill out this i ours of discovery. am at (617) 753-8083 within twenty four h the Drug Control Progr Date of Report Report Prepared By r Contact’s e-mail Contact’s Phone Numbe Title ildren and Families Facility Information _ __________________________ Name _________________________________________________ Facility _ Address________________________________________________________________________________ _ City ______________________________________________ Zip Code ___________________________ Facility Type Services, Mental Health and Ch  Clinic  Ambulance  Hospital   MAP (DDS) Manufacturer/Distributor Practitioner’s Office  MAP (DMH)    Prison/House of Correction/Jail Long Term Care  School  MAP (DCF)  VNA _ Specify) _____________________________________  Other (Please _______________ Date of Loss of loss (unit, floor, etc., i f applicable) Specific location Incident Type Diversion  Loss Documentation  Theft  Tampering   of Public Health, Developmental  Specify) _____________________________________ _________________________________ Other (Please _ Dosage Form Strength Quantity Drug (use additional sheets if needed) __________________ _ _ __________________ _ ___________________ _ _ _ _____________________________ _ _ _ __________________ _ __________________ _ _ _ ___________________ _ _ _ _____________________________ __________________ _ _ ___________________ _ _ _ _ __________________ _ _____________________________ _ chusetts Departments Narrative (Please explain what happened, what factors may have c ontributed to loss, and any other relevant se use additional sheets if necessary.) ient harm was involved. Plea information. Please indicate if pat _ _____________________________ _ ________________________________________________________________ _ _ ________________________________________________________________ _____________________________ ________________________________________________________________ _ _____________________________ _ _ ________________________________________________________________ _____________________________ _ _ ________________________________________________________________ _ _____________________________ 2017 The Massa For office use onl y Intake number Received by Drug Unit Staff initials Date facility contacted R20131010-01 Drug Incident Report 192 Massachusetts | Responsibilities in Action

193 Non-suspicious cy is when the count is off however it can be easily A non-suspicious count discrepan on and/or subtraction documented. If a non-suspicious resolved by checking the additi t book it must be corrected accurately, using as many discrepancy is noted in the coun ory’ of what happened. Make sure your documentation also lines as needed to ‘tell the st discrepancy and correction to your supervisor. includes that you reported the ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 193 Massachusetts | Responsibilities in Action

194 1| Pa ge Name: Original Entry or X David Cook Doctor: _____Transferred from page___ Dr. Black Pharmacy: Greenleaf N671 Prescription Number: Feb. 15, yr Medication and Strength: Phenobarbital 32.4mg Prescription Date: Directions: Take 3 tablets by mouth once daily in evening ildren and Families Amount Amount Amount Signature Date Time Route Left Used on Hand 2/15/yr 9am 42 Receiv ed from Pharmacy / Sam Dowd Linda White 2/15/yr 8pm mouth 42 three 39 Jenna Sherman 2/16/yr 8pm mouth 39 three 36 Jenna Sherman Services, Mental Health and Ch 2/17/yr 36 three 33 8pm mouth Amanda Smith 2/18/yr 8pm mouth 33 three 30 Amanda Smith 2/19/yr 30 8pm mouth three 27 Amanda Smith 2/20/yr 8pm mouth 24 three 27 Jenna Sherman 2/21/yr 8pm mouth 21 24 three Jenna Sherman of Public Health, Developmental 2/22/yr 10am _____ 21 nine/LOA * 12 Amanda Smith 2/25/yr 12 9 three 8pm mouth Amanda Smith three mouth 2/26/yr 8pm 5 9 Jenna Sherman chusetts Departments y ced the a mount left says 5 but the r 10am When count ing I noti 2-27- number in the medication package is 6. The math of the 2-26-yr at 8pm . I notified Linda . Correct count is 6 entry upervisor ite, S Wh is incorrect 6 _________ _______ ______ ____ Sam Dowd 2017 The Massa 194 Massachusetts | Responsibilities in Action

195 Your role in the Chain of Custody is necessary to ensure the security of the medication. , each joined to the other; the ‘ Chain of Custody’ Just like the links of a chain documentation trail of medicati out of your program must on received into or transferred never be broken. ildren and Families Let’s Review and tracked  All medications and dietary supplements must be accounted for  Medications are tracked using: o Pharmacy Ordering and Receiving Log Pharmacy receipts o o Medication sheets o Count Book Services, Mental Health and Ch o Transfer form LOA form o Disposal Record o o Blister Pack Monitoring (if used at your agency)  Always complete the appropriate tracking document o o include your signature and date If releasing medication to anot  their signature as her person, make sure to obtain accepting the medication of Public Health, Developmental he medication conciled (counted) every time t Countable medication must be re  storage keys change hands  Diversion of prescription medica tion may result in criminal pr osecution hin 24 hours must be reported to DPH/DCP wit Prescription medication losses  after discovery of the loss chusetts Departments aintaining the Chain of Custody You play an important role in m  2017 The Massa 195 Massachusetts | Responsibilities in Action

196 Unit 9 Medication Occurrences Responsibilities you will learn The definition of a medication occurrence  What you do if you make or discover a medication occurrence   When and how to report a medication occurrence ildren and Families  How to help reduce medication occurrences r medication safely, the process must be completed As you have learned, to administe from beginning to end while being mindful. Most medication occ urrences can be traced to not following the steps of the medication administration pro cess. A wrong during medication is when one of the 5 rights goes medication occurrence administration, including: Services, Mental Health and Ch Wrong  person o o medication o dose time o omission (a subcategory of wrong time)  route o of Public Health, Developmental A Medication Occurrence Report ( k and report each MOR) is a document used to trac ation. ong during medication administr time one of the 5 rights goes wr chusetts Departments ention (including but is when medical interv medication occurrence A hotline not limited to lab work, tests, E mergency Room visit, HCP visit , etc.), illness, injury or death follow the medication occurrence. See MAP Policy Section 09. 2017 The Massa Ask your Supervisor how MORs are submitted at your work locati on. 196 Massachusetts | Responsibilities in Action

197 Procedure Following a Medication Occurrence ence is identified you must: As soon as a medication occurr  Check to see if the person is ok  If not ok, call 911 o ergency procedures and where You must know your agency’s em ildren and Families emergency contact information is located Call a MAP Consultant  o onsultant, make sure you When speaking to the MAP C ctly what happened, including tell the MAP Consultant exa  the medication(s) involved   what type of occurrence happened  date and time of occurrence Services, Mental Health and Ch  Follow all recommendations given to you by the MAP Consultant Notify your supervisor   Document o what happened who you notified o of Public Health, Developmental include the MAP Cons  ultant’s full name your supervisor’s full name  the MAP Consultant’s recommendations o o tant’s recommendations) what you did (the MAP Consul o sign your name date/time o chusetts Departments Complete a Medication  Occurrence Report (MOR) o a Hotline Medication Occurrenc if the medication occurrence is e notify DPH and the MAP Coordinator within 24 hours of discover  y of the medication occurrence fax and telephone numbers fo r DPH are located on  2017 The Massa the MOR form submit the report within 7 days of discovery of the medication o occurrence  to the MAP Coordinator 197 Massachusetts | Responsibilities in Action

198 Department of Public Health Medication Administration Program MEDICATION OCCURRENCE REPORT (side one) Agency Name Date of Discovery Individual’s Name Time of Discovery Site Address (street) Date(s) of Occurrence City/Town Zip Code Time(s) of Occurrence DPH Registration No. Site Telephone No. MAP A) t) Type Of Occurrence (As per regulation, contact MAP Consultan Wrong Medication (includes medication given without an order) 4 Wrong Individual 1 5 Wrong Time (includes medication not given in appropriate timeframe) 2 Wrong Dose not given or fo rgotten) 3 Wrong Route Omission (subgroup of ‘wrong ti me’--medication B) Medication(s) Involved Medication Name Dosage Frequency/Time Route ildren and Families As Ordered: As Given: As Ordered: As Given: As Ordered: As Given: C) MAP Consultant Contacted (Check all that apply) Services, Mental Health and Ch Date Contacted Name Type Time Contacted Registered Nurse Registered Pharmacist Health Care Provider Hotline Events D) Did any of the events below Yes follow the occurrence? No , and within 24 hours of disc 53-8046 or call to notify DPH If yes, check all that apply below overy fax this form to DPH (617) 7 r. DMH/DCF or DDS MAP Coordinato at (617) 983-6782 and notify your Coordinator within 7 days. For All Occurrences, forward reports to your DMH/DCF or DDS MAP Medical Intervention (see Section E below) Illness Injury Death of Public Health, Developmental MAP Consultant’s Recommended Action E) Medical Inte rvention Yes No If Yes, Check all that apply. Clinic Visit Lab Work or Other Tests Health Care Provider Visit Hospitalization Emergency Room Visit Other: Please describe chusetts Departments F) Supervisory Review/Follow-up ck none (8) Contributing Factors: Check all that apply. If none apply, che Medication Had Been Discontinued 1 5 Failure to Properly Document Administration 2 6 Medication not Available (Explain Below) Improperly Labeled by Pharmacy 7 y Non-Certified Staff Medication Administered b 3 Failure to Accurately Record and/or Transcribe an Order (includes instances of expired or revoked Certification) 8 None Failure to Accurately Take or Receive a Telephone 4 Order Narrative : (If additional space is required, continue in box F-1) 2017 The Massa Print Name Print Title Date Contact phone E-mail address number 198 Massachusetts | Responsibilities in Action

199 The DPH Medication Occurrence R in DMH- eport form is used for all MOR’s DCF programs and in DDS programs for hotlines only. an opportunity to improve medica Medication occurrences provide tion administration nt to focus on what tion occurrences it is importa procedures. When reviewing medica ildren and Families ce. contributed to the occurrence ra ther than who made the occurren Every staff can and should learn from someone else’s mistake. If you make a mistake ember that the safety of when administering medication, it is extremely important to rem e occurrence to the the person must always be your primary concern and to report th MAP Consultant immediately. decreased by The chances of a medication occurrence happening can be greatly Services, Mental Health and Ch inistration process you learned in this curriculum. always following the medication adm me you administer medication. Follow the same process each ti cation licy/procedure is regarding medi Ask your supervisor what the po occurrence follow up specific to your work location. Expect that if you discover or make of Public Health, Developmental an occurrence your supervisor w the circumstances of ill speak to you to learn about what happened. A supervisor does this to determine if the: ptly to the MAP consultant occurrence was reported prom   MAP consultant responded in a timely manner recommendation was followed  chusetts Departments In addition a supervisor reviews:  if there was an impact on the person  the completed medication occurrence report lated o which of the five rights of medi cation administration were vio right person  2017 The Massa  right medication  right dose  right time omission  199 Massachusetts | Responsibilities in Action

200 right route   the form was forwarded to the office, if necessary It is important for a supervisor to know: stood?  Was the HCP order clearly under Was the HCP order posted and verified before the medication was given?   Was the proper procedure used to assure the identity of the person? ildren and Families Were three checks for the five  ication was rights conducted before the med administered?  Were the contents of the medication cabinet secured? t filled out correctly?  Was the medication shee and correct? ountable controlled medications completed  Were counts of the c  egible and correct? Was the pharmacy label l Was the correct medication available to be given?   Is the medication HCP order book current and correct? Services, Mental Health and Ch t secure (under Certified staff Was the prepared medication kep  ’s control) until the intended person swallowed the medication? Were medication counts completed upon receipt of medication?  Gathering this information will help a supervisor determine the reason for an occurrence. Reasons for an occurrence may be:  on administration process Failure to follow the medicati Failure to follow the correct process in ordering and receivin  g medication of Public Health, Developmental Contributing environmental  factors such as a: snow storm o  Documentation errors such as a: transcription error o  Other contributing factors such as: chusetts Departments o noise Gathering this information helps a supervisor determine any cor rective action such as: Reviewing procedures  with the staff (retraining specific to wh at went wrong) specific to what went Reviewing regulations he staff (retraining and/or policy with t  wrong) 2017 The Massa  Requiring complete formal retraining such as: o Repeating a full MAP Cert ification training Providing 1:1 supervision practi ce until the supervisor is sat isfied of correct  practice such as: o supervised medication passes 200 Massachusetts | Responsibilities in Action

201 Disciplinary action  hen the staff me mber participation in a medication Other responses may be necessary w occurrence was only a partial caus e of the occurrence (certain types of pharmacy error, HCP error, etc.) ildren and Families Number the ‘Procedure Following a Medication Occurrence’ in the order to be completed if you make or disco ver a medication occurrence. A. __ Complete a Medication Occurrence Report ltant B. __ Follow all recommendations given to you by the MAP Consu C. __ Notify your supervisor Services, Mental Health and Ch D. __ Call 911, if needed E. __ Document what you did and who you notified F. __ Call a MAP Consultant person is ok G. __ Check to see if the of Public Health, Developmental Match the term to the corresponding example chusetts Departments Ear drops ordered for the right ear were Wrong dose A 1.___ administered into the left ear A morning dose of medication was 2.___ Wrong person B administered in the evening Klonopin 2mg was ordered and Klonopin 3.___ Wrong route C 1mg was administered A discontinued medication was 4.___ D Wrong medication administered 2017 The Massa not administered Medication ordered was Wrong time E 5.___ Medication was left unattended and then 6.___ Omission F was ingested by another person 201 Massachusetts | Responsibilities in Action

202 medication occurrence means the wrong person A medication was administered  to the wrong person, either by o misidentification distraction o else ended or not secured and someone the medication was left unatt o ingested it ildren and Families wrong person, always cation occurrence involving a To minimize the chances of a medi  remain mindful Think about what you are doing ot rush or as you prepare medication; do n o skip steps to save time o If possible, bring the person to the medication area o is familiar son is, ask another staff who If you are unsure of who the per Emergency Fact Sheet picture with the person or look at the Services, Mental Health and Ch Do not try to do more than one task at the same time o  For example  e talking on your cell phone Do not prepare medication whil o Never leave medication unattended ure it until you attempt a se if the medication is refused, sec  cond or third administration Never pre-pour medication o of Public Health, Developmental gned working together; Jim is assi You and your coworker Jim will be medication administration duties and you are assigned morning h ygiene. To save time, Jim decides to ‘pre-pour’ all of the medications. chusetts Departments Just as Jim finishes preparing all of the medications he hears you call for “Help!” Jim en Jim returns to the goes to help you leaving the prepared medication unattended. Wh f the people living medication area he finds one o ith the empty pill cups. in the home w 1. What category of medication occurrence was made? ___________ ___________ _____________ 2. What should Jim do next? ______________________ ________ _____________ 3. How could this medication occurrence have been prevented? __ 2017 The Massa 4. What if the same scenario o ccurred, except Jim had correctly prepared only one set of medication; what could he have done when he heard the call for help? _____________________ _ __________________________________________ 202 Massachusetts | Responsibilities in Action

203 A occurrence means the medica tion was administered wrong medication without a HCP order  o including administering a medication using an expired HCP order  that had been discontinued  limited medication order past the stop date of a time   administering one medication instead of another ildren and Families Tegretol is ordered/Tylenol is administered instead  wrong medication, To minimize the chances of a medi cation occurrence involving a always  of the medication administrati look at the HCP order (check #1 on process) to ensure o it is valid; signed and dated by the HCP  Services, Mental Health and Ch been changed or was discontinued the medication order has not   label is what the HCP ordered what is printed on the pharmacy order call a MAP Consultant if you have a question regarding an HCP  Janet is assigned medication admini rs from the stration duties. She remembe of Public Health, Developmental .1% cream to be a has a HCP order for Kenalog 0 last time she worked that Tanish applied to the bottoms of both feet at bedtime. for bed, she gets the cream fr As Janet helps Tanisha get ready om the medication storage area and applies it to the bottom of Tanisha’s feet. Ja net then washes her hands and starts to prepare Tanisha’s oral medications. chusetts Departments HCP orders and medications shee ts she notices that As Janet is reviewing Tanisha’s the order for the Kenalog cream was discontinued yesterday. 1. What category of medication occurrence was made? ___________ ________ ______ ____________________ 2. What should Janet do nex t? _____________ 3. How could Janet have prevented this medication occurrence? ____________ 2017 The Massa 203 Massachusetts | Responsibilities in Action

204 medication occurrence means wrong dose A too much or   too little o of the medication was administered at the scheduled time wrong dose, always To minimize the chances of a medi cation occurrence involving a ildren and Families  look at the o HCP order to find the dose of the medication h of the tablet and the amount to give to o pharmacy label to find the strengt equal the dose o s correct he cup to ensure the amount i medication you have prepared in t e the tablet was popped out and did not blister pack (if used) to ensur o ‘stick’ to the foil seal o OPUS cassette (if used) to ensur e the tablet was removed and d id not l Services, Mental Health and Ch ‘stick’ in the corner give does not equal  rength of tablet and amount to call a MAP Consultant if the st the dose ordered by the HCP Tanisha Johnson has a HCP order for phenobarbital 64.8 mg once daily in the of Public Health, Developmenta directions to take 2 evening. The pharmacy had been supplyi ng a 32.4 mg tablet with tablets. When the new refill wa s obtained, it was supplied as a 64.8 mg tablet with directions to take 1 tablet. o prepare Tanisha’s medications. Serena remembers that At 8pm, Serena starts t Tanisha always receives 2 tabl ets of phenobarbital so she gets the blister pack of chusetts Departments phenobarbital, pops 2 tablets and administers them. As Serena starts to document on the medication sheet and count book she notices that the strength of the table t and amount to give has changed. 2017 The Massa occurrence was made? ___________ 1. What category of medication ___________ ___________________ _______________ 2. What should be done next? ________ 3. How could this medication occurrence have been prevented? __ _____________ 204 Massachusetts | Responsibilities in Action

205 A wrong time medication was administered medication occurrence means the  ore the scheduled time), too early (more than 1 hour bef too late (more than 1 hour a  fter the scheduled time), or use of the medica followed tion were not parameters or instructions for  A subcategory of wrong time is ildren and Families o Omission t administered; either it was Meaning the medication was no   forgotten or not available to administer  To minimize the chances of a medi wrong time or cation occurrence involving a omission, always Services, Mental Health and Ch  edication sheet to schedule ‘am’ medication times use the top two boxes on the m edule ‘pm’ medication times and the bottom two boxes to sch and up to one hou one hour before administer medication within r after, the time  listed on the medication sheet  administer PRN medication a t the exact frequency ordered keepi ng in mind the last time it was administered there is no 1 hour win o dow for PRN medication y of a medication ou have questions about the frequenc  call a MAP Consultant if y of Public Health, Developmental  document after administering the medication o to minimize the chance of a sec ond staff giving the medication again on the medication sheet and t because there was a ‘blank space’ hey were within the hour time window parameters for use of the medic  follow the instructions and/or ation as ordered by chusetts Departments the HCP Such as blood pressure monitori o o the ng, ordered to be taken prior t administration of a medication  If the medication is adminis tered without obtaining the blood me’ medication occurrence pressure, it is a ‘wrong ti s obtained from the pharmacy  ensure that medication i edication o Order refills from the pharmacy a t least one week before the m 2017 The Massa runs out o As soon as the last remaining refill is called into the pharma cy, notify the HCP that additional refills are needed. 205 Massachusetts | Responsibilities in Action

206 Be aware, the process of obtai  ning medication from the pharmac y may take several phone calls and is not complete until the medication is obtained Ask your Supervisor to explain in your work the system for obtaining refills location. ildren and Families You are assigned medication admini stration duties. You wash you r hands, unlock the medication storage ar and see that the ea, look in the medication book the blister pack of 4pm; however, when you locate person has Tegretol 400mg due at Services, Mental Health and Ch Tegretol you find the blister pack is empty. age area for a back-up supply and You check the medication stor none is found. You call the pharmacy but the pharmacist te left. lls you there are no refills 1. What should you do next? ________ _______________ ____________________ 2. If no medication is obtained _______________ , who should you call? _________ 3. What category of medication occurrence was made? ___________ ___________ of Public Health, Developmental _____________ 4. How could this medication occurrence have been prevented? __ chusetts Departments 2017 The Massa 206 Massachusetts | Responsibilities in Action

207 wrong route medication occurrence means the medication was administered A by a way (route) not ordered by the HCP  cation occurrence involving a wrong route, always To minimize the chances of a medi  look at the o of administration ordered HCP order to see the route o heet to ensure the route of adm inistration pharmacy label and medication s ildren and Families is listed and is the same as the HCP order  n storage area ute, in the person’s medicatio separate medications by their ro  remain mindful o to ensure you administer the m edication by the correct route o dication Call a MAP Consultant if you have questions about the way a me is to be administered Services, Mental Health and Ch r Debrox ear drops, 4 drops to each ear at Ellen Tracey has a HCP order fo bedtime and a second HCP order fo r Saline eye drops, 4 drops to each eye, at bedtime. cations, another staff is talki ng to Joe about the new As Joe is preparing Ellen’s medi ‘app’ he installed on his phone. Joe is very interested in the new ‘app’ and stops paying attention to what he is doing . Instead of reaching for the Sali ne eye drops he takes the of Public Health, Developmental Debrox ear drops. ebrox ear drops i Joe proceeds to administer the D nto Ellen’s ey es. Joe realizes what he has done as he is completing a ‘c loser look’ while signing the medication sheet. 1. What category of medication ___________ occurrence was made? ___________ 2. What should Joe do next? ____________________ _______________ ________ chusetts Departments _____________ 3. How could this medication occurrence have been prevented? __ 2017 The Massa 207 Massachusetts | Responsibilities in Action

208 Let’s Review n one of the 5 rights goes wrong A medication occurrence is whe   rgency gency procedures and where eme You must know your agency’s emer contact numbers are listed ildren and Families  MAP Consultant If you make, or discover, a medication occurrence, speak to a immediately o Follow all recommendations Document o lways be your first concern, ca  The safety of the person must a ll 911 if needed Medication occurrences should be viewed as ‘teachable moments’  o learn from yours and/or someone else’s mistake  Always remain mindful during the medication administration pro cess Services, Mental Health and Ch o Do not try to do additional tasks, such as answering the phone or talking administering medication to a co-worker, while within 7 days Medication occurrences must be reported to the  MAP Coordinator of discovery MAP ust be reported to DPH and the  Hotline medication occurrences m Coordinator with 24 hours of discovery of Public Health, Developmental chusetts Departments 2017 The Massa 208 Massachusetts | Responsibilities in Action

209 Words You Should Know -A shortened form of a word or phrase. Abbreviation Accuracy check- cation sheets, completed by two A review of the new month’s medi , ensuring that all information on the medication sheet is Certified and/or licensed staff complete and correct. -A severe side effect. Adverse Response ildren and Families -When the body’s immune system reacts to a medication as if it were Allergic Reaction a foreign substance. -The number of tablets, capsules e ordered by or mLs needed to equal the dos Amount the HCP. -A severe, dangerous, life threatening allergic reaction which Anaphylactic Reaction ention, such as calling 911. requires immediate medical att Services, Mental Health and Ch (HCP; see HCP below). -Health Care Provider Authorized Prescriber -A medication tracking mechanis Blister Pack Monitoring m. Documentation by staff, on removed from the package. h time a tablet or capsule is the back of the blister pack, eac -A medication created Brand name medication and named by the specific pharmaceutical company that created it. of Public Health, Developmental Chain of Custody for -A documentation trail showi ng who is, or has been, responsible the security of the medication at any given time. in Communication -Exchanging of information; this can be accomplished verbally, writing and/or in the form of listening, body language, tone of voice. Confidentiality -Keeping information about the peopl e you support private; info rmation chusetts Departments to be shared on a ‘need to know’ basis. a prescription to obtain -Schedule VI Controlled Medication medication which requires it from the pharmacy; must be si ngle locked and is not required to be tracked in the Count Book. Countable Controlled Medication -Schedule II-V medicati on which requires a 2017 The Massa prescription to obtain it from the pharmacy; must be double loc ked and tracked in a Count Book. Countable Controlled Substance Book -A book used to document and track schedule II-V medications. 209 Massachusetts | Responsibilities in Action

210 -Another name for the Countable Controlled Substance Book. A b ook Count Book used to track all countable cont on in a program. rolled (schedule II-V) medicati Count Sheet of each t Book used to track the amount -The middle section of the Coun countable medication when added or subtracted. -The last section of the Count Book used by staff to document Count Signature Sheets d from one staff to when responsibility for the countable medications is transferre another staff. ildren and Families DCF -Department of Children and Families. -Department of Developmental Services. DDS -When a medication does exactly w e person Desired Effect hat it was intended to do; th experiences the beneficial re sults of the medication. Dietary Supplements -Products not regulated by the fe a deral government that contain Services, Mental Health and Ch ubstances. dietary ingredient such as vitamins, minerals, herbs or other s cation or treatment to be stopped; typically Discontinue -When the HCP orders a medi abbreviated as D/C or DC. d on a -To render a medication unusable a Disposal nd dispose; must be documente al Record. Dispos -Document used to track the disposal of all prescription medica Disposal Record tion. of Public Health, Developmental DMH -Department of Mental Health. Documentation ppened it down; your writing of what ha -To prove something by writing rom beginning to end. should tell a story f -How much medication the HCP or time the ders the person to receive each Dose chusetts Departments medication is to be administered. DPH -Department of Public Health. Contact List Emergency -A list of contact names and telephone numbers clearly ference including: MAP Consul posted for quick and easy staff re tants, Poison Control and other emergency numbers (911, fire, police). 2017 The Massa ine, day to day matters. Reporting -Exchanging information on rout Everyday Expiration Date -Last date a medication may be administered. 210 Massachusetts | Responsibilities in Action

211 -A signed and dated HCP order that is obtained Faxed Health Care Provider Orders via a fax machine. A fax order is a legal order. d to be Frequency often the medication is ordere -Also referred to as ‘time’; how administered. -A medication known by its c Generic name medication hemical name. Generic named medications are often manufactured by many different pharmaceutical companies. ildren and Families -Different names used for the same form; the HCP Encounter/Consult/Order Form form used by the HCP to write orders. (HCP) Health Care Provider the state of Massachusetts -A person who is registered in to prescribe medication. -A set of detailed orders/ instructions many times Health Care Provider Order etimes not related to medicatio medication related, however, som n, written by the HCP for each person. Services, Mental Health and Ch goes wrong during the -When one of the 5 rights Hotline Medication Occurrence medication administrat ion process; followed by medical interven tion, illness, injury or death. -Exchanging information right away. Immediate Reporting Index t Book. The index lists the pers -The first section of the Coun on’s name, and count sheet page number for ea ch countable medication name and strength medication. of Public Health, Developmental -Code used on a medication sheet to document when a Leave of Absence (LOA) person receives their medication outside of the program, such a s a staffed outing or during a visit with family. Leave of Absence Form -Document used to track medi cation when sent on a LOA. chusetts Departments -A number assigned to each ‘batch Lot Number ’ of medication produced; used in the to be taken off the market. event a medication is required MAP - Medication Administration Program. -A licensed professional who is a MAP Consultant vailable 24/7 to answer your 2017 The Massa medication questions. A MAP Consul tant is a registered nurse (R N), registered pharmacist or HCP. MAP Policy Manual source of MAP information and -Single, topically organized policies. 211 Massachusetts | Responsibilities in Action

212 -Massachusetts Controlled Substance Registration. MCSR Medication -A substance that when put into or onto the body will change on e or more ways the body works. Medication Administration Process -When administering medication, what you must do to prepare, administer and complete each time you give a med ication. Medication Book -A medication tracking book which ty pically contains HCP orders , ildren and Families medication sheets and medication rson living at the information sheets for each pe program. -The right side of a medication tials Medication Grid sheet used to document your ini after administering a medication. Medication Information -A resource that gives information about a medication. -A resource for medication in Medication Information Sheet formation typically obtained Services, Mental Health and Ch from the pharmacy. -A mixing of medications in the body which will either increase Medication Interaction or decrease the effects and/or s ide effects of one or both of t he medications. In addition to medications interacting with each other, medications can also interact with dietary supplements, other substances (alcohol, nicotine and caffeine) and certain foods. -When one of the 5 rights goes Medication Occurrence wrong during medication administration. of Public Health, Developmental Medication Occurrence Report (MOR) k and report each time -Document used to trac ng medication administration. one of the 5 rights goes wrong duri Medication Ordering and Receiving Log -Documentation of when medication is ordered by a program and when received from the pharmacy. chusetts Departments Medication Outcome -The result a medication produces after it is administered; t Noted and/or Side Effects. Desired Effect, No Effec -Document used to track m Medication Release Document edication when moved from one location to another location, a lso known as a transfer form . rge orders to the orders the -Comparing the hospital discha Medication Reconciliation 2017 The Massa person had prior to admission; discrepancies are clarified with the prescribing HCP. Medication Refill -A number on the pharmacy label i ndicating how many times the medication may be obtained from the pharmacy. 212 Massachusetts | Responsibilities in Action

213 -When a person will not take the medication from you either by: Medication Refusal saying ‘No”, spitting the medication right back out, spitting the medication out later or n one half hour of taking it. intentionally vomiting withi Medication Schedule -A number (schedule) assigned by t he Drug Enforcement Agency tential to be abused; on based on the medication’s po (DEA) to a prescription medicati used. he more likely the medication is to be ab the lower the number t -How each person responds to the same medication. Factors Medication Sensitivity ildren and Families that affect medication sensitiv l health, medical history ity include: age, weight, genera and use of other medication(s). -Document used to track the adm inistration of each person’s Medication Sheet medication on a monthly basis. -Always paying attention to what you are doing; focusing on the task at Mindfulness hand. Services, Mental Health and Ch cation is taken for a specific -A medication outcome when a medi No Effect Noted continue; no effect reason and the symptoms medication. s are noted from the h as Ensure, gastric tube -Conventional food items suc Nutritional Supplements s are not medications akfast; nutritional supplement feedings or Carnation Instant Bre and do not fall under MAP. -Factual information that you can see, hear, smell, feel and/or Objective Information measure. of Public Health, Developmental nformation. carefully in order to obtain i -The process of watching someone Observation when the medication is not administered. -Subcategory of wrong time; occurs Omission Oral -A route; when a medication is taken by mouth. chusetts Departments Over-the-Counter (OTC) Medication -Medications which may be purchased without a prescription. Paradoxical Reaction -A response to a medication that is the opposite of what the medication was intended to produce. ation should Parameters -A set of rules or guidelines that tell you how or when a medic 2017 The Massa or should not be administered. Pharmacy Receipt -A document received from the pharmacy listing how many tablets , capsules or mLs of each medication was dispensed to the program . 213 Massachusetts | Responsibilities in Action

214 -Documentation completed by sta ff on the HCP order (under the H CP signature) Post after a medication is transcribed. -A set of instructions from t he pharmacist he HCP to the pharmacist telling t Prescription to give it for the person it what medication to prepare and how is prescribed. The on to print a pharmacy label. pharmacist uses the prescripti Prescription number -A number on the pharmacy label u sed to obtain refills; often referred to as the ‘Rx’ number. ildren and Families -Foundation of the Medica tion Administration ion Administration Principles of Medicat cation. , Supporting Abilities and Communi Process including Mindfulness -Approval from an insurance Prior Authorization company, required prior to the pharmacy being able to fill a pre ation will be paid for. scription; to ensure the medic -Latin term meaning a medication PRN to be given only when needed. Services, Mental Health and Ch for a tered only when needed ordered to be adminis -Medication that is PRN medication specific health issue. nd why to give -A detailed HCP order that includes instructions on when, how a Protocol a medication. Typically used wh en the medication is ordered to help lessen physical symptoms such as seizures or constipation. -To give spoken or written info told. rmation of something observed or Reporting dication enters the body. -The way in which the me Route of Public Health, Developmental Rx -Abbreviation for a prescription number, used to obtain refills . Shoulder to Shoulder Count -A specific procedure which transfers responsibility for the er staff. Conducted by 2 cations, from one staff to anoth safety and security of the medi Certified staff each time the nds. medication storage keys change ha chusetts Departments -Result from a medication that is not wanted or intended even if the desired Side Effect effect is achieved. Side effect s can range from mild to severe. Single Person Count -Procedure conducted when there is only one Ce rtified and/or licensed staff available to coun t the countable medication; typ ically completed when only one staff is on duty when pu tting the medication storage keys into or taking them 2017 The Massa out of the coded lock box. Special Instructions -Information listed on the HCP o rder and/or pharmacy label giving additional information about m edication administration. 214 Massachusetts | Responsibilities in Action

215 receive the first dose of a -The date a person is scheduled to Start Date medication. Stop Date -The date a person is scheduled to receive the last dose of a medication or if given continuously. r mL. d within each tablet, capsule o -How much medication is containe Strength Subjective Information -When a person speaks or signs and they tell you something. ildren and Families udes instructions on when, how a Support Plan -A detailed HCP order that incl nd why to give a medication. Typically us d to help lessen a ed when the medication is ordere behavior. Supporting Abilities -Helping a person to be as independent as possible. Tamper Resistant Packaging -A way the pharmacy packages a medication to physically limit how the m edication is accessed. Services, Mental Health and Ch Telephone Health Care Provider Orders -Documentation of an HCP order taken by Certified staff while speaking with the HCP on the telephone. T elephone orders must be signed by the HCP within 72 hours. Toxicity -When a medication builds up in the body to the point where the body cannot handle it anymore; this can be life threating. er -To copy information from one doc ument and record it onto anoth Transcribe document. of Public Health, Developmental -The completed document after information has been recorded fro T ranscription m one ents onto it. or more docum econd staff on the HCP order (under the HCP -Documentation completed by a s Verify first staffs completed transcription for accuracy. signature) after reviewing the chusetts Departments Wrong Dose -When either too much or too littl e of a medication is administ ered at the scheduled time. -When medication is administer ed without an HCP order; includes Wrong Medication using an expired or disconti nued HCP order, administering past the stop date of a time limited medication order or admin istering one medication instea d of another. 2017 The Massa -When medication is administered to a person it is not ordered for either Wrong Person by misidentification, distracti on or the medication was left un attended/not secured and someone else ingested it. 215 Massachusetts | Responsibilities in Action

216 ed by the red by a way (route) not order -When the medication is administe Wrong Route HCP. -When the medication is administered too early, too late or par Wrong Time ameters or instructions for use of the medication are not followed. ildren and Families Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 216 Massachusetts | Responsibilities in Action

217 Answer Key Unit 1 Page 16 ildren and Families 1. F 2. F 3. T 4. F 5. T 6. F 7. T Services, Mental Health and Ch Page 18 head ‘yes’ and ‘’no’ to respond t o a question or she 1. Juanita is able to nod her may ‘make a face’ to show if she liked (smiled) or did not like (frowned) a flavor when tasting the pudding -communication Related principle ministration 2. Allow Ellen to fill her own glass of water for medication ad - supporting abilities Related principle of Public Health, Developmental 3. Her HCP Related principle -communication ister the medications to of 4. Switch the order of who you admin ten Related principle -mindfulness Page 20 chusetts Departments 1. Anxiety is defined as biting hands for more than 4 minutes a nd head slapping for longer than 30 seconds or more than 5 times in 4 minutes 2. No 3. Notify HCP 2017 The Massa 217 Massachusetts | Responsibilities in Action

218 Unit 2 Page 23 1. O 2. O 3. S 4. O 5. S ildren and Families Page 27 4. _ David states he has, ‘sharp pain’ when he bends his right knee. He  _ frowns getting off the van and is limping. His right knee is now red, warm to touch uprofen 400mg for right knee pain and his and swollen. He has received Ib symptoms continue. Services, Mental Health and Ch Unit 3 Page 32 Lisinopril Omeprazole Ibuprofen Page 39 This product is a(n) of Public Health, Developmental 1. b. OTC Medication 2. Is a HCP order required for administration? Yes ed for administration? Yes 3. Is a pharmacy label requir o a medication sheet? Yes 4. Is the product transcribed ont chusetts Departments This product is a(n) 1. a. Dietary Supplement 2. Is a HCP order required for administration? Yes ed for administration? Yes 3. Is a pharmacy label requir o a medication sheet? Yes 4. Is the product transcribed ont 2017 The Massa 218 Massachusetts | Responsibilities in Action

219 Page 42 Sample Medication Information Sheet ons you are taking. Do not use Tell your HCP of all the medicati Interactions: with St. John’s Wort. Using ay increase side effects such a tramadol together with alcohol m s dizziness, drowsiness, confusion, and difficulty concentrating. ildren and Families Page 44 1. B 2. C 3. G Services, Mental Health and Ch 4. L 5. K 6. E 7. F 8. J 9. H of Public Health, Developmental 10. I 11. A 12. D chusetts Departments Unit 4 Page 51 1. Dr. Black 2. Burning in throat after eating 2017 The Massa 3. Sam Dowd 4. No known allergies 5. Gastroesophageal reflux disease 6. Prilosec fter eating 7. Remain upright 30 minutes a 219 Massachusetts | Responsibilities in Action

220 Page 52 HEALTH CARE PROVIDER ORDER Date: Feb. 2, yr Name: Tanisha Johnson Health Care Provider: Allergies: No known medication allergies Dr. Chen Lee ildren and Families Reason for Visit: Complaining of soreness in back of mouth. Current Medications:  in the evening by mouth Phenobarbital 64.8mg once daily  Clonazepam 1mg twice daily at 8am and 4pm by mouth Feb. 2, yr Date: Staff Signature: Sam Dowd Services, Mental Health and Ch Health Care Provider Findings: Inflammation of gum-line on left side of mouth Medication/Treatment Orders: Amoxil Suspension 500mg every 12 hours for seven days by mouth Instructions: complain of mouth soreness a fter 72 Notify HCP if Tanisha continues to hours. of Public Health, Developmental Lab work or Tests: Follow-up visit: None Feb. 16, yr Feb. 2, yr Date: Signature: Dr. Chen Lee chusetts Departments 1. Circle the new medication order-see above 2. 500mg 3. Every 12 hours for seven days 4. Place a checkmark next to T anisha’s current medications-see above 2017 The Massa 5. No 220 Massachusetts | Responsibilities in Action

221 Page 57 1. Yes k the information ord on a HCP Order form. Read bac 2. Record the order word-for-w given to you by the HCP to confirm you recorded it accurately. If you have trouble ke the order, then understanding the HCP, ask another staff to listen in as you ta now how to spell a gn the order too. If you do not k have staff read it back and si ildren and Families ank spaces in the spoken word, ask the HCP to spell it. Draw lines through any bl order. 3. 72 hours 4. Yes Services, Mental Health and Ch Unit 5 Page 66 1 3 2 111-222-3434 f Pharmacy Greenlea Rx # C201 20 Main Street 5 3/4/yr Treetop, MA 00000 of Public Health, Developmental 4 David Cook 6a 7 50mg Tramadol 8 6b IC Ultram Qty. 21 9 11 10 every 8 h by mouth ours for 7 days 1 tablet Take chusetts Departments 12 Take with water 13 Dr. Black 14 15 16 Refills: 0 Lot # 776-5433 ED: 3/4/yr 2017 The Massa 221 Massachusetts | Responsibilities in Action

222 Page 67 1. C. 2. C. 3. D. 4. A. B. C. D. E. Page 68 ildren and Families 1. You could give an incorrect dose of four 100mg tablets different color 2. It is a Unit 6 Page 75 Services, Mental Health and Ch 1. T 2. F 3. T 4. F 5. T of Public Health, Developmental chusetts Departments 2017 The Massa 222 Massachusetts | Responsibilities in Action

223 Page 82 f the term (p. 81) th the medication sheet o Write the number on at corresponds with information to be transcribed , listed as numbers 1-14. 3 Month and Year: month, yr MEDICATION ADMINISTRATION SHEET Allergies: 1 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 Generic Start 4 Brand 11 5 6 Dose Strength 6 7 ildren and Families Stop Amount Route 12 10 8 9 Frequency Reason: ecial instructions: Sp 14 13 Generic Start Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Strength Dose Amoun Route Stop t Frequency Sp ecial instructions: Reason: Start Generic Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Dose Strength Stop Amoun t Route Services, Mental Health and Ch Frequency ecial instructions: Reason: Sp 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 Generic Start Brand Dose Strength t Amoun Stop Route Frequency Sp Reason: ecial instructions: CODES Signature Signature Name: DP-day program/day hab 2 LOA-leave of absence P-packaged Site: W-work H-hospital, nursing home, rehab center of Public Health, Developmental S-school Accuracy Check 1______________ Date_______ Time________ Accuracy Check 2 ______________ Date_______ Ti me________ chusetts Departments 2017 The Massa 223 Massachusetts | Responsibilities in Action

224 Page 85 1. Hour 10pm ildren and Families 2. Hour 7:30am Page 86 Hour Services, Mental Health and Ch 1. 4pm 2. Hour 8am of Public Health, Developmental 8pm 1. Hour P R chusetts Departments N 2017 The Massa 224 Massachusetts | Responsibilities in Action

225 Page 87 1. E G 2. F 3. C 4. ildren and Families D 5. 6. H B 7. A 8. Services, Mental Health and Ch Page 96 1. 3/3/yr at 4pm 2. 3/3/yr 3. 3/13/yr at 8am 4. 3/13/yr 5. 3 times daily for 10 days 6. 8am, 4pm, 8pm of Public Health, Developmental 7. 666mg 8. 2 tabs 9. 333mg chusetts Departments 2017 The Massa 225 Massachusetts | Responsibilities in Action

226 Page 99 been obtained from appointment and medication has Tanisha has returned from a HCP the pharmacy. The date is Februar y 5th, yr. The time is 1pm. Use the HCP order, pharmacy label and medication shee s. Remember to post t to transcribe the new order the HCP order after completing the transcription. HEALTH CARE PROVIDER ORDER ildren and Families Date: Name: Feb. 5, yr Tanisha Johnson Allergies: Health Care Provider: Dr. Chen Lee No known medication allergies Reason for Visit: Continues to complain of soreness in back of mouth Services, Mental Health and Ch Current Medications: Phenobarbital 64.8mg once daily at 8pm by mouth Clonazepam 1mg twice daily by mouth Amoxil Suspension 500mg every 12 hours for seven days by mouth Staff Signature: Date: Feb. 5, yr Sam Dowd Health Care Provider Findings: Increased inflammation of gum-line on left side of mouth Medication/Treatment Orders: of Public Health, Developmental √ DC Amoxil Suspension √ Cleocin HCL 300mg three times a day for 10 days by mouth Instructions: fter 72 complain of mouth soreness a Notify HCP if Tanisha continues to hours. chusetts Departments Lab work or Tests: Follow-up visit: None February 16, yr Signature: Date: Feb. 5, yr Dr. Chen Lee Date: Verified by: 1pm Time: Posted by: Full Signature Date : 2/5/yr Time: 2017 The Massa 226 Massachusetts | Responsibilities in Action

227 Page 100 MEDICATION ADMINISTRATION SHEET Allergies: none Month and Year: February, yr 12 Generic Phenobarbital Hour 1 2 3 4 5 6 7 8 9 10 11 26 13 14 15 16 17 18 19 20 21 22 23 24 25 Start 27 28 29 30 31 8/31/yr Brand Luminal Strength 32.4mg Dose 64.8mg Stop Amoun t 2 tabs Route mouth TM TM TM Cont. Frequency Once daily at 8pm 8pm JS Sp ecial instructions: Reason: seizures 25 31 Start Generic Clonazepam 30 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 29 26 27 28 KM KM KM AS AS 8am 8/31/yr Brand Klonopin Strength 1mg Dose 1mg ildren and Families TM TM TM Amoun t 1 tab Route mouth 4pm Stop JS Cont. Frequency Twice daily 8am and 4pm Sp ecial instructions: Reason: seizures Start 31 Hour Generic Amoxicillin suspension 30 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 KM KM X AS 8am 2/2/yr Brand Amoxil suspension XXXXXXXX X X X X X X X X X X X X X X X Strength 250mg/5mL Dose 500mg D/C 2/5/yr initials Route t 10mL Stop Amoun TM TM 8pm 2/9/yr Frequency every 12 hours for 7 days JS X XXXXXXXXXXXXXXX X X X X X X XX Reason: gum inflammation ecial instructions: Sp 19 Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Start 18 Generic Clindamycin 20 21 22 23 24 25 26 27 28 29 30 31 17 8am 2/5/yr Brand Cleocin HCL x x x x x x x x x x x x x x x x x x x x x Strength 100mg Dose 300mg Stop t 3 tabs Route mouth 4pm Amoun x x x x x x x x x x x x x x x x x x x x x Services, Mental Health and Ch 3 times daily for 10 days 8pm 2/15/yr Frequency x x x x x x x x x x x x x x x x x x x x x Sp ecial instructions: Take with 8 ounces of water Reason: gum inflammation CODES Signature Signature JC John Craig DP-day program/day hab Name: Tanisha Johnson KM Kay Mathers LOA-leave of absence AS Amanda Smith Site: 45 Shade Street TM P-packaged Timo thy Mi ller Treetop MA 00000 W-work SW Serena Wilson H-hospital, nursing home, rehab center JS Jenna Sherman SD S-school Sam Dowd Sam Dowd Accuracy Check 2 John Craig Date 1/31/yr Time 9pm Accuracy Check 1 Date 1/31/yr Time 9pm of Public Health, Developmental Page 101 1. B. 2. C. 3. C. chusetts Departments 4. C. 5. B. Unit 7 Page 104 Blood pressure 2017 The Massa Page 105 Yes 227 Responsibilities in Action Massachusetts |

228 Page 107 1. PRN medication 2. For complaints of right knee pain 3. No 4. 5PM 5. Notify HCP ildren and Families Page 111 No. Aspirin EC is ordered. Aspirin was supplied. Page 114 Amount 2 tablets Services, Mental Health and Ch 2 tablets 2 capsules 3 tablets 1 capsule 4 tablets of Public Health, Developmental 5 tablets 2 capsules 2 tablets chusetts Departments 2 tablets ½ tablet Page 117 2017 The Massa 4. _  _ Ask your Supervisor to arrange a specialized training for Epi Pen® use 228 Massachusetts | Responsibilities in Action

229 Page 122 1. HCP Order and pharmacy label 2. pharmacy label and medication sheet 3. pharmacy label and medication sheet on administration process to its corresponding reason. Match each check in the medicati ildren and Families Check 1 C Check 2 A Check 3 B Page 123 Services, Mental Health and Ch order is ‘daily in the evening’ and the frequency No. The frequency listed on the HCP ‘every evening at 8 PM’ listed on the pharmacy label is Page 125 1. T 2. T 3. F 4. T of Public Health, Developmental 5. F Page 133 250mg chusetts Departments 2017 The Massa 229 Massachusetts | Responsibilities in Action

230 Page 134 1. 1200mg/15mL ildren and Families ed to the 30mL line You should have fill Page 135 2. 100mg/5mL Services, Mental Health and Ch You should have filled to the 10mL line Page 136 of Public Health, Developmental 3. 262mg/15mL chusetts Departments You should have filled to the 15mL line Page 137 4. 50mcg/one spray 2017 The Massa 230 Massachusetts | Responsibilities in Action

231 Page 142 Amount 20mL 12mL 4mL ildren and Families 8mL 10mL 9mL 8mL 20mL Services, Mental Health and Ch 15mL 30mL 20mL of Public Health, Developmental Page 143 appropriate measuring device. _Call the pharmacy and request an 3. _  Match the terms with the corresponding letter. chusetts Departments 1. C 2. D B 3. 4. A 2017 The Massa 231 Massachusetts | Responsibilities in Action

232 Page 143 continued True (T) or False (F) 1. T 2. T 3. T 4. F ildren and Families 5. T 6. T Pages 146-147 You should: _ Ask David why he doesn’t w  3._ ant to take the medication Services, Mental Health and Ch You should: the purple color of the tablet. David tells you he doesn’t like _ Secure the medication, return in 15 minutes and offer it again  4._ fuses the medication. You should first: After 3 attempts, David still re _ Notify Dr. Black of the refusal  4. _ of Public Health, Developmental chusetts Departments 2017 The Massa 232 Massachusetts | Responsibilities in Action

233 Page 147 Using the medication sheet and ument the medication corresponding progress note, doc refusal. Your initials circled Generic Omeprazole Hour 1 2 3 4 5 6 7 8 9 Start 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Brand Prilosec 8/31/y r ildren and Families 20mg Strength Dose 20mg WD JC mouth 4pm Stop t Route Amoun 1 tabs WS Once daily before suppe r Frequency Cont. GERD Special instructions: Reason: March, yr MEDICATION PROGRESS NOTE dose of Prilosec. I attempted to 3/4/yr 4:45pm David refused his 4pm administer it 3 times. Dr. Black and (your supervisor’s name) notified. Services, Mental Health and Ch _______________________________________________________Your full signature Page 149 Your initials Your initials circled 6 7 8 2 1 9 10 Hour Generic Start 3 11 12 13 14 15 16 17 18 19 20 21 22 4 23 24 25 26 27 28 29 30 5 31 WS WS AS JC Brand r 8/31/y 8am Check blood pressure (BP) Strength BP Dose 130 132 90 120 134 S Stop Route t Amoun of Public Health, Developmental 64 66 62 60 50 Cont. D Daily in the morning Frequency Reason: elow 100 and notify HCP lood pressure (BP) reading is b Hold Zestril if systolic (top) b Special instructions: Start Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Lisinopril Generic WS WS AS JC 8/31/y r Brand Zestril 8am Dose 20mg 40mg Strength t Amoun mouth Route 2 tabs Stop Frequency Daily in the morning Cont. chusetts Departments Reason: Hold Zestril if systolic (top) b high BP Special instructions: elow 100 and notify HCP lood pressure (BP) reading is b MEDICATION PROGRESS NOTE March, yr 2017 The Massa 3/5/yr 8am Blood Pressure 90/50 Zestril 40mg held. (Name of HCP notified.) ___________________________________________Your full signature 233 Massachusetts | Responsibilities in Action

234 Your initials circled Page 150 Start Generic Omeprazole 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 r Brand 8/31/y Prilosec Strength 20mg Dose 20mg WD JC Stop mouth 4pm Route 1 tabs t Amoun WS r Once daily before suppe Frequency Cont. Special instructions: Reason: GERD ildren and Families MEDICATION PROGRESS NOTE March, yr 3/4/yr 4PM Omeprazole 20mg held per HCP order to hold before scheduled test ---------------------------------------------------------------------------------------Your full signature Your initials circled Page 152 Services, Mental Health and Ch 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Hour 1 2 3 4 5 6 7 8 9 Omeprazole Generic Start Prilosec Brand 8/31/y r 20mg Strength Dose 20mg WD JC t Amoun Stop mouth 4pm 1 tabs Route WS Once daily before suppe r Cont. Frequency Reason: GERD Special instructions: March, yr MEDICATION PROGRESS NOTE Spoke to Forrest Greenleaf at the 3/4/yr 4PM Prilosec was unavailable. of Public Health, Developmental Greenleaf Pharmacy. He stated medication will be delivered by 7:30pm. He stated to omit 4pm dose and give the next scheduled dose when due. (Name of your Supervisor) also notified ________________________Your full signature Unit 8 chusetts Departments Page 167 1. F 2. T 3. T 4. T 5. T 2017 The Massa Page 168  Unlock the medication storage area , obtain the drug reference b ook for the 3._ _ Certified staff and relock. 234 Massachusetts | Responsibilities in Action

235 Page 168 N 1. 2. N 3. N Page 168 ildren and Families 1. The ‘Chain of Custody’ is broken and medications could be st olen. o person count with 2. To MAP Certified and/or licensed staff after conducting a tw them. Page 169 Yes, (the tablets were popped out of order) Services, Mental Health and Ch Class Discussion Page 178 . Residential staff ive the discontinued medication Day program staff continued to g should have faxed or sent a copy of the new order over to the day program. Page 189 of Public Health, Developmental 1. two 2. count book 3. item number 4. Supervisor chusetts Departments 2017 The Massa 235 Massachusetts | Responsibilities in Action

236 Unit 9 Page 201 Number the ‘Procedure Following a Medication Occurrence’ in the order to be completed if you make or disco ver a medication occurrence 7 Complete a Medication Occurrence Report ildren and Families 4 en to you by the MAP Consultant Follow all recommendations giv 5 Notify your supervisor 2 Call 911, if needed 6 Document what you did Services, Mental Health and Ch 3 Call a MAP Consultant person is ok Check to see if the 1 corresponding example Match the term to the 1. C 2. F of Public Health, Developmental 3. A 4. D 5. B 6. E chusetts Departments Page 202 1. W rong Person 2. Check to make sure the person is ok, if not call 911, if ok contact MAP consultant for recommendation 2017 The Massa 3. Medications should never be pre poured and never left unatte nded edication before assisting with 4. Jim could have secured the m the emergency or taken the medication with him 236 Massachusetts | Responsibilities in Action

237 Page 203 1. Wrong Medication 2. Check to see that Tanisha is ok, if not call 911, if ok contact MAP Consultant for recommendation ildren and Families 3. By looking at the HCP order ( check #1 of the medication admi nistration process) Page 204 1. Wrong Dose 2. Check to see that Tanisha is ok, if not call 911, if ok contact MAP Consultant for Services, Mental Health and Ch recommendation abel to find the strength of the tablet and the amount 3. By looking at the pharmacy l to give to equal the dose Page 206 1. Call the HCP for a refill of Public Health, Developmental 2. MAP Consultant 3. Omission e been ordered at least one week before the medication ran out 4. Refills should hav chusetts Departments Page 207 1. Wrong Route 2. Check to make sure Ellen is o k and if not call 911, if ok contact MAP Consultant for recommendation 2017 The Massa 3. Joe should have instructed the other staff to stop talking w ith him until he finished could have been mindful and com administering medications so he pleted his three checks before administering the medication 237 Massachusetts | Responsibilities in Action

238 Ask Your Supervisor Specific to Your Work Location 1. Where are MAP Consultants, poison control and other emergenc y numbers located? ildren and Families 2. Who is responsible for cont acting the HCP to report changes observed in the people you support? 3. How is information shared between shifts, such as how new HC P orders are hift? communicated if there is no staff present when you arrive for your s for ‘high alert’ medication? 4. Does anyone have HCP orders 5. Does anyone have HCP orders for ‘high risk’ for abuse Schedu le VI medication Services, Mental Health and Ch and if so, how they are tracked? 6. How does the pharmacy identify countable controlled medicati on? 7. Where is the drug reference book located or how is the reput able online resource accessed? 8. What HCP visit forms are required specific to the people you support? of Public Health, Developmental e order, if yes, where are th e telephone order 9. Am I allowed to take a telephon forms kept? n medication refills from the p harmacy? 10.What method is used to obtai 11.Are there HCP orders for ant ipsychotic medications requirin g a Rogers Decision? chusetts Departments 12.How is the backup set of keys accessed, if needed? 13.What is the medication adm inistration time schedule? 14.When will I receive training on all other rout es medications are administered? 2017 The Massa 15.Is blister pack monitoring required? atic refills? If yes, what system is used to 16.Does the pharmacy supply autom cross check the medication I am expecting to receive to what th e pharmacy delivers? 238 Massachusetts | Responsibilities in Action

239 o is responsible edication sheets generated and wh 17. How are the new month’s m for completing accuracy checks? d the residential communication syst 18.What is the em between the day program an program? r all medication disposals or may two Certified staff 19.Is the supervisor required fo medication? (no supervisor) dispose of a refused dose or a dropped dose of ildren and Families 20.How are MORs submitted? 21.What is the policy/procedure e follow up? regarding medication occurrenc Services, Mental Health and Ch of Public Health, Developmental chusetts Departments 2017 The Massa 239 Massachusetts | Responsibilities in Action

Related documents

Nastran Dmap Error Message List

Nastran Dmap Error Message List

Overview of Error Messages NX Nastran displays User Information, Warning, and Error messages in the printed output. The amount of information reported in a message is controlled by system cell 319. Wh...

More info »
PB

PB

OFFICIAL 2019 CONNECTICUT PRACTICE BOOK (Revision of 1998) CONTAINING RULES OF PROFESSIONAL CONDUCT CODE OF JUDICIAL CONDUCT RULES FOR THE SUPERIOR COURT RULES OF APPELLATE PROCEDURE APPENDIX OF FORMS...

More info »
bookdraft2017nov5

bookdraft2017nov5

i Reinforcement Learning: An Introduction Second edition, in progress ****Complete Draft**** November 5, 2017 Richard S. Sutton and Andrew G. Barto c © 2014, 2015, 2016, 2017 The text is now complete,...

More info »
LawReferenceBook2018

LawReferenceBook2018

California Contractors License Law & Reference Book 2018 Edition With Rules and Regulations Contractors State License Board State of California Edmund G. Brown, Jr., Governor

More info »
Safeguarding California Implementation Action Plans

Safeguarding California Implementation Action Plans

Safeguarding California: Implementation Action Plans MARCH 2016

More info »
OctoberCUR2018

OctoberCUR2018

CHANCELLOR'S UNIVERSITY REPORT OCTOBER 29 2018

More info »
Microsoft Word   Table of Contents Full Report with ES.doc

Microsoft Word Table of Contents Full Report with ES.doc

Stern Review: The Economics of Climate Change PAGE TABLE OF CONTENTS i-xxvii Executive Summary i Preface & Acknowledgements iv Introduction to Review vi Summary of Conclusions Part I Climate change: o...

More info »
Implementation Handbook For The Convention On The Rights Of The Child

Implementation Handbook For The Convention On The Rights Of The Child

IMPLEMENTATION HANDBOOK FOR THE CONVENTION ON THE RIGHTS OF THE CHILD FULLY REVISED THIRD EDITION IMPLEMENTATION HANDBOOK IMPLEMENTATION HANDBOOK FOR THE CONVENTION ON THE FOR THE CONVENTION ON THE RI...

More info »
GAO 19 157SP, HIGH RISK SERIES: Substantial Efforts Needed to Achieve Greater Progress on High Risk Areas

GAO 19 157SP, HIGH RISK SERIES: Substantial Efforts Needed to Achieve Greater Progress on High Risk Areas

United States Government Accountability Office Report to Congressional Committees March 2019 -RISK SERIES HIGH Substantial Efforts Needed to Achieve Progress on Greater Risk Areas High- 19 - GAO - 157...

More info »
WeAreEverywhere

WeAreEverywhere

edited by Notes from Nowhere we are everyw here the irresistible rise of global anticapitalism

More info »
Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

MANAGING THE RISKS OF EXTREME EVENTS AND DISASTERS TO ADVANCE CLIMATE CHANGE ADAPTATION SPECIAL REPORT OF THE INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE

More info »
Bandit Algorithms

Bandit Algorithms

Bandit Algorithms ́ Tor Lattimore and Csaba Szepesv ari st Draft of Wednesday 1 May, 2019 Revision: c0525791b66f0f41db4e87204ac91f41693d4365

More info »
Draft Environmental Impact Statement for the Safer Affordable Fuel Efficient (SAFE) Vehicles Rule for Model Year 2021 2026 Passenger Cars and Light Trucks

Draft Environmental Impact Statement for the Safer Affordable Fuel Efficient (SAFE) Vehicles Rule for Model Year 2021 2026 Passenger Cars and Light Trucks

The Safer Affordable Fuel-Efficient (SAFE) Vehicles Rule for Model Year 2021–2026 Passenger Cars and Light Trucks Draft Environmental Impact Statement July 2018 Docket No. NHTSA-2017-0069

More info »
Department of Defense   Law of War Manual (June 2015)

Department of Defense Law of War Manual (June 2015)

D E A R T M E N T O F D E F E N S E P N A L O F W A R M A W U A L J U N E 2 0 1 5 O F F I C E O F G E N ER A L C O U N S E L D P A R T M E N T E O F D E F E N S E

More info »
School, Family, and Community Partnerships: Your Handbook for Action. Second Edition.

School, Family, and Community Partnerships: Your Handbook for Action. Second Edition.

DOCUMENT RESUME ED 467 082 PS 030 545 Epstein, Joyce L.; Sanders, Mavis S.; Beth Simon, G.; AUTHOR Natalie Rodriguez; Van Jansorn, Salinas, Karen Clark; Voorhis, Frances L. Handbook for School, Family...

More info »
Pennsylvania Climate Action Plan

Pennsylvania Climate Action Plan

Pennsylvania Climate Action Plan Pennsylvania Climate Action Plan , 2018 (DRAFT) November 20 Prepared for: Prepared by: A cknowledgements and Disclaimer 0

More info »
June2018CUR

June2018CUR

CHANCELLOR'S UNIVERSITY REPORT JUNE 25 2018

More info »
Microsoft Word   A) Division 245.docx

Microsoft Word A) Division 245.docx

tables Attachment Division 245, including A: Nov. 15-16, 2018, EQC meeting 1 of 121 Page Division 245 CLEANER AIR OREGON 340-245-0005 Purpose and Overview (1) This statement of purpose and overview is...

More info »