MEDICATION ADMINISTRATION IN BOARD OPERATED PROGRAMS AND SERVICES

Transcription

1 IX. 04 MEDICATION ADMINISTRATION IN BOARD OPERATED PROGRAMS AND SERVICES POLICY The Board shall ensure medications are administered/applied in a safe manner to all individuals we serve. Pursuant to Ohio Revised Code Sections through and in accordance with the authorization of the statue, the Montgomery County Board of Developmental Disabilities Services shall conduct health services associated with administration of medications and health related services performed by MCBDDS personnel according to the Ohio Department of Developmental Disabilities Administrative Rules 5123: through 5123: The Board shall permit nurses and the trained DDS personnel who meet the training requirements and complete training prescribed by the Ohio Bureau of Nursing to give/apply prescribed medications in accordance with applicable state laws and regulations. The Board shall permit the giving/applying of prescribed medication in the following settings: where county Board programs and services are being provided by DDS personnel, while individuals are on community/field trip outings (does not include Family Home Services), or while individuals are being transported in a vehicle operated by the Board. The Board encourages individuals to self-administer prescribed and over the counter medication when they are capable of exercising the judgment to do so. The Board shall permit a DDS personnel to assist an individual with self-medication. The Superintendent shall develop procedures to implement this policy. This policy replaces the previously effective Policy IX.04, adopted May 15, Reference: ODMH Adm. Rule (A) (5a) Approved by Legal Counsel: Laura Mariani First Reading: December 8, 2015 Date Approved: January 19, 2016 Effective Date: February 19, 2016

2 IX.04 MEDICATION ADMINISTRATION PROCEDURES: I. Definitions Definitions used in this section will be consistent with of the Ohio Revised Code and OAC 5123: A. Health Related Services means the following: 1. Taking vital signs 2. Application of clean dressing that do not require health assessment 3. Basic measurement of bodily intake and output 4. Oral suctioning 5. Use of glucometers 6. External urinary catheter care 7. Emptying and replacing colostomy/ileostomy bags 8. Collection of specimens by non-invasive means II. Self Medication (ORC , OAC 5123:2-6-02) A. An individual who can safely self-administer medication or receive assistance with self-administration of medication has the right to self-administer medication or receive assistance with the self-administration of medication. Therefore, the Montgomery County Board of DDS shall provide assistance with self-administration of medication for those individuals who can safely self-administer medication. B. Self-Administration assessment: Based on department approved selfadministration assessment the individual service plan shall document when the individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication. The department-approved self-administration assessment (Attachment 1) shall be used by this Board. 1. The self-administration assessment will be reviewed annually at each IP meeting (at least annually) and a new form will be conducted at least every three (3) years or when ever the individual s condition (mental or physical) changes. The self-administration assessment is defined by the department as an assessment of mental alertness.

3 MEDICATION ADMINISTRATION PROCEDURES, PAGE 2 IX.04 The IP will document self-administration assessment as stated on the assessment form. 2. The self-administration assessment shall be completed by those MCBDDS personnel, residential providers, and/or family who best know the individual. The IP Team may conduct the self-administration assessment. The assessment should be conducted in the setting where the client is to take his/her medications. The nurse may participate on the self-administration assessment team, however, the self-administration assessment is not a nursing assessment. All self-administration assessments will become part of the individual s central file and be part of the IP. There shall be documentation about when and who conducted the self-administration assessment. There will be no documentation required by the nurse in the Medication Administration Record (MAR). Guardians must give permission for self-administration of medications. 3. MCBDDS personnel who are not specifically authorized by other provisions of the Revised Code to provide assistance in the selfadministration of prescribed medication may, under ORC and 5123: OAC provide that assistance as part of the services they provide to individuals. To provide assistance with self-administration of prescribed medication, MCBDDS personnel are not required to be trained or certified in accordance with OAC and OAC 5123: and OAC 5123: a. When assisting with self-medication of prescribed medication, DDS personnel shall take only the following actions: i. Remind an individual when to take the medication and observe the individual to ensure that the individual follows the directions on the container. ii. Assist an individual by taking the medication in its container from the area where it is stored, handing the container with the medication in it to the individual, and opening the container, if the individual is physically unable to open the container. iii. Assist, on request or with the consent of, a physically impaired but mentally alert individual, with removal of oral or topical medication from the container and with the individual s taking or applying of the medication. If an individual is physically unable to place a dose of oral medication to the individual s mouth without spilling or

4 MEDICATION ADMINISTRATION PROCEDURES, PAGE 3 IX.04 dropping it, the MCBDDS personnel may place the dose in another container and place that container to the individual s mouth. b. Medications for individuals who are self-medicating, will be brought in to programming on a daily basis by him/herself and kept in a secure location. (locker, fanny pack, etc.). 4. If a consensus is not reached to determine if the individual is able to selfmedicate or self medicate with assist, then the determination will err on the side of health and safety. The focus will then be to continue to develop the goals that would enhance the individual s right to selfadminister their medications. III. Authorization of MCBDDS personnel to administer prescribed medications, perform health-related activities, or perform tube feedings: In the case of individuals receiving early intervention, preschool, and school-age services, or individuals receiving adult services, offered pursuant to OAC 5123 or 5126 the following shall apply: ( 5123:2-6-06) Montgomery County Board of MCBDDS personnel may provide/administer oral and topical medication and provide health related activities. A. MCBDDS personnel must hold a valid Certification 1: Oral/Topical Medications and Health Related Activities Certification. The certification must be documented in the State of Ohio Data Base. To obtain/maintain a valid Certification 1: Oral/Topical Medications and Health Related Activities DDS personnel must: 1. Attend an ODDD approved course that is a minimum of fourteen hours as per 5123: Be at least 18 years old and hold a high school diploma or a certificate of high school equivalency (GED). Those employees hired prior to February 1, 2000 and determined to be eligible to give oral or apply topical prescribed medications without a high school diploma or GED, by demonstration to a nurse instructor sufficient skills in writing, reading and mathematics to be able to safely give oral or apply topical prescribed medications are not required to have a high school diploma or GED, but must successfully pass a written closed book test 80% or better. 3. Successfully return demonstration for each route of oral/topical medication administration and health related activity as trained.

5 MEDICATION ADMINISTRATION PROCEDURES, PAGE 4 IX MCBDDS personnel do not maintain their certification for lack of continuing education training, their certification will be suspended (along with their ability to administer medications) for up to 60 days to enable the MCBDDS personnel to obtain required training. If they fail to obtain training by that time, they must start over with the fourteen-hour course. 5. MCBDDS personnel cost of attending Certification 1 course will be paid by Montgomery County Board of Developmental Disabilities Services and will be considered 14 hours for those employees directly employed by Montgomery County Board of DDS. 6. Prior to permitting MCBDDS personnel to take the Delegated Nursing program, the Montgomery County Board will determine that employee has been cleared through the a) state nurse aide registry, b) abuser registry, and c) criminal background check. B. Prior to delegating under this rule, the delegating licensed nurse shall: 1. Assess the individual and evaluation of the conditions under which the delegated task or delegated prescribed medication will be done. This assessment should be an on-going basis, but at least annually, including determination that delegation continues to be necessary and appropriate, determination that the individual continues to be stable, and determination that the MCBDDS personnel continue to have the skills to perform the nursing task or activity or to administer prescribed medications. 2. Select the MCBDDS personnel that have the current training and complete individual specific training. MCBDDS personnel shall not provide any delegated task or administer any prescribed medication for any individual for whom they have not been trained specifically. 3. Document assessment and training 4. The Montgomery County Board shall ensure that MCBDDS personnel have been trained specifically with respect to each individual for whom they administer prescribed medication, perform health-related activities administer food or prescribed medication via a stable labeled gastrostomy or jejunostomy tube. 5. Renewal of MCBDDS personnel certification for Category I: MCBDDS personnel shall complete at a minimum two hours of continuing education annually that relate to the information taught in the medication

6 MEDICATION ADMINISTRATION PROCEDURES, PAGE 5 IX.04 administration and health related activities training program or that will enhance the role of the MCBDDS personnel who have completed the prescribed medication administration and health related activities. If continuing education is not completed by the annual anniversary date of the certification, then the rule 5123: shall apply. C. If the Montgomery County Board of DDS, as employer, believes or is notified by the department, a delegating licensed nurse or the registered nurse responsible for quality assessment, that DDS personnel have not safely administered or will not safely administer prescribed medications, including feeding and medications through a stable labeled gastrostomy or jejunostomy tube, or will not safely perform health related activities the employer shall: 1. Prohibit the action from continuing 2. Immediately make other staffing arrangements so that administration of prescribed medications, or performance health related activities, including administering food or medication through a stable labeled gastostomy or jejunostomy tube can take place. (Including compliance of the ODDD rule.) 3. If applicable, notify the Department of Investigative Services through the incident reporting system. 4. If applicable, notify the delegating nurse. D. If the licensed nurse delegating believes that the DDS personnel have not safely performed the task or administered the tube feed or medication, then the nurse shall withdraw authorization for the action to continue. The nurse will then immediately notify the Supervisor and the nurse responsible for quality assessment. E. Requirements of the Delegating Nurse: Requirements for the delegating nurse will be in compliance with 5123: OAC. 1. To maintain certification to teach/delegate to DDS personnel, the registered nurse shall complete a minimum of four contact hours of continuing education per licensure renewal period that relates to the information taught in the Train the instructor program. CPR, FA and Universal Precautions training shall not make up any part of the four hours of training. These contact hours may be part of the twenty four hours required by the Ohio Board of Nursing during each licensure period.

7 MEDICATION ADMINISTRATION PROCEDURES, PAGE 6 IX.04 F. Certification II: Administration of food and prescribed medication per stable/ labeled gastrostomy tube and stable/labeled jejunostomy tube (D). 1. Training provided to allow MCBDDS personnel to provide prescribed medication administration or feeding via stable labeled gastrostomy tube or stable labeled jejunostomy tube by nursing delegation shall be at a minimum four hours and shall be in addition to the prescribed medication and health-related activities training (Certification I). Training will be in compliance with said rule. 2. MCBDDS personnel completing requirements as described in the rule must receive a Certificate of training. Certification II administration of medication and feeding through a stable labeled gastrostomy tube or a stable labeled jejunostomy tube will be issued by the registered nurse providing the training and entered in the State of Ohio Data Base. 3. Renewal of Certification II requires that the MCBDDS personnel shall complete one hour of continuing education annually that is planned or coordinated by a registered nurse that relates to the information taught in the feeding tube training program. This continued training must be in addition to the two hours required for Certification I and CPR, FA or Universal Precautions shall not make up any part of this one hour. IV. Written authorizations A. In order to receive nursing services from Board nurses and delegated services from trained MCBDDS personnel, the following requirements are made of individuals served, their parents or their guardians: 1. Individuals served by the Board or their guardians or if the individual served is a minor, their parent, guardian or other person having care or charge of him/her, will provide written authorization from a physician for prescription medication given or applied, including food, water and medication through a feeding tube. Also requiring a physician written order is: as needed medications (PRN), treatments, assessments and over-the-counter medications. Faxed authorizations will be accepted. The information contained in this authorization shall include: a. Name and address of individual; b. Name of the medication, dosage to be given or applied, and the method of administration/route; c. The times the medication is to be given;

8 MEDICATION ADMINISTRATION PROCEDURES, PAGE 7 IX.04 d. Possible side effects or adverse reactions; e. Telephone number of physician in case of an emergency; f. Special instructions for storage, giving or applying; g. Date when medication is to begin and end; and h. Date of request. 2. Individuals receiving nursing services or delegated nursing services shall provide written request/signature from the individual, their guardian, or if the individual served is a minor, their parent or guardian to allow: a. Medications to be given by nurse or delegated to MCBDDS personnel. (Medication Authorization) b. Medications or feedings through a stable-labeled gastrostomy tube or a stable-labeled jejunostomy tube that are given by a nurse or delegated to MCBDDS personnel. (Medication Authorization) c. Delegated tasks, administration of medications and health related activities will be identified on the Medical Assessment Profile. Signature will be obtained at the bottom of the Medical Assessment Profile from individual, parent or guardian. 3. All delegated and nursing services must be identified on the Individual s Service Plan (ISP) or Individual s Education Plan (IEP). 4. The written authorizations from the physician, individual/parent/guardian are valid for one year only from the date of the signature. At the end of that time, new authorizations must be obtained. 5. An order for a change in medication or treatment that was ordered by a physician, may only be changed with a physician s order. a. All contacts with the physician for change orders shall be communicated with and accepted by the registered nurse. The registered nurse will write all verbal/telephone orders on the Medication Authorization Form. Written authorization must be obtained within 5 working days. (Fax is acceptable.) b. After the physician authorization, a verbal request for this emergency change will be acceptable from the individual/parent/guardian or other person having care or charge of a minor. The request and verbal consent from the individual, parent or guardian shall be documented.

9 MEDICATION ADMINISTRATION PROCEDURES, PAGE 8 IX.04 V. MEDICATION STORAGE: A. Delivery and Storage of Medication other than self-medication: 1. The parent/guardian or residential provider shall be responsible for providing all medication and equipment needed for identified nursing procedures and medication administration. All medication shall be sent in a container with the original pharmacy label. Over-the-counter medications shall be in the original containers. 2. All medications sent in with an Individual on the bus, shall be handed to the bus driver who shall maintain it in a safe location throughout the ride and shall hand the medication directly to staff that have been identified to receive such at the facility. The medication shall be kept in a secure location. 3. Documentation of quantity of medication received and the receiving MCBDDS personnel s signature shall be maintained. 4. If special storage is indicated, such as temperature control or light protection, the facility nurse will assure the medication is properly stored. For medications that require refrigeration, the refrigerator will be in a secure location in the nurse office and will not be accessible for food storage. 5. Disposal of medication for reasons of expiration date, discontinuation of medication or other physician order will be under the supervision of the facility nurse. Method of disposal of medication can include: a) returned to pharmacy for disposal, b) mixed in cat litter or coffee grounds and disposed in closed container, or c) returned to parent or guardian for disposal. Medication for disposal will not be placed in open trash container to avoid possible consumption by others. 6. Any disposal of controlled substances shall be supervised by the nurse and shall have a dated witness signature. VI. Reporting Errors A. Any error in giving/applying medication shall be reported immediately. MCBDDS personnel shall report to the nurse. Nursing errors shall be reported to the supervisor. B. Upon learning of the error, the nurse shall report the error immediately to the supervisor and. a UI form will be completed per UI reporting procedure.

10 MEDICATION ADMINISTRATION PROCEDURES, PAGE 9 IX.04 C. The nurse will notify the parent, residential provider or guardian as soon as possible. Appropriate steps should be taken to ensure the individual s health and safety, which may include calling the physician. D. In Adult Services a copy of the UI report will be sent to the nursing supervisor for quality assurance monitoring. In Education programs a copy will be sent to the program supervisor. VII. Use of EPI Pen Epinephrine Auto Injector A. The use of the EPI pen does not require the adherence to the standard set for Nurse Delegation. It is covered in the Ohio Revised Code , Liability for Emergency Care (Good Samaritan Statute.) B. Use: The emergency treatment of allergic reactions/anaphylaxis it is an emergency supportive therapy only and is not a replacement or substitute for immediate medical or hospital care. Anyone receiving this medication should be transported to the nearest hospital. EMS personnel should be given the empty injector to establish dose and the time it was administered. VII. Rectal Diastat A. Rectal diastat and the vagus nerve stimulator are able to be utilized by direct care staff for the client and are covered under the Ohio Revised Code , Liability for Emergency Care (Good Samaritan Statute). Staff must be trained specifically to the client and training shall be documented. Physician orders must be specific for when to utilize and for post treatment care. Delegated nursing certification is not required to be able to provide this treatment for the client. Submitted to the Board: January 19, 2016