Assistance With Self-Administered Medication Teaching Plan Note to leader: Complete Page 4 of the learning guide and insert it in the learning guide before making copies of the lesson for each learner. To use this lesson for self-study, the learner should read the material, do the activity, and take the test. For group study, the leader may give each learner a copy of the learning guide and follow this teaching plan to conduct the lesson. Certificates may be copied for everyone who completes the lesson. Objectives: A participant in this lesson will be able to: Define assistance with medications according to your organization s rules Comply with state and company regulations when assisting a client to self-administer medicine Practice the Six Rights of medication assistance Decrease opportunities for medication errors Suggestions: Post the Six Rights on page 6 in a prominent location so all those who assist with medications can see it often. Make copies of your organization s policies and procedures regarding assistance with selfadministered medications and distribute them to participants along with the learning guide. Activity I Discuss page 4 of the Learner s Guide Activity 2 Discuss your organization s policies and procedures regarding the responsibilities and reporting requirements of the caregiver in the following situations.? A client who self-administers his meds asks a caregiver to put in his eye drops.? A client who self-administers his meds takes two water pills because of swollen feet, instead of one tablet as the doctor ordered.? A client seems to be confused about his medications.? What should be documented and/or reported about clients who self-administer medications, and when should it be recorded or reported? The Lesson The way you teach this lesson will depend on your setting. Be sure to cover the following points in your discussion: 1. The difference between assisting with medications and medication administration 2. The role the workers can play in medication assistance or administration 3. The rules of your state and organization 4. The Six Rights 5. How to avoid errors 6. How, when, and what to record and report Conclusion Have participants take the test, and then grade it together. Each participant answering 70% correctly (at least 13 points) may receive a certificate. Test Answers: 1. True. 2. True. 3. True. Assistance With Self-Administered Medications Page 1 of 12
4. a, b, c. 5. False. 6. True. 7. Person, Drug, Dose, Dosage Form, Time, Route. 8. Wash hands. 9. Interruptions & haste. 10. True. Assistance With Self-Administered Medication Learner s Guide Each state, facility, and agency has rules for assisting with selfadministered medications. It is the company s responsibility to educate personnel regarding these rules. Medications are widely used in the care of the elderly and disabled, and are necessary for maintaining health and for improving quality of life. Yet, if these medications are improperly prescribed or administered they can cause death or increase falls and other adverse outcomes. Therefore, guidelines for assisting clients with medications are necessary. Medication administration is giving medication. This means that when a doctor orders medication for a client, a qualified person administers it to the client. Medication self-administration is when a client is responsible for taking his medications. The client may keep his medications and take them as directed. Fast Fact Assistance with selfadministered medication means that a caregiver helps someone who is unable to take his medications by himself. Sometimes a client becomes unable to remember to take his medication, or has difficulty opening medicine containers. Perhaps he has diabetes and needs help with blood glucose testing or insulin injections. When you remind someone to take his medicine, or help him get the correct dosage, you are assisting with selfadministration of that person s medication. In most states, there is a difference between medication administration and medication assistance. Ask your supervisor about the differences in your state. Usually the state only allows licensed nurses and medication aides to administer medications. No special license is required in most states to assist clients with medications. These rules may be different in your state. Some companies do not allow unlicensed personnel to assist with selfadministered medications. Some companies and states allow unlicensed personnel to administer certain types Assistance With Self-Administered Medications Page 2 of 12
of medications in certain situations. Self-Administration of Medication, Says Whom? Who or what determines whether a client is able to self-administer his medications? It depends on the setting. An individual in the care of a skilled nursing facility usually will not self-administer his medications. If a nursing facility allows its clients to self-administer medications, the facility needs a written policy outlining the criteria a client must meet (his knowledge, skills, and abilities) before he can undertake this responsibility. It must be determined that a client can safely and accurately self-administer his medications. In addition, the physician should give permission in writing. A client must not be responsible for taking his medications if his health condition is not stable. A nurse or physician should re-evaluate the client periodically for competency. The client must keep his medication in the original container in a locked cabinet or drawer out of reach of other clients. Clients who live at home and use home health caregivers usually self-administer their medications, or a family member assists them. Home health workers might also assist clients in various ways with self-administration of medications. Clients in assisted living facilities or personal care homes usually need assistance with self-administration of medications. This can range from reminders to take their medications to helping them open bottles to assisting with or even giving insulin injections (in some states). Some companies assign levels of care for medication administration and assistance. The levels described here are examples: Level 1 Assistance is for competent clients who are independent or need only minimal help in taking medications, such as an occasional reminder to take medication, or assistance with opening containers or obtaining prescription renewals. Level 2 Assistance is for clients who require regular reminders and help. Client and staff share the responsibility for such things as taking meds at the right time, monitoring the effects of medications, and glucose testing and insulin syringe preparation for diabetics. Level 3 Assistance is for clients who do not have the physical or mental capacity to self-administer medications. Staff would have full responsibility for these clients. Medication Assistance Guidelines in My State and Workplace Each state and organization has guidelines for medication administration and assistance with self-administration of medication. States differ in the kind of assistance an unlicensed person can give. Organizations must define the scope of duties permitted to unlicensed personnel, such as administration of oral medications, inhalers, injections, reminding, etc. The facility or agency must provide adequate training for unlicensed personnel, and regular inservice education for those involved with medication administration Assistance With Self-Administered Medications Page 3 of 12
or assistance. Page 4 of this packet, when completed, should provide guidance concerning the rules for your state and workplace. Name of Company Date This organization authorizes the following unlicensed personnel to assist with self-administered medications: Medication Aides Certified Nurse Aides Aides, Assistants, Attendants, Technicians, Other (Specify) Yes No Unlicensed caregivers may assist clients who self-administer medications in the following ways. Yes No Remind client to take medication Ask client if he took his medication Take the medication container from the storage area and hand to client Remove the cap from the prescription bottle Remove the correct dosage if the client requests help Break a scored tablet or crush a tablet if client needs this done Return medication to the secured place Assist with skin patches Assist with eye and ear medications if client asks Put drops or ointment in the client s eyes or ears Insert rectal or vaginal suppositories (specify which or both) Assist with inhalers Assist with topical medications (apply lotions, creams, ointments to skin) Assist with injections (specify type and amount of assistance allowed) Assistance With Self-Administered Medications Page 4 of 12
Is Documentation of Assisted Self-Administered Medications Required? Organizations must maintain a record of all medication on each client who receives assistance with medications. This record should document daily: Client s name Room number Date and time of medication assistance Type, dosage, date and time taken, any comments by client, and any changes in client s condition Name and initials of the person assisting with the medication Other information for the record should include: Allergies Diagnoses Prescriber s name (doctor who prescribed the medicine) Current record of all prescription and non-prescription medication Medication name, strength, dosage form, dose, route of administration, and any special precautions Indications or reasons for using PRN medications (medicines the client can take as needed for certain problems, such as pain) Frequency of administration and administration times Duration of therapy Date ordered, date changed, date discontinued Valid physician s order for a client to participate in self-administration of medications (if necessary, depending on setting) Location where client s medications are stored (if necessary, depending on setting) The Goal is 100% Accuracy Fast Facts Assisting clients with their medications is one of the most important things you do. A lot of harm can result when medications are taken improperly, when the wrong drug is taken, or when a client doesn t get the right medicine at the right time. When you assist a client with medicines, you are responsible for being sure that the client takes the medication correctly. Even one error is too many! Assistance With Self-Administered Medications Page 5 of 12
The Six Rights Let s review some tried and true practices that will help in assistance or administration of medications. There are six important rules to remember when providing medication assistance or administration. 1. Right Person: Speak the client s name out loud. Be sure that the medication paperwork and the medication container match before you hand any medication to a client. 2. Right Drug: Compare the name of the drug on the container to the name of the drug on the medication paperwork. 3. Right Dose: Check the dosage on the medication container and be sure it is identical to the dosage on the medication paperwork. 4. Right Dosage Form: Every letter and number on the medication orders must match the medication package. Is the medicine a tablet, a capsule, a suppository, a liquid, or some other form? Is it extended release or immediate release? 5. Right Time: The date, the day of the week, and the time of day must be the same on the medication paperwork and the medication container. Assistance With Self-Administered Medications Page 6 of 12
6. Right Route: This means the way to take or use the drug, such as by mouth, under the tongue, injected, inhaled, or applied to the skin. The route ordered by the physician is the only way the medication may be given. Other Guidelines for Assisting with Medications Wash your hands before assisting with medication and after helping each client. Check the expiration date on medications the clients are taking. Expires 2/3/01 Be aware of instructions about when and how medications should be taken. Some meds need to be taken on an empty stomach and some need be taken with food. Keep medications in a cool, dry place. Do not store meds in the bathroom, because heat and humidity can harm drugs. Refrigerate medications that require it in a refrigerator that does not contain food. Monitor and record the refrigerator s temperature daily. Keep it within the recommended temperature range. Try to assist with medication in good light and with a minimum of distractions. Errors often occur because of interruptions and haste. Report any error to the supervisor immediately. Many errors will not have serious consequences if medical personnel can respond soon. Documentation of medication assistance must follow correct procedures and be clear and accurate. If your facility uses abbreviations, be sure you know what they mean. Use only approved abbreviations. B.I.D P.O. H.S. All medicines have a scientific or chemical name, called the generic name, and a brand name from the manufacturer. Whichever name identifies a medicine, Furosemide Generic for Lasix Assistance With Self-Administered Medications Page 7 of 12
the same name must appear on the medicine container and on the paperwork. If the names are not the same, clarify them with your supervisor. Unlicensed caregivers that assist with self-administered medications may find the following instructions useful for guiding two common assistance procedures. Assisting With Eye Drops 1. Wash your hands, and put on gloves. 2. Review the Six Rights while holding the bottle of drops. 3. Tell the client how you will help him put the drops in his eye(s). 4. With the client either sitting or lying down, tilt the head back. 5. With the medication in the dropper, hand the dropper to the client. Have the client look up as you pull down the lower lid, creating a pocket. Have the client squeeze the dropper and count the required drops as you guide the dropper over the pocket, NOT on the eyeball. Do NOT touch the tip of the dropper to anything. 6. Release the lower lid, and ask the client to blink. 7. Wipe excess medication with tissue. 8. Repeat steps 4 through 7 if both eyes are to have drops. 9. Store eye drops in designated storage area. 10. Remove gloves and wash hands. 11. Record/Report as directed. Assisting With Ear Drops 1. Wash your hands. Put on gloves if there is drainage. 2. Review the Six Rights while holding the bottle of drops. 3. Tell the client how you will help him put the drops in his ear(s). 4. Have him lay on the side opposite the affected ear. Adult: grasp the top of the affected ear and pull it gently up and back. Child: gently pull the affected ear down and back. 5. Hold the ear in position and guide the client to put drops into the side of the ear canal. DO NOT touch the tip of the dropper to anything. Make sure the drops flow into the ear canal. Release the ear. 6. Have the client remain on his side for 5-10 minutes. 7. Repeat steps 4-6 for the other ear, if ordered. 8. Store drops in designated storage area. 9. Wash hands. 10. Record/Report as directed. OD OS GTT (gtt) Q.D. Q.I.D. T.I.D. B.I.D. PRN Abbreviations Right eye Left eye Drop Daily Four times daily Three times daily Twice daily As needed Assistance With Self-Administered Medications Page 8 of 12
CC/ML PO Cubic centimeter / milliliter (the same thing) By mouth Assisting with Self-administered Medications Test Name Date Score 1. In most states there is a difference between medication administration and medication assistance. True or False 2. Medication administration is when the care provider is responsible for giving the client s medicines. True or False 3. Assistance with self-administered medication is when the client is responsible for taking his medicine, but requires help from a care provider. True or False 4. Clients who self-administer medicines must: (Choose all that apply. Worth 3 pts.) a. Keep medicine in the original container b. Keep medicine in a secure location c. Keep medicine out of reach of other clients d. Keep medicine in the bathroom 5. It is not necessary to keep medication records on clients who are assisted with selfadministered medications. True or False 6. When you assist a client with his medication, you are responsible for being sure the medicine is taken correctly. True or False 7. List the Six Rights of providing medication assistance. (Worth 6 pts.) The Right: (1), (2), (3), (4), (5), (6) 8. What is the first thing you should do when assisting with medications? (Worth 2 pts.) your 9. Errors in administering medication often occur because of and. (Worth 2 pts.) Assistance With Self-Administered Medications Page 9 of 12
10. When you assist a client with his medications, you are responsible for knowing whether it is all right to give a medicine on an empty stomach or if the client should take it with food. True or False Certificate of Achievement Presented to For completing the one-hour course Assistance with Self-Administered Medications Date Organization Presented by (Signature of presenter or write self study ) Assistance With Self-Administered Medications Page 10 of 12
Medication of the Month Lasix Furosemide Furosemide is the generic name for the potent diuretic, Lasix. It is metabolized in the liver and excreted through the urine. It is often called a water pill because it causes the body to pull excess fluid from the tissues and often causes increased urination. Indications: Edema, a condition in which the body tissues contain an excessive amount of fluid. The edema may be local or generalized. Lasix has a slight effect of lowering blood pressure. It may be effective for clients resistant to thiazides (another type of diuretic). How Supplied: Tablets for oral administration in dosage strengths of 20, 40, and 80 mg. Lasix for injection is available in 10 mg/ml solution in ampules, disposable syringes, and single dose vials for intravenous and intramuscular injection. Oral solution of 10 mg/ml is available in an orange-flavored liquid. Side Effects: Fluid and electrolyte depletion leading to dehydration and/or low potassium Nausea and vomiting Ringing in the ears and hearing impairment Headache, dizziness, blurred vision, restlessness, weakness, muscle spasms Allergic rash Urinary frequency Following IV use, cardiac arrest; following IM use, pain and irritation at injection site, cardiac arrest Drug Interactions: Charcoal causes decreased absorption of furosemide from the gastrointestinal tract. Clofibrate (used to lower cholesterol) enhances the diuretic effect of furosemide. Hydantoins (used to produce amino acids) cause a decrease in diuretic effect. Increases plasma propranolol levels (Inderol, a beta-blocker given for heart conditions). Precautions: Because this drug is resistant to the effects of pressor amines (norepinephrine) and potentiates the effects of muscle relaxants, it is recommended that the oral drug be discontinued one week before surgery and the IV drug two days before surgery. Assistance With Self-Administered Medications Page 11 of 12
Special Concerns: Use with caution in premature infants and babies. Geriatric clients may be more sensitive to the usual adult dose. Allergic reactions may be seen in clients who are sensitive to sulfonamides. Assistance With Self-Administered Medications Page 12 of 12