Arrow Child & Family Ministries



Medication Administration and Control Training HandoutWhy this training You are training to keep children safe by reducing risks.This training is a TDFPS Minimum Standard’s and Arrow Policy requirementArrow PolicyThe administration and control of medication is governed by Arrow policy, best practices, state and federal laws, and regulations.Psychotropic medication is used as a last resort after all other interventions have been tried and failed. Information in this training is generalized and not intended as specific medical advice.Consult with a healthcare professional when in doubt. Medication is ONLY administered by trained employees and caregivers. Important DefinitionsCaregiver refers to any approved individual counted in the child/caregiver ratio whose duties include direct care, supervision, guidance, protection of a child in care, and the administration of prescribed and over-the-counter medication. Caregivers may include foster parents, adoptive parents, respite providers, approved alternate caregivers, short-term caregivers, and babysitters.Basic Pharmacology includes drug preparation, properties, uses and effects.Schedule II drug is a category of drugs that have legitimate medical use, but are considered to have a strong potential for abuse or addiction. Schedule II Drugs require a new written prescription each month when the medication is refilled.PRN medication (from the Latin pro re nata) refers to medication that is ordered by a healthcare professional to be administered on an as-needed basis in accordance with written parameters of the healthcare professional.Over-the-counter Medication (OTC) is a drug for which a prescription is not needed. This includes vitamins and supplements.Medication Consent Arrow obtains the written, informed consent of birth parents/legal custodian for the administration of prescription and over the counter medication, at placement or when medication is initially prescribed.NEW PRACTICE. OTC may NOT be administered without the written consent of the parent or legal custodian. (This form is signed at placement.)If the birth parent/legal custodian does not provide the consent, efforts to obtain consent must be documented in the client case record.The birth parent/legal custodian is invited to attend medical appointments and is informed of medical and dental treatment, unless the court has restricted such contact.Medical ConsenterDesignated medical consenters typically include Arrow and the family with whom a client in care is placed. NEW PRACTICE. Medical consenters are responsible for attending ALL physicians’ appointments.Medical consenters are responsible for informing the birth parent/legal custodian of:The benefits, risks, and side effects of all prescription medications and treatment procedures used;The medical consequences of refusing the prescription medication or treatment procedures; and Providing the birth parent/legal custodian with the name and telephone number of the prescribing health-care professional to contact for more information, if needed.The state of Texas requires that medical consenters utilize all possible alternatives prior to consenting to psychotropic medication. Discuss how this practice will be monitored to ensure compliance. Medication Self-Administration Before permitting clients 16+ years to self-administer medication, the responsible Arrow case manager:Consults with the prescribing healthcare professional and document any concerns related self-administration. Obtains written consent from the birth parent/legal custodian.Document client’s ability to self-administer medication and self-administration supervision requirements in treatment/service plan.*Not applicable in California.Psychotropic New Medication/Medication Changes When a psychotropic medication/Schedule II drug is initially prescribed or when a medication is changed:Foster caregiver notifies the AFSThe responsible Arrow case manager notifies the referring agency caseworker or supervisor in writing by the next business day (TX only). Transcribe the written medication order/prescription onto the MAR.The employee/caregiver administering the first dose of the medication provides medication teaching to the client Ex. Explain the reason for the medication and the color size and shape.All physicians’ medication orders written by healthcare professionals are maintained in the client case record.Psychotropic Medication MAY NOT be administered without a written physician’s order or prescription.Verbal orders MUST be followed up with a written order/prescription BEFORE administering medication.Medication Monitoring Arrow employees/caregivers monitor and document any noticeable changes in the client’s behavior in response to any medication. These observations are submitted to Arrow and documented in the client’s treatment/service plan and reported to the prescribing healthcare professional for use in evaluating the appropriateness and effectiveness of the medication.In evaluating for the continued use of psychotropic medications and Schedule II drugs, the healthcare professional considers, in accordance with relevant state laws and regulations, the client’s target symptoms and treatment goals.If the prescribing healthcare professional does not substantiate the effectiveness of a specific psychotropic medication within 90 days, he or she provides a written rationale for continuing the medication for an additional period.The continuation of the medication may not exceed an additional 90 days (for a total of 180 days), if the healthcare professional does not substantiate effectiveness.Documentation of the prescribing healthcare professional’s decision to continue or discontinue medication is maintained in the client’s case record.Medication Administration Do’s: Dispense medication in a quiet place.Administer medication according to label instructions or prescribing healthcare professional’s signed order.Administer to one client at a time.Within 30 minutes of preparation.Without physical force. Watch client to ensure medication is actually swallowed. Be informed of possible side municate information to the parent/legal custodian as deemed appropriate.Check with school nurse on policy for medication client will need while in school.Medication Administration Don’ts: Do not leave medications unattended.Do not administer medication without supervision or ask a client to secure medication without supervision.Do not borrow or administer medication prescribed to another person.Do not administer prescription medication to more than one client from the same container.Do not put medication in a client’s back pack. SCHOOLS ARE DRUG FREE ZONESProhibited Practices Arrow strictly prohibits the administration of the following medication without a physician’s written order (prescription) or physician’s approval (OTC):Prescription medicationDrug samplesSupplements, excluding Vitamins for clients under 5 years old (§749.1541)Herbal medicationHomeopathic treatment Borrowing/administering medication prescribed to another personUnless, FP contacts physician regarding a client’s medical or behavioral needs outside of office/pharmacy hours. Physician has prescribed another client in the home the medication needed and gives verbal orders to administer the medication to the child in need. Call is documented in the appropriate space on the MAR. Medication Label Each medication label includes the:Client’s nameMedication name and strengthPrescription numberQuantity dispensed Count immediatelyRefills left Visit or contact physician before refills are outDirections for use Prescribing healthcare professional’s name.8. A number or code that identifies the written order, when applicable. (RTX)Pharmacy Information Sheet Prescribed medication comes with a Pharmacy Information Sheet that provides important things needed to know before starting a medication. Employee/caregivers are responsible for understanding and following the instructions.5210176-127000Keep it with the MAR for easy reference regarding possible side effects.Do NOT trust your rmation includes:Ingredient Name (generic name of drug)Common uses (some drugs are used for other reasons)How to use the medication – includes tips on how to administer for best effectiveness, how to store and what to do if a dose is missedCautions – important information on needs for lab work and other precautions while taking this drugPossible side effects – including which ones require that you contact the physician immediatelyOverdose – what it might look like and what to do if suspected. Remember the client can have signs of overdose on the prescribed dosage.Generic name is the common name of the active ingredient in the medication.The brand name is given by the drug company and will be different for each company that makes it.Example: Tylenol = brand nameAcetaminophen = genericSupplements To administer supplements, herbal medications or homeopathic treatments; caregiver must have a physician’s approval to ensure they do not contraindicate any other medication the client is taking. Supplements include but are not limited to: Common SupplementsMelatonin – SleepProbiotic – Gut healthCalcium – Maintain bone density; Maintaining normal blood pressureOmega 3/Fish Oil – ADD; ADHDFive Rights of Medications Right DrugRight ClientRight DoseRight RouteRight Time…AND Right Documentation.If you do not write it down, it did not happen. Sign the MAR after EACH medication administration. Do your medication from start to finish, the same way EVERY TIME and Check and Re-checkCheck the medication label: When taking out of the locked storage, Before giving to the client, and When putting back into locked storageLOOK! :The medication on the left is Cortef, a steroid commonly used to reduce inflammation in the respiratory system during an asthma exacerbation.The medication on the right is Digoxin, a cardiac medication used for irregular heartbeat. When Cortef is mistakenly replaced by Digoxin, the Digoxin causes toxicity in the body that can cause death.It is critical that medications are checked for accuracy. Compare to refill medication to the current medication to confirm they are the same pare color, size, shape, dosage. If there is any concern that the refill is not the same as the prescription medication, take both to the pharmacist for mon Medication Administration Techniques and Methods Based on the diagnosis and pharmacokinetics (next slide), medication is administered:OralGastro-tubeIntravenous (including port-a-cath, subclavian, broviac, pic-line etc.)Intramuscular injection (into muscle)Subcutaneous injection (under skin) Soft Mucosa (Sub-lingual-under tongue, Rectal, Vaginal)Transdermal (directly to skin)Ears R/L or Both (Bottom middle picture)Eyes R/L or Both (Bottom left picture)Nose R/L BothInhaled (Bottom Right)Elements of Pharmacokinetics 4724400-190500Absorption-Crossing the membranes into the blood stream.-Effected by food and other medications when taken orally.DistributionWhen the medication binds to something that circulates through the body, like lipids or serum or another medication (Mylanta given too close to a seizure medication). Metabolism The processing of a specific substance within the living body.ExcretionEventually most drugs are filtered through the liver and kidneys.Accepted Medication Administration SchedulesDuring Waking Hours OnlyQD/q.d. – 1x a day374332511049000BID/b.i.d. – 2x’s a dayTID/t.i.d. – 3x’s a dayQID/q.i.d. – 4x’s a daySpecified times around the clockQ 12 Hours, specified times AM and PMQ 8 Hours - specified times around the clockQ 4 Hours - specified times around the clockQ 6 Hours - specified times around the clockQHS - Bedtime, same time each nightClient sleeps in on weekends and in summerClient is prescribed Zoloft for depression. The healthcare professional prescribes Zoloft to be given BID, at 0630 and 1600 to allow medication to be given before he leaves for school and after he arrives home from school. On the weekends, the client sleeps in and is not taking the Zoloft at 0630. Employee/caregiver gives the medication when client wakes and does not note the change in time. This practice continues during the summer. What can employee/caregiver do, regarding the administration and recording of the Zoloft, to stay compliant?Answer: The caregiver contacts the prescribing healthcare professional and requests that the order be changed to allow a later dose on weekends and summers. If the licensed healthcare professional agrees, amend the MAR to reflect the change subsequent to the receipt of the written order. If physician does not agree, the caregiver must wake the client to administer the medication at the prescribed time.Remember! Prescription medication IS NOT be administered without a written physician’s order or prescription.471487512001500Some Medication Causes Drowsiness Some medications cause drowsiness. Talk with the prescribing physician to schedule the medication late in the day or bedtime to prevent interference with school, homework, family time, playtime and chores.Parents: Avoid Medication Mistakes Dose: Amount of medicine to give at one time. Know how long to wait in between doses.One study found that parents gave their children the wrong dose 47% of the time. The main reason was confusion over how to measure and give the medicine.45053256223000More than half of U.S. medical errors involve medication. Mistakes can be deadly.Read Labels Carefully. Make sure the medication is safe for children.Measuring Liquid Medication 477202531686500Liquid medication is to be measured per pharmacist’s instruction. If a medication syringe or medication delivery cup is not provided, ask for one.Using kitchen flatware instead of a measuring device that comes with a medicine can result in the wrong dosage, too much or too little of the medicine. Use the measuring device provided with the medicine instead of kitchen flatware.1 ml = 1 cc2.5 ml = 2.5 cc = ? teaspoon (tsp)414337522225005 ml = 5 cc = 1 tsp15 ml = 15 cc = 3 tsp = 1 tablespoon (Tbsp.)30 ml = 30 cc = 2 Tbsp. = 1 fluid ounce (oz.)When filling a syringe with medication, fill to prescribed mark and be certain that air is expelled to deliver the most accurate dose possible.When using a graduated medication delivery cup, place the cup on a level surface to fill and check the medication dose while on the level surface to deliver the most accurate dose possible.Pill, Capsule and Enteric Medication Delivery Pill/tablet/caplet – round/oval solid pharmacological oral dosage form (Aspirin, Tylenol, Motrin)Capsule – Small gelatinous case enclosing a dose of medication (liquid or tiny control released pills)NEVER break or cut a capsule.Enteric – Coating is a barrier applied to oral medication that controls the location in the digestive system where it is absorbed. NEVER break or cut an enteric (coated) pill or tablet (one that is designated for extended release).Pill Cutter NEVER break a pill/tablet/caplet when half or a quarter of a pill is required for the dose.ALWAYS use a pill cutter.ALWAYS wash pill cutter after each use.Medication Documentation Always document the MAR in INK.Medication Administration Record (MAR) Arrow employees/caregivers are responsible for documenting and maintaining a cumulative MAR for prescription and non-prescription medication dispensed in accordance with relevant laws and regulations in each respective state. Originals are maintained in the client’s case record.The MAR includes:The client’s full nameKnown allergies;The prescribing healthcare professional's name;The reason the medication is prescribed;Medication name, strength, dosage, frequency, and administration route;Date (day, month, and year) and time the medication was administered for medications with regularly-scheduled dose times;Initials reflecting administration, if administration occurred within thirty minutes of the scheduled time;Name and signature of the person who administered the medication;Documentation of a client’s refusal to accept medication, if applicable;Documentation of medication errors, if applicable; andIdentification of prohibited prescription or over-the-counter medication for each client.Sample MAR For all medications you must document the actual time the medication is given.Sample PMN MAR For PMN Treatment Services, for medications with regularly scheduled doses, you may use the regularly scheduled time to document giving the medication as long as it is given within thirty minutes of the scheduled time. Otherwise, you must document the actual time the medication is given.Maintaining the MAR The MAR is always completed in INK.The MAR is maintained in the foster home for the current 30 days for each client prescribed medication.Foster caregivers submit an original copy of the MAR to Arrow for each client on a monthly basis and as requested. MAR is maintained in each client case record.Clients who self-administer medication are responsible for reporting the time and dosage that a medication was self-administered to a designated Arrow employee/caregiver. The designated Arrow employee is then responsible for accurately documenting the client’s medication record.Arrow makes MARs available to employees/caregivers for maintaining adequate records of all medications administered to the client.The MAR CANNOT be completed on the computer. Actual times (when given outside of the prescribed time or given as needed) and initials must be handwritten. Lines CANNOT be drawn through boxes where initials are required, unless a medication is discontinued and discontinuation is properly documented in the medication change portion of the MAR.MAR Codes AAWOLJDJuvenile Detention/JailHVHome VisitHHospitalizedMEMedication ErrorREFRefusedRESRespiteSSchoolOOtherOver-the-Counter (OTC) Medication REMEMBER! Prior to administering an over-the-counter medication, the responsible Arrow employee/caregiver consults with the prescribing or other healthcare professional regarding any contraindications. OTC Antihistamine + RX Sedative = Increased SleepOTC Antihistamine + RX BP Med = Increased Blood PressureThe consultation is documented on the MAR including:The date;The time;The healthcare professional’s name and position title; andA description of the conversation. Over-the-counter medication may be administered to more than one client from the same container.Targeted symptoms/behaviors MUST be documented on the MAR when administering PRN and over-the-counter medication (OTC).For example: Benadryl for sleep or Benadryl for allergies\sMedication ErrorsEvery year, 1.5 million Americans suffer injuries from medication errors.Medication Error Occurs when a Client Receives: Wrong medicationWrong dosage of medication.Medication prescribed to someone elseMedication at the wrong timeMedication dose is skipped or missedMedication on an empty stomach when should be given with foodExpired medicationMedication not stored as requiredIncorrect documentation or failure to document that a medication was administered, missed, or refused.How to Respond to a Medication Error Contact a healthcare professional immediately.Follows instructions/recommendations.Indicate error on the MAR.Call 911 immediately in the case of an overdose.NEW PRACTICE! Document the medication error in an incident report.NEW PRACTICE! Conduct medication error review.Details of both are in the Medication Access and Control Policy348615014287500If a Dose is Missed Never double upConsider the intervalDocumentHow to Respond to a Medication Label Error Report error to pharmacist immediately. Have label on medication container corrected no later than the next business day.Medication Refusal Arrow respects the right of any capable and informed client to refuse medication. However, when a client refuses medication that has been determined by a healthcare professional to be necessary, an assessment is made as to the level of need for the medication and the reasons for refusal. If it is determined that a client has sound reasons for refusing a prescribed medication, the prescribing healthcare professional and appropriate treatment team members are notified, when applicable. Decisions about how to proceed are then made based on accumulated information.When it is determined that a prescribed medication is absolutely necessary for continued health and safety of a client (e.g., insulin for and individual with diabetes), necessary precautions are taken in collaboration with the client’s treating physician. The decision to administer medications against a client's is documented in an Incident Report and maintained in the client case record.All medication refusals are documented in a manner defined by the program and maintained in the client’s case record.MEDICATION REACTIONSALLERGIC REACTIONS Common allergic reaction signs:Hives (a red itchy rash)Runny noseSneezing and cold like symptomsAnaphylactic reaction-serious allergic reaction that may cause throat to swell resulting in difficulty breathing. This is life-threatening and immediate medical attention is needed. SIDE EFFECTS510540013144500Side effects occur when treatment goes beyond the desired effect or problems that occur in addition to the desired therapeutic effect.Report to healthcare professionalDocument in an Incident Report within 24-72 hours of the occurrence.ADVERSE REACTIONS An ADVERSE REACTION is an abnormal effect caused by a medication or exposure to a chemical. Symptoms may include:Nausea and vomitingHeart PalpitationHypertensionHypothermiaSlow/Absence breathingComaCardiac arrestDeathHow to Respond to an ADVERSE REACTION Report the adverse reaction to a healthcare professional immediately.Follow the healthcare professional’s recommendations. Seek further medical care if condition appears to worsen.Document within 24 hours on the Incident Report.Medication Access - ControlMedication storage areas are clean, organized with adequate temperature, light, moisture.Medication is maintained in a locked, supervised storage, with access limited to authorized personnel, compliant with relevant state laws and regulations.Kept in original container.Each client’s medication is separated.Medications for external use are stored separately from medications for internal use.Refrigerated medications are kept in a labeled, locked container away from foods.Prior to certifying/licensing a family, the home MUST be equipped to appropriately secure ALL medication types including OTC, prescription and Schedule II drugs. LOCKED BEDROOM OR BATHROOM DOORS IN THE HOME ARE NOT CONSIDERED AS A LOCK FOR MEDICATIONS.462915049657000In residential treatment and group living facilities, medications are locked in a supervised area with limited access.Medication Access and Storage for Refrigerated Medications Refrigerated medications are to be kept in a labeled, locked container in the refrigerator and away from foods.Place on a shelf or in a bin designated for mediations onlyKeep lockedMedication Access and Storage while Traveling51911254445000Secure medications when travelingKeep the locked medication boxes in the possession of the caregiverFor medications requiring refrigeration, place locked medication box into ice chest to maintain proper temperature for medication, under supervision of the caregiver.By their curious nature, children are prone to overdose. 5257800381000Talk with your prescribing health care professional about administering first time medications with extreme caution and start at a lower dosage. Drug pharmacokinetics is different in childrenMedications are typically prescribed based on an average child’s weight. Watch carefully for adverse reactions and signs of overdose. If overdose occurs call 91145624755397500Emergency 911Always remember and in the case of any medical emergency, immediately call 911.519112512890500Regularly Check Expiration DatesPrescription medications that are prescribed ‘as needed’ are to be checked monthly and before administration to confirm that the medication is not expired.More often over-the-counter medications will be expired when ready to use, due to being bought in bulk or on sale and not being used on a regular basis. OTC medications should be checked monthly and before administration to confirm that the medication is not expired44767503619500Medication DestructionThis is not the proper way to dispose of medications!Discontinued and Expired Medication Medication is removed and destroyed in accordance to U. S. Food and Drug Administration regulations within 30 days after it is:DiscontinuedExpiredClient has left care without the medicationMedication of a deceased client is removed and destroyed immediately.If your local health department or pharmacy has a drug take back program, Leave medication in the bottleConceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off.Take to disposal container located at health department or pharmacyIf a drug take‐back or collection program is not available:Take the prescription drugs out of the original containers.Mix drugs with cat litter or used coffee grounds.Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.Conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off.Place the sealed container with the mixture, and the empty drug containers, in separate trash containers.Medication Destruction RecordThe destruction of medication is documented on the Medication Destruction Record, which includes:Client’s name Date of destruction Name of medication Reason for destruction Initials, name, and signature.An Arrow employee and additional person MUST be present and sign for the destruction of Schedule II medications.Universal PrecautionsAs defined by the Center for Disease Control (CDC), Universal Precautions are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood borne pathogens when providing first aid or health care.Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV, and other blood borne pathogens.GlovesGloves will be worn when touching blood, body fluids, body substances, and mucous membranes.Gloves will be worn when there are cuts, breaks, or openings in the skin.Gloves will be worn when there is possible contact with urine, feces, vomit, dressing wound drainage, soiled linen, or soiled clothing.Masks, Goggles or Face Shields/Resuscitation DeviceMasks, goggles, or face shields are worn when splattering or splashing of blood or body fluids is possible (this protects your eyes and mucous membranes of your mouth).Use resuscitation devices when mouth-to-mouth resuscitation is required.Wash your hands, Wash your hands, and Wash your hands!Hands and other body parts and clothing are washed immediately if contaminated with blood or body fluids.Hands are washed immediately after removing gloves.Hands are washed after each client’s medication(s) is given.18573752857500Hand Washing StepsSlide #6931813509334500Speaking Points: Singing the ABC song will time your hand washing. “God made us then whispered, ‘think symphony, not solo.’ Individually capable, collectively unbelievable” Arrow staff covers our families and children; families cover children; children living to their fullest potential ................
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