Medication Administration



Medication Administration

Lo-Se-Ca Foundation

As revised by Marie Gauvin & Patrice Patterson, Feb 2016

As revised by Marie Gauvin & Patrice Patterson, April 2014

As revised by Marie Gauvin & Laine McGinley November 2010

As revised by Jules Lefebvre & Marie Gauvin, October 2006

Original developed by Joanne MacLean per

CORE Standards, November 1995

Table of Contents and Course Outline

1. Introduction (Objective of Course) 4

2. Lo-Se-Ca Medication, Catalyst oneMAR Computer Program for Medication

Administration & Self-Administration Policy and Procedures …………………………………. 5-12

3. Medication Administration Shadow Form……………………………………………………………… 13

4. Independent Administration Plan ………………………………………………………………….. ….14-18

5. Medication Delivery

a) General Rules 19

b) Seven Rights 20

c) Medication Orders 21

d) Individual Profile Form 22-24

e) Medication Administration Challenges 25

6. Medication Documents and Instructions

a) Administration Record 26

b) Medication Administration Record (form) 27,27

c) Medication Administration Record (PRN) 29,30

d) Medication Administration Incident 31

e) Medication Incidents/Errors………………………….…………………………………………..32

f) Medication Error Flow Chart 33

g) Medication Incident Report (Form) 34,35

h) Leave of Absence (LOA) Medications 36

i) Transfer Release Form 37

7. Medical Appointments 38

a) Medical Treatment Form 39

8. Adding New Medication Instructions 40

9. Discontinued Medication Instructions 41

10. Specific Delivery of Medications 42

a) General Application for Topical Preparations 43

b) Administration Technique for Eye Drops and Ointments 44

c) Illustration – Eye……………………………………………………………………………………..45

d) Administration Technique for Ear Drops……………………………………………………..46

e) Illustration – Ear………………………………………………………………………………………47

f) Administration Technique for Nose Drops and Nasal Sprays…………………………48

g) Illustration – Nose……………………………………………………………………………………49

h) Use of Inhalers………………………………………………………………………………………..50

i) Administration Technique for Vaginal Creams 51

j) Administration Technique for Vaginal Inserts/Suppositories and Tablets………..52

k) Administration Technique for Rectal Suppositories ……………………………………. 53

11. Common Medical Symptoms/Conditions 54,55

a) Observation and Documentation of a Seizure 56

b) Types of Seizures 57

c) Seizure Record Form 58

d) Asthma 59,60

e) Diabetes 61

f) Diabetic Reactions 62

g) Treatment Guidelines for Diabetes 63

12. Common Medication Administration Abbreviations 64

13. Medication Administration Summary 65

14. Self-Study Questions .66,67

15. Bibliography and References 68

Introduction (Objective of the Course)

The objective of this course is to provide practical, appropriate and relevant information and instruction for the safe delivery of medications by staff to Lo-Se-Ca clients.

LO-SE-CA FOUNDATION

LO-SE-CA FOUNDATION___________________________________________

| | | |

|Approved: 08-01 |Replacing: 3-107 |Policy Number: 3-14 |

|Revised: 05-15 | | |

TITLE: MEDICATION ADMINISTRATION

POLICY:

The Lo-Se-Ca Foundation will ensure the appropriate administration of medications for the individuals served.

PROCEDURES:

1. All staff will be required to take the Medication Administration Course within his/her three month probationary period. The employee will be responsible for doing a minimum of three medication administration shadows before giving medications on his/her own. The Medication Administration course must be renewed a minimum of every three years.

2. The Medication Administration course will be taught by a qualified person. This includes a pharmacist, pharmacy technician, registered nurse, licensed practical nurse, or emergency medical technician. They will have at least two years of relevant medication administration experience and have maintained recertification.

3. It is the responsibility of the employee to familiarize his/herself with the medical condition of the individual, side effects of the medication, dosage and time of the medications, medical history of the individual, foods or medications that adversely interact with the current medication, allergies, and any other information pertinent to the safety and health of the individual.

4. All medication, including over the counter and prescription drugs, will be stored in a locked, secure location within each residence if required to manage the risks identified in that program/home.

5. Whenever possible, medication will be packaged by the pharmacy in med strips.

6. Medications will be kept in appropriate containers with current labels securely attached. Prescription medications must have a label from the pharmacy indicating the name of the individual, name of the medication, the dosage and the times of the administration.

7. All medication records, including those for non-prescription medications must be current. Information regarding medication changes will be shared with relevant staff members in writing.

8. New and discontinued medication, changes in medication, administration times or dosage, must be accompanied by written documentation from the Team Leader, designate or guardian outlining the doctor’s orders and medical protocol.

9. All medication prescribed and over the counter drugs will be monitored using the Catalyst oneMAR computer system. Medication administration records (paper MAR) will be issued by the pharmacy to use as a back up.

10. Individual and guardian written permission for administration of identified non-prescription drugs will be obtained upon admission and thereafter when circumstances change. These will be approved and monitored by a Pharmacist or medical professional.

11. Foundation staff are at times required to transport medication between residences and day programs. Written consent will be obtained from the individual and guardians when applicable, for those individuals considered able to independently transport and administer their medication.

12. When an individual receiving services from the Foundation is away from their home over a period that medications are to be dispensed, medications will be given to the parent/guardian or designate. Clear instruction on medication type, dispensing time and any other special instructions will be provided. Staff are responsible for having the parent/guardian or designate sign a Medication Transfer form.

13. Foundation staff in each program are responsible for ensuring that medication refills are completed as required.

14. Foundation staff are responsible for ensuring the disposal of all outdated or discontinued medication through the pharmacy.

15. If an error or incident in the administration of medication occurs, the appropriate pharmacist is to be consulted immediately and their recommendations followed. Staff are responsible for reporting all errors and incidents on a Medication Incident Report form and then immediately fax or scan and email it to the office. The original copy of the report will be submitted to the Team Leader and then Program Manager for review and their signature as soon as possible.

16. If a staff member has three medication administration incidents or error within a three month period, they will be required to retake the Medication Administration course at his/her own cost and time.

17. If an individual refuses to take a prescribed drug on a regular basis (two consecutive days) the Team Leader or designate will consult with the Pharmacist and then the Doctor, if applicable, for instructions. The Team Leader or designate will also notify the guardians. All concerns and suggestions from the Pharmacist and the Doctor should be recorded in writing and when required a program designed, implemented and monitored.

18. It is the individual’s right to refuse medication.

19. All medication and medical directives are monitored in the following areas:

• Reason for administration

• Desired effect

• Undesired effects and adverse reactions

• Reviewed by medical professional

• Prolonged unnecessary use of any medication

20. If medication is being used as a restrictive procedure, medical reasons for the behavior must be ruled out. Implementing the use of a PRN for a restrictive procedure must follow the restrictive procedures guidelines. (see policy 3-10)

21. If medication is being used as a PRN to influence behavior, the following components should be provided within a restrictive procedure plan:

• Definition of the behavior, its frequency and intensity

• Positive strategies to be used first before utilizing the PRN

• Actions to occur after the PRN is administered

• Monitoring the usage for further assessment and/or a regular prescription

• Length of time that a PRN hasn’t been used before it will be discontinued

22. When using medications to influence behavior, informed consent must be received from the individual and guardian if applicable.

• The individual must be involved as much as possible

• Consent is given voluntarily

• Appropriate information is provided to ensure an informed decision is made. This information should include but not be limited to:

o The diagnosis

o How the monitoring of the behaviors will take place

o The length of time the PRN would be used

o The side effects of the medication

o Alternatives to the medication

o The dose range of the medication

o The people who will be responsible for administering the medication

o The explanation that consent is time limited and must be reviewed periodically

o The individual has the right to refuse the medication

23. Individuals who wish to take medication independently will be supported to do so (see policy 3-15)

LO-SE-CA FOUNDATION___________________________________________

| | | |

|Approved: 05-15 |Replacing: |Policy Number: 3-14-1 |

|Revised: | | |

TITLE: Catalyst oneMAR Computer Program for Medication Administration

POLICY:

The Lo-Se-Ca Foundation will ensure the appropriate administration of medications for the individuals served using Catalyst oneMAR computer program.

PROCEDURES:

1. All staff will be required to learn the oneMAR computer system during their initial orientation period at the program. At the end of their orientation period staff will sign a statement saying that they understand how to use the system and are able to use it independently.

2. All staff are required to perform the “4 Easy Steps for Managing oneMAR” at the start and end of every shift. This ensures that they are aware that all medications have been given and documented and know what PRN medications have been used in the last 24 hours. They will then check the medication strip to ensure that the previous medications were given and that the medications for the next delivery time are present. If they discover that there are medications remaining that should have been given or that there are medications that were due to be administered that have not been signed off in oneMAR they will follow the steps outlined below:

Medications Not Signed Off and Missing from Strip

1. Attempt to contact the staff member responsible for administering the dose to find out if the medication was in fact administered. The absence of medication from the strip does not necessarily mean that the medication was administered. It may have been refused, or accidentally taken home by staff, etc.

2. The following procedure will depend on whether or not the medication was actually administered or not and should be as follows:

a. If the medication was not administered:

i. Phone the pharmacy for further instruction (it may still be appropriate to administer the medication; the pharmacist will determine the best course of action)

ii. If the pharmacist directs staff to still administer: Perform a “Replace Bag” and sign off the medication as normal using that replacement bag. The medication will show up pink because it was administer late, but a comment may be added ie.) “Medication missed by previous staff, pharmacy directed to administer.”

iii. If the pharmacist directs staff not to administer: Manually sign off on the affected medications as “0%” given and add a comment ie) “Medication missed by previous staff, pharmacy directed not to administer”.

iv. Complete a Med Incident Report and submit to office

b. If the medication was administered:

i. Manually sign off on the affected doses as “100%” given and add a comment ie) “Medication not signed off by previous staff but was given”

ii. The pharmacy does not have to be contacted about this type of error because it is a documentation error only (The medication was given appropriately)

iii. Complete a Med Incident Report and submit to office

c. If the staff who was to administer the medication cannot be reached to confirm the administration:

i. Phone the pharmacy for further instruction

ii. If the pharmacist directs staff to administer: Perform

a “Replace Bag” and sign off the medication as normal using that replacement bag. The medication will show up pink because it was administered late, but the comment “Medication not signed off by previous staff, staff unavailable to confirm administration, pharmacy directed to administer” can be added.

iii. If the pharmacist directs staff not to administer: Manually sign off on the affected doses as “0%” given and add the comment “Medication not signed off by previous staff, staff unavailable to confirm administration, pharmacy directed not to administer”.

iv. Complete a Med Incident Report and submit to office

3. Contact the appropriate Supervisor (Team Leader/On-Call) as per the Medication Incident Protocol

Medications Not Signed Off and Present in Strip:

1. Attempt to contact the staff member responsible for administering

the dose. It cannot be assumed that the individual was not given any medication. They could have been administered the wrong day and/or time.

2. The procedure will depend on whether or not medication was actually administered (given to wrong individual, wrong date/time, etc.) and should be as follows:

a. If any medication was administered to the individual in error:

i. Phone pharmacy for further instruction

ii. If the pharmacy directs to administer the medication: scan the appropriate medication pouches and sign off as normal. The administration will show up in pink, but a comment ie) “Wrong medication administered, pharmacy directed to monitor but still administer the correct medication” can be added.

iii. If the pharmacy directs not to administer the medication: manually sign off all affected doses as “0%” given with a comment ie) “Wrong medication administered, pharmacy directed to monitor and not to administer correct medication”, etc.

iv. Complete a Med Incident Report and submit to office

b. If no medication was administered:

i. Phone pharmacy for further instruction

ii. If the pharmacy directs to administer: scan the appropriate medication pouches and sign off as normal. Add a comment ie) “Medication missed by previous staff, pharmacy directed to administer”.

iii. If the pharmacy directs not to administer: manually sign off all the affected doses as “0%” given with a comment ie) “Medication missed by previous staff, pharmacy directed not to administer”

iv. Complete a Med Incident Report and submit to office

c. If the responsible staff member cannot be reached to confirm administration:

i. Phone pharmacy for further instruction

ii. If the pharmacy directs to administer: scan the appropriate medication pouches and sign off as normal. Add a comment ie) “Medication not signed off by previous staff and present in strip, staff unavailable to confirm administration, pharmacy directed to administer.”

iii. If the pharmacy directs not to administer: manually sign off all the affected doses as “0%” given with a comment ie) “Medication not signed off by previous staff and present in strip, staff unavailable to conform administration, pharmacy directed not to administer”.

iv. Complete a Med Incident Report and submit to office

3. Contact the appropriate Supervisor (Team Leader/On-Call) as per the Medication Incident Protocol

3. As part of the “4 Steps”, all overdue alerts will be corrected by the first staff to discover the error. Overdue alerts will appear on the Resident Search Page until that dose has been corrected (signed off) which means that staff are not able to see the next medication administration time resulting in future missed doses.

4. If medications cannot be signed off due to an internet and or computer access problem staff will follow the steps below:

1. Staff will use the back up paper MAR issued monthly by the pharmacy until the internet/computer issue has been resolved.

2. Staff will immediately notify the Supervisor (Team Leader/On-call) of the issue.

3. When the internet/computer issue is restored, staff will notify the Supervisor (Team Leader/On-Call) who will then “Release” medications for the time period affected. This is an administrative function that only Superusers can perform. This function will be performed right away so staff can once again see future meds due on the resident search page.

5. All Programs and On-Call supervisors will have a copy of the Catalyst oneMAR manual located in the red medication administration binder. A copy of the manual can also be found on the LoSeCa Cloud in the Programs (Q) drive.

Self Administration

Policy and Procedure

|Approved: 08-01 |Replacing: 3-109 |Policy Number: 3-15 |

Policy

The Lo-Se-Ca Foundation respects the individual’s rights to participate in administration of their medications.

Procedure

1. Individuals who wish to self-administer their medications will sign release forms, which will also be signed by their parent/guardian when necessary. Whenever possible a pharmacist and/or doctor will also sign the release outlining the parameters of the individual’s participation in the administration of medication.

2. Foundation staff will assist the individual to complete a risk assessment relating to medication self-administration and then develop, with the individual, a personalized plan, which will support them in their successful administration of medication.

3. All individuals served by the Foundation will have access to modified medication administration by a qualified person.

Medication Administration Shadow

Employee Name _____________________________

Employee # _____________________________

1. Program ______________________

Date ______________________ Time ________________

Shadowed by _______________________________________

Comments/Concerns

____________________________________________________

____________________________________________________

2. Program ______________________

Date ______________________ Time ________________

Shadowed by _______________________________________

Comments/Concerns

____________________________________________________

____________________________________________________

3. Program ______________________

Date ______________________ Time ________________

Shadowed by _______________________________________

Comments/Concerns

____________________________________________________

____________________________________________________

Next Medication Administration Course Date: __________________

Staff Signature __________________________________________

Team Leader ___________________________________________

Program Manager _____________________________________

* This document is to be filled out at beginning of employment with Lo-Se-Ca. New staff must shadow a minimum of 3 times before administering meds independently. Please have Team Leader review & submit once completed.

Independent Medication Administration Plan

Assessment:

Right Person

|Can the person identify their own medication or strip packaging/bubble pack? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Right Medication

|Can the person recognize their own medications (colour/size/shape)? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|Can the person understand medication information? (ie. Name of med, dose, potential side effects) |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|Can the person administer PRN’s with the same accuracy as regular medication? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Right Time

|Can the person identify the appropriate time to administer medication? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Right Dose

|Can the person identify the appropriate amount of medication required? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|Can the person describe the potential risk(s) and likely outcomes if they do not take their meds as prescribed? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Right Route

|Which administration routes would the individual be capable of independently using? |

|Route: |YES |NO |Comments: |

|Oral (by mouth) |( |( | |

|Pulmonary (into lungs) |( |( | |

|Topical (to skin) |( |( | |

|Transdermal (through skin) |( |( | |

|Otic (ear medications) |( |( | |

|Eye Medications |( |( | |

|Nasal Medications |( |( | |

|Suppositories (rectal, vaginal) |( |( | |

|What would be required to increase independence in this area? |

| | |

| | |

Right Documentation

|Is the person able to sign in the appropriate location? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|Can the person identify a medication incident and how to respond? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|Can the person write the incident report? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Right Response

|Can the person indicate or identify adverse reactions to medication? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

|How would the individual react if they identify an adverse reaction? |

|( |Do nothing | |

|( |Tell staff | |

|( |Call pharmacist |(do they know where to find the number?) | |

|( |Call 911 | | |

|( |Call PADIS | |

|What would be required to increase independence in this area? |

| | |

| | |

Travel

|Can the person take their meds on outings/overnight/trips? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Storage

|Does the person know where or how to store their medication properly/safely? |

|( yes |( needs training, adaptation or prompts |( no |

|What would be required to increase independence in this area? |

| | |

| | |

Current Task Analysis and Development Plan

|Identify appropriate time for medication, using the 24 hour clock: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

|Obtain medications: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

|Remove medications from package or container: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

|Administer medication via proper route: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

|Sign MAR sheet: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

|Put medications away: |

|Staff Role: |Individual’s Role: |

| | |

|Plan to increase the role of the | |

|individual: | |

| | |

| | |

General Comments:

| |

| |

Signatures:

|Individual: | | |Date: | |

Medication Delivery

General Rules

➢ Always wash your hands before and after administering medication.

➢ Ensure all information (e.g. Labels, OneMAR tracking, etc.) is read prior to administering medication.

➢ Always refer to the person by name when administering medication.

➢ Medication is to be administered within one hour before or after the specified time of administration, called the one hour window.

➢ Optimal therapeutic levels must be regularly checked for certain medication. Ensure that blood work is completed according to the doctor’s orders, whether it is once a week, once a month, once a year, twice a year, etc.

➢ NEVER give any medication that is not prescribed by a physician. All medication, including over the counter drugs must be prescribed by a physician or can also be approved by the Pharmacist at Stony Plain Wellness & Compounding Pharmacy. Always check OneMAR PRN’s.

➢ If you use the last days medication (providing it is the same medication), call the pharmacist for replacement medication or use OneMAR system to re-order online.

➢ All medication has an expiry date. In order to receive the most benefit, ensure that the medication has not expired. Do not dispose of expired or dropped medication, these are to be returned to the pharmacy, for appropriate chemical disposal. The pharmacy delivery driver will pick up expired meds weekly.

➢ If a medication looks different in any way, call the pharmacy.

➢ Do not handle medication. ALWAYS use a spoon, a medication cup, or a glove.

➢ Observe individual for positive/negative reaction to the medication. Notify the doctor if there are any concerns.

➢ Some strategies to be used to remind yourself of medication times are timers, sticky notes, alarms, counting on double staffing, associate with a daily event (dinner), etc.

Seven Rights of Administering Medication

Community Support Workers should not have the responsibility of administering medication unless they have taken an appropriate course in medication administration. In some organizations, one staff person per shift is designated to administer medication to all individuals.

In anticipation of the time when you do have the responsibility of administering medication, you should know the seven “rights” of medication. (These “rights” also apply of course, to administering medication at home to your family.) Before, during and after delivering medication, check the SEVEN RIGHTS to ensure the correct procedure is followed:

RIGHT PERSON

• Check the person’s name on documents

• Check the person’s name on med strip packaging/labels

• Refer to the person by name

RIGHT MEDICATION

• Check the medication name on documentation

• Check the medication name on med strip packaging/labels

• Ensure the two names are identical

RIGHT TIME

• Check the date and time on documentation

• Check the date and time on dispensing container

RIGHT DOSE

• Check the dosage listed in documentation

• Check dosage on dispensing container and med strip packaging/label

RIGHT ROUTE

• Check the route listed in the documentation

• Look for route directions, words like “take”, “drop”, “apply”

RIGHT DOCUMENTATION

• Sign for medication

RIGHT RESPONSE

• Observe individual for correct or adverse reactions

Please Mind The Drug Rules, Don’t Rush!

Medication Orders

All medication that you will administer will be ordered by a physician or approved by the Pharmacist (for over the counter medications). There are three types of orders that you will deal with:

1. Prescription Medication: A medication order that must be prescribed by a physician and filled by a pharmacist. (For e.g. antidepressants, antibiotics)

2. Over the Counter (OTC) Medication: A medication order does not require a doctor’s order, but must be approved by pharmacist before administration to individual. (For e.g. cough syrup, antacid).

3. PRN Medication: Medication that is given to an individual when observable and measurable criteria are met. It is a medication that is given as needed/as necessary only. A doctor will determine the criteria. This medication can be a prescription or over-the-counter medication. (For e.g. Ativan, Tylenol)

* The Pharmacist can approve of a PRN if it is an over the counter medication.

Every month, Stony Plain Wellness & Compounding Pharmacy will send regular MAR sheets as well as PRN sheets for over the counter and prescription PRN medication orders to deal with common difficulties such as colds, headaches, stomachache, etc.

Paper MAR sheets will be used in the event that OneMAR is unavailable.

|LoSeCa Foundation Individual Profile |Updated: |

| | |

|Name: |Jane Doe | |Intake Date: |1/16/05 |

|Address: |1234 Street Name | |DOB: |1/1/61 |

| | | |PHN: |0123456 |

| | | |AISH#: |X1234567 |

|Phone: |(780) 555-5555 | |SIN: |123 456 789 |

| | | |Email: | |

|Allergies/Medical Concerns: No known allergies/Heart Murmur, Limited Hearing Left Ear, Pre-menopause, High Cholesterol levels. |

|Method of Communication: Verbal-use simple phrases (no more than 3-4 words). Ensure she knows what is being said to her. |

[pic]

Legal Guardian? ( No ( Yes ( ( OPG or ( Private

Legal Guardian(s) Contact Information:

|Name: | | |Phone: | |

|Address: | | |Alt: | |

| | | |Email: | |

[pic]

|Alternate Guardian: | | |Relationship: | |

|Address: | | |Phone: | |

| | | |Alt: | |

| | | |Email: | |

|Alternate Contact: | | |Relationship: | |

|Phone: | | |Alternate: | |

| | | | | |

|Alternate Contact: | | |Relationship: | |

|Phone: | | |Alternate: | |

| | | | | |

| | | | | |

Legal/Formal Trustee? ( No ( Yes ( ( OPT or ( Private

Formal/Informal Trustee Contact Information

|Name: | | |Phone: | |

|Address: | | |Alt: | |

| | | |Email: | |

|AISH Worker: | | |Phone: | |

|PDD Coordinator: | | |Phone: | |

|Height: |4’8” |

|Weight: |166 lbs |

|Eye Colour: |Hazel |

|Hair Colour: |Light brown |

|LoSeCa Foundation Lifestyle Profile |Updated: |

|Name: | | |Transportation:(check all that apply) |

|DOB: | | |( Handibus/DATS: | |

|PHN: | | |( Public (ETS/STAT): | |

| | | |( Staff Drive: | |

|Services through Lo-Se-Ca: |( Residential ( Discoveries ( Both |

| |( Other: | |

|Diagnosis: |Down Syndrome |

| | |

| | |

|Description of | |

|complex behaviour: | |

| | |

| | |

|Doctor: | | |Phone: | |

|Address: | | |Fax: | |

| | | | | |

|Dentist | | |Phone: | |

|Address: | | |Fax: | |

| | | | | |

Specialists:

|Name |Specialty |Phone # |

| |Optometrist | |

| |Podiatrist | |

| |Psychiatrist | |

| |Dietician | |

Medication:

|Name |Dose |Times |Date Prescribed |

|Acetylsalicylic Acid |81mg |0800 | |

|Levothyroxine Sodium (Synthroid) |.100mg |0800 | |

|Multivitamins |1 Tablet |0800 | |

|Fenovibrate |200 mg |1200 | |

|Calcium |650mg |1700 | |

|Apo-Clomipramate |25mg |1700 | |

|Apo-Clomipramate |50mg |1700 | |

|Olanzapine(Zyprexa) |50mg |1700 | |

|Vitamin B Complex | |1700 | |

|Novo-Olanzapine |5mg |2100 | |

|Orecort 0.1% (Dental Paste) |Dental Paste |0800, 1200, 1600,2000 | |

|Apo-Remipril |5mg |0800 | |

|Aporomoxi |125-500mg |0800, 1200, 1700 | |

|Erythromycin |Drops |0800, 1200, 1300, 2100 | |

|Acetominophen |325mg |PRN | |

|Becitrocin/Polymyxin B Sulphate |Ointment |PRN | |

|Captopril |25mg |PRN | |

|Loperemide HCL |2mg |PRN | |

|Betaderm |Ointment |PRN | |

|Glaxal Base |Ointment |PRN | |

|Hydrocortisone Cream | |PRN | |

|Mobility Aids: |None | |Communication Aids: | |

|Hearing Aids: |( Yes (No | | | |

|Visual Aids: |( None ( Glasses ( Contacts ( Both |

| |Laser surgery Right eye April 1995 |

| |When? (always, reading etc.): | |

|Day Program: | | |Phone: | |

Medication Administration Challenges

There are many reasons why an individual may refuse to take their medication. If challenges arise in this area, you may wish to consider the following potential reasons and solutions:

Reason #1: Person does not understand why they must take medication.

➢ Explain each medication to the individual.

➢ Explain the positive effects of taking the medication.

Reason #2: Person has difficulty swallowing the medication because of taste or size.

➢ Ask the doctor if the medication can be given in another form.

➢ Place the medication far back in the throat and have the individual quickly take a drink.

➢ Mix or give the medication with a favorite liquid or food item (not to hide meds; individual must be aware medication is inside their food/beverage).

➢ Cut the medication in half, if possible (if approved by pharmacist).

➢ Have the individual suck on some ice to numb the taste buds before taking the medication.

Reason #3: Person shows or complains of adverse side effects of the medication.

➢ Have the person see their doctor as a medication review may be in order.

➢ If the doctor recommends that the individual remain on the medication, have him/her explain the advantage to the individual.

Reason #4: Person may feel he/she does not want or need the medication.

➢ Have the individual see the doctor. Have the doctor explain the importance of taking the medication.

➢ If the person refuses even after seeing the doctor, try methods previously discussed.

Medication Administration Record (M.A.R.)

Please note, that Stony Plain Wellness & Compounding Pharmacy currently provides all Paper MAR sheets to programs prior to the beginning of the month. However, there may be incidences when staff will have to update, fill out, or complete a MAR sheet.

The Medication Administration Record (M.A.R.) is completed in the following manner:

1. Print the individual’s name.

2. Print the current month and year in the appropriate spaces.

3. Copy information from the medication strip packaging/bubble pack as follows:

a) Medication and dosage

b) Frequency guideline (i.e. dosage may be repeated every 12 hours or not exceed 4 tablets/day)

c) Circumstances under which medication is to be given

NEVER use white out, red pen, or pencil on medication documentation as these are legal documents.

If there is a change or error on medication documentation simply draw one line through the information and initial it.

ALL individuals who administer medication for a person will insert their name and initials in the space provided on each Medication Administration Record.

P.R.N. medications are also listed on Medication Administration Record.

The 24 hour clock is used at LoSeCa for all Medication Administration.

Medication Administration Record 27

Name ______________________________

Month __________ 20 __ Page ___ of ___

|Medication |Time |1 |2 |3 |4 |5 |6 |7 |

| | | | | | | | | |

| | |

| | |

|Wrong Individual |Dropped meds (by staff) |

| | |

|Omitted dose |Meds given late |

| | |

|Wrong medication | |

| | |

|Contamination of meds |Administering over the counter meds not authorized by Pharmacy |

| | |

|Wrong time |Not filling out med transfer form |

| | |

|Double dose |Pre-signing before meds taken |

| | |

|Vomited | |

OTHERS AT THE TEAM LEADER’S DISCRETION

➢ If a staff has 3 incidents/errors within a 3-month period they must retake the med admin. course at their own cost and time.

Medication Incident Flow Chart

Medication Incident/Error

Non-Emergent Emergency

Dropped Medication Contact Pharmacist Contact Pharmacist

Retrieve a new medication Follow Instructions Follow Instructions

from last day of med. strip

for individual. Put dropped meds.

in envelope and ensure it is

returned to pharmacy.

Leave note in comm. book

in regards to the incident.

Contact Team Leader

Medication Incident Medication Incident Medication Incident

Report Report Report

Re-order Medication Re-order Medication Re-order Medication

From Pharmacy If necessary If necessary

**Please note, there is a Pink Med Admin.

Reference Sheet hanging in every program.

Medication Incident Report

Program: ____________________________ Date: ____________________

Incident Discovered by: ____________________________________________

Individual’s name: _________________________________________________

Name of Medication and Dosage: _____________________________________

Prescribed Date and Time of Medication: _______________________________

Time noted: _________________________________

Staff Responsible: __________________________________________________

Medication Incident

____ Omitted Dose

____ Incorrect Dose

____ Incorrect Individual

____ Incorrect Medication

____ Incorrect Time

____ Incorrect Method

____ Other _________________________________________________

|Persons Notified |√ |Name |Date |Time |

|Pharmacist | | | | |

|Supervisor | | | | |

|Parent/Guardian | | | | |

|(if applicable) | | | | |

* Remember to email report to TL or PM after completed, and leave original for Team Leader to review and sign at the Program.

Description of Incident:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Pharmacist’s Instructions:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Supervisor/Team Leader Comments:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Faxed to the office (780-459-1380) Date: ________________ Time: ________________

__________________________________ _________________

Reported completed by Date

_________________________________ _________________

Team Leader Date

__________________________________ _________________

Program Coordinator Date

Leave of Absence (L.O.A.) Medications

If an individual will not be on site at the time medication is to be administered, prepare medication in the L.O.A. envelopes as follows:

1. Follow basic medication delivery procedure as previously described.

2. If the individual is still using a bubble pack, pop the med into a medication cup and put it into an envelope. If the individual is using medication strips, the staff member can take the correct package for the time of the outing. If the medication cannot be put into an envelope then the container must be given to the person who will administer the medication.

3. An envelope still must be made for medication that cannot be placed inside of the envelope (i.e. liquid medication, eye drops, etc.)

4. Label each envelope as follows:

➢ Name of individual

➢ Date the medication is to be taken

➢ Time the medication is to be taken

➢ Name and dosage of the medication

➢ Your initials

5. Provide clear WRITTEN and VERBAL instruction to the person who will administer the medication.

6. Write “L.” for ‘Leave’ in the appropriate spaces on the Medication Administration Record after client returns, or sign daily when administering other individual’s medication. Refer to legend on MAR sheets provided by Stony Plain Wellness & Compounding Pharmacy for this and other codes.

A separate envelope must be used for each dispensing time.

Sample: Jenny Patient

January 1, 1998

0800 Hrs.

Vitamin “C” - 1 tablet

Tylenol (15 mg.) - 2 tablets

Lo-Se-Ca Medication Transfer Release Form

This is to certify that I, ____________________________, have received __________________’s medications for the period of ____________________ to ____________________. I understand that it will be my responsibility to administer these medications while in my possession.

_____________________________

Receiver

_____________________________

Staff Witness

______________

Date

PRN’s

Record Name of Drug and Bar Code Numbers of PRN’s transferred:

______________________ _____________________

______________________ _____________________

______________________ _____________________

______________________ _____________________

______________________ _____________________

______________________ _____________________

This is to certify that the above named individual’s medications have been administered or returned to a staff’s possession, and are no longer the receiver’s responsibility to administer.

_____________________________ ____________________

Staff Signature Date

Medication Incident Report? ( Yes ( No

_____________________________ _____________________________

Receiver Staff Witness

______________

Date

Medical Appointments

You may be required to accompany individuals to doctor’s appointments. You will assist the individual to describe why the appointment was made, and after the examination you will discuss the finding with the physician. If there are to be medication changes, you will ask the following FOUR questions:

1. What are the proposed changes?

2. How long will the changes be in effect?

3. Is follow-up required?

4. What should be observed about the individual?

After returning from a doctor’s appointment ensure that all pertinent information is documented in the appropriate place (i.e. log book, communication book, medical contact notes, etc).

If more than one physician is involved with an individual ensure that each is aware of what the other is doing in regards to medication changes.

Have any new prescriptions filled as soon as possible by faxing to the Pharmacy. If Stony Plain Wellness & Compounding Pharmacy is closed, fill the prescription at the local pharmacy and enter it into OneMAR under Non-Pharmacy Supplied Meds using the generic barcode provided from Pharmacy. (See OneMAR Manual). If OneMAR is unavailable, add the new medication to the existing paper MAR sheets.

You need to fill a medical treatment form when the individual goes to the doctor, the dentist, optometrist, specialists, medicenter, hospital, footcare, etc. It is recommended that you take the individual’s medical information with you, when you accompany the individual. Only give pertinent medical information when necessary.

Medical Treatment Form

(Doctor Visits/Emergency Room Visits)

Individual’s Name: _________________________ Program: ______________________

Date: ________________Time: _______________ P.H.N.:___________________________

Allergies: _______________________________________________________________________

Reason for Visit:

Treatment Received/Direction Given:

How long is the treatment in effect?

What should be observed?

What follow up is required?

Prescription assigned: ( Yes ( No

Staff Signature: ___________________________________________

Attending Physician: __________________________________________________

Address: __________________________________________________

Phone #: _________________________________________________

Adding New Medication Instructions

All new prescriptions must be ordered by a physician. These medications must be delivered or picked up as soon as possible to ensure that they are started promptly. When these medications arrive, the following procedures should be followed:

1. Compare doctor’s information to that on the labels/med strips.

2. Check new medication for correct numbers and consistency in size, shape and color.

3. Add new information to the paper MAR.

4. Draw a line from the first day of the month to the date that the new medication is to start.

5. Put new medication in the appropriate place for storage.

6. Document new medication information in the staff communication book.

7. Educate yourself by calling the pharmacist and/or reading the drug monogram.

CALL PHARMACIST if:

A) Label/med strip information does not agree with doctor’s orders

➢ Person’s name

➢ Medication name

➢ Medication dosage

➢ Medication times

➢ Administration instruction

B) Number of medication is not correct for the time period of the prescription.

C) Color, shape and/or size of medication is not consistent.

Discontinued Medication Instructions

Any medication that is discontinued must be ordered by a physician. When medication is discontinued, the following procedure should be followed:

1. Draw ONE line diagonally across the medication name and dosage on the Medication Administration Record.

2. Write the word DISCONTINUED, today’s date, and your initial over the line.

3. Draw a line from the last time the medication was administered to the end of the month.

4. Write the word DISCONTINUED, today’s date and your initial across the line.

5. Take discontinued medication and store it in the appropriate place or send it back to the Pharmacy.

6. Document information in the communication book.

If any part of the original order is changed, this is handled as a discontinued medication and a new medication.

DO NOT throw old or discontinued medication in the garbage or flush it down the toilet. Send all unused or expired medications back to the Pharmacy. (the delivery driver will pick them up weekly)

Specific Delivery of Medications

Oral Dosage Forms

Tablet: compressed powder

Capsule: 2 piece, hard gelatin, easier to swallow

Caplet: special shape, easier to swallow

Spansule: long acting capsule (SKF)

Pulvule: company brand capsule

Gelcap: 1 piece soft gelatin capsule (liquid)

swallow whole, DO NOT chew

SR, LA, PA, TR: specific for “long acting”

Chewable: must be chewed thoroughly before swallowing

Infatab: chewable tablet

Enteric Coated: special tablet coating designed to dissolve in duodenum,

used for drugs that cause GI irritation

Solution: usually a clear liquid

DO NOT dilute in water as this may change the effect

Drops: usually concentrated liquid or suspension

Sublingual: designed to dissolve quickly under the tongue and to be rapidly absorbed into blood stream (bypasses GI)

i.e. nitroglycerin (angina), Ativan (panic attack)

Effervescent: either tablets or powder designed to dissolve in a liquid (usually water) before swallowing

Granules: some are to sprinkle on food and swallowed, some are to be stirred into water

DO NOT CHEW

Powder: designed to be mixed with liquid before swallowing

General Application Techniques for Topical Preparations

1. Wash hands and gently cleanse skin area with water unless otherwise directed by the doctor. Cleansing should be specified by the doctor (i.e. whether it should be with soap or water, etc.).

2. Pat area with clean towel until almost dry or slightly damp.

3. To prevent CONTAMINATION of the preparation, staff should use gloves. DO NOT touch the tube opening to the affected area.

4. Apply a small amount of the drug to the affected area and spread lightly and sparingly. ONLY THE MEDICATION TOUCHING THE SKIN WILL WORK, A THICK LAYER IS NOT MORE EFFECTIVE THAN A THIN LAYER.

**This is especially important if the preparation is a STEROID. These drugs may be absorbed through the skin and will cause untoward side effects. Use thinly and sparingly.

5. DO NOT bandage unless directed by the doctor.

6. DO NOT apply to broken skin unless this is what the cream is intended for.

7. Keep the preparation away from eyes, nose and mouth.

8. CONTACT THE DOCTOR if after applying the medication the area develops hives, skin rash, blistering, burning, itching, peeling, redness, stinging, swelling, changes in color, thinning of the skin, or an ulceration.

9. For “External Use Only” label should be on all topical preparations and these preparations should be kept separate from oral preparations.

10. DO NOT expose areas treated with topical preparations to direct sunlight unless approved by the doctor.

Guidelines for Administrating Eye Drops and Ointments

1. Wash hands thoroughly with soap and water.

2. The medication must be kept free of contamination. DO NOT touch the tube against the face or anything else.

3. Have the individual lie down or tilt their head backward.

4. Gently pull down the lower eyelid to form a pouch. You may have to use distraction, such as looking at ceiling.

5. Hold the dropper or tube and approach the eye from the side. Hold it as close to the eye as possible without touching it.

6. Have the individual close their eye(s). They should not rub them.

7. Blot excess medication around the eye with a tissue (have tissue with you before administering). Inform and ask individual if you can blot their eye. Individuals need to be informed what you are doing, before you do it.

8. DO NOT use the medication if it has changed in color or has changed in any way since it was purchased.

9. Keep the container tightly closed when not in use.

10. If you have more then 1 eye drop/ointment wait 15 minutes between administering second drop/ointment. Know the order, as directed by physician or pharmacist.

Technique for Insertion of Eye Drops/Eye Ointment

[pic]

Administration Technique for Ear Drops

1. Wash hands thoroughly with soap and water.

2. Most droppers are now plastic, examine dropper to ensure there are no cracks, debris, etc.

3. SHAKE WELL before using if necessary/directed.

4. The dropper must be kept free of contamination. DO NOT allow the tip of the dropper to touch against the ear or anything else.

5. Have the individual tilt their head or lie on their side so that the ear to be treated is facing up.

6. To allow the drops to run into the ear hold the ear lobe up and back.

7. Place the prescribed number of drops into the ear. DO NOT insert the dropper into the ear as it may cause injury. You may want to ask the individual to swallow, as it may help the drops to reach the ear canal.

8. Have the individual remain in the same position for a short time (approx. 2 minutes) after you have administered the drops or insert a soft cotton plug.

9. DO NOT use the eardrops if they have changed in color or in any way since being purchased.

10. Keep the bottle tightly closed when not in use.

Technique for Insertion of Ear Drops

[pic]

Administration Technique for Nose Drops and Nasal Sprays

1. Blow nose gently.

2. Wash hands thoroughly with soap and water.

3. Check the dropper tip for cracks &/or debris.

4. Have the individual sit upright and tilt their head backwards.

5. FOR NOSE DROPS:

• The nose drops must be free of contamination. Avoid touching the dropper against the nose or anything else.

• Draw the medicine into the dropper and place prescribed number of drops into nose. Try not to touch the inside of the nose with the dropper as it will probably make the person sneeze and will contaminate the dropper.

• To allow the medication to spread into the nose, have the individual remain in the same position for a few minutes.

6. For NASAL SPRAYS:

• Place atomizer at entrance to the nostril and close the other nostril by pressing your finger on the side.

• Squeeze the prescribed number of sprays, no more! Have the individual inhale through their nose and breathe out through mouth.

*REMEMBER* For all eye, ear and nose medications:

1. Wash hands after use.

2. DO NOT use more frequently or in larger quantities than prescribed by the doctor.

3. DO NOT use the medicine at the same time as any other similar medication without the approval from the doctor.

4. If there is more than 1 medication, ensure you know the order as directed by pharmacy & physician along with time in between administration.

5. USE only as long as prescribed.

6. Contact the doctor if the condition does not improve or worsens.

Techniques for Insertion of Nose Drops

[pic]

Technique for Insertion of Nasal Sprays

[pic]

Important Information Regarding the Use of Inhalers

1. If the individual is using a STEROID inhaler, they must rinse their mouth after each use to avoid developing a yeast (thrush) infection. Instruct the individual not to swallow the rinse.

2. If the individual is using a STEROID and a BRONCHODILATOR inhaler (opens airways for quick relief), the bronchodilator should be used first, followed by the steroid 15 minutes later. As well, make sure the individual understands that the steroid inhaler will not produce immediate relief like the bronchodilator, but that it is still effective and important to use regularly at recommended intervals.

3. Recommend that the individual keep a spare inhaler in a safe place at room temperature.

4. Body posture is important when using the inhaler. Have the individual sit up as straight as possible.

5. The internal pressure of the propellant-powered inhalers is sensitive to temperature. Store in a cool place. Keep away from heat source. Place dust cap on.

6. If expected or normal relief of symptoms are not obtained from an established dosage regimen, the individual should consult a doctor immediately.

7. Before each use check the mouthpiece for any objects that may be lodged in the opening.

8. It is better if the individual pre-medicates than to inhale medication after wheezing is induced (i.e. exercise-induced asthma).

9. If a respiratory infection develops, the individual should see a doctor as additional measures should be taken to control the infection and maintain potency of the airways.

10. The two vital factors for optimal inhalation are:

i) a slow deep inhalation (a rapid inhalation results in more of the drug being deposited in the upper airways)

ii) subsequent breath holding for at least 10 seconds or as long as possible. If the individual has difficulty inhaling through the mouth when using the inhaler, get them to try pinching their nose while inhaling or use a SPACER (or aero chamber).

11. Remember to shake the inhaler well prior to use.

Administration Technique for Insertion of Vaginal Creams

1. Wash hands thoroughly with soap and water, put on gloves.

2. Remove the cap from the tube. If tube is sealed, reverse cap and pierce tube.

3. To fill applicator – REUSABLE AND DISPOSABLE

➢ Screw applicator to the tube (for disposable applicators, place an open end over the tube).

➢ Lubricate the tip of the tube by applying a small amount of the cream to the outside of the applicator.

➢ Squeeze the tube until the applicator plunger is fully extended. The applicator will now be filled with medicine. If your doctor has prescribed a smaller dose, use as he/she has directed.

➢ Remove applicator from tube.

4. To insert applicator:

➢ For proper insertion the individual should be lying on her back with knees drawn up. Pointing the applicator slightly downward, insert it deeply into the vagina as far as it will comfortably go without using force.

➢ Press the plunger gently all the way and empty the cream into the vagina while keeping the plunger-depressed remove the applicator from the vagina.

5. Cleaning the applicator:

➢ Separate the plunger from the barrel by pulling it all the way out.

➢ Wash and rinse both sections thoroughly with soap and water.

➢ DO NOT boil the applicator as it is plastic and may soften.

➢ Dry and reassemble.

➢ Store in a clean place.

6. CAUTION: During pregnancy, the applicator should only be used on the advice of a doctor.

7. If possible, have a second staff present for ethical reasons. Back-up homes may be able to provide assistance.

8. If possible, direct individual to administer meds (mirror may be useful tool). Or use hand-over-hand technique.

Remember to protect the individual’s privacy and dignity

| Administration Techniques for Insertion of Vaginal Inserts/Suppositories and Tablets |

1. Wash hands thoroughly with soap and water, put on gloves.

2. Remove the wrapper and dip the tablet into water quickly, just enough to moisten it.

3. Put the tablet/suppository into the applicator.

NOTE: If there is not an applicator, insert the wide end of the tablet/suppository into the vaginal canal.

4. Insert the applicator into the vaginal canal and depress the plunger.

5. Remove the applicator.

6. After each use wash the applicator with warm water and soap. Rinse and store in a clean place.

*REMEMER for any vaginal medication:

1. DO NOT use the drug more frequently than prescribed by the doctor.

2. The medication should be used continuously even during the menstrual period.

3. A sanitary napkin may be worn to protect clothing during use.

4. Continue to use this medication for the prescribed length of time.

5. Contact the doctor if the condition becomes worse or if a constant irritation such as itching or burning develops.

Remember to protect the individual’s privacy and dignity

Administration Technique for Insertion of Rectal Suppositories

1. Wash hands thoroughly with soap and water, put on gloves.

2. Store suppositories in a cool place. If necessary, suppositories may be held under cool water to harden them prior to insertion.

3. You may lubricate the suppository by dipping the tapered end in some tap water.

4. Have the individual lie on their left side with lower leg straightened out and upper leg bent forward toward stomach.

5. Lift upper buttocks to expose rectal area.

6. Insert suppository with tapered end first into rectum with finger until it passes the Musculus

Sphincter of the rectum (about 1 inch in adults). If not inserted past the sphincter, the

suppository may pop back out.

7. Hold buttocks together for a few seconds.

9. Have the individual remain lying down for about 15 minutes to avoid having the suppository coming back out.

10. Discard used materials and wash hands thoroughly.

11. DO NOT use medication past expiry date.

Remember to respect the individual’s privacy and dignity

Common Medical Symptoms/Conditions

Fever

Normal oral temperature for most people will fall between 36.5 and 37.5 degrees Celsius with the average of 37 degrees. Normal rectal temperature for most individuals will fall between 37 and 38 degrees Celsius with the average of 37.5 degrees. A person is said to have a fever any time his/her temperature goes higher than the range.

Fever is usually a symptom of another medical concern. Although the fever will be treated, it is important to get to the cause. Fever can be a symptom of a bacterial infection, a viral infection, or serious illness.

Treatment of Fever

➢ Have the individual drink plenty of fluids

➢ Give the individual a sponge bath. Be sure the water is at room temperature (no ice water) to prevent causing chills or increased fevers.

➢ Sponge the individual’s face, neck, and torso.

Check the person’s P.R.N. medications to see what can be given to the individual for fever.

Observe the individual for other symptoms that may help determine the cause of the fever.

Take the person’s temperature every hour until it is normal two times in a row.

A doctor should be contacted any time a person has a temperature over 39.5 degrees Celsius or if a person has a temperature higher than normal for over 24 hours.

Epilepsy

Epilepsy is a seizure disorder where the normal electrical impulses of the brain become unusually excessive, causing sudden uncontrolled changes in an individual’s sensory, motor, and/or behavioral patterns.

Epilepsy can begin at any time in an individual’s life, and periodically will go undiagnosed. Although epilepsy may be attributed to head trauma, excessive fever, chemical imbalance or substance abuse, it may be very difficult to determine the cause of a seizure disorder.

Most individuals who have epilepsy are on medication to control their seizures. While decreasing the frequency, duration or intensity, medication may not eliminate the seizures. Medications do not cure epilepsy. It is very important that these individuals take all medications as prescribed, visit their doctor regularly, and have therapeutic blood levels checked as required.

Some people will experience an unusual sensation (aura) prior to having a seizure, while others will have no warning at all. Certain conditions such as flashing lights or hot weather may induce seizures for some while physical conditions such as hunger, stress or lack of sleep may be the trigger for others.

If you are present when someone has a seizure use the following steps to aid in the prevention of serious injury of the person:

➢ Time the seizure

➢ Remain calm

➢ Remove glasses, loosen tight clothing, and move dangerous items away to protect the person from injury

➢ Turn them onto their side (Recovery Position)

➢ Stay with them until they are fully alert

➢ Speak softly and reassure them

➢ DO NOT put anything in their mouth

➢ DO NOT try to restrain the individual

Most people do not remember having a seizure. Reassure the person that everything is all right, and tell them that they had a seizure.

An epileptic seizure is not considered a medical emergency unless:

➢ The individual is injured

➢ The individual is pregnant

➢ The seizure lasts longer than “normal”

➢ Seizures happen consecutively (status)

➢ The person has never had a seizure before

Observation and Documentation of a Seizure

When a person has a seizure it is important to observe and document what happened. This will assist the doctor in determining any change in the DURATION, INTENSITY, or FREQUENCY of the seizures. Record the information in the individual’s logbook or, for more details, use a seizure record to check off observations.

Record observations based on the following:

➢ Check the time at the start and at the end of the seizure, and record the duration.

➢ Record if the person fell or became stiff

➢ Observe the skin color – is it flushed, pale or bluish?

➢ Look at the general body movement of the limbs and torso. Is the person jerking or twitching?

➢ Watch the eyes – Are they rolled back, staring, or blinking?

➢ Did the person lose control of bowel/bladder functions during the seizure?

➢ After the seizure, was the individual sleepy, confused, or alert? Did the person complain of a headache?

➢ Comment on the things you feel may be of assistance to the doctor (e.g. A seizure occurred at a rock concert when strobe lights were flashing).

Take the seizure record to doctor appointments.

Check seizure records frequently to identify any change in the normal seizure pattern of the individual.

Types of Seizures

(For Information Only)

There are over thirty types of seizures affecting all or only parts of the brain. Listed below are the names and descriptions of some of the more common seizures.

Generalized Tonic Clonic (Grand Mal)

➢ The person may cry out

➢ The individual will fall

➢ The body will become very rigid

➢ Muscles in all parts of the body will jerk and/or twitch

➢ Breathing may become shallow or temporarily interrupted

➢ The individuals/ lips may appear bluish

➢ The person may be incontinent

Absence (Petit Mal)

➢ The person may experience brief loss of time

➢ The person will likely not fall

➢ The person may stare or blink rapidly

➢ The individual’s face may twitch

Simple Partial (Focul Motor Jacksonian)

➢ One limb or one side of the body will stiffen or jerk

➢ The person is aware but cannot control his/her movement

➢ The individual may experience tingling in parts of the body

Complex Partial (Psychomotor, Temporal Lobe)

➢ The person may seem aware but will not have awareness of surroundings

➢ The person will repeat purposeless behavior

➢ The person may wander around the room

➢ The person may become agitated

➢ The person may appear confused and have no memory of the seizure when it is over

Atonic (Drop Seizure)

➢ The person will suddenly collapse or fall

➢ The person will become very limp

➢ The person will usually recover quickly from this type of seizure

Seizure Record

Name: _________________________________________________

Place a check mark where applicable and describe in detail.

|Date | | | |

|Location | | | |

|Time and Duration | | | |

| | | | |

|Prior to Seizure | | | |

|Activity |( | | |

|Warning signs (e.g.) |( | | |

| | | | |

|During Seizure | | | |

|Body – Stiffen |( | | |

|Body – Shake |( | | |

|Eyes – Blink, Stare, etc. |( | | |

|Parts of Body |( | | |

|Incontinent Urine |( | | |

|Color- Lips, etc. |( | | |

|Breathing – Fast |( | | |

|*Fell, Injury? |( | | |

| | | | |

|Following Seizure | | | |

|Disoriented |( | | |

|Cry |( | | |

|Sleep |( | | |

|Other |( | | |

|Comments | | | |

| | | | |

*If injured, complete incident report – Additional comment on back

_____________________________ _______________

Staff Signature Date

_____________________________ _______________

Program Manager Date

Please note seizure records might be altered to tailor the needs of the individual.

Asthma

Asthma is characterized by recurring shortness of breath, cough, an increase of mucus production and wheezing. This condition is usually controllable with medication treatment.

Asthma is a chronic condition. The person’s airways become extremely sensitive which leads to inflammation and an increase in mucus production in the lungs that leads to broncho constriction (narrowing of the airways).

The goal in treating asthma is to maintain normal exercise levels, prevent troublesome symptoms, and avoid drug side effects. Usually asthma therapy is long term with the person avoiding events that may trigger attacks.

There are two types of asthma

1. Atopic (Extensic)

2. Non-Atopic (Non-Extensic)

Atopic Asthma

➢ The airways of an individual become sensitized to allergens (e.g. pollen, dust, etc)

➢ Hay fever often accompanies this type of asthma

Non-Atopic Asthma

➢ This type of asthma may occur due to factors such as an infection, cold, and emotional upset

Asthma Severity is classed into Three Types:

1. MILD

➢ Intermittent coughing spells

➢ Little wheezing

➢ Minor extra mucus production

➢ Person is able to tolerate mild to moderate exercise activity

2. MODERATE

➢ Frequent coughing spells

➢ Noticeable wheezing

➢ Person can tolerate only mild exercise activity

3. SEVERE

➢ Coughing spells throughout each day

➢ Wheezing all the time

➢ Multiple emergency or doctor’s visits

➢ Person cannot tolerate exercise activity

➢ Symptoms are worse at night and early morning

Two signs that a person may be experiencing an asthma attack are:

1. Shortness of breath

2. Wheezing and mucus secretion from mouth

If the attack does not subside after normal medication intervention take the person to EMERGENCY.

Diabetes

(For Information Only)

➢ Insulin is a natural hormone, one of the many chemical substances produced by the pancreas

➢ When diabetes develops, the body does not produce enough insulin or may not be able to use what is produced

➢ Without insulin, glucose accumulates in the blood until some of the surplus is eliminated by the kidneys and passed off in the urine

➢ The cause of diabetes is unknown

TYPES OF DIABETES

Type I – Insulin Dependent Diabetes Mellitus (I.D.D.M.)

➢ Have very little or no insulin and need injections to preserve life

➢ New patients may be of any age but usually “juvenile”

Type II – Non-Insulin Dependent Diabetes Mellitus (N.I.D.D.M.)

➢ May be treated with diet, oral medications or insulin

➢ May be of any age but usually over 40 years

➢ Usually obese

The high sugar (glucose) level in the blood directly causes damage to the eyes, kidneys, and nerves therefore early diagnosis and proper treatment can delay complications.

SIGNS OF DIABETES

➢ Frequent urination

➢ Continuing thirst

➢ Abnormal hunger

➢ Obvious weakness and fatigue

➢ Irritability

➢ Sometimes nausea and vomiting

➢ Blurred vision

➢ Tingling or numbness in the extremities

➢ Skin infections and slowed healing of cuts and scratches

Diabetic Reactions

HYPOGLYCEMIA HYPERGLYCEMIA

(Insulin Reaction) (Diabetic Acidosis)

Onset sudden, 15-60 minutes gradual, 1-2 days

Skin pale, moist, cold, perspiring flushed and dry

Behavior excited, confused drowsy

Breathing normal, rapid, shallow deep, rapid

Vomiting absent present

Tongue moist dry, coated, swollen

Thirst absent present, severe

Hunger present absent

Sugar in Urine slight, absent large amount

Ketones in Urine slight, absent large amount

Causes taking too much insulin or too little insulin

oral anti-diabetic drug

not eating enough eating too much

unusual amount of exercise infection, fever, emotional stress

What to do take sugar or food containing call doctor

sugar (fruit juice, candy, IMMEDIATELY

2 tsp. sugar)

call the doctor call doctor

IMMEDIATELY

DO NOT take insulin, or call doctor oral anti-diabetic drugs IMMEDIATELY

DO NOT give fluids if continue testing unconscious urine/blood at regular

intervals

Treatment Guidelines for Diabetes

1. Diet

➢ A nutritional diet should be prescribed by the doctor and should be followed strictly

➢ Try to eat the same amount at the same time each day

2. Exercise

➢ An exercise regime should be prescribed by the doctor

➢ Try to exercise the same amount at the same time each day

3. Medication

➢ Oral anti-diabetic (oral hypoglycemics)

➢ Insulin for injection (many types)

➢ To be taken/given at SAME time each day

4. Eye Care

➢ Eye examination should be done annually (at least)

5. Teeth/Gum Care

➢ Special effort to brush and floss daily

➢ Routine check-ups by dentist are a must

6. Skin Care

➢ A program of daily hygiene helps prevent problems

➢ Monitor skin for development of boils or recurrent skin infection or minor scratches and cuts that take a long time to heal

7. Doctor’s Visits

➢ Measurement of kidney function should be done at least once a year BUT if you notice swelling in the ankles, tell the doctor IMMEDIATELY

➢ Analysis of nerve function should be done periodically and if you notice any pain or tingling sensations in the extremities contact the doctor

8. Testing Blood and/or Urine Glucose

➢ One of the most important aspects of avoiding the complications of diabetes

➢ Should be carefully done and recorded daily

9. Foot Care

➢ Take special care when caring for the feet, washing daily, gently drying, trimming nails straight across, avoiding harsh substance and avoiding tight-fitting shoes

Common Medication Administration Abbreviations

a.c. Before meal

B.I.D. Twice daily

Cap. Capsule

c.c. = 1 m.L. Cubic centimeter

gtts. Drops

h.s. At bedtime

m.g. Milligrams

m.L. Milliliter

O.D./Q.D. Once daily

Padis Poison and Drug Information Service

p.c. After meals

p.o. By mouth

P.R.N. As necessary (latin for pro re nata)

Q.I.D. Four times daily

q4h, q6h, etc. Every _____ hours

Tab. Tablet

tsp.= 5 m.L. Teaspoon

T.I.D. Three times daily

ung. Ointment

Medication Administration Summary

When administering medication, follow these steps:

1. Log into OneMAR online

2. Wash hands and wear medical gloves where applicable

3. Take medication from cabinet

4. Review the “Seven Rights” before administering medication

1) Right Person (check photo, if applicable)

2) Right Medication

3) Right Time

4) Right Dosage

5) Right Route/Method

6) Right Documentation

7) Right Response

“Please mind the drug rules, don’t rush”

5. Dispense medication into medication cup or prepare for appropriate administration of medication (i.e. ointment, drops, etc.)

6. Place medication back into cupboard or storage areas and re-lock.

7. If possible, have client come to medication cupboard or storage area with liquid (i.e. water, juice, etc.) for swallowing medication

8. Refer to the person by name and check photo again (if applicable)

9. Administer the medication

10. Stay with the individual and observe that the medication has indeed been swallowed or procedure is complete

11. Confirm medication has been given on OneMAR system.

12. Complete OneMAR 4-steps as per Policy & Procedures.

Study Questions

Fill in the blanks:

1. Never give any medication unless it is prescribed by a ________________________ or ________________________.

2. Never use ____________ or ______________ or _______________ on medication documentation as these are legal documents.

3. In case of emergency at 2000 hrs on Tuesday, who would you call? _________________

4. For which med incident would you call the Team Leader? __________________________

5. When administering suppositories or enemas ensure the individual’s _____________________ and ____________________.

6. After returning from a doctor’s appointment ensure that all pertinent information is _________________________________.

7. If part of the original medication order is changed it is handled as a ____________________ order and a _____________________ medication. Ensure proper changes are made to the _______________________.

8. Ensure that all P.R.N. medications are checked for ___________________ monthly.

9. What is the difference between LOA meds and a Med Transfer release form? ______________________________________________________________________

10. Always call the ____________________ when a medication incident has occurred, except for 1)_________________2)____________________3)___________________________.

11. Over the counter medication can be approved by a ____________or by the ____________.

Short Answer:

1.What five steps do you follow when a medication incident occurs?

2. List and describe the 3 types of medication orders

a.

b.

c.

3. What are the “Seven Rights”?

1. ____________________ 5. ____________________

2. ____________________ 6. ____________________

3. ____________________ 7. ____________________

4. ____________________

4. When do you fill out a Med Transfer Release Form?

5. What 2 pieces of information do you compare before administering medication?

1. ____________________ 2. _____________________

6. What do you do if there is a discrepancy in the size, shape, or color of a medication?

7. List 4 possible reasons why an individual would refuse to take their medication?

1. _____________________ 2. ____________________

3. _____________________ 4. ____________________

8. What are 4 questions that you ask if a doctor has ordered medication changes?

1. _____________________ 2. ____________________

3. _____________________ 4. ____________________

Bibliography and References

Graedon, Joe, and Graedon, T., The New People’s Pharmacy. Toronto, ON: Bantom, 1985.

Kepler, James, Kepler, A., and Salafsky, I., Children’s Medicine, Parent’s Guide to Over the Counter Drugs, Signet, Markham, ON: Signet 1985.

Readers Digest, The Canadian Mental Association Guide to Prescription and Over the Counter Drugs. Montreal, PQ: The Readers Digest Association (Canada) Ltd., 1990.

Smith, Dorothy L., Understanding Canadian Prescription Drugs. Toronto: Consumer Health Information Corporation, Virginia, USA, 1992.

Zinnerman, David R., The Essential Guide to Non-Prescription and Over the Counter Drugs. Toronto: Fitzherry & Whiteside Limited, 1983.

Clinical Pharmacy and Therapeutics. Editors, Herfindal, E.T., Gourley, D.R., Hart, L.L., Williams and Williams Publishers, Baltimore: 4th Edition, 1988.

Compendium of Pharmaceutical and Specialities. Editing Chief, Kragh, Carmen M. E., Canadian Pharmaceutical Association, Ottawa, ON: 1993.

Current Medical Diagnosis and Treatment. Krupp & Chatton, 1984.

GSHCS Department Manual. Good Samaritan Society, 1989.

GSRS Medication Training Course. Good Samaritan Society, 1989.

Handbook of Clinical Drug Data. Editors, Knoben, J. E., Anderson, P.O. Intelligence Publications Inc. Hamilton, Illinois: Fifth Edition.

Manual of Medical Therapeutics. Editors, Orland, M.J., Saltman, R.J. 25th Edition, Little Brown and Company, Toronto, ON: 1988.

Medication Guide. Dorothy L. Smith, 2nd Edition, 1981.

Medication Teaching Manual. CSHP, 3rd Edition0, 1983.

Self-Medication. A Reference for Health Care Professionals. Editor Clarke, Cheryl B.J., Canadian Pharmaceutical Association, Ottawa, ON: 1988.

The Nurses’ Drug Handbook. 3rd Edition, 1981.

USP DI Vol. 172, 6th Edition 1986, 1990.

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