Topic Medication Administration in Assisted Living …b.ahca.myflorida.com/MCHQ/Field_Ops/Training/2013_Joint_Training/... · Medication Administration in Assisted Living Facilities

Topic

Medication Administration in Assisted Living Facilities

Speakers

Anne Avery, RN, LNC Registered Nurse

AHCA

Feb 6, 2013 Kissimmee/Orlando, Florida

Ron Hoover, MS, CPh, RPh Consultant Pharmacist

iRxAdvice, LLC

Learning objectives for this presentation

• Review assistance with self-administration of medication (Trained unlicensed person)

• Discuss medication administration (Nurse) • Identify self-administration (Resident)

Medication Administration in Assisted Living Facilities

Chapter 1 - FLORIDA LAW and MEDICATION MANAGEMENT • Law/Section 429.255, FS - Use of Personnel (Nurses vs CNA - vital signs) • Law 429.256, FS - Assistance with self-administered medication (unlicensed) • Law 429.256(1)(a), FS - Informed Consent (written) • Law 429.256(1)(b), FS - Unlicensed personnel defined: (NOT licensed) • Law 429.256(2), FS - Facility must encourage and allow self-administration of

medications to competent residents. Oral and topical Rx/OTC medications only. • Law 429.256(3), FS - Assistance with self-administration of medication: DOs • Law 429.256(4), FS - "NOT" Assistance with self-administration: DON'Ts • Law 429.256(5), FS - “Assistance with the self-administration” by an unlicensed

person shall NOT be administration of medication (465.003, FS, Nurse Practice Act). • Law 429.41, FS - The management of medication (chemical restraints) • Law 429.42, FS - Pharmacy Issues (violations) • Law 429.52, FS - Training requirements for unlicensed person prior to assisting with

medications. A curriculum developed by DOEA: Must complete "Initial" four (4) hour training with certificate provided by a licensed Registered Nurse (RN) or Pharmacist (RPh or CPh).

• Rule 58A-5.0181 ADMISSION, PLACEMENT AND CONTINUED RESIDENCY CRITERIA must meet the minimum criteria to be admitted to a facility holding a standard, limited nursing or limited mental health license: Be capable of taking own medication with assistance from staff.

• Rule 58A-5.0185, FAC - Medication Practices • Rule 58A-5.0191, FAC - Training requirements for ALF staff include two (2) hours

continuing education annually, with certificate provided by a licensed Registered Nurse (RN) or Pharmacist (RPh or CPh)

• Facility Policy - "Best practice is more stringent than laws & rules".

SEE enlarged copy of laws and rules: NOTES:

• Rule 58A-5.0185, FAC - Medication Practices

• (1) SELF-ADMINISTERED MEDICATIONS • (2) PILL ORGANIZERS • (3) ASSISTANCE WITH SELF-ADMINISTRATION • (4) MEDICATION ADMINISTRATION • (5) MEDICATION RECORDS • (6) MEDICATION STORAGE AND DISPOSAL • (7) MEDICATION LABELING AND ORDERS

• OVER THE COUNTER (OTC) PRODUCTS • SAMPLES

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FLORIDA LAW 429.52 FS

Assistance with self-administered medication

• Informed written consent required by resident

• Caregiver must be 18 years old to assist

• Pass four (4) hour training class and two (2) hour update annually

• Demonstrate to the administrator or nurse skills of assistance with self-administration.

This certifies thatM A RY S A M P L E

Has successfully completed the four (4) hour INITIAL training program requirements for

Assistance with Self-Administration and Medication ManagementAs required by Florida Statute Section 429.52(5) and Rule 58A-5.0185, FAC

DATE PRESENTED

July 11, 2012 ________________________________________________________Ronald C. Hoover, MS, CPh, RPh

Consultant and Registered Pharmacist Florida License PU#2190 and PS#17311Certified ALF Administrator Cert. #100920442

iRxAdvice, LLC2300 S. Flagler Avenue

Flagler Beach, FL 32136CERTIFICATE NO.

iRxAdvice: ASSISTANCE with SELF-ADMINISTRATIONand MEDICATION MANAGEMENT

C E R T I F I C A T Eof T R A I N I N G

0001

6


Training must cover :

• State law and rules regarding supervision, assistance, administration, and management of medications in ALFs

• Procedures and techniques for assisting the resident with self-administration of medication including how to read a prescription label,

• Providing the right medication to the right resident,

• Common medications

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Training must cover :

• The importance of taking medication as prescribed,

• Recognition of and procedures to follow when residents appear to be experiencing side effects and adverse drug reactions (ADRs),

• Documentation and record keeping,

• Medication storage and disposal.

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Assistance with Self-Administration of Medication

DOEA GUIDE 2012 After successful completion of: 1) four (4) hour training program, 2) completion of a post-test, and 3) demonstration of competence in tasks associated with assistance with self-administration of medication in Assisted Living Facilities (ALFs).

*certificate from a licensed registered nurse (RN) or pharmacist (RPh or CPh), to be kept in facility personnel file at all times.

This certifies thatM A RY S A M P L E

Has successfully completed the four (4) hour INITIAL training program requirements for

Assistance with Self-Administration and Medication ManagementAs required by Florida Statute Section 429.52(5) and Rule 58A-5.0185, FAC

DATE PRESENTED

July 11, 2012 ________________________________________________________Ronald C. Hoover, MS, CPh, RPh

Consultant and Registered Pharmacist Florida License PU#2190 and PS#17311Certified ALF Administrator Cert. #100920442

iRxAdvice, LLC2300 S. Flagler Avenue

Flagler Beach, FL 32136CERTIFICATE NO.

iRxAdvice: ASSISTANCE with SELF-ADMINISTRATIONand MEDICATION MANAGEMENT

C E R T I F I C A T Eof T R A I N I N G

0001

2013 © iRxAdvice, LLC.

9

DOEA 2012 MEDICATION GUIDE

Chapter 1. FLORIDA LAW 429 and MEDICATION PRACTICES 58A Chapter 2. MEDICATION ADMINISTRATION and SAFETY PRACTICES Chapter 3. SELF-ADMINISTERED MEDICATION USE & STORAGE Chapter 4. PILL ORGANIZERS - ONLY FOR SELF-ADMINISTRATION Chapter 5. ASSISTANCE WITH SELF-ADMINISTRATION of MEDS Chapter 6. MEDICATION ORDERS and PRESCRIPTION LABELS Chapter 7. MEDICATION DOCUMENTATION and RECORDS (MOR)


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DOEA 2012 MEDICATION GUIDE

Chapter 8. DRUG RETRIEVAL, STORAGE, and PROPER DISPOSAL Chapter 9. HOW TO ASSIST WITH ORAL & TOPICAL MEDS Chapter 10. COMMON MEDICATIONS, DRUG CLASSIFICATIONS, SIDE EFFECTS and ADVERSE DRUG REACTIONS (ADR's). PRACTICE EXERCISES - SKILLS 1-11. POST-TEST - must achieve 80% or greater to receive certificate. APPENDICES: Informed consent, resident assessment, AHCA 1823, certificate, MOR sample.


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Assistance with Self-Administration of Medication

DOEA PURPOSE TRAINING STANDARDIZATION

Teaching guide for Nurse (RN) and Pharmacist

1. Guidelines for training unlicensed personnel 2. Reduce medication / drug errors in ALFs, 3. Improve the quality of care and quality of life 4. Review guidelines for prescribing,

dispensing, delivering, storing, administering, and monitoring of medications

5. Reduce risk and professional liability in ALFs.


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What You Should Learn From DOEA Training Program

OBJECTIVES• Upon completion you should be able to:

– Read and understand a Prescription LABEL, – Read and understand a Medication ORDER, – Provide assistance with ORAL Medication, – Measure LIQUID Medication, – Break SCORED Tablets, and – Crush tablets as prescribed by prescription order. – Provide assistance with TOPICAL forms of

medication for the SKIN, EYE, EAR, NOSE, and MOUTH such as creams, ointments, patches, drops, suspensions, sprays, HFA inhalers, and diskus.

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OBJECTIVES

– Recognize the general side effects of medication classes,

– Recognize the need to report Adverse Drug Reactions (ADRs),

– Recognize the need to clarify "as needed" or PRN medication orders,

– Recognize a medication order that requires "judgement" or "discretion", and advise the resident, HCP, and facility employer of the unlicensed caregiver's inability to assist with such orders by law.

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OBJECTIVES

– Develop and understand questions to ask a health care provider (HCP) regarding a residents medication,

– Complete a Medication Observation Record (MOR),

– Understand how to retrieve, store, and dispose of medication properly.

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Competent resident means:

Resident is cognizant or aware of when medication is required (Time due).

Resident understands purpose for taking the medication (Reason for use).

Fever Sleep

FLORIDA LAW 429.256(4)(h) Rule 58A-5.0185(3) FAC

COMPETENT RESIDENT

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MEDICATION ADMINISTRATION

and SAFETY PRACTICES

Chapter 2. MEDICATION ADMINISTRATION and

SAFETY PRACTICES.

Rule # 1. “DO NO HARM”


SAFETY Original FIVE (5) RIGHTS increased to NINE (9) RIGHTS of Medication Administration

1. Right RESIDENT gets 2. Right MEDICATION in 3. Right DOSAGE at 4. Right TIME by the 5. Right ROUTE for the 6. Right REASON, has the 7. Right RESPONSE, has the 8. Right to REFUSE, and has the 9. Right DOCUMENTATION on the

Medication Observation Record (MOR).2013 © iRxAdvice, LLC.

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Chapter 3. SELF-ADMINISTERED MEDICATIONS

Maintain list of medications for EMS

FLORIDA LAW Rule 58A-5.0185(1) FAC

SELF-ADMINISTERED MEDICATIONS


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Chapter 4. PILL ORGANIZERS

"Only for self-administration" Unlicensed personnel

are forbidden from using “Pill Organizers.”


PILL ORGANIZERS


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Chapter 5. ASSISTANCE WITH SELF-ADMINISTRATION of MEDICATION

All residents have the right to privacy and

medication decisions.

FLORIDA LAW-PRIVACY Rule 58A-5.0185(3) FAC

ASSISTANCE


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INFORMED CONSENT

ASSISTANCE WITH SELF-ADMINISTRATION

Informed consent means advising the resident if a licensed nurse will or will NOT supervise unlicensed ALF staff. ALF NOT required to have a licensed nurse on staff.

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Chapter 6. MEDICATION ORDERS and PRESCRIPTION LABELS

(1) Ned Halftab (2) Atenolol (generic for TENORMIN) (3) 50 mg (4) #45 (5) Take one-half (1/2) tablet two times daily (6) for Hypertension (high blood pressure). (7) Fill Date: January 21, 2012 3 Refills before 01/21/2013 (8) Dr. Pill Splitter, MD. (10) Rx # 772001 (9) ALF PHARMACY (11) Discard after 01/21/2013 2300 Flagler Avenue Flagler Beach, FL 32136 386-555-1212

FLORIDA Rx LABEL LAW Rule 58A-5.0185(7) FAC

PRESCRIPTION LABELS


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Chapter 7. Medication Documentation and Records (MOR).

1

MEDICATIONS DOSE DIRECTIONS for USE TIMES INDICATION ALERTS

Lipitor 10 mg 10 mg Take one tablet daily. 8 am Cholesterol Muscular pain

Lisinopril 20 mg 20 mg Take one tablet daily. 8 am HypertensionHeadache,

dizziness, fatigue

Plavix 75 mg 75 mg Take one tablet daily. 8 am Antiplatlet drugBleeding, bruising

Nexium 20 mg 20 mg Take one tablet daily. 8 am Acid reflux Headache

Metoprolol 50 mg 50 mgTake one tablet two (2)

times daily.

8 am, 8 pm

HypertensionHypotension,

dizziness

Metformin 500 mg 500 mgTake one tablet two (2)

times daily.

8 am, 8 pm

Diabetes Mellitis

Type 2Diarrhea,

nausea, vomiing

Amoxicillin Suspension 250 mg / 5 ml

500 mgTake two (2) teaspoonfuls

(10 ml) three (3) times daily.

8 am, 4 pm, 12 am

Infection"Shake Well"

Diarrhea, Gi Upset

Sertraline 25 mg 25 mg Take one tablet at bedtime. 9 pm Depression Suicidal thinking

Hydrocodone/ APAP

5-500 mg

5-500

mg

Take one tablet every six (6)

hours as needed for pain.8 am, 2 pm, 8 pm, 2 am

PRN as needed for Pain

Constipation, drowziness

Physician Name Phone Practice Pharmacy Name Address Phone

Dr. Hope U. Feelgood 386-555-7777 Family ALF Pharmacy 2300 S Flagler Ave. 386-555-1212

Flagler Beach, Fl 32177

Ron Sample DOB: 1/21/1955 AGE: 57 yrs JUNE 1-30, 2012

Allergies: Codeine, PCN Height: 5'11" Weight: 201 lbsMEDICATION OBSERVATION RECORD

MOR

DIAGNOSIS: High Cholesterol, Hypertension, Stroke Prevention, Acid reflux, Diabetes Mellitus

Type 2, Depression, Back Pain, Nasal Infection,

LABS / NOTES: Check LFT's, HR, BP, Blood sugar, Cholesterol, and temperature.

Lipitor 10 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Take one tablet 8 am

Plavix 75 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Lisinopril 20 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Nexium 20 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Take one capsule 8 am

Metoprolol 50 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Take one tablet 8 pm

Metformin 500 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31




DOCUMENTATION and RECORDS


1

MEDICATIONS DOSE DIRECTIONS for USE TIMES INDICATION ALERTS

Lipitor 10 mg 10 mg Take one tablet daily. 8 am Cholesterol Muscular pain

Lisinopril 20 mg 20 mg Take one tablet daily. 8 am HypertensionHeadache,

dizziness, fatigue

Plavix 75 mg 75 mg Take one tablet daily. 8 am Antiplatlet drugBleeding, bruising

Nexium 20 mg 20 mg Take one tablet daily. 8 am Acid reflux Headache

Metoprolol 50 mg 50 mgTake one tablet two (2)

times daily.

8 am, 8 pm

HypertensionHypotension,

dizziness

Metformin 500 mg 500 mgTake one tablet two (2)

times daily.

8 am, 8 pm

Diabetes Mellitis

Type 2Diarrhea,

nausea, vomiing

Amoxicillin Suspension 250 mg / 5 ml

500 mgTake two (2) teaspoonfuls

(10 ml) three (3) times daily.

8 am, 4 pm, 12 am

Infection"Shake Well"

Diarrhea, Gi Upset

Sertraline 25 mg 25 mg Take one tablet at bedtime. 9 pm Depression Suicidal thinking

Hydrocodone/ APAP

5-500 mg

5-500

mg

Take one tablet every six (6)

hours as needed for pain.8 am, 2 pm, 8 pm, 2 am

PRN as needed for Pain

Constipation, drowziness

Physician Name Phone Practice Pharmacy Name Address Phone

Dr. Hope U. Feelgood 386-555-7777 Family ALF Pharmacy 2300 S Flagler Ave. 386-555-1212

Flagler Beach, Fl 32177

Ron Sample DOB: 1/21/1955 AGE: 57 yrs JUNE 1-30, 2012

Allergies: Codeine, PCN Height: 5'11" Weight: 201 lbsMEDICATION OBSERVATION RECORD

MOR

DIAGNOSIS: High Cholesterol, Hypertension, Stroke Prevention, Acid reflux, Diabetes Mellitus

Type 2, Depression, Back Pain, Nasal Infection,

LABS / NOTES: Check LFT's, HR, BP, Blood sugar, Cholesterol, and temperature.

Lipitor 10 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Plavix 75 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Lisinopril 20 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Nexium 20 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Take one capsule 8 am

Metoprolol 50 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31



Metformin 500 mg TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31



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Chapter 8. Medication Retrieval, Storage, and Proper Disposal.

Residents who self-administer may keep both Rx and OTC meds in room

if done safely. If NOT, then centrally locked

if due to hazard, request, or facility assists or administers the medication.



STORAGE and DISPOSAL

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OTC Products

Must be labeled properly

1. Resident's name LABEL

2. Manufacturer's label with directions for use or licensed health care provider directions.

FLORIDA LAW Rule 58A-5.0185(8)FAC

OTC Products


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FLORIDA LAW MEDICATION PRACTICES

Chapter 9. How to Assist with Oral and Topical Medications

ASSISTANCE WITH SELF-ADMINISTRATION OF MEDICATION FOR UNLICENSED ALF STAFF

INCLUDES: Oral and Topical Dosage Forms including skin, ophthalmic (eye), otic (ear), and nasal (nose) or mouth (Inhaler or diskus) dosage forms.


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MEDICATION ADMINISTRATION

and SAFETYUNIVERSAL PRECAUTIONS

1. HAND WASHING


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ORAL MEDICATIONS

ORAL MEDICATIONS • Check expiration date • Break scored-tablets • CRUSH tablets • LIQUIDS - pour under

labels and shake well.

SKILL 6

TOPICAL CREAMS SKIN MEDICATIONS

TOPICAL SKIN MEDICATIONS • Check expiration date • Privacy & dignity • Wear gloves • Do not touch drug • Focus on what resident

can do.


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FLORIDA LAW MEDICATION PRACTICES

Chapter 10. Common Medications, Drug Classifications, Side Effects, and Adverse Drug Reactions (ADRs).


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SKILL 1 PRESCRIPTION LABEL

SKILL 1. READ AND UNDERSTAND PRESCRIPTION LABEL.

© 2012 Ron Hoover

(1) Ned Halftab (2) Atenolol (generic for TENORMIN) (3) 50 mg (4) #45 (5) Take one-half (1/2) tablet two times daily. (6) for Hypertension (high blood pressure). (7) Fill Date: January 21, 2012 3 Refills before 01/21/2013 (8) Dr. Pill Splitter, MD. (10) Rx # 772001 (9) ALF PHARMACY (11) Discard after 01/21/2013 2300 Flagler Avenue Flagler Beach, FL 32136 386-555-1212

(1) Ned Halftab (2) Atenolol (generic for TENORMIN) (3) 50 mg (4) #45 (5) Take one-half (1/2) tablet two times daily. (6) for Hypertension (high blood pressure). (7) Fill Date: January 21, 2012 3 Refills before 01/21/2013 (8) Dr. Pill Splitter, MD. (10) Rx # 772001 (9) ALF PHARMACY (11) Discard after 01/21/2013 2300 Flagler Avenue Flagler Beach, FL 32136 386-555-1212

Rx LABEL READ and UNDERSTAND the following: Check

List1. Location of resident’s name2. Medication name (brand versus generic)3. Medication strength or dosage4. Quantity of medication in container5. Directions for use6. Condition for which medication is used7. Prescription fill date and number of refills allowed8. Name of health care provider (HCP) - doctor9. Name, address, and phone number of pharmacy

10. Prescription number or Rx number11. When medication expires or when to discard

SKILL EVALUATION 1. READ and UNDERSTAND Rx LABELS PRESCRIPTION (Rx) LABEL

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Class I or II, or uncorrected III

Employ / Contract with licensed Registered Nurse or Consultant Pharmacist per Section 465.0125 Only CPh, NOT RPh.

FLORIDA LAW 429.42 FS Rule 58A-5.033 FAC

Contract Pharmacist or Nurse


Documents

Topic Medication Administration in Assisted Living …b.ahca.myflorida.com/MCHQ/Field_Ops/Training/2013_Joint_Training/... · Medication Administration in Assisted Living Facilities