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Washtenaw County CSTS Medication Training Module for Specialized

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									Medication Training
     Module
                for
Specialized Residential Group Home,
  Community Supported Living, &
   Special Contract AFC Staff
                          Definitions
• Specialized residential setting is a program licensed to serve
  adults with mental illness or developmental disabilities where
  treatment is designed to meet the unique programmatic needs
  of all residents of that home as set forth in each individual
  client’s person-centered-plan.

• Special contract in a general Adult Foster Care (AFC) home is
  the same as above except that the specialized
  treatment/service is specific only to individuals in the home
  designated under contract for additional supports/services.
  Most residents in the home are not receiving the additional
  supports.

• Non-licensed settings are all other settings in which you will be
  assisting clients with their medications.
                   Special Concerns

• Medication errors must be reported to your
  supervisor, the physician, and the Office of Recipient
  Rights, using the Incident Report form.

• There are policies and procedures for supervision of
  administering medications.

• Staff should have a positive attitude regarding
  medications.

• Questions should be answered accurately and
  honestly.

• Additional training is provided for special procedures.
  Injections and other procedures are not to be done
  without the special training.
     Before Administering Medication
• Staff must pass the medication training and be
  supervised administering medications before
  administering medications independently.

• Staff must have information about the purpose, dose,
  route, time and side effects/adverse effects of
  medications.

• Questions regarding medication administration can be
  answered by the assigned nurse, medical provider,
  medication reference book, pharmacist or Medication
  Information Line at U-M Hospital (734-936-8200)

• Staff must know the policies and procedures for
  administering medication.
    Independent Medication Administration


• Clients who want to administer their own medication
  must have a written goal for it in the person centered
  plan

• Staff should contact the Case Manager/Supports
  Coordinator if the client wants to learn more about
  medications or administer their own

• The Case Manager/Supports Coordinator needs to
  make a referral for nursing services for the client
                 Over the Counter and
                Prescription Medications
• Over the counter (non-prescription) medications do not need a
  prescription to buy them

• There must be an order or prescription for all prescription and
  non-prescription medications

• Prescription medications are prescribed by a physician, dentist,
  CSN or psychiatrist and dispensed by a pharmacist

• Scheduled or Controlled Medications (narcotics) need special
  handling procedures for storage and administration because
  there is high potential for abuse

• Controlled medications include: Ativan, Ritalin and Valium.

• Non-scheduled medications are all other prescription or non-
  prescription medications
            Psychotropic Medications

• Psychotropic medication includes:
   – anti-anxiety
   – antidepressants
   – antipsychotics
   – mood stabilizing medications
   – medications for side effects
   – medications needed for sedation

• The client must sign a Consent to Treatment with
  Psychotropic Medications
                  Forms of Medication
• Capsules – small gelatin pills containing
  medication
   – Capsules with tiny beads are time released
     and should never be opened or crushed
   Tablets are powdered medications that are molded
     and pressed
   – Enteric coated tablets – have a hard covering
     and should never be crushed or broken –
     coated to protect the stomach lining or
     slowly release the medication
   – Scored tablets – have a line on them – can be
     broken to give smaller doses
   – Dissolvable tablets-
   – INJECTIONS-NOT TO BE GIVEN BY
     STAFF UNLESS THERE ARE ORDERS
     AND YOU HAVE BEEN TRAINED
                 Forms of Medication
• Ointments and Creams – for external
  application to skin and mucus membranes

• Suppositories – inserted into vagina or rectum
   – dissolve or melt at body temperature
   – absorbed through mucus membranes

• Liquids – suspensions, elixirs, syrups
   – Directions on bottle need to be followed
     carefully
   – Must be measured with appropriate
     measuring device
       • Graduated measuring cups
       • Liquid measuring syringes
       • Measuring spoons used for cooking
     Medications Work on the Body in the
                Following Ways


• Local action – applying medication directly to tissue or
  organ

• Systemic action – circulates through bloodstream and
  carried to cells capable of responding to them –
  effects the whole body
           Medications Effect the Body
               In Different Ways

• Therapeutic effect – obtaining the desired response on the body
  system is was prescribed for

• Side effect – response to the medication other than which it was
  prescribed

• Adverse effect – a side effect which may be harmful
   – Medication should never be taken again
   – Allergic reaction – monitor client closely for increased
     irritability, respiratory difficulty, changes in pulse –
     anaphylactic shock
   – This is a medical emergency - Call 911 if these symptoms are
     present or institute emergency response system for your
     facility
   – Document allergy to medication in record
        The Five Rights of Medication
               Administration
The Five Rights:               Another way to help
1. Right Person – positively     remember “The Five
    identify the client          Rights” is using the
2. Right Medication – have       acronym Dr. Tim
    the correct medication
3. Right Dose
                               •   D = dose
4. Right Time – as close as
    possible to the            •   R = route
    prescribed time            •   T = time
5. Right Route                 •   I = individual (person)
    oral, topical, patch,
    rectal, vaginal,           •   M = medication
    injectable, inhalers
           Protocol for Storing Medication

• Must be stored in the containers they were dispensed in

• Stored in a locked box in the refrigerator if refrigeration
  required

• Medication cabinets:
   –   Not located over heated areas
   –   Used only for medication storage
   –   Kept clean and orderly
   –   Sufficient storage space and adequate lighting
   –   Kept locked when not being used

• All external medication must be stored separately from oral
  medications

• Keys to medication storage cabinet kept on the person assigned
  to medication administration on each shift
Nevers when passing medications
                           NEVERS
•   Never   give medication not prescribed by a licensed prescriber
•   Never   use a medication ordered for one person to treat another.
•   Never   give a medication to one person from another bottle.
•   Never   pour medication to another or relabeled bottle.
•   Never   give medication when the label is illegible.
•   Never   force a medication.
•   Never   give a medication without an order.
•   Never   give out a medication you did not “set up”.
•   Never   change a pharmacy label.
•   Never   mix medications
•   Never   return an unused dose of medication to the bottle.
•   Never   cut an unscored tablet.
•   Never   leave medication cabinets unlocked
•   Never   call medications “candy”.
•   Never   take a telephone order from a physician/dentist.
    Important Things to Be Aware Of When
    Preparing And Administering Medication
•   While preparing or administering medication concentrate on
    this task only.

•   Prepare and administer one person’s medication at a time.

•   Check each person’s medication record to see if he is
    scheduled to receive medication on your shift.

•   Make sure any medication or food allergies are noted on the
    front of chart in a brightly colored label and on medication
    and treatment record.

•   If you are unfamiliar with a medication you are going to
    administer check with the nurse
    consultant/pharmacist/current medication book.
    Important Things to Be Aware Of When
    Preparing And Administering Medication
•   In specialized residential settings always have medication
    orders for anything that you are administering to the client,
    including over the counter medications.

•   Never give a medication prescribed for one client to another.

•   Keep medications in the original containers dispensed from
    the pharmacy.

•   Prepare medications in a clean, well-lit, quiet work area.

•   Measure liquid medication in graduated measuring cups, liquid
    measuring syringes and measuring spoons.
    Important Things to Be Aware Of When
    Preparing And Administering Medication
•       If there is anything unusual about the appearance or the
        smell of the medication, DO NOT GIVE IT until you check
        with the pharmacist.

•       Make sure each client has enough medication AT ALL
        TIMES.
    –      One week before medication runs out, contact staff to reorder
    –      If no refills, contact the primary care physician or psychiatrist
           to make an appointment or ask for refills
    –      Be aware of prescriptions needed at physician appointments
    –      New prescriptions are to be filled and administered as soon as
           possible
    –      IT IS YOUR RESPONSIBILITY TO MAKE SURE THERE IS
           ENOUGH MEDICATION TO ADMINISTER
   Important Things to Be Aware Of When
   Preparing And Administering Medication
• Never force a client to take medication

• If the client refuses medication
   – Counsel client on importance of taking medication as prescribed
   – Ask for reasons client is refusing medication
   – If the client refuses reasons, wait 15 minutes and offer the
     medication again
   – If client still refuses, have another staff talk to him
   – If the client continues to refuse, continue to approach him every
     15 minutes until designated time has passed


• Medication should not be given sooner than ½ hour
  before or later than ½ hour after designated time
  Protocol for Administering Medication
• Positively identify client – at least 2 identifying
  methods:
   –   Knowledge of client by name.
   –   Have other person identify client.
   –   Have a photo of client in the chart.
   –   Ask for picture identification.


• Wash your hands.

• Have a clean work area.

• Prepare and administer only one client’s medication at
  a time.
  Protocol for Administering Medication

• Compare the label of the medication with the
  medication record 3 times to ensure accuracy:
   – As the container is taken from the storage area
   – Before the medication is removed from the container
   – Before the container is returned to the storage area


• Compare the Medication and Treatment Record to
  the orders and the label of the prescription bottle.
  If they do not match, DO NOT GIVE the medication
  until you have checked with the pharmacist,
  supervisor, nurse or primary care physician
  Protocol for Administering Medication
• Prepare the right medication in the right dosage at
  the right time by the right route for the right person

• Follow special instructions written on pharmacy label
  or attached to the container

• Pour liquid medication from the unlabeled side of the
  bottle at eye level then wipe off any excess with a
  paper towel

• Pour capsules or tablets into the led, then into the
  medication cup.
   – Medication in the medication cup is considered contaminated,
     cannot be put back into the original bottle and must be
     disposed of according to the policy and procedure for your
     setting.
  Protocol for Administering Medication

• Explain to the client why the physician ordered the
  medication and the procedure.

• Provide privacy.

• Assist the client in taking the medication:
   – Position the head correctly
   – Give adequate water
   – Notify the nurse if the client has difficulty swallowing the
     medication
   – Stay with the client until they swallow the medication
 Protocol for Administering Medication

• Administer only medication that you prepare.

• Observe, document, report client’s response to the
  medication

• Wash your hands, clean work area, go to the next
  client

• There are protocols for administering eye drops, nose
  drops, suppositories, etc.
         Telephone Medication Orders

• Staff cannot take medication orders from the
  physician over the phone

• The physician should fax the prescription to the
  pharmacy and to the home or provider agency
            Telephone Medication Orders

HOLD OR DISCONTINUE ORDERS FROM PHYSICIAN:

• These orders can be taken over the phone

• Steps:
   – Repeat the order back to the physician for confirmation.
   – Be sure you understand what you are instruction to do. Ask any
     necessary questions.
   – Immediately write it down in the client’s record. Include
     physician’s name, date, time, order, your signature
   – Inform all staff of the changes by communication book or verbal
     report
   – Notify your supervisor and assigned nurse
           Telephone Non-Medication
            And Treatment Orders

• For orders that are not for medications

• Repeat the order back to the physician for
  confirmation

• Be sure you understand what you’re instruction to do.
  Ask any necessary questions.

• Immediately write it in client’s record, include
  physician’s name, date, time, order, your signature
                  Pharmacy Label

• The pharmacy label contains the information from the
  prescription that you must have to correctly and
  safely administer the medication.

• The pharmacy label should give at least as much
  information as the prescription gives.

• The medication container frequently has small labels
  attached giving special directions regarding the
  administration and storage of the medication.
                     Pharmacy Label

• All containers in which prescription medication is
  dispensed must have a label, with the following
  information:

      LABELS MUST BE LEGIBLE
      Pharmacy name and address
      Prescription number
      Client’s name
      Date the prescription was most recently dispensed
      Physician’s name
      Directions for use
      The name of the medication
      Amount dispensed
      Strength of medication
      Dosage of medication
  Generic and Brand Name Medication

• Generic medications are nonproprietary and not
  protected by trademark
   – Have to meet the same testing requirements as
     brand name medications
   – Cost less
   – In Michigan, the pharmacist must substitute brand
     name medication for generic unless DAW (dispense
     as written) is written on the prescription

• Brand name medications are protected by trademark
   – A generic equivalent cannot be dispensed for a
     brand name until the patient has run out
      Medication and Treatment Record

• The Medication and Treatment Record is used to
  document medications

• If another form is used, it must have the same
  information as the Medication and Treatment Record

• Medication and Treatment Record
              Documenting on the
        Medication and Treatment Record
•   Draw a single line through errors, initial, rewrite
•   Use pens
•   Write clearly and legibly
•   All medications must be documented including over
    the counter
•   The person administering medication must document
•   Sign your name, title and initials at top of the page
•   STAT and single dose medications must be
    documented
•   Codes must be explained at the bottom
•   If medication is not given, circle in red and explain
    why, inform supervisor or nurse, complete an Incident
    Report
           Abbreviations and Symbols

• Do not use abbreviations

• All sites have a list of abbreviations posted for you to
  refer to

• Abbreviations and Symbols
           When Not to Give Medication

• Unusual circumstances when you should not administer
  medication:

   – If the Medication and Treatment Record form is missing – contact
     your supervisor
   – If the pharmacy label is not legible – contact your supervisor
   – If the medication has expired
   – If visible changes or an unusual odor – contact the pharmacy
   – A client exhibits a dramatic change in status – seizures,
     unconsciousness, difficulty breathing, other change which appears
     to be life threatening – follow instructions for reporting
   – If you have doubts about if you have the right person, dosage, time,
     route – get assistance from supervisor or nurse
   – Person refuses to take the medication
Medication Side Effects and Special
             Concerns
Anti-psychotic medication side effects-mild to those
  with special concerns

    Tardive dyskinesia

    Neuroleptic malignant syndrome

    Agranulocytosis
    Anti-psychotic Medication Side
               Effects
Anti-psychotic medication side effects
   (Example: Haldol, Prolixin, Risperdal, Zyprexa, Geodon, Abilify,
     and Seroquel)
   – Side effects may include:
      •   Drowsiness
      •   Constipation
      •   Rapid heartbeat
      •   Dizziness
      •   Decrease in sexual interest or ability
      •   Weight gain
      •   Sensitivity to the sun
      •   Restlessness, pacing, slowing down of movement and speech,
          shuffling walk.
    Anti-psychotic Medication Side
               Effects
Tardive dyskinesia:

• This is a movement disorder that results in unusual
  and uncontrollable movements

• Usually of the tongue and face (such as sticking out
  the tongue and smacking the lips)

• sometimes jerking and twisting movements of other
  parts of the body

• (see Tardive Dyskinesia handout)
      Anti-psychotic Medication Side
                 Effects
    Neuroleptic Malignant Syndrome (NMS), a potentially
    fatal disorder characterized by:

    – Severe muscle rigidity (stiffening)


    – Fever


    – Sweating


    – High blood pressure


    – Delirium and sometimes coma


•   Call 911 if you suspect NMS. (see NMS handout)
    Anti-depressant Medication Side
                Effects
Anti-depressants-Serotonin Reuptake Inhibitors (SSRIs)
    (example: Paxil, Prozac, Zoloft) and Tricyclics (example:
    Doxepin, Amitriptyline) may cause nausea:
•   Dizziness, drowsiness, dry mouth
•   Problems with sexual interest or performance.
•   Constipation
•   Blurred vision
•   Weight gain
•   Increased heart rate
•   Drowsiness
•   Urinary retention
•   Impotence
•   Decreased blood pressure
•   Dizziness when standing up
    Anti-depressant Medication Side
                Effects
Anti-depressant Monoamine Oxidase Inhibitors (MAOIs)
    (example: Nardil, Parnate)
•    Nausea, vomiting, high blood pressure, fast or slow heartbeat,
    severe headache, increased sweating, sensitivity to light, severe
    chest pain, stiff or sore neck
•   MAOIs can be dangerous when given with certain medical
    conditions, taking certain drugs, or even eating certain foods
•   Stop MAO immediately if there are reports from the client of a
    severe headache or palpitations, then call the client’s physician,
    nurse or 911
•   Dietary Restrictions Don't eat or drink any of the following
    when taking MAOIs unless the doctor advises otherwise: aged
    foods, alcoholic beverages, salami, summer sausage, pepperoni,
    cheeses, fermented foods, any overripe fruit, meat prepared
    with tenderizers, smoked or pickled meat, poultry or fish, soy
    sauce (if you have a client on an MAOI, consult your nurse or
    physician for a list of diet restrictions)
      Anti-anxiety Medication Side
                Effects
Anti-anxiety medication side effects (Example:
  benzodiazepines, such as Valium, Klonopin, Ativan and Xanax)
• These drugs do carry a risk of addiction so they are not as
  desirable for long term use
• Other possible side effects include drowsiness, poor
  concentration and irritability


Bipolar medication side effects (Example: Lithium, Depakote,
  Tegretol)
• May cause increased thirst, urination, diarrhea, vomiting, weight
  gain, drowsiness, poor concentration, impaired memory
• Notify the client’s nurse, physician or call 911 if the client
  reports persistent symptoms from Lithium or if they develop
  diarrhea, vomiting, fever, unsteady walking, fainting,
  confusion, slurred speech, or rapid heart rate
                      Tardive Dyskinesia
•   A condition characterized by involuntary, abnormal movements
     – Most often around the mouth – grimacing, tongue protrusion, lip
        smacking, pursing, puckering
     – Rapid eye blinking
     – Rapid movements of arms, legs, trunk
     – Impaired finger movements
•   Seen most often after long term treatment with typical antipsychotic
    medications – Haldol, Prolixin, Mellaril, Thorazine
•   Higher incidence of TD in women, risk increases with age
•   There is not a way to determine if somebody will develop TD
•   There is no effective treatment
•   Symptoms can be reduced by using atypical antipsychotics – Clozaril,
    Zyprexa, Seroquel
•   Vitamin E also reduces symptoms
•   The psychiatrist will do an Abnormal Involuntary Movement Scale test
    every three months for early detection
          Mental Health Disorders


Schizophrenia



Depression



Bipolar



Anxiety
         Mental Health Disorders
             Schizophrenia
• Schizophrenia is a serious brain disorder that
  distorts the way a person thinks, acts, expresses
  emotions, perceives reality and relates to others
• Often have problems functioning in society, at work
  at school, and in relationships
• Contrary to popular belief, schizophrenia is not a split
  personality
• A type of mental illness in which a person cannot tell
  what is real from what is imagined
• The world may seem like a jumble of confusing
  thoughts, images and sounds
• The behavior of people with schizophrenia may be
  very strange and even shocking
          Mental Health Disorders
                Depression
• An individual with major depression feels a profound
  and constant sense of hopelessness and despair

•    Major depression is marked by a combination of
    symptoms that interfere with the person's ability to
    work, study, sleep, eat, and enjoy once pleasurable
    activities

• Major depression may occur only once but more
  commonly occurs several times in a lifetime
         Mental Health Disorders
                 Bipolar
• Bipolar, also called bipolar disorder or "manic-
  depressive" disease, is a mental illness that causes
  people to have severe high and low moods

• People who have this illness switch from feeling
  overly happy and joyful to feeling very sad, and vice
  versa

• Because of the highs and the lows -- or two poles of
  mood -- the condition is referred to as "bipolar"
  depression
          Mental Health Disorders
                  Anxiety
• Anxiety is a normal human emotion that everyone
  experiences at times

• Anxiety can cause such distress that it interferes
  with a person's ability to lead a normal life

•   An anxiety disorder is a serious mental illness

• For people with anxiety disorders, worry and fear are
  constant and overwhelming, and can be crippling
                   Handouts

• Tardive dyskinesia

• Neuroleptic malignant syndrome

• Mental Health Disorders
TIME TO TRANSCRIBE
    Protocol for Administering Medication
        when Client is in a Residential
              or School Setting
• Have pharmacist give two labeled bottles of each
  medication, one for each location
• Give the pharmacist the necessary information for
  each bottle
• Give the medication containers and physician’s order
  directly to the appropriate facilities
• Share information about the medication and potential
  response of the client
• Do not move medication from one bottle to another
• Register the correct code on the Medication and
  Treatment Record
 Protocol for Administering Medication when
       Client is on a Leave of Absence

• Pharmacist should dispense medications to be given on
  leave.
• Medications should be sent in original pharmacy
  container.
• Share information with family/guardian about the
  medication and potential response.
• When client returns, ask family/guardian if
  medication was administered and client’s response
• Document the correct code in the Medication and
  Treatment Record
• Return medication to client’s medication box
        Medication Errors Occur When

• The wrong medication was given to a client.

• One client’s medication was given to another client.

• The wrong dosage was given to a client.

• A medication was given at the wrong time to a client
  or a medication was not administered at all.

• A medication was given by the wrong route.
       How to Prevent Medication Errors
• Stay alert, and always observe the “Five Rights” or
  “Dr. Tim” of medication administration.
• Avoid distractions when preparing, administering and
  documenting medication.
• Be knowledgeable about the medications you
  administer.
• Ask for help from your licensed health provider if you
  are unsure about the preparation, administration, and
  documentation of medications.
• If an error occurs, it must be reported immediately
  to your supervisor, the nurse, or prescriber. The
  error must be recorded on an Incident Report (IR)
  and your agency’s policies followed.
 Protocol for Disposing of Discontinued,
  Contaminated or Expired Medications

• A physician’s order authorizing discontinuation should be on file
  in the client’s record for discontinued medications

• Contaminated or expired medications do not need an order to
  destroy them

• Two direct care staff:
   – Compare pharmacy label with physician’s order
   – Destroy medication by flushing down toilet or in garbage
     disposal
   – NEVER DISPOSE OF MEDICATIONS WHERE HUMANS OR
     ANIMALS MAY COME IN CONTACT WITH THEM
    Protocol for Disposing of Discontinued,
     Contaminated or Expired Medications

• Document disposal on client’s record, include both
  staff’s signature

• Write discontinued in bold letters on Medication and
  Treatment Record starting where next dose would
  have been recorded

• Make other staff aware of discontinuation

• Medication can be discarded or returned
  to pharmacy

• Replace expired medication
    Protocol for Administration of Topical
                 Medications

•   Wash hands. Put on non-sterile gloves.

•   Remove medication from the jar with tongue blade or cotton
    tipped applicators. DO NOT USE YOUR FINGERS.

•   Insert applicator or tongue blade into container only once,
    NEVER RE-INSERT.

•   Use cotton tipped applicators, sterile gauze, or gloved hand to
    apply topical medications unless otherwise directed.

•   Remove gloves and wash hands.
          Protocol for Administration
                of Nose Drops
•   Wash hands. Put on non-sterile gloves.
•   Check the dropper tip for chips or cracks.
•   Have client gently blow their nose.
•   Have the client tip their head back while either sitting or
    lying flat.
•   Draw the medication into the dropper.
•   Avoid touching the dropper against the nose or anything else.
•   Replace dropper and secure.
•   Encourage the client to remain with head tilted back for 3-5
    minutes. Provide tissue for nasal drainage.
•   Remove gloves and wash hands
          Protocol for Administration
                 of Ear Drops
•   Wash hands. Put on non-sterile gloves.
•   Check the dropper tip for chips or cracks.
•   If the drops are a cloudy suspension, shake well for ten
    seconds.
•   Position the client with the affected ear up.
•   Draw the medicine into the dropper.
•   Avoid touching the dropper against the ear or anything else to
    reduce chance of contamination or ear injury.
•   To allow the drops to run in, straighten the ear canal on an
    adult by pulling the ear up and back.
•   Replace dropper and secure.
•   Keep the ear tilted up for 3-5 minutes.
•   Remove gloves and wash hands.
          Protocol for Administration
                 of Eye Drops
•   Wash hands. Put on non-sterile gloves.
•   Check the dropper tip for chip or cracks.
•   Have the client lie down or tilt head back.
•   With your index finger, pull the lower lid of the eye down to form a
    pocket.
•   Draw the medicine into the dropper.
•   Hold the dispenser with the opposite hand and place as close to the
    eye as possible, without touching it.
•   Hold the dropper tip down all the time. This prevents the drops from
    flowing back into the bulb where they may become contaminated.
•   Brace hand on forehead.
•   Drop the prescribed amount into the pocket made by the lower lid.
•   Avoid touching the eye with the dropper or anything else.
•   Replace dropper and secure.
•   Caution the person not to rub their eyes. Wipe off any excess liquid
    with a tissue.
•   Remove gloves and wash hands.
           Protocol for Administration
                of Eye Ointment

•   Wash hands. Put on non-sterile gloves.
•   Tilt head back.
•   Hold the tube between your thumb and forefinger
    and place the tube as near to the eyelid as possible.
•   Avoid touching the top of the tube against the eye
    or anything else.
•   With your finger on the other hand, pull the lower
    lid of the eye down to form a pocket.
•   Place the ointment into the pocket made by the
    lower lid.
•   Have the client blink eye gently.
•   With a tissue, wipe off any excess ointment.
•   Remove gloves and wash hands.
          Protocol for Administration
            of Rectal Suppositories
•   Wash hands.
•   Remove suppository from storage (Store suppositories in a cool place to avoid
    melting. Refrigerate them if so labeled.
•   Explain to the client why the physician ordered the medication and the
    procedure.
•   Provide privacy.
•   Have the client remove their undergarments and lie on their left side with
    the lower leg straightened out and the upper leg bent forward toward the
    stomach. Cover exposed area with a towel or sheet. Do not give in a sitting
    position.
•   Remove wrapper if present.
•   Put on disposable gloves. Lubricate suppository, finger and rectal opening
    with water-soluble lubricant (e.g. K-Y Jelly).
•   Lift upper buttock to expose rectal area. Encourage the client to take
    several deep breaths to help relax.
•   Insert suppository with finger until it passes the muscular sphincter of the
    rectum, about ½ to 1 inch in infants and 1 inch in adults. If not inserted past
    this sphincter, the suppository may pop back out.
•   Hold buttocks together for a few seconds.
•   Have the client remain lying down for about 15 minutes to avoid having the
    suppository come back out.
•   Remove gloves and wash hands.
     Protocol for The Administration
         of Vaginal Suppositories
•   Wash hands and remove suppository from storage. (Store
    suppository in a cool place to avoid melting. Refrigerate them
    if so labeled.)
•   Explain to the client why the physician ordered the medication
    and the procedure.
•   Select a private location with adequate lighting.
•   Have the client lie on back with knees bent.
•   Remove the wrapper if present.
•   Put on gloves.
•   Identify vaginal opening.
•   Insert medication approximately two inches into vaginal canal,
    following the instructions on the pharmacy label.
•   Ask the client to remain lying down for 15 minutes.
•   Remove gloves and wash hands.
    When the Client is Hospitalized

• All previous orders clarified and a new order obtained

• Family members or guardians need to be notified

• Routine and emergency medical consents needed for
  treatment

• Notify the primary care physician

• Staff will be responsible for follow up appointments
   The Client Resides in a Licensed
               Setting


CSM and home staff need to be informed of all

  Treatment plans

  Procedures

  Doctors orders
        Medication Reconciliation

• Medication

  – Dose

  – Frequency

  – Continue

  – Discontinue

  – Change: specify changes
              Making the Most of a
              Medical Appointment
WHAT TO BRING:

• The client’s medical book.
• A consultation form with client information
  included.
• A current medication sheet, including information
  on PRN use.
• List of allergies.
• Information on the reason for the appointment;
  chief complaint, signs/symptoms etc…. KNOW
  WHY YOU ARE THERE.
• Seizure record if applicable i.e. Neurology or
  Annual physical
• Menses record for Annual physical or GYN exam
              Making the Most of a
              Medical Appointment
DURING THE APPOINTMENT:
   – Enable the client to be part of the
     appointment as much as possible.
   – Enable them to say as much as possible,
     even when speech is difficult (staff
     providing additional information only as
     necessary).
   – Nonverbal clients can hand a completed
     consultation form to the doctor (stating
     reason for appointment, medications and
     allergies).
   – Speak to the client not about them.
   – Clients have feelings that need to be
     recognized.
   – Staff may need to remind doctors or other
     health care professionals of this.
                  Making the Most of a
                  Medical Appointment
AFTER THE APPOINTMENT:
• Make sure you understand any orders etc…before you leave the office. If any
   things is unclear ask questions. Make sure the consultation form is completed
   and prescriptions obtained. REMEMBER: Prescription and Nonprescription
   medications must have a physician order in a licensed setting.
• Fill the prescription and keep a copy of the prescription for the client record.
• If the medication is to be given at school/work a separate pharmacy bottle,
   clearly marked must be obtained.
• If you are unsure of the purpose, direction for giving or possible side
   effects/adverse effects, ask the pharmacist.
• Make sure this medication does not contain anything the client is ALLERGIC to,
   if unsure ask.
• At home record medication or any new orders on the medication and treatment
   record. This might include discontinuing a medication etc.
• Alert staff through the communication log of the appointment and any new
   orders.
• Make sure any follow up occurs as ordered and paperwork is properly filed.
• If a medication is ordered to change behavior (psychotropic), for sleep or to
   sedate, or a change in seizure medications, consent must be obtained from the
   client or guardian, by the assigned nurse or psychiatrist before the medication
   can be given.
     Recognizing Signs of Illness


• Observe



• Record



• Report
        Recognizing Signs of Illness

• Change in dietary habits, an increase or decrease in appetite
• Change in sleep pattern, an increase or decrease or interrupted
  sleep pattern
• Changes in skin
   – Color: pale, flushed, cyanotic (blue), blotchy (reddish spots),
     jaundice (yellow)
   – Condition: dry, clammy, cold, hot, increased perspiration, rash, itchy
• Changes in vital signs; an increase or decrease in body
  temperature, pulse, respiration or blood pressure
• Changes in body odor: breath, perspiration, urine or stool
• Changes in elimination (consistency, color and odor of urine and
  stool and increase or decrease or absence of urine or stool)
• Change in level of consciousness (confused, stuporous, dizziness,
  fainting, coma or convulsion)
       Recognizing Signs of Illness

• Change in weight (significant increase or decrease)
• Change in body or limb movement (shaking, tremors,
  jerking, stiffness, paralysis, unsteadiness, staggering)
• Changes in breathing (difficulty breathing, rapid,
  slow, wheezing, gasping, coughing or sneezing)
• Changes in behavior (crying, restlessness, withdrawn
  or anxious)
• Change in the digestive process: nausea, vomiting,
  diarrhea or constipation
• Injury to the body: bruises, cuts, punctures,
  abrasions, swelling or pain
• Discharge (drainage) from any body opening or the
  skin
      Recognizing Signs of Illness

• VITAL SIGNS: These are frequently the first
  indicators of a problem

Normal range
• Temperature: Oral 98.6   Rectal 99.6 Axially 97.6

• Pulse 60 to 80 beats per minute

• Respiration 12 to 20 breaths a minute

• Blood Pressure below 140 above 100 / less than 90
  above 60
                       Hand Outs

• ABBREVIATIONS commonly used by prescribers on
  prescriptions. ( Abbreviations must be avoided, but for
  transcription purposes knowledge of abbreviations is helpful.)

• BODY SYSTEMS REVIEW

• CONSENT TO TREAT

• MEDICATION AND TREATMENT RECORD

• CONSULTATION REPORT

• INCIDENT REPORT
                Definitions

• DEVELOPMENTAL DISABILITY

• AUTISM

• CEREBRAL PALSY (CP)

• MENTAL RETARDATION

• SYNDROME

								
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