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Medication Administration Program

Residential Program Medication System Overview

Spring 2015

ObjectivesTo become familiar with a

medication system Technical Assistance Tool sections

To know how to access MAP resources Required Informational Training

MAP Monitoring Tool

Tech Assist Tool Evaluates a medication system

Sections within the toolCorrespond with MAP Policies

MAP Technical Assistance Tool

Provider:Address:DPH MCSR:Contact(s):Date of Visit:MAP Coordinator/Reviewer:

 A. HEALTH CARE PROVIDER (HCP) ORDERS & TRANSCRIPTIONS (SECTIONS 13 & 06) YES NO COMMENTS

1. There is a HCP order for all prescription meds, OTCs and herbal supplements or products

2. HCP orders are valid with HCP signature on the same page as orders and dated within 1 year

3. All HCP orders (including new orders and telephone orders) are posted and verified (includes signature, date and time) below HCP signature

4. Changes in medication orders are handled as new HCP orders      

5. Staff are not using outdated HCP orders which have been superseded by newer orders or superseded by hospital discharge orders

6. On HCP order forms listing multiple meds, after med(s) are DC’d; staff indicate in the margin - DC, date, initials and see new order, if applicable

7. PRN orders have the specific reason for use and instructions (including hours apart from any regularly scheduled doses ordered) and guidelines when to notify HCP, if applicable.

8. Prescriptions are not substituted for HCP orders      

9. HCP orders, pharmacy labels and medication sheets agree      

10. HCP orders are correctly transcribed on the medication sheets      

11. Telephone orders for med changes are documented on a HCP telephone order form and cosigned by HCP within 72 hours

12. Monthly med sheet accuracy check by 2 Certified and/or licensed staff      

13. There is an internal MAP monitoring system      

B. VITAL SIGNS (SECTIONS 03 & 08) YES NO COMMENTS 1. Each HCP is consulted to determine if vital signs are required for medication administration

MAP Resource

mass.gov/dph/map

MAP Resource 2

Health Care Provider (HCP) Orders

Health Care Provider OrdersTelephone/Fax OrdersHospital Discharge OrdersPRN Orders

MAP Policy Sections 06 & 13

Tech Assist Tool Section A

Telephone/Fax Order

Hospital Discharge Order

MAP Resource 3

mass.gov/dph/map 2

Transcriptions

Transcriptions• Agree with HCP Orders and Pharmacy Labels

Monthly Med Sheet accuracy check

MAP Monitoring System

MAP Policy Section 13

Tech Assist Tool Section A

Vital SignsHCP is Consulted

If required, HCP order includes Specific written parameters What to do if outside parameters

Documentation HCP Notification

Staff Training & Competency At Site and Provider main office

MAP Policy Sections 03 & 08

Tech Assist Tool Section B

Sample Med Sheet

Month and Year: DECEMBER (year) Medication SheetMedication or Treatment

Start: Generic: Digoxin Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

11/1/yr Brand: Lanoxin 8am CW CWDSDS DS DS

Stop: Strength: 125mcg Pulse 62 68 60 54 52

Cont. Amount: 1 tab Dose: 125mcg

Frequency: daily am Route: by mouth

Special Instructions: If pulse is less than 56 hold the dose. Notify HCP is does are held 2 days in a row,Notify HCP is dose is held 2 days in a row.if dose is held 2 days in a row.

Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Brand:

Stop: Strength:

Amount: Dose:

Frequency: Route:

Special Instructions:

Sample Progress Note

Date Time Medication Reason Response Signature

12/5/yr 9:30a Notified Dr. Jones that Digoxin was held for the second day in a row. Pulse was 54 yesterday and 52 this morning. Dr. Jones said to continue with the med as ordered. He said if the pulse is less than 56 tomorrow morning to call back. He may change the dose at that time. Don Stevens

Medication Documentation

Medication Sheets Organized Boxes initialed that meds are given

No blank spaces Corresponding signature of staff

MAP Policy Sections 06; 08 & 13

Tech Assist Tool Section C

Sample Med Sheet 2

Month and Year: DECEMBER (year) Medication SheetMedication or Treatment

Start: Generic: Digoxin Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

11/1/yr Brand: Lanoxin 8am CW CW DS DS DS CW CW DS DS CW CW

Stop: Strength: 125mcg Pulse 62 68 60 54 52 62 62 68 72 60

Cont. Amount: 1 tab Dose: 125mcg

Frequency: daily am Route: by mouth

Special Instructions: If pulse is less than 56 hold the dose. Notify HCP is does are held 2 days in a row,Notify HCP is dose is held 2 days in a row.if dose is held 2 days in a row.

Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Brand:

Stop: Strength:

Amount: Dose:

Frequency: Route:

Special Instructions:

Medication Documentation 2

Progress Note Examples of when to use

Med is not given as orderedPRN med givenLeave of absenceRefusalHeld

Medication Documentation 3

AllergiesData

PRN bowel meds PRN seizure meds

Seizure record

Staff CertificationOn SiteCurrentAll Staff Administering Meds

Regular Relief

Acceptable Proof Master list

MAP Certification expiration dates Certification letter

www.hdmaster.com

MAP Policy Section 02

Tech Assist Tool Section D

Certification Letter

www.hdmaster.com

Ancillary Practices

Blood Glucose Testing Certified Staff training

Documentation is on site HCP Order Requirements

Upper/lower parameters Steps to take when outside parameters

MAP Policy 08 Tech Assist Tool Section E

CLIA Waiver

Required if monitoring Blood Glucose Urine [dipstick]

Ketones, glucose, blood, etc.Pregnancy

MAP Policy 08 & 17Tech Assist Tool Section E

mass.gov/dph/map 3

mass.gov/dph/map 4

mass.gov/dph/clp

CLIA Waiver 2

Required if monitoring PT/INR

Licensed staff

MAP Policy 08 & 17Tech Assist Tool Section E

High Alert Medication

Warfarin sodiumClozapineBuprenorphine/naloxone

MAP Policy Section 08 Tech Assist Tool Section E

mass.gov/dph/map 5

Training Resource

Training Resource 2

Ancillary Practices 2

G/J Tube med administration Certified Staff training

Documentation is on site

Training is Individual specific

MAP Policy Section 14Tech Assist Tool Section E

Ancillary Practices 3

Injectable Epinephrine Certified Staff training

Documentation is on site

Training is Individual specific

MAP Policy Section 14Tech Assist Tool Section E

InsulinAdministered only by licensed staff

Unless Individual is self-administering Defined in MAP policy Section 07

“Self-injecting” does not automatically mean self-administering

MAP Policy Section 07; 14-1

Sample Med Sheet 3

Month and Year: DECEMBER (year) Medication SheetMedication or Treatment

Start: Generic: Insulin glargine Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

12/1/yr Brand: Lantus 7am

Stop: Strength: 100U/mL

Cont. Amount: 50 Units Dose: 50 Units

Frequency: daily am Route: SC

Special Instructions: ADMINISTERED BY VNA NURSING STAFF

Start: Generic: Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Brand:

Stop: Strength:

Amount: Dose:

Frequency: Route:

Special Instructions:

ADMINISTERED BY VNA NURSING STAFF

Insulin 2

MAP Certified Staff may NOT Administer Insulin Dial a dose on an Insulin pen Double check

A dose dialed by an Individual The amount of insulin drawn up into a

syringe by an Individual

“Sharps” Disposal

DisposalNeedleSyringeLancet

Ancillary Practices 4

Oxygen Therapy All methods of delivery including

Oxygen cylinders Oxygen concentrators

MAP policies applyOxygen training guidelines

MAP Policy 08-4

Countable Substance Packaging

Schedule II-V meds must be Received from pharmacy In tamper resistant packaging

Blister pack OPUS Opti-Pak

MAP Policy Section 10Tech Assist Tool Section F

OPUS Medication System

Countable Substance Packaging 2

Schedule II-V meds must be Received from pharmacy In tamper resistant packaging

Schedule VI

DPH recommends Two Schedule VI meds

Add to countFioricetGabapentin (Neurontin)

MAP Policy Section 10Tech Assist Tool Section F

Blister Pack Monitoring

Tracking method to determine meds are given as prescribed Not required

Staff Initial Date Time

Backside of package

Blister Pack Monitoring 2

Countable Substance Documentation

Count Book Index

Complete Accurate

Count Sheets Countables subtracted as removed Entries not squeezed in between lines

Shift Count Sheets Reflect meds are counted

Each time key changes hands

MAP Policy Section 10Tech Assist Tool Section G

Countable Substance Documentation 2

Signature Requirements Two signatures when

Beginning a new count sheet Adding a refill onto a count sheet Transferring from

Bottom of old page/top of new An old count book to a new count book

Disposal

MAP Policy Section 10Tech Assist Tool Section G

mass.gov/dph/map 6

MAP Resource 4

Drug Loss (Schedules II-VI)

Include All prescription meds Written prescriptions

Reported to DPH First business day after discovery Drug Incident Report form required

MAP Policy Section 10Tech Assist Tool Section G

mass.gov/dph/dcp

mass.gov/dph/map 7

MAP Resource 5

Self-Administration

Achieved only when Medication is under complete

control of individual With no more than minimal

assistance from staff

MAP Policy Section 07Tech Assist Tool Section H

Transitioning to Self-Administering

Self-administering assessmentISP reflects statusPill organizer preparation

Only by Pharmacist Individual

Documentation

MAP Policy Section 07Tech Assist Tool Section H

mass.gov/dph/map 8

Off-Site Medication Administration

PreparationDocumentation

Med sheet Acceptable Codes

DP-day program W-work H-hospital, skilled nursing facility,

rehabilitation center S-school

Med-Release document Signatures

Releasing/Accepting MAP Policy Section 11Tech Assist Tool Section I

Leave of AbsencePreparationDocumentation

Med sheet Acceptable code

LOA-leave of absence

Med progress note LOA form

Signatures Releasing/Accepting

MAP Policy Section 11Tech Assist Tool Section I

Leave of Absence 2

Certified staff may prepare if Unexpected Pharmacy is unable LOA is less than 72hrs

MAP Policy Section 11Tech Assist Tool Section I

mass.gov/dph/map9

MAP Resource 6

Medication Ordering/Receiving

Prescription Deliveries Tracking

Pharmacy ReceiptsMaintained for 90 days

MAP Policy Section 10Tech Assist Tool Section J

Cleanliness and Security

Contains only med administration supplies Internal/External separated No more than 37 day supply of

prescription meds Unless prescription plan requires otherwise

Documentation

Locked Countable meds are double locked

MAP Policy Section 10Tech Assist Tool Section K

Medication Disposal

“Expired” or “discontinued” Disposal completed with

2 Certified staff present 1 must be a Supervisor

MAP Policy Section 10Tech Assist Tool Section L

Medication Disposal 2

“Dropped” or “refused” Disposal is with 2 MAP

Certified staff present If unavailable, a Supervisor is

not required to be presentUnless your agency requires it

MAP Policy Section 10Tech Assist Tool Section L

DPH Disposal Form

mass.gov/dph/map10

MAP Resource 7

Policies & Resources

Must be on site MAP policy manual Med Info sheets Drug reference MAP training manual Provider policies

MAP Policy Sections 01; 06; 08; 10 & 11Tech Assist Tool Section M & N

Policies & Resources 2

Staff Education

Training BinderOngoing med education Documentation is on site

MAP Policy Section 06Tech Assist Tool Section O

mass.gov/dph/map11

MAP Resource 8

MOR System Principles

Opportunity to improve Procedures or systems

That put people at risk

Focus on “cause” Rather than “who”

Made the mistake

MAP Policy Sections 09 &10Tech Assist Tool Section P

Medication Occurrence Process

Tracks Certified staff onlyOne of five rights went wrong

Individual Medication Dose Time

Omission Route

MAP Policy Sections 09 &10Tech Assist Tool Section P

MOR Process

Self reporting system Staff must immediately contact

MAP Consultant Follow recommendation

• Document recommendation

MAP Policy Sections 09 &10Tech Assist Tool Section P

Medication Occurrence Reporting

Emergency numbers include911Poison Control MAP Consultant(s)

Available 24/7

MAP Policy Sections 09 & 10Tech Assist Tool Section P

Reporting Requirements

MORs reported to MAP Coordinator Within 7 days of discovery

Via HCSIS

“Hotline” MORs reported Within 24 hours of discovery

DPH Clinical Reviewer MAP Coordinator

MAP Policy Sections 09 & 10Tech Assist Tool Section P

DPH Hotline Form

mass.gov/dph/map12

MOR Follow-Up

Retraining (usually) Should occur

Each time a med occurrence happens Can be determined jointly

Supervisor MAP Consultant

Documentation

MAP Policy Sections 09 &10Tech Assist Tool Section P

MOR Follow-Up 2

Tech assist visit Hotline Multiple MORs

Revocation Occasionally

MAP Policy Sections 09 & 02Tech Assist Tool Section P

DPH Registered Programs

Massachusetts Controlled Substance Registration Number (MCSR) Issued by DPH Original or copy stays on site

Where medication is stored

MAP Policy Section 01Tech Assist Tool Section Q

MAP CoordinatorsCarolyn Whittemore, RN

Central/West 413.205.0914

carolyn.whittemore@state.ma.usMary Despres, RN

Metro 781.314.7506

mary.despres@state.ma.us

MAP Coordinators 2

Gina Hunt, RN Northeast 978.774.5000 x354

gina.hunt@state.ma.usSusan Canuel, RN

Southeast

susan.canuel@state.ma.us

MAP Resource 9

mass.gov/dph/map13

The End