Pre- Study

The Medication Assistance Program pre-study manual has been prepared for HCA’s to read prior to attending an education session. The information will assist the learning process.

-Passage of a medication through a membrane into the bloodstream

- Moving from the bloodstream into the tissues and fluids of the body

- Physical and chemical alterations that a substance undergoes in the body

- Eliminating waste products of drug metabolism from the body.

- An agent that alters the body’s mechanism

Another term for drug: a substance used in the prevention or treatment of disease

- An abbreviation of the chemical name for a drug. It is spelled with a small letter at the beginning of the name and remains the same for all manufacturers of the drug (i.e. carboxymethylcellulose ophthalmic drops).

- The name given to a medication by the manufacturer. It is spelled with capital letter at the beginning and is often ‘catchy’ to make it easier to remember (i.e. Refresh eye drops)

c- Special medications that are closely controlled because of their potential for abuse (i.e. Tylenol #3, morphine)

- An oral medication that comes in the form of a liquid that is made by dissolving a powdered medication in water. These must be shaken before they are administered.

- The effect on the person’s body that the physician desires when a medication is ordered. (I.e. relief of pain)

- Unwanted effect of a medication that is mild and annoying (i.e. Tylenol #3 has desired action of pain relief, but also has some unwanted effects such as nausea, constipation, and drowsiness)

- Unwanted effect of a medication that is serious (i.e. vomiting, fainting) Often the medication needs to be stopped and treatment may be necessary to reverse the adverse effect.

- Unwanted effect of a medication that results in itching, a rash, hives, swelling or difficulty breathing. This needs to be reported to your supervisor immediately, and client should be monitored.

-an adverse effect of a medication that results in the client experiencing difficulty breathing. This is an emergency that must be reported to your supervisor IMMEDIATELY.

- The action of a medication at the site where it is given. (i.e. topical medication affects only the skin where it is applied).

- The action of a medication that affects the whole body (i.e. drowsiness, fainting).

- Medications that a client takes on a regular basis.

- Medication that a client takes ‘as needed’. (I.e. Tylenol for a headache)

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- medication that must be ordered by the doctor before the client can take it.

- Medications that a client or their family can purchase without a prescription.

- medications that are individually sealed into plastic ‘blisters’ or bubbles on a card.

- as above

e- A plastic container with compartments for medications. They are labeled by the day of the week and the time of day to make it easier for clients or their caregivers to keep track of the medications taken or given.

The amount of medication to be given at a specific time (i.e. one pill, one teaspoonful, 10ml)

Abbreviations should not be used on medication labels, the medication administration record(MAR)or when documenting medication activities. . If an abbreviation is used and you are unclear what it means, be sure to ask your supervisor. Do not guess. Some are prone to misinterpretation leading to fatal errors. So always ask if you are unsure. You may encounter abbreviations. Here are some of the more common abbreviations:

Gm/gms- gram or grams- a measure of weight for a medication. There are 1000 grams in a kilogram.

mg-milligrams-a tiny measure of weight for a medication

mcg/ µg -micrograms-an extremely tiny measure of weight

ML/ml- milliliters-a measure of volume for a liquid medication; e.g 5ml in a teaspoon.

b.i.d. /BID- twice a day

t.i.d. /TID-three times a day

p.r.n.-as required or as needed

po-by mouth

sl-sublingual (under tongue or spray that is absorbed via membranes in mouth)

Gtt/gtts-drop or drops

Supp- suppository

Ungt/ung- ointment

Q4h-every 4 hours

Q4-6h-every 4-6 hours

AC- Before meals

ADL- Activity of Daily living

HS-Bedtime

LPN- Licensed practical nurse

MAR- Medication administration Record

MDI- Metered Dose inhaler

NPO- Nothing by mouth

OTC- Over the counter

PC- After meals

PO- Orally (to be given by mouth)

RN- Registered Nurse

RPN- Registered Psychiatric Nurse

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The Medication Assistance Program (MAP) assists clients in the continuing care program to maintain their independence and optimal level of functioning by supporting them to

manage their day to day medication needs.

This pre-study module is an additional learning resource for care providers who are required to provide medication assistance for their clients.

On completion of reviewing this module, you will:

• Understand the reasons why a client may need assistance with their medications • Review the principles of assisting with medications • Know the 3 levels of MAP • Understand the difference between medication assistance and medication

administration • Describe the four conditions necessary for a HCA to assist with medication

delivery • Describe the role of the health care team related to medication assistance • Identify common abbreviations and terminology used in medication assistance • Understand the way medications work in the body • Identify common side effects/serious side effects and how to respond and report

them • Identify common errors and why it is important to report them • Describe the importance of a client’s care plan when assisting with medication

delivery • Understand their role in reporting and documenting • Describe infection control methods to be used when assisting with medications • Understand the 7 Rights of medication assistance • Recall the three checks then the rights are checked when giving medications

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MEDICATION ASSISTANCE PROGRAM

There are many reasons why clients may be unable to take their medications independently

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The Medication Assistance Program or MAP is designed assists clients to

and by supporting them in managing their day to day

medication needs.

• Support safe medication management, reduce stress on client and/or family and maintain or improve clients’ health.

• Clients are treated with and . • Clients are supported to and be as as

possible • Medication support services are based upon unmet needs • The client’s own family and natural supports will be considered as an

option for meeting medication support needs • for both the client and the HCA must be a primary

consideration

These terms are often used interchangeably, but they are very different.

Medication Assistance: a service provided to clients to ensure medication is taken as intended by the prescriber when the client is by a health care professional as being unable to independently take medications safely. Medication assistance includes a range of activities from verbal reminders to full hands-on assistance and observation to ensure the medications have been taken as prescribed

Medication Assistance may be assigned to a Health Care Aide when it is safe and appropriate to do so as part of the client’s routine daily activities.

Clients requiring medication assistance recognize the need to take medications and consent to the assistance provided. Clients unable to take their own medications because of cognitive changes may have medication assistance by a HCA as long as the client has been and it is deemed safe to do so as indicated in the established care plan.

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Medication Administration: This is more than just the task of giving a medication. It requires assessing the client, making clinical decisions and planning care based on this assessment as well as monitoring and evaluating the care provided. This role is for the Regulated health care professional.

Level 1 REMINDER Client needs to be verbally reminded to take medications, and is independent otherwise. Client manages own PRN medications. Client does NOT need to be supervised

Level 2 Some/partial assistance

Client is able to self-manage own medications with minimal assistance. Client needs assistance in opening containers, stand-by or hands on assistance, including use of PRN medications. Client does not need to be supervised to take medications

Level 3 Full Assistance

HCA takes medications out of container and assists client to take medications including PRN medications as appropriate. Client is supervised to ensure medications are taken.

The level of MAP will be indicated and any specific instructions will be written on the care plan.

REMEMBER our ultimate goal is to as much as possible. for a HCA to assist with medication delivery

- A job description outlines the roles and responsibilities of a HCA employed by a facility or agency. It is also legal protection for the HCA. Your job description MUST state that as an HCA you are to assist with medications.

- Employers have documents that set out policies and procedures that specifically describe how certain

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tasks, including medication assistance, are to be done safely. The policies and procedures should detail the type of medication system used by the employer and the types of medications that HCA’s can assist with.

and training-Before a HCA can safely assist with medication delivery, he or she must have the appropriate education and training. This education and training includes the knowledge, skills, and attitudes required to safely assist with medications.

- HCA’s who assist with medication delivery must be under the ongoing supervision, whether direct or indirect of a regulated health care professional.

of can assist with

ORAL MEDICATIONS

Oral medications may come in several different forms Solid pills, capsules, tablets, time released capsules, liquids (suspensions, solutions, syrups, emulsions), lozenges and are delivered using a controlled dosage system (dosette, bubble pack) Sublingual (Under the tongue)

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OPTHALMIC (eye) medications

Eye drops and eye ointments

OTIC (ear) medications

Eardrops are given using a dropper and bottle or directly from a nozzled bottle.

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TOPICAL medications

Consists of ointments/creams in a tube or jar, lotions, powders, scalp lotions and shampoos. The medication is put on the area affected.

TRANSDERMAL medications

Medicated skin patches. The medication is absorbed into the skin through a semi permeable membrane

INHALED medications

Medications given via the mouth that are inhaled into the lungs.

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NASAL medications

Medications sprayed or dropped (using a dropper) into the nasal passage

PRE-DRAWN INSULIN

“Pre-drawn” insulin is drawn up by a pharmacist correctly labelled and stored in the fridge or other storage area. It may come in a single dose insulin syringe or a multi dose insulin pen, where the client must dial the necessary dose. The Health care aide is assisting only, not administering the medication. You help prepare the site, observe as the client injects self, and assist with disposal of needle in a sharps container

Insulin Syringes

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Oral medications will be packaged by a pharmacy in a .

The following are examples of the packaging you may come across.

NAME OF SYSTEM PICTURE

DOSETTE

FLEX-A-TOP

POUCH PACK/MEDICATION

STRIPS

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Let us not focus on our differences but on our one

common goal….our clients!

BLISTER PACK

The Medication Assistance Program requires a collaborative team approach. Members of the care team may vary, depending upon the care setting and the client’s unique circumstance. Each team member is expected to:

Acknowledge and agree to their role Understand the roles of all other team members Clearly communicate with other team members Follow all related, current or relevant policy and procedures

There are many benefits to working on a team. Collaboration is essential. Working in a team to achieve a common goal is rewarding. It is a time for sharing abilities, skills and perspectives.

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We all come with a variety of experience, skills and talents. We need to appreciate and understand the uniqueness of individual members to make the team a success.

Effective healthcare teams incorporate the following values:

rust, mpathy, ttitude and utual espect.

Trust is and our own roles and the roles of all team members. Trust means we can be honest about our own strengths and weaknesses. Empathy is the ability to imagine ‘being in someone else’s shoes’; it means appreciating another’s experience and feelings. Not only our clients but each other’s as well. It is crucial to have a positive attitude and resolving conflict early before hard feelings develop is crucial. Mutual respect involves recognizing and striving to uphold the rights and dignity of another person. We need to accept each other’s views and the right to have them (even though we may not always agree with them). Team members need to not only share disappointments but also be able to celebrate our successes together.

Participate with the case manager in the assessment of unmet medication assistance needs and development of the care plan

Agree to participate in MAP and acknowledge their roles and responsibilities

Choose a single pharmacy to provide all medications (note: it is recommended that supportive living sites designate a single pharmacy provider to ensure standardization of processes)

Arrange for payment of any medication-related expenses, including purchasing of equipment/supplies that are required for the safety of health care providers

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Support the care team in following all protocols according to practice

setting and policy Maintain an accurate up to date medication list in collaboration with

their community pharmacist and other healthcare providers as applicable

Support the care team to ensure all medications are securely stored as per pharmacy directions

Ensure all medication changes are directed to the pharmacy for appropriate processing

Be responsible whenever possible, for managing all medications while away from the home/supportive living environment

Be responsible whenever possible, for managing PRN medications and or directing the use of PRN medications when assessed as safe and appropriate

Participate in regular medication reviews

Prescribe all medications which are then communicated to the client’s pharmacy

Review and approve the use of over the counter or OTC medication as requested by the care team

Ensure prescriptions (scheduled and PRN) contain all relevant information, such as indications for use, areas of application

Communicate as soon as reasonably possible to any regulated health care professionals whose care of the client may be affected by their prescribing decision

Collaborate with the care team in optimizing the client’s medication management support

Responsible for making sure that the medication ordered is safe for the

client

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Dispenses the medication into the container from which it will be

taken (fills dosette, bubble packs)

Check that the client is receiving the correct medication from the pharmacy providing teaching to the client and family

Assess and determine the unmet needs and develop a care plan with client/family

Delegate and ensure HCA is competent to assist with medications Supervise and mentor the HCA Ongoing assessment and evaluation of the client while on medications

Demonstrate competency to assist with medications Must follow the Care plan/MAR Ask for help when needed Observe the client Report any changes in the client Report any problems with the client/medications i.e. Medications

don’t look right, client confused, meds fell on floor, error was made assisting with medications

Communicate with clients Communicate with team Document Share information with the team Develop rapport and maintain relationships Give and accept constructive feedback Provide support and assistance Problem solving abilities

(Reflection is for your personal learning only;

you do not have to share and will not be marked on this). Self -reflection assist in identifying values and biases that could impact the care we give. We need to examine honestly our thoughts and reactions to different

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situations in both our personal and work life. By reflecting we can discover why we respond or act a certain way) (Ontario, 2010) Who are the members of my team and how can I contribute and foster teamwork in my own job? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Communication is a common theme in healthcare. It is necessary to have effective interpersonal communication to provide safe effective health care. Not only do we have to communicate with our clients, but also with one another. Health care team members share information about what has been done for the client, what needs to be done for the client and the clients’ response to care and treatment. Good communication skills lead to better relationships with clients, families and coworkers.

Successful communication occurs when the receiver understands the meaning of the message sent. Sometimes we know the receiver does not interpret the message in the way the sender intended. When this happens mistakes and hurt feelings can occur. Effective communication is affected and influenced by the following

(how we view an event or understand a message).Our perceptions are based on our cultural, educational and personal background. You always need to aware of and remember that your client’s perceptions may be very different from your own.

Your confidence and success in communication will grow with experience.

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Physical and mental conditions can

affect not only your client’s ability to communicate with you but also your ability to communicate with your clients

As a Health Care Aide you must keep your emotions under control at all times. It is important to be prepared for changes in your client’s emotions and respond with appropriate communications.

Your client may have values that are different from your own and these differences can affect their communication with you. As a professional, you must respect your client’s methods of communication without making any judgement of or reference to the difference in values.

As a Health Care provider you will be working with clients from different cultures. It is helpful to find out about their culture and respect their dignity and willingness to share information.

Males and females communicate in different ways. Generational differences often influence how we communicate.

To effectively communicate with your clients, you must understand, respect and be sensitive to each client’s unique situation and needs. You must respect your client’s culture and lifestyle. This is what providing person centered care is aout.

with your clients:

Communication is vital to everyone. It plays an essential role in maintaining a sense of self and affects our mental and physical wellbeing. When speaking or communicating with clients it is important to avoid the following:

Language to and about older people; i.e. ignoring or ‘talking over’ someone; use of patronizing or infantilising language and tone (baby talk), parental or bossy (i.e. Honey, dearie, you have to do this now etc.).

Not allowing the clients to make choices 11

Underestimating the client. Assuming because they are older they

cannot hear, or understand, or have a meaningful conversation.

These all undermine confidence, self- esteem and well-being. This can lead to loneliness and feeling left out. Infantilising or ignoring and talking over the clients makes an older person feel without any power and of little value.

Something to think about…

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How do I feel when others are rude, critical or impatient with me? Such as interactions with people in the service industry,

banking or sales clerks…

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Choose your words carefully Use simple, everyday language Speak clearly, slowly and distinctly Control the volume and tone of your voice Present information in a logical manner Ask one question at a time Determine understanding Do not pretend to understand Be courteous Introduce self to client and others Respectfully address clients by their last name DO NOT EVER use terms such as ‘honey’, ‘dear’, ‘sweetheart’

NON-VERBAL COMMUNICATIONS are messages sent without words. This is through body language, touch, or even the use of silence.

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Posture Appearance (dress/ clothing, hygiene) Facial expressions Body movements Eye contact Gestures Body language affects communication and can change the meaning of a verbal message. You need to be aware of the messages you send with your body language as well. You send messages by how you act and move. Your facial expressions, how you stand, sit, walk and look at a person all send messages. Positive messages come from;

• Attentiveness: Maintain eye contact, appear relaxed, look at and face the person you are listening to, do not interrupt.

• Voice and facial expression: Relaxed facial expressions with smile (when appropriate) and avoid frowning.

• Movement: don’t stand stiffly in one spot: sit down or move around with a relaxed open stance

Effective team communication involves: Open communication and shared decision making Actively listening to my team members (patients, clients, families,

other staff) Developing trusting relationships with my team Involving patients and families as part of the team (person –centered)

The MAP process is a collaborative process. This means we all have a role in making it a success and providing safe care to clients. This requires effective communication skills for alking to each other using the above mentioned

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strategies. cting together to care for our clients and families, to isteningeach other, and finally and understanding each other. (Let's Talk A guide for Collaborative Structured Communication, 2009)

(For personal learning only) How can I better communicate with my clients and within my healthcare team? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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The purpose of most medication is to help the body (and the individual) function as normally as possible. For example, if a client’s heart has been weakened by a heart attacked, the client may require medication to help the heart beat more strongly and regularly.

the basics of how medications affect the body is important. When a constant level of medication is maintained in the blood stream, your client will benefit most effectively from the medication they are taking. This is why it is very important to give the medication on time and as scheduled.

Understanding the basic action of medications and the physiology how each organ has a role to play in processing medications is vital to understanding how medications can affect the older adult.

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Cardiovascular (heart and vascular system)

• Heart rate slows, causing a slower pulse and less efficient pumping of blood throughout the body.

• Blood vessels lose elasticity and develop calcium deposits which result in narrowing of the vessels

• Blood pressure increases because of these narrowing and changing vessels

• It takes longer for the heart rate to return to normal after exercise • Veins become enlarged, causing the blood vessels near the surface of

the skin to become more prominent.

Respiratory

• Lungs become more rigid and stiff • Cough becomes less effective, allowing pooling of secretions and fluid

in the lungs, increasing risk of infection • Less effective exchange of oxygen, carbon dioxide in lungs

Urinary

• Bladder capacity decreases, increased urination • Kidneys function better at night/at rest causing older adults to have to

get up at night to urinate • Bladder muscle weakens, causing leaking or inadequate emptying of

bladder • Prostate gland often enlarges, causing dribbling, urinary obstruction,

and unable to urinate

Digestive system

• Saliva production in the mouth decreases, interfering with digestion of starch, and creates difficulty swallowing

• Taste buds on tongue decrease

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• Gag reflex is less sensitive, increasing the risk of choking • Movement of food into the stomach through the esophagus is slower • Stomach takes longer to empty into the small intestine, so food stays

in the stomach longer

Nervous system

• Problems develop with balance and coordination as a result of deterioration of the nerves that provide information to the brain on the movement and position of the body.

• The lens in the eye becomes less flexible creating vision problems • Decreased secretion of fluid in the eye causes dryness and itching • Nerves and blood supply to the ears decrease, causing a difficulty

hearing. • There is a decrease in the ability to sense pressure and heat/cold

Musculoskeletal changes

• A loss of elasticity of muscles causes a decrease in strength, endurance, muscle tone and therefore reaction time.

• Bones lose minerals, become brittle, and break more easily • Spine is less stable, less flexible and more easily injured • Degenerative changes and deterioration occur in the joints resulting in

limited movement stiffness and pain

Integumentary (skin) changes

• Skin thins and becomes less elastic, wrinkles appear, skin tears easily • Blood vessels that nourish the skin become more fragile and break

easily, resulting in increased bruising • Blood flow in vessels to skin is reduced resulting in slower healing. • Oil glands secrete less, causing dry, itchy skin • Perspiration decreases, and the body’s ability to regulate temperature

is impaired • Decrease in overall body water

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• Blood supply to feet and leg decreases. • Hair thins and turns gray • Less fat in skin

Endocrine system

• Blood sugar level increases because of delayed release of insulin (a hormone that regulates blood sugar use in the body)

• Lower metabolism or slower bodily functions.

Reproductive system

• Hormone production decreases, causing decreased size of testes and decreased sperm count

• Fewer hormones are produces • Breast tissue decreases and muscles supporting the breasts weaken.

Muscles weaken

Strength decrease

Bones more brittle

Joints become stiff

Mobility decreases

Blood to kidneys decreases

Kidney function decreases

Urinary frequency, urgency, and incontinence may occur

Vision/hearing decrease

Sense of taste, smell, touch decrease

Blood flow to brain decreased

Ability to respond slows

Decreased number of neurons

Respiratory muscles weaken

Lung tissue less elastic

Breathing becomes difficult

Strength for coughing decreases

Saliva decreases

Swallowing more difficult

Digestive juices decrease

Prone to constipation

Heart pumps less

Arteries less elastic

Less blood flow

Heart has to work hard to pump blood

Skin is less elastic

Skin loses its strength

Blood vessels decrease

Fatty tissue layer is lost

Skin thins and sags

Skin is fragile

Oil and sweat glands decrease

Hair whitens/thins

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DRUG PROCESSING by THE BODY

In stomach, mouth, small intestine, rectum

or blood vessels in muscles or

subcutaneous tissues or dermal layers

Incorrect administration may destroy the drug before it

reaches the bloodstream or its site of action (ie giving certain antx after meals instead of on

an empty stomach).

Drug is distributed through capillaries and across cell membranes

Poor circulation (impaired blood flow) can prevent drug from reaching the target area it is meant for.

Liver

Any damage to the liver through disease/aging may

prevent proper breakdown of the drugs causing a build-up

of the medication

Drugs usually excreted thru kidneys, sweat

glands, lungs or intestines

Kidney damage or failure may prevent the passage of drug waste from leaving the body, therefore causing build-up

Absorption

Distribution

Metabolism

Excretion

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WHAT THIS MEANS For older adults taking medications

Physiological CHANGES EFFECTS ON MEDICATIONS

Slower Gastrointestinal tract Medication is absorbed slower

Dry mouth Difficulty swallowing medications

Decreased blood flow to organs

Delayed metabolism in liver, kidneys, means body unable to get rid of

(excrete) leads to toxicity of medications.

Decrease fat in skin Decrease in absorption from patches

Decrease in body water Increased toxicity of water soluble medications

Decrease of proteins in blood Toxicity of protein bound drugs

Decrease in blood flow to kidneys Toxicity of drugs that aren’t being excreted

Increased sensitivity of drug receptors

Increased drug effects of some drugs, decrease in other drugs

Visual and hearing changes Interference with being able to take

own medications or hearing instructions on how to take safely

Changes in the brain Increased central nervous system side effects (tremors, falls)

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A side effect is an unwanted response to a medication that occurs with the intended response.

For example… a person taking a pain medication may feel pain relief, but may also experience constipation and nausea. Many side effects are predictable and relatively harmless. However, others can be serious and need to be reported to the supervisor.

Common Side Effects include:

Sleepiness Weakness Thirsty, dry mouth Dizziness Chills Cramps Diarrhea Sweating Trembling Blurred vision

These examples are a guideline. Always report ANY changes you see in a client.

Confusion Falls Bruising Incontinence Skin Rash Fainting Difficulty Breathing Hearing or seeing things that aren’t there

Mood changes Headache Upset stomach Vomiting Bruising Bleeding Sleeplessness Loss of appetite Lack of energy

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An allergic reaction is an abnormal response to a drug caused by the body fighting or attacking the drug by releasing chemicals called the antibodies.

Antibodies attack the medication and can cause symptoms ranging from mild;

• Skin rashes • Swelling • Puffiness • Nasal drainage • Itchy eyes

A severe sensitivity to an antigen (medication) that occurs very quickly and causes a life threatening response involving the whole body. This reaction can lead to difficulty breathing and shock and can ultimately lead to death.

Signs and Symptoms include: • Development of severe reddened warm skin with hives • Sweating • Shortness of breath • Low blood pressure • Irregular pulse • Breathing difficulties • Hoarseness • Unable to breathe

MILD MODERATE

• Fever • Wheezing • Nausea • vomiting

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The purpose of the clients care plan (also called a support plan or nursing care plan) is to outline the care a client will receive. It ensures consistency of care by the health care team. The care plan has the client’s identifying information and may be written so it can be reviewed and updated regularly by a regulated health care professional. The care plan should contain the clients’ diagnosis, goals of care and the activities to support these goals. Health Care Aides are front line care providers who spend much time in health care activities with their clients so their input is extremely valuable.

Special instructions are

on care plan

Harry

Oct.1/2014

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An example of some of the information related to medication assistance that may be on the care plan is:

• Give medication in applesauce- Some clients prefer to swallow their oral solid medications with applesauce, and moistens the mouth to prevent the pills from ‘sticking’.

• Ensure client is lying down in bed when giving eye drops. Some clients may wish to have their eye drops or ear drops in a lying down position instead of a sitting position.

• Full assist with transdermal patch. Partial assist with oral medications-Set up only. The care plan should indicate the level of assistance needed for that client. Certain tasks may require different levels of assistance based on client abilities and needs.

• Approach client from right side or from directly in front; Speak to client while approaching to alert her you are there. Some special techniques may be used for clients who may have challenges such as dementia. (Wellness, 2013)

Communication is the key. The care plan is another form of communication. If you are caring for a client and they talk to you about a certain request, or you notice a certain approach that works well for that client, discuss this with the care team so this information can be added to the care plan. This will make providing the care easier for both the caregiver and clients.

Care plans need to be read very carefully. A care plan will give the reader special instructions on exactly how to assist with the medications. It also should specify things like, what order to give medications, and special things to observe for such as bleeding gums or other side effects that are relevant.

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Also called charting or reporting. This involves recording care and observations.

The most common form for documenting medication assistance is the Medication Assistance Record (MAR). The MAR is a legal document used to record all types of medication the client may be taking.

The HCA should know how to read the medication list on the MAR and locate the times that the medications are given. The MAR should list the medications exactly as they appear on the medication label on the packaging or medication bottles.

Based on the facility process and type of MAR, the HCA may have to verify the appropriate name/size/shape/colour of each tablet/capsule. Sometimes medications on the MAR are grouped by the time of day or event such as breakfast medications, noon medications, and supper or bedtime medications.

When documenting, the HCA is accountable for:

• Signing that assistance was provided according to directions in the care plan.

• Sign for all medication support activities immediately after assistance with each client- Never document assistance before it is given

• NEVER document information for another staff member • Use permanent black or blue ink: Never write in pencil or with

erasable ink • Never use white out, markers or obliterate an entry such as scribbling

out an error.

Employers are required to have their own policies and documentation records. It is the employer’s responsibility to instruct you on which forms to use, how often to document, what to document, when to document and who should document.

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When documenting it is your responsibility to focus on:

• What you observed, (including what the client reported to you) • What you did • When you did it • The client’s response • Be precise and accurate • Provide details of what you see, hear, touch and smell • Report the clients exact words • Do not assume or make inferences (e.g. instead of: ‘the client was

unhappy’ write ‘the client seemed unhappy, she did not smile as she usually does when I arrive and she sat looking out the window, responding to questions with one word answers only’

• Include the date and time • Ensure you writing is legible and neat • Use only approved abbreviations • Never chart until you actually assist with medications • Be accurate and concise • Report any changes from normal or changes in the clients condition Document that you reported information about client to your supervisor

The client chart and information on the computer is confidential. You are ethically and legally bound to keep this information confidential. This includes any information about the client that is recorded. Always remember… If you know what you know (about the client) because of your job, that information is not to be shared!

Only health care team members who are directly involved in the client’s care have access and can use confidential information. Discussion about clients’ personal information is only with the team providing care for the client. Talking about the client outside of the care setting is not appropriate, violates their right to privacy and is illegal!

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Health care or ‘hospital’ acquired infections are serious client-safety issues and may lead to serious injury or even death of clients. Specific infection prevention and control guidelines apply during medication delivery. Routine practices are used when there is potential for contact with blood and body fluids.

Hand washing and hand sanitizing are key aspects of infection prevention and control. These are also a very important part of assisting with medications. Gloves are used when there is potential for contact with blood and/or body fluids or mucous membranes. Gloves are not a substitute for proper hand washing.

.

Assisting with medications requires the use of CLEAN TECHNIQUE. This means that you will prevent the medications or the supplies used from being contaminated. It also means that medications are prepared using clean supplies and in a clean area.

Maintain asepsis by following Universal Precautions

• Use disposable items (i.e. medication cups, drinking cups,) • Wear gloves ANY TIME there may be contact with blood, mucous

membranes and any body fluids (urine, feces, vaginal secretions, saliva, respiratory secretions,)

• Wear gloves if you have any opening in your skin

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• Wash your hands and giving medications. • If the client’s skin is not clean where you will be applying a topical

medication, and t gently before applying the medication. • the client has signs of where you will be

applying medication or if you will have contact with the client’s body fluids when giving medication.

Handle medications in a way that ensures your hands

• Wear to prevent your skin from having contact with and absorbing the medication.

• Place the s of medication bottles or containers on a clean surface to prevent anything from touching the inside of the lid.

• Store medication and equipment in a area.

These ‘rights’ must be checked 3 times in total. 2 of these times are by the health care aide including once while preparing medications and once just before giving to client.

Who is the individual that should be receiving this medication? In the client’s home, this might be easier to identify. In a lodge setting where there are many clients, it is very important for you to take the appropriate steps to accurately identify the client for whom the medication is intended.

The Health Care Aide must use to

medication assistance tasks are performed. The Health Care Aide obtains the client identifier and verifies the identifiers against the care plan or controlled dosage packaging.

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Acceptable Client Identifiers

Ask for the Client’s first and last name (No prompting) Client’s Date of Birth Client’s Unique Lifetime Identifier (ULI) Client’s personal Health number (PHN) Client’s medical record number Client’s Patient identification barcode Client’s government issued identification number Recent photograph (used in settings with an approved photo

identification process in place)

You need to ensure that you read the label on the medication very carefully so that you are giving the right medication to the right client at the right time.

• Controlled dosage/packaged medications containing the client’s regular medications: The names of the medications are listed on the packaging (e.g. back of blister pack) you need to note the number of pills to be given at a specific time.

• For medications not in a controlled dosage system (liquid medications) you need to read the name of the medications on the label.

o Check that the name of the medication on the medication label matches the name of the medication on the MAR (Medication Administration Record)

o If the medication is a liquid, it will have the strength of the medication listed beside the name on both the medication label and the MAR. Check that these are the same i.e. Refresh Tears 0.5% OR ampicillin 250mg per 5ml.

o Check that the medication is intact o If the client or family member states that the pills do not look

right, do not give the medication. Call your supervisor.

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The dose for medication in dosette is most often written on the back of the dosette. For regular medications dispensed in blister packs, the dose of the medication will appear on the label or foil at the back of the blister pack.

• In a rare circumstance if you must give any medication from a container of medications you need to carefully compare the dose of the medication listed on the MAR. Again, if they are not the same, DO NOT ASSIST with the medication.

• If you do not understand an abbreviation that is used on either the MAR or medication label, check with your supervisor, before assisting with the medication.

• Drops or Liquid medication: It is advisable to make sure you have measured the dose accurately. MEDICATION doses need to be measured exactly. It is not acceptable to estimate.

• Double check to ensure the client takes all of the medication you offer. If he/she was unable or did not to take all of the medication, it is required that you document what was taken and what was left.

The timing of medications is important because it maintains a constant level of medication in the client’s blood. This maximizes the effectiveness of the medication.

• Check that the time the medication should be given is the same on the medication label and the MAR. If there is a difference, contact your supervisor.

• If a medication label states specifically that a medication is to be given before meals or after meals, give the medication accordingly.

• If several medications are given together make sure you know in which order they are to be given. If two different eye drops are to be instilled in the same eye, you need to know which eye drop to put in

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first and how long you must wait between each different eye drop. This information should be in the care plan.

Some medications can be given using several different routes. The label on the medication and the MAR should clearly indicate the route by which the medication is to be given.

ORAL- pills or liquid medications that are taken by mouth. The majority of medications are given this way because it is the most safe and efficient route to use.

SUBLINGUAL- Small pills or a spray that is placed under the tongue for quick absorption.

INHALATION- Puffers or side stream nebulizers instill medication directly into the lungs to help breathing.

TOPICAL- Lotions, creams, ointments, shampoos applied directly onto the skin.

TRANSDERMAL- Specialized patches that are placed on the skin. They are specially designed to release medication slowly so it is gradually absorbed through the skin.

OPTHALMIC- ointments or drops instilled into the eyes.

OTIC- Drops instilled into the external ear canal.

NASAL- Drops or sprays instilled in the nostrils of the nose.

Any medication that is given must be documented properly, according to your agency policy. Medications are usually documented in the MAR. It is your responsibility to document immediately once you have assisted with the medication for each resident.

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The client has the right to refuse medications and live at risk. The HCA respects the client’s right to refuse medications. If the client refuses their medication, the HCA should document the refusal and immediately

. notify their supervisor

-This check is done by the health care professional who verifies the completeness and appropriateness of the prescriber’s order. This step should be completed in the pharmacy prior to delivery of the medication to the practice setting. If the HCA has reason to believe the first safety check has not been done (ie. The tablets/capsules in the controlled dosage system are not consistent from day to day, or the client indicates that the medications look different than usual), they must contact their supervisor or health care professional prior to assisting with the medication.

- This check is done by the HCA just before preparing the medication while it is still in the package. The HCA verifies the medication label with the care plan and medication record and identifies any special instructions such as ‘shake well’, ‘give first’ etc. The expiry date is checked and the seven rights are reviewed.

- This check is done by the HCA just before medication assistance is provided. The HCA prepares the medication according to instructions and before assisting the client the seven rights are reviewed again to ensure the right medication, is given to the right client, in the right amount, by the right route, and at the right time.

Errors/ adverse events are described as ‘any preventable event which may cause or lead to inappropriate medication use or client harm while the medication is in control of the health care professional, HCA or client.’

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Examples of Adverse Events

Medication dose was missed by staff (not considered an adverse event if the client refused the medication or the medication was unavailable)

Client received medication that was expired, discontinued or past the stop order date.

Medication assistance was provided either too early or late (ie. Greater than 1 hour before or after designated time or outside the instructions in the care plan.)

Medication was given twice within the same time frame Medication given via the wrong route or to a different site than

indicated. Medication patch was not removed at the prescribed time. The client received a medication that was not ordered for the client. Inaccurate documentation and charting of medications. Altering the medication form without direction to do so (crushing a

med to put in someone’s food when this was not instructions on the care plan)

There are many reasons errors are made. A common contributing factor to medication errors and poor management of medication delivery times are caused by frequent interruptions. When you are assigned to assist with medications, particularly with several clients, it is necessary to focus directly on the task at hand. You need to be organized, prepared and have processes in place to prevent interruptions. If a client raises an issue or requests help while you are assisting with medications, you must stay focused on the task until it is finished. Politely let the client know you must finish the task you are doing and then you will gladly help them. Complacency or not paying careful attention while doing the same routine tasks over and over again may increase chances of medication errors. Also,

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being overconfident and omitting the necessary safety checks while assisting with medications can lead to errors.

We all make errors at one time or another; it is human to do so. In healthcare we support a ‘Just Culture Philosophy’ where everyone feels safe, encouraged and enabled to discuss quality and safety issues where reporting and learning are critical, such as when an error is made. (Alberta Health Services. Just Culture Guiding Principles) We feel bad when an error is made that could potentially cause harm to our clients. We also may feel fearful that we may be in trouble. However, it is very important to report these incidents immediately to ensure prompt intervention is initiated for client safety and care.

If an error is made, the HCA should take the following steps: Notify the immediate supervisor, case manager and health care professional, follow instructions and report back if required.

Document what was observed, instructions received, care provided, the names and roles of the person contacted.

Complete an incident /adverse event report according to employer policy.

Client safety is the number one reason for reporting errors. Another reason is to assist in identifying how to potentially eliminate the risk of the error occurring again. By gathering information on the error and how it happened gaps in the system can be identified and appropriate adjustments made to prevent this type of error from happening again. By reporting the error you are protecting the clients’ health. Admitting, reporting and recording mistakes in a timely manner so that clients may be assessed and monitored and corrective actions can take place is the Right thing to do.

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Problem solving is a process. You will learn in the classroom on how to problem solve effective solutions to some behaviors you may see in clients with dementia or mental health challenges. The process of problem solving involves identifying and analyzing a problem, finding a solution and devising a plan to apply to that solution.

You must first determine if you have a problem and what it is. Ask yourself these questions:

• Is the situation or issue affecting me, coworkers, or a client? • Can I contribute to a positive outcome? • Does the issue require immediate attention?

Analyzing a problem involves COMMUNICATION. You need to ask the client questions about the problem; listen attentively to the answers and pay attention to both verbal and nonverbal messages. Once you know the problem, think about what kind of problem it is and whether you can solve it on your own. REMEMBER to consult your supervisor when: There is an emergency You observe a change in the client’s condition or normal functioning The client becomes ill (vomits, diarrhea, fever) Client is in distress You believe the client’s safety is at risk A problem with the clients medication (it doesn’t look right) The client complains about his/her condition The client or family member asks you to do something that goes

against the care plan You have a conflict with a client or family member

Try and think of many different solutions. Decide which is the most practical and helpful, but always safe. (Sheila Sorrentino, 2013)

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Example: The HCA needs to help her client get dressed in the morning. Every morning this particular client chooses to wear the same tattered sweater. The HCA doesn’t want her client to wear it as she thinks that it doesn’t look nice and will be judged for putting her in that old tattered sweater. This client has other clothes, she however chooses this one every day. In applying the problem solving process the health care aide must ask these questions:

1. Is the situation or issue affecting me, a co-worker, or my client? No

2. Should I be concerned about what is happening? No

3. Can I influence or contribute to a positive outcome? No

4. Does the issue require immediate attention? No

The sweater is clean, the client wants and chooses to wear it and it is not affecting anyone. The situation just requires thinking about it differently. If the HCA would have forced the client to wear a different sweater so that she would ‘look better’ according to the HCA’s preference, then really the HCA is not allowing the resident to make their own choices. This then becomes an actual problem.

will often require contacting your supervisor immediately. The following are the most common issues you may find and the solutions to them.

Expired Medications

Expired medications can have the potential to cause unintended consequences for a client.

• Do not assist the client with this medication and inform the client why

• Decline to assist even if the client insists on accepting the medication. • Dispose of the medication according to the established process (i.e.

discard drug box, set aside for family to return to pharmacy) • Notify immediate supervisor case manager or health care professional • Document observations and response to the situation.

Refused Medications

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Clients have the right to refuse medications. If the client refuses the HCA will:

• Ask the client why so they can document the reason stated by client and notify supervisor of reason.

• Dispose of the medication according to the established process • Notify supervisor immediately • Document observations and response to the situation-documentation

must indicate that the medications were offered and refused by the client, the manner in which the medications were disposed of and the actions taken by the HCA.

Spilled/Dropped Medications If medications are spilled or dropped on the floor they are contaminated and cannot be ingested by the client. The HCA shall:

• Ensure all medications are located and verified by count, shape or colour of the medications against the description in the care plan or from the label on the controlled dosage system.

• Dispose of the medication according to the established process • Report the contamination to the immediate supervisor.

Client Vomits after medication If a client vomits after ingesting medications the HCA tends to the client’s immediate care needs and then is responsible to:

• Use routine infection prevention control practices when cleaning up vomit (wear gloves etc...)

• Check the care plan for any special instructions • Notify immediate supervisor • Document observations and response to the situation

Discontinued or Undocumented medication If the HCA observes a medication present which is not on the medication document record, the immediate supervisor should be contacted for further instructions. The HCA will not assist the client with this medication.

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Emergency situation The HCA shall follow established processes regarding emergency situations when the client has a suspected severe allergic reaction or severe adverse reaction. The HCA shall:

• Call for assistance from another person or care provider • Call 911 if client is in immediate danger (unable to breathe, sever

bleeding or pain, change or loss of consciousness) • Remain with the client to provide comfort • Enable access to EMS • Provide any requested information

Once the client is under the direct care of the health care professional, the HCA should report the situation to their immediate supervisor. The HCA will also document their observations and response to the situation.

The client or family indicate the pill doesn’t ‘look right’ • Do not give • Call supervisor

A family member requests some but not all of a client’s pills to give to the client (i.e. when a client is having day surgery, he/she may only take certain medications before the procedure.)

• Give the family member all of the pills for that time and let him/her select the desired pills.

• Document this in the MAR and Chart • Notify supervisor

You notice alcohol smell on a client or near clients’ medications when assisting with medications

• Do not be judgemental • Ask the client out of concern as taking alcohol

with medications can be dangerous • Notify supervisor • Document your observations

Remember: Your supervisor is always available to help provide guidance. Even when you work in

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the community, you are not alone; there is someone at the other end of the phone for you to call when you need it.

SUPERVISION:

Health Care Aides must have some level of supervision by a Regulated Professional at all times when involved in any kind of medication support. Supervision and guidance can be provided through the following: Direct Supervision- A regulated Professional is present at the point of care (directly with the HCA) Indirect Supervision- A Regulated Professional is readily available for guidance and consultation in the same location where care is being provided, but not directly with the HCA.

Indirect Remote supervision- This is seen in community settings. The regulated professional is available for guidance and consultation but is not physically located at the point of care. They need to be contacted through the use of technology such as a telephone, pager or other electronic means to provide verbal assistance or guidance as required. (CARNA, 2013)

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NOTES

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NOTES

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