medication policies & procedures for the elc...• the bottle needs to contain the appropriate...

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UCP’sMedication Policies

& Procedures for The ELC

Required Training

• Administering medication is a tremendous responsibility.

• There are thousands of medications on the market and many new ones are approved for use each year.

• Staff are expected to know the nature of every drug they administer.

• This information can be found on the attached prescription label or attached doctor’s note.

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Required Training

• It is essential that all ELC employees be well trained on medication administration policies and procedures.

• All ELC employees must take and pass the UCP policies and procedures training. Although only designated individuals may administer medication it is important all staff understand and adhere to medication storage and administration policies and procedures.

• The Director is the designated administrator, in her absence the lead teachers are authorized to be the designated administrator.

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Know the 6 Rights

The Right Person

The Right Medication

The Right Dose

The Right Time

The Right Route

The Right Documentation

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Common Abbreviations

To administer medications properly, it is essential that you understand the meaning of the terms which will be used in medication administration – you will encounter and use these terms on a daily basis.

BID=Twice a day OTC=Over the counter

TID=Three times a day PM=Afternoon

QID=Four times a day PO=By mouth

AC=Before meals PRN=As needed

D/C = Discontinue QD=Every day

HS = Hour of sleep NPO=Nothing by mouth

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Types of Medications

Medications come in different forms, such as:

• Liquid preparations: Those containing a medication, which has been dissolved, or suspended in a solvent. Two common solvents are water and alcohol. Liquid preparation are designed to be consumed and are quickly absorbed through the stomach or intestinal walls. Liquid medications are usually administered using a measuring spoon such as a teaspoon or using a liquid medication measuring cup. If a member has a problem with alcohol, please remind the parent/guardian of the facts.

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• Tablets, Caplets, Pills: Are the most popular form of medication used today and usually come in one of two forms: capsule or solid tablets. Some tablets are scored. Scored tablets are marked with indented lines which divide them into halves or quarters. This scoring allows them to be broken easily for administering a proper dose (for example, Lasik). You should never divide a medication that is not designed to be divided. ELC staff do not alter medication in any way, including cutting doses.

• Ointments/Creams (Topical): Ointments and creams are generally used on the skin as a topical medication.

• Suppositories: Mixtures of drugs in a waxy base, which melts at body temperature. Molded into shapes that are suitable for insertion in the rectum, vagina or urethra. ELC Staff do not administer suppositories.

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• Nose Drops: Have member remain I position until medication reaches throat (2-3 seconds). Replace medication dropper in bottle or wash if not part of bottle. Use tissue or cloth to wipe off any spilled medication from member’s face area.

• Eye Drops: Draw medication into dropper. Pull down lower lid by gently placing index finger in center of lower lid, below lashes. Have member look upward. Place proper number of drops in inverted lid. Instruct member to gently close eyelid, dry cheeks and lids.

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Administration for Liquid Medications

• If using a disposable med cup, place cup on a flat surface, squat down so you are eye level with the prescribed amount.

• Hold bottle covering label with your hand to protect from med running over label.

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• If using a med dropper, draw up the amount needed. Holding the dropper at a 45-degree angle, release the med into a med cup.

• If syrup is intended to soothe, such as a cough syrup, it should be given undiluted and should not be followed by juice or water.

• Med glasses should be thoroughly washed with hot, soapy water and scalded with hot water.

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• Elixir is generally a potent preparation and dose is usually small. ELC Staff may not alter medication, including diluting medications.

• Bottle rim should be wiped before replacing cap. If any medicine dripped down label side of bottle, wipe clean before putting away.

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Administration of Tablets, Capsules, Pills

Pour out the required number of tablets, capsules or pills into the cap of the med bottle first, then to the dixie cup.

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Administration of Tablets/Capsules Pills

• ELC Staff may not alter medication in any way including cutting, crushing, opening or adding to food or liquid.

• Infant formula or breast milk bottles containing medication over the counter or prescription, may not be served or stored during program hours.

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Administration of Tablets/Capsules Pills

• Soft gelatin capsules should NOT be opened.

• Spansules are capsules with small particles that dissolve at varying times to provide longer effect. Spansules should not be given less than 12 hours apart.

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Administration of Topical

• Wear gloves when administering topical medication.

• Clean area of body where medication will be applied.

• Apply medication using clean gauze, paper towel, tissue, etc.

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Medication Storage and Inventory

• Members attending the ELC are expected to provide their own medications.

• Whenever possible, medications will be administered before or after program hours. Medications should only be given during program hours when required to maintain schedule or as prescribed by a physician.

• Family members/residential staff shall give mediations to staff upon arrival at the day program site.

• A designated staff will inventory the medication to ensure an adequate supply and to verify all medications received are according to the label including name, dosage, time, route, reason for med, change in med and a valid date on the prescription bottle.

• Medications are placed in a secure locked designated storage area – unless the medication is a life saving medication such as an epi pen. (Medications stored in the refrigerator must be kept locked in a lock box.)

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• Any discrepancies are to be reported immediately to the parent and the medication must be sent home.

• If medications have expired, they should be returned to the parent/guardian. This includes over the counter medications.

• Prescription medications must be contained in a bottle from the pharmacy with an accurate, complete and legible label along with a medical consent form.

• The bottle needs to contain the appropriate amount of medication that will be administered at the program for the duration of the required prescription.

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• In addition, over the counter medications (with the exception of diaper cream and sunscreen) must provide a physician consent stating their full name, name and dosage of medication, route and time of administration, as well as a completed Medication Consent Form for staff to administer medications.

• Homeopathic remedies will not be administered.

• Medications must be stored under sanitary conditions and in a manner that is consistent with the label instructions.

• All medications are to be stored in their original container and the container must be kept clean.

• Containers for liquid medications must be wiped clean and closed tightly following administration.

• Pain relieving or fever reducing medications (i.e. Tylenol, Advil or Motrin) will not be administered during program hours unless medical conditions require these medications. In this case, the child must be sent home after administration.

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• Medications can be administered from the prescription bottle or bubble pack.

• In any case, the medication container must be clearly labeled with the member name, medication name and storage.

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Medication Administration

• An assigned staff will be responsible to administer medication for the day, week and or month. In addition, a second staff will observe the administration process.

• If assigned staff is absent, a supervisor will ensure there is a back up staff assigned to administer medication.

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Following the important steps below will empower staff to successfully administer and prevent contamination:

Designate an area to administer medications. Use an area that is easily accessible for the members to be able to come to you. And large enough to hold the necessary supplies.

Wash your hands and wear gloves (that’s mandatory) for everymedication.

Inform your co-workers that you are about to administer medications. This will cue them so you are not distracted.

Retrieve all necessary supplies: med cups, measuring cups/spoons, water and/or food (pudding/applesauce) needed to administer medications, mediation storage box, med logs, and a pen.

Read and check the label and check it against the med chart.

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Take out one member’s medications and medication log at a time. Double check to ensure it matches the medication recording log, prescription bottle or bubble pack.

Check the “6 Rights”:

1. Right member

2. Right medication

3. Right time

4. Right dose

5. Right route

6. Right Documentation

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Once you have ensured that you are administering the medication prescribed, place the medication in the medication cup, ensuring you do not touch the medication with your hands.

Gloves must be worn when giving medication.

If the medication touches your hand and you’re not wearing gloves, the medication is considered contaminated and must be destroyed.

If you are wearing gloves the medication is not contaminated, however, you need to change your gloves in between medications to avoid cross contamination.

Ask the member to come with you to a quiet area to administer medication. If the member is unable, be sure to lock all medications before you leave designated area.

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Hand the med cup, and water/food needed for the member to take their medication and watch the member swallow their medication.

Once you see the member swallow their medication, immediately document the administration in the med log by initialing for the medications given. A second staff will witness the administration of medications.

Do not administer medication to another member until you complete member’s med log. Do not administer medication to all the members before you document in the med logs. Do not wait until the end of your shift to document medications.

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Follow the same routine for medication administration, like the same place in the home.

Document initials on med chart for the correct date, time and med AFTER the med has been administered and swallowed. NEVER BEFORE.

Staff members should be knowledgeable of the drug treatment plan for behavior modifying meds for each individual prior to administering the med in order to be aware of side effects.

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Medication Records

When a new medication is started or any prescription information changes, the designated staff will collect a new Medication Administration Form.

The name of the medication, the dosage, the route and planned time of administration(s) will be indicated on the form. Specific times must be listed unless it is an “as needed” medication. If “as needed” the form must include the criteria.

Each staff who administers medications should first sign as well as the second staff who witnessed the medication administration will initial the Medication Record.

After the administration of the medication, both staff must place initials across from the medication time/dosage under the correct day.

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Medication Records

DO NOT use ditto marks, white out or pencil on a Medication Record. This is a legal document.

If a dose is missed (i.e. 60+ minutes off scheduled time) note on medication form.

If a full dose is not ingested (i.e. child spits out) note on form, do not attempt to give another partial dose.

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Medication Discontinued

• The Program Supervisor/Lead should ensure that remaining medication is returned to the parent. We do not discard any medications.

• If a medication cannot be administered due to a special circumstance, circle the box and explain the reason on the back of the sheet.

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Medication Documentation Error

Any of the following examples constitutes a medication error:

Wrong Member: For example, giving an individual someone else’s medication.

Improper Dosage: For example, giving too much or too little medication

Wrong time: For example, giving a 4pm medication at 8pm

Forgetting to Give a Medication: Realizing at 4pm that 8am medications were not given.

Late: Giving medications more than one hour late. Medications must be administered within an hour before or an hour after the scheduled medication time. When this time frame is exceeded, a medication error has occurred.

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At any time a member’s health is at risk due to a medication error, call 911 immediately.

If there is a medication error, staff will notify the Director and then contact the medical personnel (pharmacy, poison control, physician, nurse, etc.) for instructions.

The family/guardian will be contacted and an incident report completed.

Staff should then document the error on the Medication Record.

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If the staff should make a documentation error (for example, initials in the wrong box), the staff draws a single line through the error and circles the entry and initials error and write an explanation on the back. Do not use white out, do not black out the error, do not write over the error and do not erase.

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Review and Corrective Action of Medication Error

Medication errors will be reviewed by the Program Director; the review will address the need for additional training, coaching, and possible discipline of staff.

The review will also be utilized to determine if changes need to be made to UCP Medication Administration training or policy.

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Charting

• Black or blue ink must be used.

• Don’t use white out. Don’t erase. This is a legal document. Circle box with your initials and chart reason on the back of the medical record.

• Familiarize yourself with medication, dosages and abbreviations.

• Document medications as given after member has swallowed it.

Quiz Time

Please refer to the Medication Policies Quiz – DTA/DTT on the intranet under Training Opportunities and take the quiz. Print out the quiz, compete it and return to Melinda or Campbell-Weber or Daniela Serrano by fax, email or mail.

Thank you!

This training material has been created for the exclusive use of UNITED CEREBRAL PALSY OF CENTRAL ARIZONA and may not be used for any other purpose without the express written consent of UNITED CEREBRAL PALSY.

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