10 Rights and Medication Orders

10 Rights of Medication

• Right medication
• Right person
• Right dose
• Right route
• Right time
• Right day
• Right reason
• Right expiry date
• Right documentation
• Right education

Process of How Medication Orders are Given

• Prescribed by MD/NP to a client and filled by a Pharmacist
• Can be given in bottles or blister packs for daily/weekly use
• Personal medication, if not in a blister pack, can be put into a daily dossette.
• Blister packs use a 7-day dossette

Process of How Medication Orders are Given - Hospital

• Medication prescribed by MD/NP on MD notes in the client's chart
• Transcribed by a nurse to MAR (PSWs not allowed)
• Subsequent steps depend on the hospital, individual bottles with patient labels are sent
• Daily doses that have a barcode to be scanned using client arm ID and electronic records

Process of How Medication Orders are Given - Long Term Care

• Medication prescribed by MD/NP on MD notes in client's chart
• Transcribed by a nurse to MAR (PSWs not allowed)
• Order sent to facility pharmacy
• Subsequent steps depend on the facility, individual bottles with patient labels may be sent
• Daily doses that have a barcode to be scanned

Safety Components of Medication Management

• Need to understand how to follow directions.
• Apply school-learned theories to real-life situations.
• Understand medication abbreviations
• Read military time accurately
• Read labels
• Read and use MAR
• Perform the 10 rights of medication management
• Perform simple math calculations

Delegation Process

• Review the document of D2L with the delegation case scenario

Following Directions

• Accuracy is more important that speed
• Read with care or twice if necessary
• Ask for clarification if unclear
• Do not assume knowledge or understanding
• Understand the responsibility involved
• Use school experience in following directions as a guide

Medication Abbreviations

• ORAL = PO
• INTRAMUSCULAR = IM
• INTRAVENOUS = IV
• IMMEDIATELY = STAT
• AS NEEDED = PRN
• Every 4 hours = q4h
• Every 6 hours = q6h
• Before meals = AC
• After meals = PC
• Twice daily = BID
• Three times daily = TID
• Four times daily = QID
• Before bedtime = qhs

Accurately Reading Military Time

• Ensure you know military time

MAR

• MAR (Medication Administration Record) is a legal document of actions related to medication administration
• The patient's care plan details the care required and medication assistance
• The exact form varies by setting and employer
• It always contains the client's name, medication name/dose/time/administration instructions, and a place to initial after administering medication
• Can be paper or electronic
• Can contain extra information such as client's allergies, expected adverse effects, and special instructions

Do's and Don'ts

• Medication should be stored in the original labeled container with the lid tightly closed
• Remain with the client until the medication has been taken.
• Do not remove labels from the containers
• Do not use discolored or deteriorated medications
• Do not leave any medications at the client's bedside
• Do not assume that the client will take them correctly.
• Medications must not be taken from an unlabeled container or that has an unreadable label
• Check the expiry date on the labels before giving medications to the client
• Notify your supervisor of expired or deteriorated medication

Medication Storage

• Store according to the label or packaging instructions, like refrigeration
• Otherwise, store it in a designated location just for the client's medication
• Store in a cool and dry place (not in the bathroom medicine cabinet)
• Keep out of reach of children and people with dementia
• Keep the medication in the original labeled container and lid tightly closed
• If medications are running low, tell the client/family and your supervisor

When to Report to Your Supervisor

• If the client does not take medication correctly
• If the client does not understand why medication should be taken or know the dosage/schedule involved
• If the client refuses to take the medication or forgets/omits a dose.
  • The client should not take a double dose if one has been omitted.
• If the client shows any adverse effects.

When to Escalate to Your Supervisor

• Listen to your client
• If a client questions something about medication, STOP and call your supervisor immediately
• Ask on the slides to give some examples of questions that a client might ask about their medication
• Use validation techniques:
  • It seems like...
  • It sounds like...
  • I can't imagine how you feel...
  • I can tell you are upset...
  • I can see this is affecting you...
  • I get the sense that...
• If the client wants to take medications (including OTC) that are not listed on the MAR and care plan
• If the client wants to take medications other than those in the dosette
• If the client wants to take medication prescribed to someone else
• If the client takes any other medications.
• If the client takes recreational drugs or alcohol - mixing prescription medications with these substances may cause a drug interaction
• If the client complains that the medication is no longer working/producing the desired effect
• The client's medication dose may need to be increased, or another medication may have to be substituted
• Good rule of thumb: if you are not sure, speak to your supervisor.

Discarding Medication

• Never discard medications down the toilet.
• If medication drops or is found on the floor, discard it according to the agency's policies, which may include a witness and completing an incident report.

Medication Error

• A failure in the medication treatment plan that leads to, or has the potential to lead to, harm to the client.

Types of Medication Errors

• Failure in one of the rights
• Giving the wrong drug, wrong route, wrong time, wrong dose, or wrong patient
• Errors in technique, such as dropping a pill in the sink
• Omission

Reporting Medication Errors

• Need to report to your supervisor immediately and you are required to report an error
• Failure to do so could result in a dismissal or a civil action
• An incident report will be filled out by you and your supervisor
• It will be kept on the client's record, but is not meant to be punitive, to ensure that any untoward effects of the error on the client may be monitored
• An incident report must be filled out if you believe you made a drug error, you noticed a drug error was made by someone else, or a medication was documented incorrectly