Ms. P's Updated Doctor's Orders

• The DOT (Doctor's Orders) for Ms. P has been changed.
• Ms. P's prescription cream was discontinued
• Ms. P. has developed a flu and ear infection
• Ms. P's productive cough and her asthma has worsened

New Doctor's Orders

• Polysporin (antibiotic) ear drops to each ear daily for 7 days in the evenings
• Amoxil antibiotic “suspension” 30ml four times a day (QID)
• Advair Diskus medication is to replace the Ventolin at bedtime
• Document these changes on the MAR (Medication Administration Record) immediately

Special considerations

• Advair is a combination of Ventolin and Fluticasone (steroid)
• Shake Amoxil Suspension before pouring
• Provide oral care after diskus administration

Medication Information and Responsibilities

• Polysporin ear drops must be administered daily in the evenings and when needed
• Administer while performing ear hygiene.
• Amoxil suspension must be shaken before pouring
• Make sure that the amount of 30 ml is properly measured when administering 4 times a day
• When giving Advair Diskus medication, ensure it is used instead of Ventolin
• Assist her with one dose at bedtime, and provide a cup of water for her to rinse her mouth after every use to prevent side effects

Suspension Administration

• Shake the suspension well before pouring.
• Use an oral syringe or medicine cup for accurate dosing.
• Make sure to finish the entire prescription, even if symptoms improve

Required observations with each medication

• Polysporin ear drops: observe for swelling and redness which indicates allergic reaction.
• Amoxil suspension: observe for rash, swelling, breathing issues, nausea, diarrhea
• Advair Diskus: observe for white patches in her mouth which shows the sign of oral thrush, increased heart rate, shakiness or sleep disorder.

Adverse Drug Reaction vs Side Effect

• An adverse drug reaction (ADR) is an unintended reaction to a drug that can be harmful, severe, or life-threatening.
• Side effects are usually not so harmful and are manageable, such as dizziness and drowsiness.

Diskus Activation Duration

• A diskus is effective for 30 days once activated.

Shaking the diskus

• Do not shake the diskus before or after use because the medicine in the diskus is a dry powder, not liquid.

Breath-holding after diskus Inhalation

• The client should hold their breath for 10 seconds after inhaling the medication to allow time for the lungs to absorb the medicine.

Positioning and Administration of Ear Drops

• Have her lie on her side of the unaffected ear, which means the affected ear is facing up.
• Clean the ear, if needed, with cotton ball gently
• Pull the ear auricle up and back for adults
• Pull the ear lobule down and back if administering to a child under 3
• Have Ms. P stay lying for at least 5 minutes after the drops and gently message the tragus.

Responding to a request to help organize the medication

• As an HCA, you are unable to place the medications in a dosette.
• Nicely explain that your role is not allowed or authorized to do so
• Offer to ask the nurse or pharmacist to pre-fill the dosette for a week for her.

Ms. P's DOT (Doctor's Orders) have been modified. New orders include Polysporin ear drops, Amoxil suspension (30ml, QID), and Advair Diskus to replace Ventolin at bedtime. Document changes on the MAR immediately, and provide oral care after diskus administration.