HCA203 - PP - Assisting With Medications - Feb2022.pptx

Assisting With Medications  Drug Administration Assistance › A medicine is a drug used to treat or prevent a disease or illness. › As a Health Care Assistant one of your delegated tasks maybe assisting clients with their medications. › Be sure you are familiar with your scope of practice a...

Assisting With Medications  Drug Administration Assistance › A medicine is a drug used to treat or prevent a disease or illness. › As a Health Care Assistant one of your delegated tasks maybe assisting clients with their medications. › Be sure you are familiar with your scope of practice and the facility’s policies and procedures › The information you are about to receive is a guide for HCA’s to help them to do this safely. › The guidelines and procedures may vary depending on the facility’s polices and procedures 2 Medications › Medications are drugs and other substances used to prevent or treat diseases or illness › Self-directed medication management – Is taking medication independently – Medications should be kept in its original labelled container › Support workers may be responsible for assisting a client with his/her medication › This must be specifically in your job description and within your scope of practice for your province 3 Scope of Practice Assisting vs Administering Medications Assisting › involves helping clients self -medicate – handing them their medications, opening bottles – Loosening and removing the container lids Administering › involves measuring medications, getting them into the person’s body – Requires judgement and knowledge If you are asked to administer medication – it is your employer’s responsibility to ensure that you are formally trained, supervised, and monitored 4  Scope of Practice cont’d Scope of Practice depends on: › Your provincial or territorial legislation, employer policy, your training and education › Support workers are not responsible for monitoring the outcome of drug therapy › Support workers must observe for and report any changes in the client’s condition or behaviour › Nurse or pharmacist teaches the client about the medications 5  Scope of Practice depends on: cont’d › Your Role › Your role in assisting with drugs depends on: › Your province, territory, › Employer policy › Your training and education Remember: › The person has the right to refuse to take prescribed drugs. › Residents manage and take their own drugs if able. › This is called self-directed medication management. › The person is able to question changes in the usual drug routine 6 Definitions: › Allergic reaction – The body becomes sensitive to a drug and then behaves as if the drug is something that does not belong in the body › Therapeutic – Causing a desired, positive effect in the body › Route – How a medication enters and is absorbed in the body › Adverse effect – An undesirable, possibly harmful drug side effect › Metabolization – Chemical reactions that take place to convert a drug from smaller molecules into waste products before it can exit the body 7 Abbreviations › Abbreviations are the shortened form of a word or phrase › Physicians, nurses, and pharmacists use many abbreviations when ordering and managing medications › Never guess about the meaning of an abbreviation – this can cause serious harm Common abbreviations: – ac, pc, bid, tid, qid, hs, po, qd – am, pm, Hx, Dx, Temp, BP, resp 8  Common Abbreviations › ADL Activities of Daily › CAD Coronary Artery Living Disease › Am/am Morning, before › cc cubic centimeter noon › Cap capsule › Bid twice a day › CNS central nervous › BP blood pressure system › BS blood sugar › COPD chronic obstructive pulmonary disease › c (with a line above) with › d day › c cup › D/C discontinue › C centigrade › DM diabetes mellitus › Ca calcium › ca cancer 9 Common Abbreviations cont’d › FBS Fasting Blood Sugar › IDDM Insulin Dependent Diabetes Mellitus › GI gastrointestinal › K. Kg kilogram › gtt drop › L, l litre › GTT Glucose Tolerance Test › lb pound › h, hr hour › Liq liquid › HR heart rate › LPN licensed practical nurse › hs bedtime › MAR medication administration › ht height › MD doctor › HTN hypertension › med medication › H2O water › mg milligram › I&O intake and output 10 Common Abbreviations cont’d › MI myocardial › OU both eyes infarction › t, tsp teaspoon › min minute › T, Tbs Tablespoon › ml millilitre › Tab, tab Tablet › NIDDM noninsulin › tid three times a day dependent diabetes mellitus › TPR Temperature, Pulse, Respirations › no. number › U Units › NS normal saline › via through › NTG nitroglycerine › VS vital signs (TPR & BP) › OD right eye › wk week › OS left eye › wt. weight › OTC over the counter 11  › NPO Nothing by mouth › STAT immediately › ac before meals › prn as needed › pc after meals › hs hours of sleep › q2h every two hours › oz ounce › qdevery day › sl sublingual › qid four times a day › po by mouth › bid twice a day › NTG nitroglycerin › tid three times a day Common Abbreviations cont’d 13 Pill Organizer › Blister pack/bubble pack – Supplied by pharmacy – Medication for the day, or time, – May group medications together › Dossettes/pill organizer – A person, a family member or legal representative, or a nurse prepares the pill organizer – Preparing the pill organizer is not the responsibility of the support worker › Always check for allergies › Medic Alert bracelets 14 Blister Pack Dossettes http://clinical.diabetesjournals.org/content/diaclin/26/1/17/F2.large.jpg https://www.forgettingthepill.com/sc_images/products/452_image.jpg 15 How Medication Works › Medications cause a specific effect on the body, and are prescribed and taken to obtain various desired results in the body Medications › Treat illness or pain (e.g., aspirin) › Promote health (e.g., stool softener) › Prevent illness (e.g., antibiotics) 16 Route identifies how a medication enters the body › Oral – capsule, lozenges, tablets, elixirs, suspensions, syrups › Topical – ointments, cream, transdermal disc or patches › Inhalation – respiratory inhalers › Ear & eye drops Cont’d 17 › Suppositories – vaginal, rectal › Parenteral – Injection Drug Interaction › Body absorbs and distributes the medication › Medication is metabolized in the liver › Medication is excreted by way of urine or stool 18 Drug Interactions › Drug synergism – combined effect of two drugs is greater than the effect of either drug given alone – combined effect may cause extreme drowsiness, hyperactivity , nausea, affect heart function or blood pressure › Drug antagonism – a medication may counteract the actions of other drugs when combined › Antacid – might prevent an antibiotic or birth control pill from being absorbed 19 Types of Medications › OTC: Bought without a physician’s prescription – over-the-counter medication – should be discussed with doctor, pharmacist or nurse › Alternative remedies – Herbal, natural, do not require a prescription › Prescription (Rx) – Dispensed by a pharmacist 20  Medications › Serious harm may result from combining medication, with other drugs or alcohol › Support worker only assists with medications that are listed in the care plan › Respectfully, but firmly refuses to purchase or obtain OTC medications or alternative remedies 21 Drug Effects › Topical effect – Works on the skin surface – Localized effect – Works on a specific part › Systemic effect – Relief is felt elsewhere in the body – Medications have common side effects › Support worker is responsible for common observations and reporting concerns regarding any medication taken 22 Drug Classifications › Alzheimer’s Disease Medications (Aricept) – Treats mild to moderate symptoms of Alzheimer's › Analgesics (Tylenol) – Relieve mild to moderate pain › Antacids (Tums) – Relieve heart burn › Anti-anginals (Nitroglycerin) – Relieve angina chest pain › Antibiotics (Penicillin) – is a substance or compound that kills, or inhibits the growth of bacteria 23 Drug Classifications › Antihypertensive (Altace) – medicines that help lower blood pressure › Anti-parkinsonian agents (Sinemet) – Reduce symptoms of Parkinson's disease › Anti-psychotics (Haldol) – Reduce psychosis, severe agitation, severe vomiting, or hiccups – Antitussive (Robitussin DM) – Liquefy phlegm, making it easier to cough › Antiviral (Zovirax) – any drug that destroys viruses › Bronchodilators (Ventolin) – Reduce spasm in breathing passages 24 › Decongestants (Sudafed) – Reduce nasal congestion › Diuretics (Lasix) – Lower blood pressure and body swelling by increasing urinary output › Hypoglycemic (Metformin) – Improve insulin production in body › Insulin (Humulin-R injection) – Makes up for lack of natural insulin – Laxatives (Glycerin suppository) – Help with bowel movements – Nonsteroidal anti-inflammatory agents (NSAIDS) › Reduce pain that comes with swelling – Thyroid replacement (Eltroxin) – Make up for lack of natural thyroid 25 Drug Names: Generic vs Trade › The brand name is Tylenol® and the generic name is acetaminophen › The brand name and drug patent is awarded for around twenty years › “Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years” (https://www.news-medical.net/health/Drug-Patents-and-Generics.aspx) › Once the patent has expired, the drug can be manufactured and sold by other companies › At this point, the drug is referred to as a generic drug. › Generic drugs have the same active ingredients as brand name drugs 26 Factors Affecting Drug Action › The same drug can affect two people very differently › Store drugs in a dry safe place to avoid chemical changes › Factors affecting drug action include: – Age: Infants and the elderly need less – Body size: Weight – Sex: Women need less than men – Disease: Can affect excretion or absorption – Route of administration: e.g. PO (by mouth) or IV (Intravenous) – Emotional state – Genetic factors – Physical conditions 27 Side Effects vs Adverse Effect Side Effect: › Most medications have side effects › A side effect is another response to a medication (drowsiness) that occurs along with the intended response (pain relief) › Many side effects are predictable and may be harmless › For example, a person taking pain medication may experience pain relief as well as drowsiness, nausea, and constipation Adverse Effect: › An adverse effect is a serious or harmful effect › An unexpected or dangerous reaction to a drug. An unwanted effect caused by the administration of a drug › e. g. stomach irritation and bleeding often occur in people who regularly use aspirin or other Nonsteroidal anti-inflammatory drugs › The medication may need to be stopped 28 Drug Allergy › A drug allergy is an abnormal response to a drug › The body tries to fight or attack the drug by releasing chemicals called antibodies › An antibody is a protein made by the body that latches onto foreign bacteria and viruses to make them ineffective Allergic Reaction: › The body becomes sensitive to a drug and then behaves as if the drug is something that does not belong in the body Drug Allergy Symptoms: – Mild symptoms › skin rashes, swelling, nasal drainage, itchy eyes – Moderate symptoms › fever, wheezing, weakness, nausea or vomiting – Severe symptoms › low blood pressure, cardiac arrest 29 Drug Allergy Anaphylaxis › Life-threatening › Sensitivity can occur within seconds › Anaphylaxis is an emergency situation – Requires Epinephrine Auto Injector – Keep airway open › Signs and symptoms – Shortness of breath – Sweating – Low blood pressure – Irregular pulse – Respiratory congestion – Swelling of the larynx – Hoarseness – Dyspnea › http://www.medicalestudy.com/wp-content/uploads/2017/10/Anaphylaxis-Sing-and-symptoms.png 30 Documentation Medication administration record (MAR) *Handout – Serves as a record for documenting medications – Exact form may vary by setting and employer MAR contains: – The client’s name – The name of the medication – Medication dose and administration – Instructions for each medication – A place to sign or initial after assisting with the medication – May also include client allergies, and special instructions 31 Medication Administration Record (MAR) MO/YR 06/21 Date: 12 Facility Name: Twin Lakes Care Center Medication Note Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 30 31 9 Nitro-Dur Patch 0800 D Started B 0.6 mg/hr patch June Apply @ 0800 12/21 remove at HS Flovent 125 mg MDI 0800 D via aero Started June B Chamber, 2 puffs – 1600 BID (0800,1600) 12/21 LB Wait 1 min. between puffs Diagnosis: CVA, RF Diet: Regular: Cut up Comments: Choking risk A. Put initials in appropriate box when medication is given Physician Name: Dr. K. Martin Allergies: Penicillin B. Circle initials when not given C. Chart/Document reason for refusal Phone Number: 250-444-5555 NAME: Record # Date of Birth: Sex: Mr. George Campbell # IH 84957364758 12/07/1924 M Documentation › In facilities, a nurse is responsible for signing or initialling the MAR › Clients who administer their own medications may not be able to sign the MAR – As a support worker caring for these clients, you may need to sign the recording for these clients › Follow your employer’s policies and procedures for recording 33 9 “Rights” of Assisting with Medication › To help the client take medications accurately and safely, know and follow the nine “rights” of medication administration These nine rights are: Try an acronym  MPDRT – 1. The right - Medication – 2. The right - Person – 3. The right - Dose (amount) – 4. The right - Route (by mouth, injection, applied to the skin, inhalation, vaginally, or rectally) – 5. The right - Time – 6. The right day – 7. The right expiry date – 8. The right documentation – 9. The right to education 34 Right Medication › Identify the drug – read label carefully › Check (Compare) label with care plan and MAR › Read label twice – When removing medication from shelf – When preparing dose https://opentextbc.ca/clinicalskills/wp-content/uploads/sites/82/2015/09/DSC_17601.jpg 35 Right Person › Check the prescription label on the container for client’s first and last names – Ask client to state his or her name – Two clients may have the same name › Identify the client following employer policy › Ask another staff member to confirm client, if you are unsure › Check client’s photo just before administration of medication 36 Right Dose › The dose is listed on – the prescription label – the care plan – the MAR › The correct amount of medication must be taken › Liquid form – the dose may be in – Imperial measurement (ounces) – Household measurement (teaspoons, tablespoons) – Metric units (millilitres) 37 › Right Route › The route is listed on: – The prescription label – Care Plan – MAR Routes › Oral: by mouth and swallowed › Sublingual: under tongue › Usually given last: pills, tablets, sprays › Topical: applied to skin/mucous membrane › Skin application: Transdermal disc, patches › Rectal/Vaginal: Enema, suppositories › Inhalant: breathed in through the mouth or nose › Parenteral: injected by a needle 38 Right Time › In order to work properly, medication must be taken at the correct time. › The number of times per day is stated on the prescription label – E.g., two, three times a day › The care plan/MAR states the time – (24 hour clock) 0600, 1400, 2200 › Taking medication at the wrong time of the day or taking them too close or too far from meals and other medications can affect their effectiveness and can cause serious side effects http://www.marcs.com/Marcs/medials/marcs-pharmacy-prescription-refill-label.jpg 39 Right Time › Medication to be taken on an empty stomach – 1 hour before or 2 hours after a meal › Taken with food or milk – To reduce stomach irritation and promote absorption › Warning labels on the prescription container and care plan › Strongly recommended to avoid alcohol and tobacco 40 Right Day › Not all medications are taken daily – Some medications taken every other day › Some medications taken prior to appointments – You need to check the MAR to ensure that the medication the client is taking is meant for that day 41 Right Expiry Date › Medications have an expiry date – Medication should never be taken beyond the expiry date › Medications can: – Lose their potency (strength) – Change chemically – Become toxic › If in doubt, check with supervisor, pharmacy, before assisting with the medication 42  Right Documentation › Any medication must be documented properly, according to your agency policy › Medications are usually documented in the MAR › It is your responsibility to document any medication that you have assisted to the client to take › If you have any questions about documenting, you need to ask your supervisor (this should be a nurse) to clarify it for you › Remember! If you are not 100% confident, you need to clarify. 99.99% is not 100% you are.01% probable error 43  Medication Errors › A drug error can cause severe harm › Report: – If you believe you made a drug errorClipart.com – If you believe someone else made a drug error – Even if you feel you may get into trouble › Supervisor assesses the situation and determines the next course of action › Incident report › Completed by you and your supervisor 44 Medication Errors › A medication error means one or more of the following: – Taking another person’s medication – Taking the wrong medication – Taking the wrong dose – Taking a medication at the wrong time – Taking a medication by the wrong route – Not taking a medication when ordered 45 Medication Errors › Some errors are caused by – problems in technique, such as dropping a pill down the sink by accident – by omission such as forgetting to give a medication – Incorrectly documenting – by failing to follow any of the nine “rights” › A drug error can cause severe harm to the client, so errors must always be reported 46 Discovering a Med Error What should you do? › Notify your supervisor immediately, provide all pertinent information (what the error involved) › Fill out an incident report as per facility policy and procedure › Learn from your mistake – reflect why/how the error occurred › Be accountable › Remember! If it’s not documented, it wasn’t given 47 Concerns which need to be Reported to your Supervisor › Unable to find medication › Client is on new medication that are in a bottle at home and are not documented on the care plan › There is an extra blister pack, care plan only specifies one blister pack (more than one blister pack – each blister pack must be numbered i.e. blister pack #1, blister pack #2) › Blister packs show signs of tampering/medications have been removed/loose pills › Wrong date 48 Concerns which need to be Reported to your Supervisor › Medication has been punched out of order i.e. day or time slot › Drops/ointments have expired › Client is taking many over-the-counter medication/herbal remedies/vitamins etc. › Client refuses medication (client has the right to make their own choices) 49 Important Points › Store medication in a safe dry place and out of reach of children › Give medication with water, unless directed otherwise › Never use medication from a container that is unlabelled › Report and record medication that is not taken › Some liquids need to be shaken prior to pouring › Write the date and time on transdermal disc › Always record medication after it has been taken, never before › Always ask your supervisor if you are in doubt about a medication › You won’t be fired for asking questions, but you can get fired for not asking questions 50