January 2020 Edition Cat 1 Manual PDF

Category 1 Certification Training Curriculum Prescribed Medications and Health-Related Activities ***Report to DODD immediately if you have received training that does not meet the legal standards for Initial or Renewal r...

Category 1 Certification Training Curriculum Prescribed Medications and Health-Related Activities ***Report to DODD immediately if you have received training that does not meet the legal standards for Initial or Renewal requirements (1-800-617-6733). You must receive the legally required training before administering medications*** January 2020 Edition January 2020 Edition I  CAUTION! If you receive orders or directions to perform ANY medical care: not specified in this curriculum or anything you do not understand Contact your supervisor. Additional training or nursing delegation may be required. January 2020 Edition II  Category 1 Table of Contents: Prescribed Medication Administration and Health-Related Activities Training Manual ***If RNs or an Agency rearrange this book prior to printing, create and include a revised Table of Contents for users to be able to quickly locate reference material. Notes to RN Trainers: This manual contains the STEPS to perform Medication Administration and the 13 Health-Related Activities. EVERY SKILL NEEDS TO BE CHECKED. Steps are imbedded in the curriculum. Corresponding skills checklists are on the DODD website. All the content in this curriculum is required to be taught¹ ². RN Trainers may supplement with any additional materials they believe to be relevant for the group they are training. The content is arranged into broad categories. RN Trainers may present the content in any logical order that meets the needs of the group being trained. Additional time beyond the 14 hours minimum classroom instruction, is required for training agency specific procedures. ¹ The RN Trainer may waive the material on Standard & Universal Precautions if it has been covered elsewhere within the previous year as per OAC (Ohio Administrative Code) 5123:2-6-06. ² Nasal Versed® (midazolam) may be taught at the RN Trainer’s discretion. Use manufacturer’s instructions to train for Valtoco® (diazepam nasal spray). Page Subject 1 Definitions of Terms Found in This Curriculum 7 Course Objectives 8 Information about the Initial Category 1 Certification Course 11 What it Means to Be a Certified DD Personnel 12 Medication Administration: Self-Administering or Help Needed 18 Use of Pill “Caddies” or Pill “Minders” 19 Medication Administration-Health and Safety Alert #55-3-17 21 The Process of Delegation from Licensed Nurse to Certified DD Personnel 22 Medication Administration Reference Grid 23 Medication Administration and Health-Related Activities By MA Certified Personnel 23 Employer Oversight 24 Family Delegation 24 Function of Others Involved in Medication Administration 25 Individual Specific Training 26 Medications Certified Personnel Are Not Permitted to Apply/Administer 27 Standard and Universal Precautions 28 What You MUST Know About Any Medication Before Administering It 29 Giving or Applying Medication 30 Prepare and Administer Medications for Only One Person at a Time 31 Getting Medication From the Original Container 32 Techniques for Measuring Liquid Medications 33 Steps for Administering Medications by Mouth (Oral) 35 Steps for Administering Medication MAR Documentation Using the “Dot System” (or method) 36 Special Instructions for Sublingual and Buccal Medications 39 Categories of Skin Medications 40 Steps for Administering Medications to Skin 42 Transdermal Medications 45 Eye, Ear and Nose Medications 46 Categories of Eye Medications January 2020 Edition III  47 Steps for Administering Eye (Ophthalmic) Medications 49 Categories of Ear (Otic) Medications 50 Steps for Administering Ear (Otic) Medications 52 Categories of Nose (Nasal) Medications 53 Steps for Administering Nose (Nasal) Medications 55 Categories of Inhaled Medications 56 Inhalers 57 Steps for Administering Metered Dose Inhalers 60 Steps for Administering Nebulizer Treatment 62 Oxygen Administration 69 Steps for Administering Oxygen (O2) 71 Rectal Medications 72 Steps for Administering Rectal Suppositories 74 Vaginal Medications 75 Steps for Administering Vaginal Medications 77 Receipt and Transcription of Medication Orders 79 Procedure for Transcribing Orders from a Dispensing Container 80 Procedure for Receiving Verbal Orders 81 When the Medication in the Container Does Not Match either the Medication Description on the Container, or the Medication Insert from the Pharmacy 82 Rules for As Needed Medications 84 Examples of Correctly Written Orders for As Needed Medications 86 Rules for Documenting 87 Documentation of Medications Administered and Health-Related Activities Performed 88 Storage and Care of Medications 89 Disposal of Medications 90 Preventing or Reducing Occurrences of Medication Theft 91 Medication Errors 92 Missed Medication 93 Repackaging Pharmacy Dispensed Medication for Leave Away from Home 94 Things to Know About Medications 100 Psychotropic Medications Overview 101 Scheduled Drugs 102 Signs and Symptoms to Observe and Report 104 Pain 106 Pain Assessment Scales 107 Health-Related Activities (HRAs) 108 Taking a Temperature (T) 109 Taking the Pulse (P) and Counting Respirations (R) 110 Taking the Blood Pressure (BP) 112 Application of a Clean Dressing 113 Measuring Intake and Output 114 Oral Suctioning 115 Use of a Glucometer 116 External Urinary Catheter Care 118 Steps for Emptying the Urine Collection Bag 119 Ostomy Care 122 Pulse Oximetry 126 CPAP/BiPAP 131 Percussion Vest January 2020 Edition IV  135 Cough Assist Insufflator-Exsufflator 140 Application of Compression Hose 145 Collection of Urine Specimens by Non-Invasive Means 146 Topical Over-The-Counter (OTC) Medications For Musculoskeletal Comfort 151 When to Seek Assistance 154 Quick Overview of Selected Emergency Situations 155 Seizures 158 Treatment of Repetitive or Prolonged Seizures with Diastat® 161 Diabetes Mellitus 163 Treatment for Hypoglycemia (low blood sugar) 165 Glucagon 169 Proper Disposal of Sharps 171 Summary 173 Appendices Index – Separate Documents (available on DODD website) 1. Nasal Versed® 2. General Documentation Examples 3. How to Document Use of As Needed Medications 4. Extrapyramidal Side Effects (EPSE) Associated with Psychotropic Medications 5. Psychotropic Medication Side Effects 6. Recommendations for Managing Diabetes 7. Suggestions to Follow When Calling a Pharmacy 8. Watching for Adverse Drug Reactions 9. Individual Specific Training Form (sample form) 10. Intake Record (sample form) 11. Intake and Output Record (sample form) 12. Medication/Treatment Administration Record (MAR/TAR) (sample form) 13. Nursing Statement of Delegation (sample form) 14. Verbal Order Form (sample form) 15. Steps for Administering Medications by Mouth (Oral) from a Bubble/Blister Pack January 2020 Edition V  Table of Contents Indexed by Subject A Alex – You are Your Brother’s Keeper – 19 Appendices List – 173 As Needed Medications – 82, 83, 84, 85 B BiPAP/CPAP – 126, 127, 128, 129, 130 Blood Pressure – 110, 111 Buccal Medications – 36, 37, 38 C Catheter Care and Emptying Bag – 116, 117, 118 Certification – 8, 9, 10, 11, 23, 26 Certification Registry – 10 Colostomy Care – 119, 120, 121 Compression Hose – 140, 141, 142, 143, 144 Cough Assist Insufflator-Exsufflator – 135, 136, 137, 138, 139 CPAP/BiPAP – 126, 127, 128, 129, 130 D Definitions of Terms – 1, 2, 3, 4, 5, 6 Delegation by Family – 24 Delegation by Nurse – 21 Diabetes – 161, 162 through 168 Diastat® – 154, 158, 159, 160 Diazepam – 45, 158, 159, 160 Dispensing Medications – 31 Disposal of Medications – 89 Documentation – 35, 86, 87, 92 Dot System – 35 Dressing Change – 112 E Ear Medication – 45, 49, 50, 51 Emergency Situations – 154 Employer Oversite – 23 Eye Medications– 45, 46, 47, 48 F Family Delegation – 24 G Glucagon – 154, 165, 166, 167, 168 Glucometer – 115 January 2020 Edition VI H Healthcare Professionals – 24 Health and Welfare Alert –19, 20 Health-Related Activities – 107, 108 through 145 Hyperglycemia – 162 Hypoglycemia – 154, 162, 163, 164 I Individual Specific Training – 25 Inhaled Medications – 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 Intake and Output Measurement – 113 L Liability – 10 Liquid Medications – 32 M Medication Administration – 22, 23, 29, 30, 31, 33, 34, 36, 37, 38, 40, 41, 43, 44, 47, 48, 50, 51 53, 54, 57, 58, 59, 60, 61, 69, 70, 72, 73, 75, 76, 81, 92, 150, 159, 160 167, 168 Medication Administration Record/Treatment Administration Record – 81, 86, 87, 92 Medication Administration Reference Grid – 22 Medication Errors – 91 Medications – Giving and Applying – 29 Medication Preparation – 30, 31, 32 Medications – what you must know about medications – 28, 94, 95, 96, 97, 98, 99, 100, 101 Midazolam – 45, 154 Missed Medications – 92 N Nasal diazepam – 45 Nasal Versed® – 45, 154 Nebulizer – 56, 60, 61 Nose/Nasal Medications – 45, 52, 53, 54 Nurse Delegation – 21 O Objectives of Course – 7 Oral Medications – 33, 34 Oral Suctioning – 114 Orders/Prescriptions – 77, 78, 79, 80, 81, 82, 83, 84, 85 Ostomy Care – 119, 120, 121 OTC Topical for Musculoskeletal Comfort – 146, 147, 148, 149, 150 Oxygen – 62, 63, 64, 65, 66, 67, 68, 69, 70 January 2020 Edition VII P Pain – 104, 105, 106 Percussion Vest – 131, 132, 133, 134 Pill Caddy/Pill Minder – 18 Prohibited Actions – 26 Psychotropic Medications – 100 Pulse – 109 Pulse Oximetry – 122, 123, 124, 125 Puncture Wounds – 170 R Rectal Medications – 71, 72, 73 Repacking Medications – 93 Respirations – 109 Rights of Medication Administration – 29 S Scheduled Drugs – 101 Seizures – 154, 155 through 160 Self-Administration – 12,13, 14. 15, 16, 17 Sharps – 169, 170 Signs and Symptoms to Observe and Report – 102, 103, 104, 105, 106 Skin Medications – 39, 40, 41 Specimen Collection – 145 Storage and Care of Medications – 88 Sublingual Medications – 36, 37, 38 Summary – 171, 172 Suspension and Revocation of Certification – 10 T Tables of Contents – I through XI Temperature –108 Theft Prevention – 90 Topical – 146, 147, 148, 149, 150 Topical OTC for Musculoskeletal – 39 through 54 and through 150 Transcription of Orders/Prescription – 77, 78, 79, 82, 83, 84, 85 Transdermal Medications – 42, 43, 44 U Universal Precautions – 27 Urine Specimen Collection – 145 V Vaginal Medications – 74, 75, 76 Verbal Orders – 80 Vital Signs –108, 109, 110, 111 W Warming Medications – 46, 49 When to Seek Assistance – 151, 152, 153 January 2020 Edition VIII  Table of Contents Arranged in Alphabetical Order by Page Title A Appendices List – 173 Application of a Clean Dressing – 112 Application of Compression Hose – 140 C Categories of Skin Medications – 39 Categories of Ear (Otic) Medications – 49 Categories of Eye Medications – 46 Categories of Inhaled Medications – 55 Categories of Nose (Nasal) Medications – 52 Collection of Urine Specimens by Non-Invasive Means – 145 Cough Assist Insufflator-Exsufflator – 135 CPAP/BiPAP – 126 Course Objectives – 7 D Definitions of Terms Found in this Curriculum – 1 Diabetes Mellitus – 161 Disposal of Medications – 89 Documentation of Medication Administration and Health-Related Activities Performed – 87 E Employer Oversight – 23 Examples of Correctly Written Orders for As Needed Medications – 84 External Urinary Catheter Care – 116 Eye, Ear, and Nose Medications – 45 F Family Delegation – 24 Function of Others Involved in Medication Administration – 124 G Getting Medications From the Original Container – 31 Giving or Applying Medication – 29 Glucagon – 165 H Health-Related Activities – 107 I Individual Specific Training – 25 Information about the Initial Category 1 Certification Course – 8 Inhalers – 56 January 2020 Edition IX M Measuring Intake and Output – 113 Medication Administration and Health-Related Activities by MA Certified Personnel – 23 Medication Administration – Health and Safety Alert (#55–3–17) – 19 Medication Administration Reference Grid – 22 Medication Administration: Self-Administering or Help Needed – 12 Medication Errors – 91 Medications Certified Personnel are Not Permitted to Apply/Administer – 26 Missed Medications – 92 O Oral Suctioning – 114 Ostomy Care – 119 Oxygen Administration – 62 P Percussion Vest – 131 Pain – 104 Pain Assessment Scales – 106 Prepare and Administer Medications for Only One Person at a Time – 30 Preventing or Reducing Occurrences of Medication Theft – 90 Procedure for Receiving Verbal Orders – 80 Procedure for Transcribing Orders from a Dispensing Container – 79 Proper Disposal of Sharps – 169 Psychotropic Medications Overview – 100 Pulse Oximetry – 122 Q Quick Overview of Selected Emergency Situations – 154 R Receipt and Transcription of Medication Orders – 77 Rectal Medications – 71 Repackaging Pharmacy Dispensed Medications for Leave Away from Home – 93 Rules for As Needed Medications – 82 Rules for Documenting – 86 S Scheduled Drugs – 101 Seizures – 155 Signs and Symptoms to Observe and Report – 102 Special Instructions for Sublingual and Buccal Medications – 36 Standard and Universal Precautions – 27 (continued on next page) January 2020 Edition X (S continued) Steps for Administering Diastat® – 159 Steps for Administering Ear (Otic) Medications – 50 Steps for Administering Eye (Ophthalmic) Medications – 47 Steps for Administering Glucagon by Injection – 167 Steps for Administering Medication by Mouth (Oral) – 33 Steps for Administering Medication MAR Documentation Using the “Dot System” (or method) – 35 Steps for Administering Medications to Skin – 40 Steps for Administering Metered Dose Inhalers – 57 Steps for Administering Nebulizer Treatment – 60 Steps for Administering Nose (Nasal) Medications – 53 Steps for Administering OTC Topical Medications for Musculoskeletal Comfort – 150 Steps for Administering Oxygen (O2) – 69 Steps for Administering Rectal Suppositories – 72 Steps for Administering Sublingual or Buccal Medication – 37 Steps for Administering Transdermal Medication – 43 Steps for Administering Vaginal Medications – 75 Steps for Emptying the Urine Collection Bag – 118 Storage and Care of Medications – 88 Summary – 171 T Taking the Blood Pressure (BP) – 110 Taking the Pulse (P) and Counting Respirations (R) – 109 Taking a Temperature (T) – 108 Techniques for Measuring Liquid Medications – 32 The Process of Delegation from Licensed Nurse to Certified DD Personnel – 21 Things to Know About Medications – 94 Topical Over-The-Counter (OTC) Medications for Musculoskeletal Comfort – 146 Transdermal Medications – 42 Treatment of Repetitive or Prolonged Seizures with Diastat® – 158 Treatment for Hypoglycemia (low blood sugar) – 163 U Use of a Glucometer – 115 Use of Pill “Caddies” or Pill “Minders” – 18 V Vaginal Medications – 74 W When to Seek Assistance – 151 What it Means to Be a Certified DD Personnel – 11 What You MUST Know About Any Medication Before Administering It – 28 When the Medication in the Container Does Not Match Either the Medication Description on the Container, or on the Medication Insert from the Pharmacy – 81 January 2020 Edition XI This page intentionally blank for pagination. January 2020 Edition XII  Definition of Terms Found in this Curriculum Abdomen: Located between the chest and the pelvis; the “belly”. Acute: Rapid onset, severe symptoms, lasts for only a few days or weeks. Accessible: Available; easily reached or obtained. Adequate: Acceptable; satisfactory. Administer/administration: To give something to someone (ex. gives medication). Advanced Practice Registered Nurse: A nurse with specialized education for a specialty certification by the Board of Nursing: a Certified Nurse Practitioner; Mid-wife; Nurse Anesthetist or; Clinical Nurse Specialist. Anaphylaxis: Severe allergic reaction that can result in death if not reversed quickly. Apply: Place one thing on to another (ex. put a band aid on a wound; put ointment on the skin). Assure: To inform; to remove doubt. Aura: Warning sign or sensation of an on-coming seizure (varies according to person and condition). Bracing: Protective position a person takes when in pain or about to get injured. Bunion: Enlargement of the joint of the big toe. Causes toe to shift to the side. Carbohydrate: Chief fuel for the body. Found in fruits, vegetables, grains, breads, and sweets. Category: Grouping together of items with similar features. Certificate/Certification: A legally issued credential that allows for actions that a person without certification may not do. Certified Nurse Practitioner (CNP): An Advanced Practice Nurse with state certification that gives the ability to prescribe medications and other care beyond the scope of an RN or LPN. Certified personnel: Personnel who have completed the medication administration course and have a current certification issued by DODD. Chronic: A condition that lasts for more than 6 weeks; a condition that gets worse over time or shows little improvement over time. (Examples: diabetes, arthritis, multiple sclerosis, asthma) Cognitive: The way a person thinks and makes sense out of experiences. Competent: Able to do a task or job correctly and independently. Confirm: To support; to validate; to establish the accuracy of information. Confusion: Bewilderment; not understanding what is happening; inability to think clearly. Congestion: Stuffy nose that can make it difficult to breathe. Console: To comfort. Contaminated: Dirty; containing impurities or germs. Convulse: To have a seizure; uncontrolled, spastic movement of any part of the body especially arms, legs, and torso. Corn: Thickening of the skin often on the toes and caused by shoes rubbing on the area where the thickened skin develops. January 2020 Edition 1  Crucial: Most important; necessary. Curriculum: A course of study; the content of a course, class or program of study. Debriding agent: Chemical (medicated cream, ointment or liquid) used to remove dead tissue from a wound. Deformity: Malformed; not the typical shape. Usually involves a body part (ex. missing limb, club foot). Delegate: To transfer or pass on responsibility to another person. Demonstrate/demonstration: To show someone how to do a task or job; to show that you know how to do a task or job. Developmental Disability (DD): A chronic mental or physical impairment that is diagnosed before the age of 22. Developmental Disability Personnel (DDP): The workers who provide specialized services to people with developmental disabilities 2 as either a DODD Independent Provider or as an employee of a DODD certified agency. (OAC 5123:2-6-01) Disorientation: Not knowing where one is, who one is, or what time it is (season or month); not aware of time, place, or self. Dispense: To give out or distribute to another. Dispose/disposal: To get rid of; throw away. Documentation: To record or write down what has happened and/or what has been done. Dominant hand: The hand you use to write with. Dose: The amount of medication to be taken (ex. 2 tablets of Depakote 500mg). Duration: The length of time a medication is to be taken or the length of time a medication works. Elements: Component parts. Episode: An occurrence; the display of symptom or behaviors associated with an underlying condition. Error: A mistake; a wrong action. Medication errors are defined in Rule OAC 5123:2-6-01. Excess/excessive: More than what is ordered or is required. Exposure: Contact with a thing (ex. contact with a substance, material, or surface). Facility: A licensed place where care is given and where people with support needs reside. Feasible: Capable of being done; realistic ability to do something. Fracture: To break (ex. a broken bone). Frequency: How often a medication or treatment is given (ex. once a day; twice a day; every 8 hours). Gait: The way a person walks or moves about on foot. Gastrostomy/Jejunostomy tube (G/J): A tube that goes through the skin of the abdomen into the stomach (G-tube) or small intestine (J-tube), for administration of food, fluids or medications. Generic: The chemical name of a medication that is not identified by a registered trademark or brand name (ex. acetaminophen is the generic version of Tylenol®). January 2020 Edition 2  Glucagon: Hormone injected during a low blood sugar emergency. Glucose: Sugar. Glucometer: A device used to check or measure a person’s blood sugar. Hard copy: Document that is printed out on paper. Healthcare Professional (HCP): Physician (MD or DO), Certified Nurse Practitioner (CNP), Registered Nurse (RN), Licensed Practical Nurse (LPN), Pharmacist (RPh), Dentist (DDS), Podiatrist (DPM), Chiropractor (DC), Physician’s Assistant (PA). Health-Related Activity (HRA): One of 13 nursing tasks authorized by Category 1 Medication Administration Certification. Hemorrhoid: Dilated vein that may be internal or external. Commonly found inside or outside the rectum. Hormone: A substance secreted in the body for a specific purpose (ex. insulin that is needed by the body to use carbohydrates; glucagon that is used by the liver to release stored glucose). Hyper: Higher than what is considered normal (ex. hypertension = high blood pressure; hyperglycemia = high blood sugar). Hypo: Lower than what is considered normal (ex. hypotension = low blood pressure; hypoglycemia = low blood sugar). Immunity: Free from blame; protected from blame. Implement: To start something; to begin a plan or act. Inappropriate: Not consistent with the situation (ex. laughing when feeling sad). Incontinence: Spontaneous exit of urine or stool/feces (to wet or soil oneself). Incorrect: Wrong; not accurate. Individual Specific Training (IST): Training provided by a licensed nurse or employer that addresses the unique needs of the person; a summary of relevant health care information and the health care plan (OAC 5123:2-6-01). Ingest: To take into the mouth and swallow. Inhale: To breathe in; to take in air or medication into the lungs. Inject/injection: Placing a medication into the body through the skin by using a sterile needle and syringe (a “shot”). Instill: To put a medication in a body cavity or on a mucous membrane (ex. eye drops, or ear drops). Intact skin: Skin without a cut or tear. Intellectual disability: A disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 22. Intramuscular: To give an injection (a shot) into a muscle. Invert: To turn the container upside down. Lancet: A type of needle used to stick the finger to get a drop of blood for checking blood sugar. Legal: Pertaining to the law; something the law says is OK to do. January 2020 Edition 3  Lesion: Injury or wound; area of skin that has an alteration. Lethargy: Sluggishness; drowsiness; inactivity; showing lack of energy; fatigue. Liable/Liability: Responsibility; what you are held accountable for, by law, or by company rules and policies. Licensed: Legal permission granted by the state to take specific actions that are not allowed to be taken by people without the license. Licensed Physician Assistant (PA): A specially trained and licensed person who works under the supervision of a physician. LPN: Licensed Practical Nurse (ORC 4723.01). Lifestyle: The way a person chooses to live their life. Maintain: To keep something going, working, or functioning. Medication Administration Record (MAR): Where all medications to be administered are transcribed and all medications given, held, missed or declined are documented. Mental State: Describes one’s alertness, orientation. Metabolic Glycemic Disorder: Medical conditions specifically related to blood sugar metabolism such as diabetes, pre-diabetes and metabolic syndrome. Metered Dose Inhaler: A device or package that dispenses a specific amount of the medication to be inhaled. Monitor: To observe someone for a specific purpose. Muscle wasting: Loss of strength in a muscle or muscle group; decrease in muscle mass, strength and endurance; decrease in size of a muscle. Nasal cannula: Device placed in the nostrils of the nose for delivery of oxygen. Nasogastric tube (NG): A tube inserted through the nose, past the throat and into the stomach. Ohio Administrative Code (OAC): The state departmental rules that explain details of laws. Omit: To leave out. Oral: Mouth; taken into the mouth and swallowed (ex. taking a pill by mouth). Ohio Revised Code (ORC): The state laws put in place by the Legislature. Organic: Coming from a person or animal; living matter. Occupational Safety and Health Administration (OSHA): The legally authorized federal agency responsible for creating and implementing rules related to worker’s safety and health at their worksites. Over-the-Counter (OTC): Medication that can be purchased without a prescription. Oversight: Supervise; make sure a task is done correctly; be sure personnel are properly trained and performing to the standard. Packaging: Container medication comes in; wrapping around a medication. Pallor: Lack of color; paleness. Parenteral: Medication route that does not involve the digestive system (ex. injections/shots). Peripheral: Away from the center of the body (ex. hands, feet, lower legs; at the edges). January 2020 Edition 4  Persistent: Long-lasting; not giving up; keeping at a task for a long period of time; enduring. Personal Protective Equipment (PPE): Items used to put a barrier between the caregiver and all body fluids. Examples include gloves, gown, mask, eye protection and shoe covers. Pharmacy/Manufacturer’s Label: The information found on a prescribed medication or an over-the- counter medication identifying the name of the medication, the amount and strength of the medication, and how and when to take the medication. Photosensitivity: Sensitive to sunlight (ex. sunburns easily; inability to tolerate bright light). Pill Caddy/Pill Minder: A container that is filled for multiple doses of medication to be accessed by a person for multiple days (ex. a week or month of medications put in the caddy). Policy: A written statement of actions to be taken in specific situations. Potency: The power of a medication to be effective. Prefilled: Syringe or other container that has medication placed in it by the manufacturer or pharmacy. Prescription/Prescribe: A directive/order for medication/treatment by a healthcare professional with a license that allows them to legally order healthcare tasks and medications. Procedure: Steps taken to do a task properly. Protocol: States what is to be done in specific situations; plan of action. Psychotropic: A medication that causes changes in the mind/brain. Puncture resistant: Something that a sharp will not go through or penetrate. Range: The amount of variation considered as normal (ex. pulse rate between 60 and 100 is regarded as a normal range/variation for the number of times per minute the heart should beat). Rectum/Rectally: The anus or “butt hole”; medication given in the anus. Remedy: A treatment; solution to a problem. Renal: Pertaining to the kidneys. Renew: To replenish; to restore; to start over. Repetitive: To do over and over; to do the same thing many times. Resolve: To find the answer; to solve the problem. Responsive: Answering or replying right away; alert. Restrain: To refrain from acting; to keep another from acting or controlling another’s ability to act. Revoke/Revocation: To take away or remove permanently. Rigid muscle: A stiff or tight muscle. RN: Registered Nurse (OAC 4723.01). Rotate: To choose a different location. Route: Where a medication goes or how a medication is given (ex. in the mouth, in the ear, on top of the skin, etc.). January 2020 Edition 5  Scheduled substance: Legal FDA Drug classifications I, II, III, IV, V that, by law, rate a drug’s potential for misuse or abuse and the need to count supplies routinely. Secure: To make safe. Self-administer: To be able to take medication independently (OAC 5123:2-6-02). Sharp/Sharps: A device with sharp points or edges that can puncture or cut the skin. Sign: Evidence that something is wrong. Specific: Well defined; elaborated upon; spelled out. Strength: The volume of medication per unit such as milligrams per tablet or milligrams per CC of liquid (ex. Depakote 500mg tablet or Depakene 500mg per 10CC liquid). Subcutaneous: Beneath the skin; in the fatty tissue not in the muscle. Suspension: Temporary removal of certification. Sustain: To maintain, to support or to keep going. Swirl: Stir by moving the container in a circular motion. Symptom: An experience of a person that something is wrong. Symptomatic: Currently having symptoms. Systemic: Affects the entire body; more than one part of the body is affected. Treatment Administration Record (TAR): Where all treatments to be administered are transcribed and all treatments given, held, missed, or declined are documented. Topical/Topically: Placed on body surfaces including skin, hair, nails, eyes, ears, nose, rectum, vagina and oral surfaces. Toxic: Harmful, destructive, or deadly. Transcribe: To copy prescribed orders from a pharmacy label, or to change a current order on an MAR/TAR. Tremor: Involuntary shaking. Trigger: Something that causes a reaction or symptom. Universal Precautions: Treating all body fluids as if they can cause disease in others. The plan for use of personal protective equipment (PPE) when in contact with or having the potential to come into contact with body fluids. Proper cleansing of the hands and other surfaces. Unlicensed DD Personnel: Workers, without a healthcare professional’s license, who provide specialized services to people with developmental disabilities. Unusual Incident (UI): An event or occurrence that is not consistent with the person’s routine, care or service plan. All medication errors are an unusual incident (OAC 5123-17-02). Unusual: Out of the ordinary. Void: To urinate or to put a single line through an entry on a document that was written by mistake. Wheezing: Breathing that has a high-pitched, coarse, whistling or squeaking sound that indicates a tight, inflamed, or partially blocked airway that requires prompt action (use of inhaler or 911). January 2020 Edition 6  Course Goal: To teach DD personnel how to administer oral and topical medications and perform the 13 health- related activities (HRAs) specified by the Ohio Department of Developmental Disabilities COURSE OBJECTIVES OBJECTIVES By the end of this course, the participant will be able to: Demonstrate:  How to prepare, administer and document the performance of the 13 HRAs and the administration of prescribed oral, topical, and inhaled medications, and application of topical OTC medications for musculoskeletal comfort.  Having a minimum knowledge base, by scoring 80% or better on a closed book test. Explain:  What is required to maintain and renew certification for medication administration and performance of health-related activities.  How the rules and regulations governing the administration of medications and performance of health-related activities apply to caregiving activities.  What actions to take when signs and symptoms may indicate a significant health problem or medication side effect. January 2020 Edition 7  Information about the Initial Category 1 Certification Course (OAC 5123:2-6-06) 1. Although 14 hours is the legal MINIMUM time for training, the principles of quality adult learning indicate that additional hours are needed, and that many consecutive hours of training, without break times, are not effective for information retention. The 14 hours minimum time must consist of engaged learning time in the classroom and does not include lunch and break time. The course may be lengthened to meet the needs of the class participants and/or the RN trainer, and employer. ❖ Everyone should have their own personal copy of the entire curriculum to use during the course. ❖ Anyone can obtain a copy of the curriculum for personal use from the DODD website: dodd.ohio.gov ❖ A copy of the curriculum must be readily accessible on site where medication is being administered or health-related activities are being performed. 2. To obtain the Initial Category 1 DODD medication administration certification, Developmental Disabilities (DD) personnel must do all the following: ❖ Attend the ENTIRE program and participate in discussions and activities. ❖ Successfully demonstrate performance of the 13 health-related activities, and the preparation, administration, and documentation for each route of medication presented in the initial Category 1 certification training course. ❖ Pass a closed book written exam with a score of 80% or better. Personnel who do not pass the written exam with 80% or higher are required, by rule, to retake the entire initial certification training course before attempting to take the written exam again. ❖ Complete and submit an evaluation of this program to the RN trainer. The RN Trainer may provide additional time for skills development and/or study prior to testing and determining if the student meets the requirements for certification. After certification and before administering medication or performing health-related activities, with any given person, the certified personnel must have individual specific training (IST) about that person. ❖ It is the responsibility of the personnel, and employer to assure IST has been done. ❖ If delegation is required, the delegating nurse must do the IST. Attend the entire initial Earn minimum score of 80% on a Accurately perform all return certification training course. closed book test at end of course. demonstrations. January 2020 Edition 8  What You Need to Know About Your Certification 1. You are responsible for your certification. You must verify that you are currently certified to administer medication/HRAs. You must confirm your Category 1 initial certification and renewals on the DODD website. dodd.ohio.gov 2. This certification is valid only for Developmental Disabilities (DD) service settings and only in the State of Ohio. 3. Certification is valid for 1 year and must be renewed each year before the certification expiration date. 4. It is recommended that the renewal continuing education (CE) and return demonstrations be completed at least 60 days before your certification expiration date. Renewing your Certification: At least 90 days before your expiration date, plan to complete the required education and skills for renewal. 1. To renew certification, requires completing 2 hours of continuing education related to medication administration and/or health-related activities. AND 2. You must demonstrate skills of medication administration and health-related activities  Skills must be demonstrated annually to be used. Any skill not demonstrated as part of renewal must be demonstrated prior to performing the skill when needed.  If you work at a site with nursing delegation, a nurse must observe your demonstration.  If you work at a site without nursing delegation, return demonstrations are performed and monitored by the person designated by the employer.  If you are an independent provider, your return demonstration can be done by a county board nurse or any DODD certified RN trainer. The RN Trainer attesting to renewal requirements must be sure the person verifying skills and/or providing CE, has the knowledge, skills, and ability to do so. What happens if you do not renew your Certification: 1. You have 60 days past the expiration date to renew your certification without retaking the initial certification training course. You may NOT administer medications or perform HRAs during that 60-day post-expiration period. 2. If you allow your certification to be expired for more than 60 days, you are required to retake the initial certification training course to become certified again. January 2020 Edition 9 The initial Category 1 certification training course for administration of medications and performance of health-related activities must be completed before obtaining further certifications to administer medications per G/J tube (Category 2) or administer insulin and injections for treating metabolic glycemic disorders (Category 3). State of Ohio Certification Registry 1. There is a state registry listing all personnel certified by the Department of Developmental Disabilities (DODD). 2. Law requires public access to view certifications in the registry for confirming the status of current and expired certifications. This can be found on the DODD website: dodd.ohio.gov 3. Certification remains valid when personnel change employers. Medication Administration Certification of DD personnel is registered with DODD (not the employer). Suspension and Revocation 1. Anyone who finds that certified personnel are not safely performing or will not safely perform their duties shall immediately remove that certified personnel’s responsibility to perform medication administration. This includes the employer, delegating nurse, county board nurse, or QA nurse as appropriate. 2. Suspension of certification is done by DODD pending further investigation. It may be temporary but could lead to permanent revocation depending upon circumstances. 3. Revocation of certification may occur if certified personnel do not demonstrate compliance with the rules and curriculum, are not performing their duties in a safe manner according to certification training or have shown disregard for the safety and welfare of a person. Revocation is a permanent removal of certification. 4. The Certified DD Personnel may appeal DODD’s intent to revoke certification per the rule, OAC 5123: 2-6-07. Liability You are accountable for your own actions. However, the law, Ohio Revised Code 5123.422, establishes immunity from liability if:  All applicable laws and rules were being followed.  Certified personnel acted in accordance with the steps in the curriculum and/or the instructions of a delegating nurse. (see OAC 5123:2-6-07).  Certified personnel do not act in a manner that constitutes deliberate or reckless misconduct. January 2020 Edition 10  What it Means to Be a Certified DD Personnel Classes and skill checks for initial certification or renewal do not equal certification. You are NOT authorized to administer medications or treatments, until your certification has been entered and viewed as current on the DODD website. Having a certification from the Ohio Department of Developmental Disabilities (DODD) for the administration of medications and performance of health-related activities means you have been authorized to complete certain tasks. People who are not certified do not have this authorization. This certification does not allow you to provide care any way that you would like. The Law requires that you follow the instructions given to you during this certification course. You must follow the instructions provided in the curriculum always, NO EXCEPTIONS. With a valid Medication Administration Certification 1, you may  Administer topical, oral, and inhaled medications that have been prescribed for a person.  Perform the 13 health-related activities.  Apply OTC topical medications for musculoskeletal comfort without a prescription. Note: In some settings, you will also need a nurse to authorize and supervise your administration of medications and treatments. That is called nurse delegation. You must know what you are doing. If you You must speak up if you are ever in doubt about what to do, or how need more training. Do not to do it, you must contact your supervisor or assume others automatically a healthcare professional for additional know what you need. directions or training. Your certification DOES NOT allow you to:  Make independent diagnoses and act on them.  Perform activities not addressed in this curriculum even if you know how.  Represent yourself as a licensed healthcare provider.  Discontinue a medication without a healthcare professional’s order.  Administer a medication without a prescription (except topical OTC medication for musculoskeletal comfort).  Independently adjust the dosage of any medication.  Independently change the frequency for administering any medication.  Independently perform an activity in a way not specified by this curriculum.  Give medications or perform any health-related activities that have not been prescribed.  Share health related information with anyone who is not actively on the person’s care team. January 2020 Edition 11  Medication Administration Self-Administering or Help Needed Each person has the right, if capable, to self-administer or self-administer with assistance. Prior to restriction of a person’s right to self-administer their medication or healthcare task, the DODD approved Self-Administration Assessment must be completed (OAC 5123:2-6-02). A person is presumed to be able to self-administer unless there is a substantive indication that the person wants or needs supports. The diagnosis of Intellectual or Developmental Disability does not automatically mean a person can be assumed to need help with medication administration. People who self-administer do not need to document on a MAR. See the self-administration form instructions on www.dodd.ohio.gov website. 5123:2-6-02 Self-administration or assistance with self-administration of prescribed medication. (A) An individual who can safely self-administer prescribed medication or receive assistance with self- administration of prescribed medication has the right to self-administer or receive assistance with self- administration. (B) Prior to restriction of an individual's right to self-administer prescribed medication, the service and support administrator or qualified intellectual disability professional, as applicable, shall ensure that a department approved self-administration assessment is completed for an individual who requires prescribed medication administration. Based on the outcome of the self-administration assessment, the individual plan, or individual service plan, as applicable, shall document when the individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication. The service and support administrator or qualified intellectual disability professional, as applicable, shall ensure that the self-administration assessment is reviewed annually to confirm continued need for support for medication administration. A new self-administration assessment shall be completed at least once every three years or more often when there is a change that affects the individual's medication routine such as a change in medication route, service setting, service provider, or health status. (C) Each individual plan or individual service plan shall indicate when the individual is able to safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication including: (1) When the individual is able to safely self-administer medication independently; (2) When the individual is able to safely self-administer medication with assistance; and (3) When the individual is not able to successfully self-administer medication with or without assistance and include a statement of how medication administration will be completed. (D) When the self-administration assessment indicates an individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication: (1) Further assessment shall be conducted to determine exactly what specific steps of self- administration of medication the individual is able to safely complete. The individual shall participate in these steps under the supervision of developmental disabilities personnel who have current certification in health-related activities and prescribed medication administration and have received individual-specific training. (2) The details of the individual's specific abilities and the specific necessary support from licensed or certified personnel to complete medication administration shall be noted in the individual plan or individual service plan. January 2020 Edition 12 (E) Developmental disabilities personnel who are not specifically authorized by other provisions of the Revised Code to provide assistance in the self-administration of prescribed medication may, under section 5123.651 of the Revised Code and this rule, provide that assistance as part of the services they provide to individuals. To provide assistance with self-administration of prescribed medication, developmental disabilities personnel are not required to be trained or certified in accordance with section 5123.42 of the Revised Code and rules 5123:2-6-05 and 5123:2-6-06 of the Administrative Code. (F) When assisting in the self-administration of prescribed medication, developmental disabilities personnel shall take only the following actions as needed and identified in the individual plan or individual service plan: (1) Remind an individual when to take the medication and observe the individual to ensure that the individual follows the directions on the container; (2) Assist an individual by taking the medication in its container from the area where it is stored, handing the container with the medication in it to the individual, and opening the container, if the individual is physically unable to open the container; or (3) Assist, on request by or with the consent of, a physically impaired but mentally alert individual, with removal of oral prescribed medication or topical prescribed medication from the container and physically assist with the individual's taking or applying of the medication. If an individual is physically unable to place a dose of oral prescribed medication to the individual's mouth without spilling or dropping it, developmental disabilities personnel may place the dose in another container and place that container to the individual's mouth. (G) When an individual has been assessed as able to safely self-administer prescribed medication or self-administer prescribed medication with assistance, developmental disabilities personnel are not authorized to verify accuracy of medication being taken by the individual on a routine basis unless specified in the individual plan or individual service plan. When there is reason to question the individual's self-medication skills, a new self-administration assessment shall be completed. 5123:2-6-02 Anyone can:  Remind a person when to take medication.  Observe to assure directions on container are followed.  Remove medication from and return to storage.  Open the container if the person unable.  Assist the person to remove medication from the container.  At the direction of a person who is cognitively able but physically unable, physically assist a person to get medication from the container and to take/apply. To provide the types of assistance listed above personnel do not need medication administration certification. January 2020 Edition 13  Introduction & Instructions for Completion of Self-Administration Assessments Oral and Topical Medication; Inhaled Medications; Oxygen Administration; Using a Glucometer; Performance of Health-Related Activities; Medication, Nutrition, Fluids per G/J Tube; Insulin/Metabolic Glycemic Disorder Medications The purpose of the Self-Administration Assessment is to ensure that the person is not able to SAFELY accomplish medication administration and/or complete health care tasks prior to implementation of supports that could violate the inherent right of a person to self-administer medications and treatments (Ohio Administrative Code 5123:2-6-02). Prior to restriction of a person’s right to self-administer medication, or perform health care tasks, the DODD approved Self-Administration Assessment must be completed. When should a Self-Administration Assessment be completed? The self-administration assessment is completed when a person/guardian/advocate is requesting support services for medication administration/treatments/health-related activities or when the SSA/QIDP or another team member identifies the potential need for support. A person is presumed to be able to self-administer unless there is a substantive indication that the person wants/needs support. The person’s team must have reason/information to believe there is a potential need for the service of medication administration/treatments/health-related activities prior to use of the assessment. The presence of any given medical/psychiatric diagnosis is not evidence of an inability to self-administer. There must be some indication, other than diagnoses, to warrant assessment of the need for support with administration of medication/treatments/health-related activities. Indications that a person may need help with medication administration/treatments/health-related activities, and that an assessment should be done can include: Person/guardian/advocate requesting support with medication administration/treatments/health-related activities and expressing indications for concern Significant levels of assistance needed with other Activities of Daily Living (ADLs) that require similar skills to those needed for medication administration (ex: recognition of routines/times of ADLs, memory of basic information, awareness of physical condition/status, recognition of units/amounts) The person has not completed necessary steps to obtain refills (i.e. calling pharmacy, making or keeping scheduled prescriber appointments) Indications that health conditions continue to get worse despite current medications for those conditions Not using supports already identified to assist with medication (such as notifying personnel of the need for refills, or appointments) Statements by the person that indicate lack of medication awareness/compliance If/when the assessment is used to establish the need for medication administration/treatments/health-related activities assistance or support, it must be completed at a minimum of every three years; with a review for potential status changes done at least annually. The reassessment may indicate changes in the level/type of supports needed. Supports may need to be increased or may be decreased due to development of knowledge, skills and ability. January 2020 Edition 14  A reassessment may also need to be completed in the event of, but not limited to, the following occurrences that can affect the steps a person is completing and/or needing support with: A change in medication route, packaging, or medication delivery system A change in service setting A change in the person’s health status A change in the usual medication routine (new location, new provider) A change in functional status of other Activities of Daily Living (ADLs) A change in nutritional formula packaging If, a person who has historically been able to self-administer but due to a change is unable to do so safely, the assessment is updated. The assistance and supports are provided according to the assessment result(s) and listed in the ISP. Training and support should be provided to help the person return to self-administration status. The person should be reassessed for the ability to resume self-administration as soon as the circumstances allow. Examples of such occasions include, but are not limited to: Physical/psychiatric illness affecting memory or functional capacity New medications the person is not yet familiar with Post-operative; post-sedation Environmental changes during which time training is needed to transfer skills to the new environment When family is delegating to an independent HPC provider the assessment does not need to be completed, unless the team believes the person’s preferences and rights may be being violated. Family must reside with the person that is receiving family delegation. Additionally, family can never delegate to an agency provider. Children under the age of 18 do not have an inherent right to self-administer. The guardian/team may decide to use the assessment as a guide for planning and education. The guardian/team may allow self-administration. If medication administration/treatments/health-related activities are not part of the supports being requested, a self-administration assessment does not need to be done. If the team has concerns about the health and safety of a person, it should be addressed with a person-centered planning process. This may include discussion of the concerns with the person and identifying risks, providing education, and/or developing potential solutions that may or may not include direct assistance/supports with medication administration. Where to complete the assessment? Complete the assessment in each setting where the person will receive medication/treatments or perform health-related activities. A person-centered approach dictates the assessment be conducted in a manner that takes into consideration the location and circumstances under which the medication/treatment will be needed. The assessment is done in each applicable location to determine: What, if any, supports the person may need within the context of their personal environments Knowledge, and skills that may/may not transfer across different settings If appropriate, a single form may be used for multiple settings; list all settings assessed The approach to the assessment should be trauma-informed. Every effort should be made to assure the person feels comfortable, calm, unhurried, and unthreatened by the assessment process. The assessment should never be applied like a quiz or a test. January 2020 Edition 15 Who completes the assessment? It is recommended that the Self-Administration Assessment be completed by a person who is familiar to the person; who knows the person well and; who is knowledgeable about the person’s mode of communication. Ultimately, it is the responsibility of the SSA/QIDP to ensure that the Self- Administration Assessment is completed. When possible, it is recommended that a second observer be present to ensure results are indicative of the person’s capacity to safely self-administer or not. The person completing the assessment needs to have detailed information about the currently prescribed medications/treatments/health-related activities, including medication name, dose, route, time, purpose and basic side effects. If the medication/treatment/route is one that requires nurse delegation, a nurse must do the assessment. The assessment for self-administration of Medications, Nutrition, Fluids per G/J Tube must be completed by a licensed nurse. If the nurse does not know the person well, then it is recommended that a second observer who does and who is also familiar with the person’s mode of communication be present to ensure the results are indicative of the person’s capacity to safely administer the medication, nutrition or fluids. If the delegating nurse did not complete the assessment for Medications, Nutrition, Fluids per G/J Tube for the person, the nurse should review the assessment prior to delegation to ensure the nurse is not delegating more supports than is needed. The assessment for Insulin/Metabolic Glycemic Disorder medications must be completed by a licensed nurse. If the nurse does not know the person well, then it is recommended that a second observer who does and who is also familiar with the person’s mode of communication be present to ensure the results are indicative of the person’s capacity to safely administer the medication. If the delegating nurse did not complete the assessment for Insulin/Metabolic Glycemic Disorder medications for the person, the nurse should review the assessment prior to delegation to ensure the nurse is not delegating more supports than is needed. Important Considerations: ✓ People have an inherent right to self-administer (Ohio Administrative Code 5123:2-6-02). The assessment form is used to prove the need to override that right. ✓ The person being assessed may not be able to state medical terminology but relaying content/intent in their own words or phrases is enough. ✓ The person may not be able to state specific side effects, but the ability to report health issues is how potential side effects will be recognized by prescriber/healthcare professional/family/caregiver. ✓ People with I/DD have the right to do as many steps of self-administration as they can do, either independently or with support, even if they are not assessed to be able to self-administer with or without assistance. ✓ Support providers must be legally qualified for whatever support they provide. ✓ The team must follow the appropriate processes associated with rights restrictions if a person has been assessed as having the knowledge and skill to self-administer, but has demonstrated unsafe behaviors, and is therefore not able to self-administer (Ohio Administrative Code 5123:2-2-06). January 2020 Edition 16 (Important Considerations continued): ✓ Multiple Self-Administration Assessments may be needed for a person if their knowledge and skills vary with different medications/treatments/circumstances. Separate Self-Administration Assessment forms should be used to document variable abilities with different medications/treatments and circumstances. For example: if a person is not able to self-administer multiple medications at 8 a.m., but can self-administer one or more medications at 12 p.m., or can apply their topical medications independently, then different assessments should be completed to confirm the different outcomes. ✓ If two people do not agree with the assessment based on safety concerns, a third team member should be consulted. ✓ Complete the specific Self-Administration Assessment Form as designed for: Oral and Topical Medications; Inhaled Medications; Oxygen Administration; Health-Related Activities such as obtaining temperature or blood pressure; Glucometer; Medications, Nutrition, Fluids per G/J Tube; Insulin/Metabolic Glycemic Disorder Medications. ✓ The form is a basic assessment tool. If the outcome on this form is “unable to self-administer with or without assistance” the team needs to assess in more detail to determine what steps of medication administration the person can do and plan only to provide the necessary support for other steps. Using the form: The assessment is the first part of the form; followed by the assessment outcome. A. Answer every assessment question on the form; questions are answered with a “Yes”, “No” or “N/A”. B. Document the outcome of the assessment. One of the 3 possible outcomes will be determined based on the assessment: 1. Able to Self-Administer 2. Able to Self-Administer with Assistance 3. Unable to Self-Administer with or without assistance Other mitigating factors are then addressed in the “Other Considerations” section of page 2 regarding the assessment outcome. Processing the Assessment results: Once the assessment is completed, the ISP should specify how medications/treatments/health-related activities will be completed. The ISP will state one of the three possible outcome results: able to self-administer without assistance able to self-administer with assistance or unable to self-administer with or without assistance If the outcome is “able to self-administer with assistance” the ISP should clearly identify which of the three types of assistance is needed and who will provide that assistance (OAC 5123:2-6-02(F)) If the outcome is “unable to self-administer with or without assistance” (Ohio Administrative Code 5123:2-6-02): the ISP should clearly identify what steps of medication/treatments/health-related activities the person can do, and who will provide the other steps of the medication administration process The SSA/QIDP shall ensure the results of the self-administration assessment appear in the ISP. The current DODD approved assessment forms are on the DODD website. January 2020 Edition 17  Use of Pill “Caddies” or Pill “Minders” (pre-packaging medications in any container) A person who can fill and use their own pill caddy has the right to do so. Only a licensed healthcare professional can fill a pill caddy for a person who cannot fill it for themselves. Only the person whose medications are in the pill caddy may take the medication from the caddy, that has been prepared for them. Unlicensed personnel may not ever fill a pill caddy unless at the direction of a person who is self-administering but needs physical assistance (Self-Administration with physical assistance). Unlicensed personnel may not ever administer medications from a pre-filled pill caddy. If a person is not able to independently self-administer (or self-administer with assistance) they may be able to use a pre-filled medication dispenser (pill caddy/minder) to consume their medications. The person-centered planning team needs to assess a person’s ability to safely use this technology as part of the chain of supports put in place for medication administration. When assessing the ability of a person to safely use a pre-filled medication dispenser, or remote monitoring, the team should consider: The person’s ability to reliably consume the medication at the correct time or with some type of time reminder, or remote support. The person’s ability to recognize the presence or absence of the correct medications in the pill caddy (or access to real or remote assistance to confirm the medications in the caddy are correct before taking them). The resources and support of appropriately licensed personnel to pre-fill the caddy or to fix the contents of the caddy if it spills or if there are any other problems with it. The resources and support of a licensed healthcare professional to adjust the contents of the caddy if a person has a prescribed medication added, discontinued or changed. The resources and support of a properly licensed or MA certified personnel to administer medication if medications cannot be taken by the person from the caddy. How will as needed medications be administered (with or without being in a caddy). How will medications that do not fit in a pill caddy be administered (ex. liquids, inhaled, ear, eye, nose and other topicals). How will filling and consuming of medications be documented. What steps can be achieved with remote monitoring, how, and by whom. The use of remote monitoring to support medication administration: If a person can independently self-administer medications, remote monitoring would not be necessary for medication administration. If a person can self-administer with assistance, the remote monitoring can be used for the time reminder and medication confirmation or unlocking assistance. The person providing this assistance does not need to have medication administration certification. When a person needs more than the time reminder and medication confirmation or unlocking assistance, then the person providing remote support DOES need to be medication administration certified. Medication Administration The MA certified personnel who provide more than self-administration assistance as part of remote supports will need to have a MAR for doing the 3-step check process of medication administration, Health and Safety Alert #55–3–17 and to document administration just as if they were with the person. January 2020 Edition 18 January 2020 Edition 19 January 2020 Edition 20  The Process of Delegation from Licensed Nurse to Certified DD Personnel A. Definitions: Delegation: Transferring the authority to perform a specified nursing task or activity in a selected situation to a specific unlicensed person. Delegator: The delegating nurse is the one who provides the delegation. Delegatee: The person who receives authority to perform tasks or medication administration from the delegating nurse. B. Authority for Delegation: Ohio Board of Nursing (OBN) rule OAC 4723-13 allows a registered nurse or a licensed practical nurse under the direction of a registered nurse, to transfer the performance of a nursing task to another person who is not otherwise authorized to perform the activity or task. Ohio Administrative Code (OAC) 5123:2-6-03 authorizes the nurse to delegate giving and/or applying prescribed medications, performing health-related activities, administration of medications via gastrostomy and/or jejunostomy tube, and/or administration of insulin and other injections for metabolic glycemic disorders to unlicensed MA certified personnel in specified environments. C. Delegation: 1. All nurse delegation must comply with standards and conditions specified by the OBN in OAC 4723-13. 2. Certification is not the same as delegation. Certain services settings and tasks may require delegation in addition to certification. 3. Developmental Disabilities (DD) personnel who are trained and certified will be selected by the delegating nurse to administer medications and perform health-related activities for settings or activities where delegation is required. 4. DD personnel who are appropriately certified will be selected by the delegating nurse to perform administration of medication through a stable-labeled gastrostomy tube or stable-labeled jejunostomy tube or to administer insulin and other injections for metabolic glycemic disorders at the direction of a licensed nurse. 5. A Registered Nurse (RN) will assess the person to determine if the person’s condition and circumstances are stable and that delegation of the medication, health-related activities, or insulin and other injections for metabolic glycemic disorders administration is safe and appropriate. 6. A RN will complete a statement of delegation for each person who requires delegation for their medication administration, performance of health-related activities, administration of medication by stable-labeled gastrostomy or jejunostomy tube and/or insulin and other injections for metabolic glycemic disorders. 7. Certified personnel will receive individual specific training, detailed information and written step by step instructions from the delegating nurse, regarding medication administration, performance of the health-related activities/nursing tasks, administration of medication by stable-labeled gastrostomy tube or stable-labeled jejunostomy tube or insulin and/or other injections for metabolic glycemic disorders. 8. A nurse will observe the skills of certified personnel at least annually or more often as needed. The nurse has the authority to withdraw delegation if the nurse believes the certified personnel is not or will not safely perform the delegated nursing task or activity. 9. The nurse must provide ongoing supervision of the delegated actions. January 2020 Edition 21  Effective November 6, 2017 Authority of DD Personnel to Perform Services by Type - Medication Administration Reference Grid (ORC 5123.41-.47 and OAC 5123:2-6-3) County Board (CB) responsibility for Quality Assessment (QA) by RN. See outlined boxes Certification 1 Certification 1 Certification 2 Certification 3 Delegable Nursing Tasks 13-HRAs Medication G / J Tube Insulin Including 13 HRAs Applicable (He alth-Re late d by Sub-Q Injection Activitie s) Administation Prescribed & Pump & Setting (HRAs may be (Prescribed Oral, Medication and inje ctable Administration of de le gable without Administration tre atme nts for ce rtification pe r Topical, O2 and me tabolic glyce mic Nutrition by G/J Tube O AC 4723-13) Inhalers) disorde rs Adult Services Without nursing Without nursing With nursing With nursing With nursing Settings up to 16 delegation delegation delegation delegation delegation people Family Support Without nursing Without nursing With nursing With nursing With nursing Services delegation delegation delegation delegation delegation Certified Supported Living Services (1-4 Without nursing Without nursing With nursing With nursing With nursing individuals per living delegation delegation delegation delegation delegation arrangements) Certified Home and Community Based Without nursing Without nursing With nursing With nursing With nursing Services (1-4 individuals per living delegation delegation delegation delegation delegation arrangements) Residential Facilities : Without nursing Without nursing With nursing With nursing With nursing 1-5 Beds delegation delegation delegation delegation delegation Early Intervention, With nursing With nursing With nursing With nursing With nursing Pre-School, School delegation delegation delegation delegation delegation Age Adult Services With nursing With nursing With nursing With nursing With nursing Settings with 17 or delegation delegation delegation delegation delegation more people Residential Facilities : With nursing With nursing With nursing With nursing With nursing 6 or more Beds delegation delegation delegation delegation delegation Other Services by DD With nursing With nursing With nursing With nursing With nursing Boards or by Ohio delegation delegation delegation delegation delegation Dept of DD *As per OBN's Administrative Code Chapter 4723-13, an RN may delegate specific NURSING TASKS to uncertified personnel (following all provisions in OAC 4723-13). Delegation of MEDICATION requires DODD Certification(s). January 2020 Edition 22  Medication Administration (MA) and Health-Related Activities By Medication Administration (MA) Certified Personnel ♦ MA certified personnel have the responsibility to meet all the requirements set forth in OAC (Ohio Administrative Code) 5123:2-6-06 and comply with procedures as taught in the curriculum for certification. ♦ MA certified personnel must acquire individual specific training for each person prior to administering medications, treatments or performing health-related activities. ♦ MA certified personnel must have a directive from a Healthcare Professional prior to administration of any medications or treatment (exceptions are for OTC topical medication for musculoskeletal comfort and the taking of vital signs when illness is suspected). ♦ For every medication or treatment to be administered, MA certified personnel have the responsibility to know and understand: What medication/treatment they are administering Why they are administering that medication/treatment The expected outcome Any special instructions and precautions associated with the medication or treatment that need to be addressed Common potential side effects How to contact or get assistance from a healthcare professional if the person is having problems or the medication or treatment outcome is not as expected These are crucial elements of Medication Administration and are not exempted by any person, circumstances, employer or delegating nurse. THESE ARE YOUR RESPONSIBILITIES AS PART OF YOUR MEDICATION ADMINISTRATION CERTIFICATION. IF YOU DO NOT KNOW SOMETHING - ASK Employer Oversight The employer is responsible for:  Assuring IST (individual specific training) for each person is provided to personnel after certification and before medication administration or health-related activities occurs.  Overseeing medication administration and performance of health-related activities as specified in the Ohio Department of Developmental Disabilities (DODD) law and rule. ORC 5123.42 (D) (4)  Assuring annual relevant skills check for certified personnel. ORC 5123.45 (D) (4)  Stopping medication administration and health-related activities performance when there is a question about the skill or activity being performed by the certified personnel.  Providing ongoing oversight of personnel performing oral and topical medication administration and the 13 health-related activities.  Assuring nurse delegation for actions that require delegation. January 2020 Edition 23  FAMILY DELEGATION Ohio Revised Code (ORC) 5123.47 If services are When a person’s family member lives with them, the family member may provide an independent provider with the training, delegation and supervision needed to provided administer medications and treatments. ♦ Prescriptions or directives from a healthcare professional are still required. through an ♦ Detailed written instructions are still required. agency, family Please read ORC 5123.47 for a full explanation of requirements. Medication Administration Certification is not required when a family delegation does delegates to an independent provider. not apply. Function of Others Involved in Medication Administration and Performance of Health-Related Activities for People with Developmental Disabilities A. Physician: Prescribes treatments and medications and determines route, dosage, and frequency for medications. The physician may be consulted if there is question about any treatment or medication. Certified Nurse Practitioners and Licensed Physician’s Assistants may also write prescriptions. B. Nurse: Where applicable, the licensed nurse delegates duties to MA certified personnel, provides training for medication administration, health-related activities and glucagon. The nurse performs an assessment of the person receiving services and provides ongoing recommendations. The delegating nurse must be contacted for any questions or changes in the health of the person or the delegated activities. A nurse may be consulted when there are questions regarding medications and/or health-related activities. The delegating nurse is the only one who can transcribe orders for G/J tube food, fluids, or medications. Orders for insulin and injections for metabolic glycemic disorders must be transcribed by a nurse onto the Medication Administration Record (MAR). C. Pharmacist: Fills prescriptions and provides information about the medication. The pharmacist DOES NOT write prescriptions. The pharmacist may be contacted when there is a question regarding medications including dose, route, side effects or giving medications later than what is indicated on the MAR. D. Employer: Ensures that ONLY certified personnel perform medication administration and health- related activities according to the law and rule. In settings where delegation by a nurse is NOT required, it is the employer who oversees medication administration and performance of specific health-related activities and ensures annual skills checks. E. Other healthcare directives may be provided by: Dentists, podiatrists, nurse practitioners, clinical specialists, occupational therapists, physical therapists, speech therapists, and dietitians. January 2020 Edition 24  Health Needs Social Needs Daily Activity Needs Training on any equipment Individual Specific Training (IST) (OAC 5123:2-6-01) Individual Specific Training (IST) must be done after certification and before administration of any medication or performance of any health-related activities. Documentation of IST must be maintained. Agencies must have a policy and procedure in place for documenting and tracking all IST completed. Remember, if it isn’t documented, it wasn’t done. Individual Specific Training is the INITIAL introduction to the person and their healthcare needs and preferences. IST occurs prior to the first-time personnel administer medication or perform health-related activities to any person. Ongoing training continues to be provided as needed. As a provider, IST is the information you will need to ensure the safest care is provided to a person. IST must include:  The person’s needs (physical, social, and emotional)  A summary of the person’s relevant health care information ORC (Ohio Revised Code) 5123.42 makes IST a responsibility shared by the employer and employee. The employer is to ensure personnel receive the training. Certified personnel are not permitted to perform any task presented in Medication Administration Certification training without receiving initial IST for each person. Daily Schedule/ISP/Agency Paperwork/Documentation Cognitive abilities Policies and Procedures Ability to make decisions Personal preferences January 2020 Edition 25  Medications Certified Personnel Are Not Permitted to Apply/Administer 1. Anything through a nasogastric (NG) tube 2. Parenteral or intramuscular injection 3. Intravenous (IV) injection 4. Any debriding agent used in the treatment of a skin condition, burns or minor abrasions 5. Subcutaneous (sub Q) injection EXCEPTIONS for Injections: Category 1 certified personnel may inject glucagon after a licensed nurse has delegated the task to the certified personnel and the personnel receives Individual Specific Training from the nurse. Certified personnel may administer insulin and other injections for metabolic glycemic disorders if they hold a current Category 1 and Category 3 certification and are delegated to do so by a licensed nurse. Certified personnel may use an Epinephrine Auto-injector after receiving DODD approved training. Epinephrine auto-injector is not included in this Category 1 Certification. See OAC 5123:2-6-05 for information about approved training for the use of an epinephrine auto-injector. Certified Personnel may NOT Administer Anything through a Parenteral or IV Medications Any Debriding Agents Nasogastric (NG) Tube Intramuscular Injections Nasogastric Tube: A tube starting in the nose, passing through the throat and into the stomach. Parenteral: Delivery of medications by injection. Debriding: Removal of dead tissue from a wound. January 2020 Edition 26  Standard and Universal Precautions The concept of Universal Precautions presumes that all body fluids are potential carriers of infectious diseases and therefore blood and all body fluids are presumed contaminated. Hand washing is an important part of Universal Precautions and the NUMBER ONE technique for controlling transmission of infections. Protective measures of personal hygiene are recommended as follows: 1. Keep the body clean. 2. Practice good hand washing (Centers for Disease Control [CDC] advises a minimum of 20 seconds). 3. Don’t share used personal items such as medication cups, drinking cups, eating utensils, combs, brushes, etc. without washing them first. 4. Cough or sneeze into arm, sleeve, or disposable tissue. The Centers for Disease Control (CDC) recommends that hands be washed in certain situations including:  Before preparing medications  Before and after contact with any person  After handling any contaminated equipment  Before and after applying topical medications  After contact with organic material (i.e. after toileting or assisting with toileting or with hygiene) The CDC recommends the use of personal protective equipment such as gloves or other items as necessary when there is a possibility of contact with blood or body fluids. Guidelines for using gloves are:  Dispose of gloves following approved procedures  Change gloves before assisting a different person  Always wash hands before applying gloves and after disposing of them  Be aware of, and follow, your agency’s general universal precautions policy Waterless hand washing products are available for use in situations when using soap and water is not possible. Follow instructions with the specific product you are using. Refer to your agency’s policy and procedure for other infection control information. Sources: www.cdc.gov January 2020 Edition 27  What You MUST Know About Any Medication Before Administering It (Every Medication, Every Time it is Administered) ❖ What is the purpose of this medication for this person? ❖ How much should be taken? ❖ When should it be taken? ❖ Are there any special instructions? ❖ Can it be given late if missed? (if yes, how late is too late?) Delegating Nurse ❖ What should be done if a dose is missed or if an incorrect dose is given? ❖ What side effects may occur and who should the suspected side effects be reported to? ❖ Can anything be done to prevent side effects? ❖ Will it interact with other medications being taken? ❖ Should it be taken with food or on an empty stomach? ❖ Do blood levels need to be checked with this medication? Pharmacist ❖ If blood work is needed; how often? ❖ Are there any foods, other medications, supplements, or other things that should not be taken with the medication? Information about a specific medication can be obtained from the package insert, a pharmacist, nurse or reputable internet source such as the manufacturer or Drugs.com January 2020 Edition 28  Giving or Applying Medication A. The person giving or applying a medication should always know and consider the following:  Why the medication is being given and the expected result  Potential side effects, precautions to take, and whom to tell about any concerns B. Six rights of medication administration (I M DR T D) (I am Dr. T.D.) I = Right Individual (person) M = Right Medication including strength D = Right Dose R = Right Route T = Right Time and date (may be given 1 hour before up to 1 hour after time ordered) D = Right Documentation C. Stay with the person until the medication has been taken. Be sure medication is taken (swallowed). D. Document that you gave the medication(s) IMMEDIATELY AFTER administering. E. Medications are to be given and documented by the certified personnel who prepared the dose(s).  NEVER give any medication set up by any other person  ONLY give medications YOU have set up; this includes medications that you will give to a person who is away from home when you are out with them  DO NOT SET UP medications until you are ready to give them; prepare and administer medications at the time they are scheduled to be given  Do not give improperly labeled or unlabeled medications F. Always keep the original box or bag of the medication that has the label on it. The pharmacy labeling must be able to be read when the medication is being administered. G. Only give medications from containers:  That have an intact pharmacy label if it is a prescription medication  That have a manufacturer’s intact label if it is a non-prescription/OTC medication H. If giving a medication that the person has never had before, closely observe them for any adverse reactions. I. Certified personnel must receive Individual Specific Training about each person to whom they will be administering medications or treatments before providing medications or treatments. If the person is not capable of self-administration or self-administration of medication with assistance, then medication may be administered to them as part of their person-centered plan. Personnel administering medications must have a current DODD Category 1 medication administration certification. January 2020 Edition 29  PREPARE AND ADMINISTER MEDICATIONS FOR ONLY ONE PERSON AT A TIME A. Give FULL ATTENTION to preparing the medications you will be giving. B. Make sure the preparation area is clean and well lit. C. Check the MAR (medication administration record) to see when the last dose was given and when the next dose will be due. If a medication that should have been given already has not been given, you need to investigate, and report missed medications as Unusual Incidents. D. If medications are listed on the MAR for administration at different times, but are all within the same window of time Scored tablets may be split. (1 hour before and up to 1 hour after the scheduled time on the Unscored tablets should not MAR), check with a healthcare professional to find out if it is be split by medication safe to give them together. Medications may need to be administration certified given at separate times because they are not safe personnel. or effective when given together. Ex: Synthroid scheduled at 7 AM and Lisinopril at 9 AM should NOT be given together at 8 AM. E. Never place any oral medication (i.e. tablet, capsule, pill) Scored tablet Unscored into your own hand. tablet F. Multiple oral medications for a given person can go into the same cup, unless otherwise specified. G. Put one medication at a time from its container into the cup in the correct amount. Follow the person’s If a medication is specified as not specific instructions to know how many medications to put in a single cup. crushable, there must be a physician order to crush the H. More than one cup may be needed to safely administer medication, if it needs to be multiple medications. Carefully consider a person’s crushed. ability to swallow multiple medications at one time. I. Never use unlabeled medications. Make sure the medication in the pill J. Never prepare medications before it is time to administer the bottle or docu-dose matches the medications. Never administer medications that have been description from the pharmacy prepared by someone else; not even if a parent, guardian or nurse has prepared the medications. K. If you have any questions regarding the medications, seek assistance. Resources for medication questions include the person’s physician, nurse, or pharmacist. Unlicensed personnel, including supervisors, may not make independent judgements about medication administration decisions. L. Check each person’s MAR: Every Medication, Every Page, Every Day. NEVER prepare medications early for administration later. (Except as instructed in this manual for administration on outings). January 2020 Edition 30  Getting Medication From the Original Container Getting Medication from a Bottle or Vial Container to the Dispensing Cup When administering medications from a bottle or vial, certified personnel must be careful not to touch the capsule or tablet with their fingers. The medication is poured from the container into the lid of the container, then from the lid into the dispensing cup. Pour pill from container into lid of container Transfer to dispensing cup Getting Medications from the Blister (bubble) pack to the Dispensing Cup The packaging for medications placed in compartments for a given month is called a blister pack or bubble pack. The pills are placed in numbered windows. Put the cup under the correct pills so that you can push the pills from the appropriate window into the dispensing cup. Check to be sure the medication is in the cup (not stuck in the back of the blister/bubble pack). Getting Medications from a Multi-Dose Pack to the Dispensing Cup Multi-dose packs have all the medications for a specific time together in a single pouch. The pharmacy label and description of each medication must be included on the packaging. Personnel must identify each pill/capsule and compa