QMAP Course Syllabus 2024 PDF

QMAP COURSE SYLLABUS State of Colorado Approved ATE Adapted from CDPHE | Last Revised May 2024 QMAPCLASS.COM © 2024 Colorado QMAP Training | 1361 Francis St STE B-107...

QMAP COURSE SYLLABUS State of Colorado Approved ATE Adapted from CDPHE | Last Revised May 2024 QMAPCLASS.COM © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 1 of 98  Contents Fees policy............................................................................................................................................ 7 Overview................................................................................................................................................ 7 Statutory and Regulatory Authority.............................................................................................. 7 Purpose.......................................................................................................................................... 7 Cautions......................................................................................................................................... 8 Course Objectives:........................................................................................................................ 9 Course Competencies.................................................................................................................. 9 Resources....................................................................................................................................10 UNIT 1 | CONCEPTS............................................................................................................................11 The Seven Rights of Medication Administration..........................................................................11 The Importance of Safe Administration....................................................................................11 The Right Client...........................................................................................................................12 The Right Time............................................................................................................................12 The Right Medication..................................................................................................................12 The Right Dose............................................................................................................................13 The Right Route...........................................................................................................................13 The Right Documentation...........................................................................................................13 The Right to Refuse.....................................................................................................................14 The Four Routes of Medication Administration............................................................................14 Ingestion......................................................................................................................................14 Inhalation.....................................................................................................................................15 Insertion.......................................................................................................................................15 Application...................................................................................................................................16 Monitoring, Administering, & Self-Administration........................................................................17 Monitoring...................................................................................................................................17 Administration.............................................................................................................................17 Self-Administration.....................................................................................................................18 Forbidden Territory: Rules and Prohibitions..................................................................................19 Injections.....................................................................................................................................19 Tubes............................................................................................................................................19 Assessment.................................................................................................................................19 Physician Orders.........................................................................................................................20 © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 2 of 98  Exceptions...................................................................................................................................20 Unit 1 Review...............................................................................................................................20 UNIT 2 | INFORMATION ABOUT MEDICATIONS...............................................................................22 Basic Medication Information........................................................................................................22 Sources of Information...............................................................................................................22 What to Know..............................................................................................................................23 Therapeutic Effect – Indications for Use..................................................................................23 Contraindications........................................................................................................................23 Onset............................................................................................................................................24 Peak.............................................................................................................................................24 Duration........................................................................................................................................24 Timing..........................................................................................................................................24 Side Effects & Common Reactions............................................................................................25 Putting It All Together.................................................................................................................25 Uses & Forms of Medications........................................................................................................27 Purpose of Medication Administration.....................................................................................27 Medication Forms.......................................................................................................................28 Effects & Types of Medications.....................................................................................................30 Prescription vs. Over-The-Counter Medications.......................................................................30 Prescription Medications...........................................................................................................31 Over-The-Counter Medication....................................................................................................31 Generic vs. Trade Name..............................................................................................................32 Local Effect vs. Systemic Effect................................................................................................33 Therapeutic Effect vs. Side Effect vs. Adverse Reaction.........................................................33 Anaphylaxis.................................................................................................................................34 Psychotropic & AntiPsychotic Medications..................................................................................35 Psychotropic Medications..........................................................................................................35 Narcotics & Controlled Substances...............................................................................................36 Schedule I....................................................................................................................................36 Schedule II...................................................................................................................................37 Schedule III..................................................................................................................................37 Schedule IV..................................................................................................................................37 Schedule V...................................................................................................................................37 © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 3 of 98  Proper Handling of Controlled Substances...............................................................................38 Reporting Discrepancies............................................................................................................38 Destroying Medications..................................................................................................................39 Unit 2 Review...............................................................................................................................39 UNIT 3 | MEDICATION ORDERS..........................................................................................................43 The Six Components of a Medication Order.............................................................................43 Dose vs. Strength........................................................................................................................44 Imperial vs. Metric System.........................................................................................................44 Translating & Transcribing Medication Orders.............................................................................45 Translation...................................................................................................................................46 Transcription................................................................................................................................46 Dose vs. Strength........................................................................................................................46 Unit 3 Review...............................................................................................................................47 UNIT 4 MEDICATION ADMINISTRATION RECORDS.........................................................................49 MAR Documentation......................................................................................................................49 Rules for Documenting on the Medication Administration Record.........................................49 How to Document.......................................................................................................................50 New Medication Order................................................................................................................50 Discontinued Orders...................................................................................................................50 Creating a New MAR...................................................................................................................51 Documenting Administration or Monitoring..............................................................................52 Documenting Medications that are Not Passed.......................................................................52 PRN vs. Scheduled Medications....................................................................................................53 Scheduled Medications..............................................................................................................53 PRN Medications.........................................................................................................................53 What Not To Do!..........................................................................................................................55 Unit 4 Review...............................................................................................................................55 MEDICATION ADMINISTRATION RECORD................................................................................56 UNIT 5 | DOSAGE CALCULATION.......................................................................................................59 Calculating the Dose!......................................................................................................................59 Universal Formula.......................................................................................................................59 Something Doesn’t Add Up!........................................................................................................60 Conversions & Rules for Measuring..............................................................................................60 © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 4 of 98  Unit 5 Review...............................................................................................................................64 UNIT 6 | MEDICATION REMINDER BOXES........................................................................................67 MRB Guidelines...............................................................................................................................67 Guidelines for Filling MRBs........................................................................................................67 Filling an MRB..............................................................................................................................68 Administration of Medication from MRBs.................................................................................69 Documenting Medication Administration from MRBs.............................................................70 Unit 6 Review...............................................................................................................................70 UNIT 7 | MEDICATION ADMINISTRATION PROCEDURES................................................................71 Standard Precautions & Handwashing..........................................................................................71 Preparing to Administer | Three Checks & Beyond.......................................................................72 Time to Administer? Not Quite...................................................................................................73 Now you may administer!...........................................................................................................73 Four Routes | Ingestion...............................................................................................................74 Do’s...............................................................................................................................................75 Don’ts...........................................................................................................................................75 Special Circumstances...............................................................................................................76 Sublingual Nitroglycerin..............................................................................................................76 Administering Oral Liquid Medications.....................................................................................77 Four Routes | Inhalation..............................................................................................................78 Metered Dose Inhalers................................................................................................................78 Nebulizers....................................................................................................................................79 Four Routes | Insertion................................................................................................................80 Four Routes | Application...........................................................................................................82 After Administration....................................................................................................................85 Unit 7 Review...............................................................................................................................85 UNIT 8 | MEDICATION ERRORS & STORAGE.....................................................................................87 Medication Errors............................................................................................................................87 Examples of Medication Errors..................................................................................................87 Procedure....................................................................................................................................87 Medication Storage.........................................................................................................................88 Storage & Access........................................................................................................................88 Lock & Key...................................................................................................................................89 © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 5 of 98  Refrigerated Medications...........................................................................................................89 Storage & Counting of Controlled Substances & Narcotics.....................................................89 Unit 8 Review...............................................................................................................................89 UNIT 9 | SPECIAL CIRCUMSTANCES.................................................................................................91 Communication & Interpersonal Skills..........................................................................................91 Effective Communication and Interpersonal Skills..................................................................91 Tips for Effective Communication.............................................................................................91 Things to Avoid............................................................................................................................92 Sample Script..............................................................................................................................92 Abuse Prevention & Reporting.......................................................................................................93 Physical Abuse............................................................................................................................93 Emotional & Psychological Abuse.............................................................................................93 Sexual Abuse...............................................................................................................................94 Financial Abuse...........................................................................................................................94 Emergencies & First Aid.................................................................................................................95 QMAP Role in an Emergency......................................................................................................95 Seizures.......................................................................................................................................96 Anaphylaxis.................................................................................................................................96 Choking........................................................................................................................................96 Chest Pain | Heart Attack...........................................................................................................97 Resources....................................................................................................................................98 Unit 9 Review...............................................................................................................................98 © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 6 of 98  FEES POLICY Your Paid fees will be forfeited if you are registered for a class or Testing Session and do not attend, or miss any portion of the class or Testing Session without making prior arrangements with QMAP Training, LLC at least 24 hours in advance. OVERVIEW STATUTORY AND REGULATORY AUTHORITY This medication administration program is established in accordance with Colorado Section 25-1.5-301, C.R.S et seq. Colorado Health Facilities Division (HFD)-6 CCR 1011-1 standards for hospitals and health facilities. Chapter XXIV – Medication Administration Regulations Effective 7/1/17. These regulations require a certain level of understanding of both English and math. CDHS Qualistar Medication Program has been discontinued as of January 2019. This course is now the required medication program. The relevant documents are available on the website for The Colorado Secretary of State – Code of Colorado Regulations | Official Publication of the State Administrative Rules (24-4- 103(11) C.R.S. The QMAP must provide a copy of a government issued ID and be at least 18 years of age. The QMAP must possess basic English comprehension and mathematics skills. QMAP Candidates should not work the overnight shift before attending the QMAP class and should not work overnight before testing. The written exam must be passed with a minimum score of 88%. The practicum exam must be passed with a score of 100%. o This includes hands-on demonstrations and verbally explaining the correct steps in preparing and administering medications by all four routes. Employers must provide further “on the job training and mentoring” for all QMAPs. Employers must conduct a criminal background check prior to allowing medication administration by the QMAP employee. PURPOSE The Colorado QMAP Training Medication Administration Course is designed to teach unlicensed staff to safely administer medications in settings authorized by law, and to meet the requirements set forth by the State of Colorado to qualify as a Qualified Medication Administration Person (QMAP). © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 7 of 98  Successful applicants will pass a written exam and a hands-on practical exam. The administration of medications is a privilege. This role is a major responsibility that affects the quality of clients' lives. Improper or careless administration of medications may result in death. You are responsible for what you administer. You may administer medications using medication reminder boxes (MRBs) that others (client, family, other facility staff) have prepared. Administering medications is a very important task. Current regulations and requirements for medication administration in Colorado became effective July 1, 2017. One of the requirements is that any unlicensed person administering medications or supervising the administration of medications must pass a test approved by the State of Colorado. The purpose of the Syllabus and the Key Concepts Study Guide is to increase your knowledge of safe medication administration practices, and prepare you for the Testing Session. Both of these documents were developed as adjunctive tools for the eLearning Course, In-Person Course, and additional training your Facility will provide. Test taking can be stressful! If you have special learning needs, please inform your instructor so reasonable accommodations can be made. The exam proctored by Colorado QMAP Training covers the basic information necessary to qualify as a QMAP, and meets the requirements set forth by the State of Colorado. The questions in the Key Concept Study Guide and throughout the Online Course are guides, the questions on the written exam will be similar to those found throughout the course, and will draw on all aspects of the course. CAUTIONS This course does not lead to certification or a license. Upon successful completion of this course your name and assigned QMAP number will appear on the State Website, in about three to five business days. The QMAP may shadow another QMAP or RN until their number appears on the State Website. Once their number is visible on the State Website the QMAP may pass medications. People who successfully complete the course are not trained or authorized to make any type of judgment, assessment, or evaluation of clients or medications. Effective 1 July 2017, the CDPHE does not require you to retest, but CDPHE does maintain it is your ethical responsibility to take a refresher course every 3-5 years to maintain skills and knowledge of best practices. Every QMAP must sign a disclosure statement that he or she has never had a QMAP qualification, a professional license to practice nursing, pharmacy, or medicine revoked in any state for reasons related to the administration of medications. If you have, you must disclose the information on the disclosure form. A copy of the disclosure form is required to be provided to your employer. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 8 of 98  COURSE OBJECTIVES: The objective of this course is to train unlicensed staff to safely and accurately administer medications in authorized settings. This course provides the foundational knowledge you will need to be prepared for the written and practicum testing. The questions on the written test draw from all units in this course and will be similar to the questions found in the review sections in this course. COURSE COMPETENCIES To qualify for a QMAP training program, a person must provide proof of being at least 18 years of age and must possess English reading, writing, and math skills. By the end of this course you will know and/or demonstrate mastery of the following: The Seven Rights of Medication Administration and how they apply to: o Safe administration of medications o The Four Routes o Written physician’s/providers orders o Accurate documentation including spotting and managing medication & documentation errors. o Comprehension of various forms of medications as they relate to QMAP scope o Comprehension of important guidelines for mental health and behavioral issues, and for vulnerable populations including the elderly, physically or cognitively impaired Accurate calculation of proper dosage based on medication orders Use of proper technique when administering both prescription and non- prescription medications including: o The Three Checks o Administration by the Four Routes Performing the Right Documentation on the Medication Administration Record (MAR) including: o Accurate translation and transcription of medication orders onto the MAR. o Accurate and timely documentation of medication administration Appropriate use of Medication Reminder Boxes (MRB) including labelling, filling, and usage Reporting Narcotics/Controlled Substance Diversion Proper medication counting, storage, & destruction Understand authorized settings for use of QMAPs. Understand the difference between monitoring, administration, and self- administration. Authorized Facilities include: Assisted Living Residences. Alternative Care Facilities and Adult Foster Care. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 9 of 98  State Certified Adult Day Programs. Residential Child Care and DHS Juvenile Facilities. Facilities that Provide Treatment for Persons with Mental Illness. Secure Residential Treatment Centers. All services regulated by the Dept. of Health Care in support of persons with intellectual and developmental disabilities. D.O.C Facilities. (Department of Corrections). QMAPs may not practice in the following settings: Home health care Hospice Hospitals Nursing homes RESOURCES QMAP Key Concept Study Guide National Institute of Health | Medication Routes of Administration National Institute of Health | Administration of Medications Via Other Routes © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 10 of 98  UNIT 1 | CONCEPTS THE SEVEN RIGHTS OF MEDICATION ADMINISTRATION THE IMPORTANCE OF SAFE ADMINISTRATION 1. Administration of medications is a privilege. You are responsible for every medication you administer. 2. The QMAP’s role comes with great responsibility when it comes to affecting the quality of client’s lives. Improper or careless administration of medications can result in death. 3. Both the QMAP and the QMAP’s employing Facility are responsible for medication administration and errors. 4. According to the World Health Organization (WHO) medication errors account for 50% of preventable harm in medical care. Additionally, the highest rates of errors occur in the Prescribing, Administering, and Monitoring phases. o QMAPs play a role in two out of three of these stages! The Seven Rights of Medication Administration The Right Client The Right Time The Right Medication The Right Dose The Right Route The Right Documentation The Right to Refuse The Seven Rights of Medication Administration are the cardinal rules to follow. You will keep each of these in mind each and every time you administer medications. Breaking any of these rights can easily result in a medication error. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 11 of 98  THE RIGHT CLIENT Getting the right person is fundamental. The best way to verify your client’s identity is to use a picture. Don’t assume when they come in the room! Clients may look very similar and even in a small group setting identification can be difficult. THE RIGHT TIME Timing is everything! Medications must be given at the correct time to prevent errors. You wouldn’t drink coffee before bed! Some days are worse than others and you need second coffee* If the physician order specifies a time to administer the medication, a “window” of 30 minutes before and after the stated time must be followed. If no time is specified on a medication order, a Facility may choose to use AM, NOON, PM, HS. The Facility determines their policy regarding when these times are set. *it comes in pints?! THE RIGHT MEDICATION Giving the Right Medication means checking carefully, word by word, and letter by letter… Some meds come in multiple forms (XL, LA…)! Coffee is not the same as Coffee Decaf! Don’t make this horrible mistake! DRUG NAMES are hard, and many sound alike! Don’t give Dulcolax instead of Docusate! © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 12 of 98  THE RIGHT DOSE How much of a medication you administer is important You wouldn’t drink an entire pot of coffee!* Use the Universal Formula! Ensure you give the correct number of tablets, or amount of liquid. *Well, maybe you would if it’s been a long week. THE RIGHT ROUTE Medications can be given via several routes, and it is vital that they are given via the correct route. You wouldn’t inhale your coffee grounds!* QMAPS can administer medications via four routes: Ingestion, Inhalation, Insertion, & Application. Giving the right med via the wrong route is an error! *Then again, it’s been a rough pandemic. THE RIGHT DOCUMENTATION Document everything! If you didn’t document it, you didn’t do it! Document accurately! The client didn’t actually drink 950ml coffee, did he? Different circumstances require different documentation. I mean, have you tried being awake lately? Sometimes it takes a LOT of coffee… © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 13 of 98  THE RIGHT TO REFUSE The Right to Refuse is ALWAYS right! It is assault to give meds to a client who refuses! It is assault to hide medications in food without telling the client! Never trick, threaten, or force clients into taking medications. THE FOUR ROUTES OF MEDICATION ADMINISTRATION (Details on each of these in Unit 7) The National Institute of Health has a resource on the Routes of Administration providing details on each of the routes, and common situations. You would do well to review this material. National Institute of Health | Administration of Medications Via Other Routes INGESTION Tablets, capsules, spansules Liquids and suspensions © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 14 of 98  INHALATION Metered Dose Inhalers Nebulizers Dry Powder Inhaler Discs INSERTION Rectal Suppositories Vaginal Suppositories © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 15 of 98  APPLICATION Ointments, gels, liniments, gargles, patches… Eye drops Ear Drops Nose Drops & Nasal Sprays © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 16 of 98  MONITORING, ADMINISTERING, & SELF-ADMINISTRATION This lesson will teach you the difference between monitoring, administering, and client self- administration of medications. The authorized practitioner must state, in writing, which option is permitted/required if medication is taken in a designated setting by a client. An authorized practitioner is a licensed physician (MD/DO), physician’s assistant (PA), nurse practitioner (NP) with prescriptive authority. MONITORING Reminding a specific client to take medications at the time ordered. Delivering a container of medication lawfully labeled to a client if needed. Ex: MRB. Observing a client to make sure they took medication. Documenting administration of each medication with the note ‘monitored’. Notifying the physician if the client refuses or is unable to comply with the physician’s instructions regarding the medication. Note: Regulations do not require successful completion of a QMAP course if staff only ‘monitors’ and does not ‘administer’ medications to a client. ADMINISTRATION Assisting a client in the ingestion, inhalation, insertion or application of medication according to the written directions of an authorized practitioner. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 17 of 98  This includes handing medications to a client that were prepared (poured) by the QMAP or other qualified staff member. Documentation of each medication administered is a requirement, even if it is an over-the- counter medication. SELF-ADMINISTRATION The client has the ability to take the medication independently without any assistance from another person. It is acceptable to make a general ‘reminder’ to self-administering clients. The client is completely responsible for taking their own medications. Staff are not involved other than to ensure safety of clients and encourage notification of updated medications. It is best practice for the Facility or Agency to have a list of the medications a client so self-administering, so in the event of an emergency the information can be provided to emergency personnel. Encourage self-administering clients to check the expiration dates on their medications and offer assistance if needed. There is no requirement for daily documentation of Self-Administered medications. There should be a note on the plan of care at least one yearly, updated as appropriate, documenting the facility’s knowledge of medications being self-administered. If the facility administers some medications, and the client self-administers others, the Facility must have written physician approval for each self-administered medication. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 18 of 98  FORBIDDEN TERRITORY: RULES AND PROHIBITIONS Everything related to QMAP training is designed to prevent errors and promote client safety. Click through each of the flashcards below to learn more about what QMAPs are not permitted to do, and what the exceptions are. INJECTIONS QMAPS may not administer medications by injection. Nor can they draw up medication from a vial with a needle. QMAPs may not change the dial on a medication pen (insulin / Ozempic). A good rule of thumb is if it involves a needle, a QMAP cannot do it. Exception – A QMAP may administer an Epi-pen under certain circumstances. TUBES QMAPs may not ever administer medications through any kind of tube, including gastrostomy (placed through the abdomen into the stomach), and nasogastric (inserted through the nose into the stomach) tubes. ASSESSMENT QMAPs cannot perform assessments or make judgment calls regarding clients. QMAPs cannot perform assessments when administering medications that are ordered PRN; the client must understand and request the medication. Sublingual Nitroglycerin © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 19 of 98  Administration of repeated doses of SL nitroglycerin needs oversight by a licensed professional as QMAPs are not allowed to make assessments. Know your Facility’s Policy and Procedures for when someone requests SL Nitroglycerin. As a QMAP you should give the first dose, and then immediately notify your supervisor. Do not leave the client alone, follow your facility’s policy, and follow 911 operator instructions. PHYSICIAN ORDERS The only acceptable orders are written orders containing all six necessary components. While a QMAP requires a written physician/provider order for every action they take, a QMAP cannot ever take a physician order verbally, even in an emergency. EXCEPTIONS Injections Epi Pens A QMAP may administer an Epi-pen under two circumstances: The QMAP has received training from their facility, taken a first aid course, and there is an order on the chart to administer. The QMAP has called 911 for emergency assistance Group Home Setting A QMAP who administers medications in a developmentally disabled group home setting is another exception. The QMAP in this setting will receive additional Client Specific Training by the PASA Agency’s Nurse that governs the client care. Prn & Psychotropic Medications QMAPs may not perform assessments or make judgement calls when administering prn medications, and specifically cannot administer prn psychotropic medications. Psychotropic medications that are routinely scheduled on the MAR may be administered by a QMAP. PRN medications, and PRN psychotropic medications may be administered if the client understands the purpose of the medication and requests it. Anti-anxiety medications such as alprazolam or Ativan are examples of psychotropic medications that may be ordered PRN. Psychotropic medications may be administered by a QMAP if scheduled regularly. UNIT 1 REVIEW 1. List two examples of monitoring medications: 2. List two examples of administering medications: © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 20 of 98  3. This course qualifies you to do finger sticks (glucose checks): _______ True _______ False 4. This course qualifies you to administer medications through a G-tube or IV port: _______ True _______ False 5. You would not need this course to “monitor” a client injecting insulin: _______ True _______ False 6. List the Four Routes for administering medications and give an example of each route. ROUTE EXAMPLE 7. The QMAP may dial up and inject routine insulin injections if the client has an insulin pen: _______ True _______ False © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 21 of 98  UNIT 2 | INFORMATION ABOUT MEDICATIONS BASIC MEDICATION INFORMATION This lesson will cover the importance of knowing the basics about medications you administer, as well as resources to find the information you need. It is considered Best Practice to understand the medications you are administering. SOURCES OF INFORMATION Know Your Meds! As a QMAP you will be administering many medications to your clients. You are the last safeguard against medication errors, and so your role is vital! In order to safely care for your clients you need to know the basics about the medications you are administering. Your Facility will train you on policy and procedures when you have questions about medications, including whom to ask or go to. Sources of information include but are not limited to: PDR | Physician’s Desk Reference – A textbook reference of all available medicines and their uses. Fascinating information, but far more than is needed for a QMAP, though you can still use it to find everything you need. Medication Package Insert – A sheet of paper that comes folded up into a tiny square with the medication. This matches what is found in the PDR for the specific medication, though it may be abbreviated. It will generally provide the information you need. Nursing Drug Handbook – A collection of the most commonly prescribed and Over-The- Counter (OTC) medications, including all information on administration, onset, peak, duration, side effects, guidance as to whether the medication may be crushed or broken (if there is a physician order to do so), available forms of the medication (pill, liquid, suspension etc…) © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 22 of 98  Pharmacist – Many national pharmacies such as Walgreens and CVS have a pharmacist on staff 24 hours a day. While you may need to wait on hold for some time, they can also answer all your questions. WHAT TO KNOW As a QMAP everything starts with the Seven Rights of Medication Administration. Each of the items below fall under at least one of the rights, and sometimes more than one! Therapeutic Effect – Indications for Use Contraindications Onset Peak Duration Timing Side Effects & Common Reactions THERAPEUTIC EFFECT – INDICATIONS FOR USE Why are you administering the medication? Examples: analgesic medication to reduce pain, psychotropic medication to reduce anxiety, etc. Make sure it makes sense! You wouldn’t give antihypertensive (blood pressure) medication to someone who doesn’t have high blood pressure! CONTRAINDICATIONS When should you not administer an ordered medication? Each medication has circumstances under which it should not be given. These are called contraindications. For example: Make sure you don’t administer nitroglycerin tablets to someone who has taken sildenafil within the last 24 hours! The most common contraindication is hypersensitivity (or allergy) to the medication. ALWAYS CHECK YOUR MAR AND BE AWARE OF CLIENT ALLERGIES. Anaphylaxis is a severe allergic reaction that requires immediate response. These reactions usually begin within minutes, but can take longer to appear. An allergen is any substance causing an allergic reaction. Common symptoms include hives or a rash, headache, or a runny nose, Concerning © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 23 of 98  symptoms may include wheezing, coughing, swelling of the eyes lips and throat, airway constriction and difficulty breathing. Common allergens can include foods such as nuts, wheat, and eggs, fish and shellfish, or insect bites and stings. But there are many others! ONSET How quickly will the medication begin to work? Part of the Right Documentation is documenting the effect of the medication. So you’ll need to know when to check! Some medications can start working within seconds, others may take up to an hour or more. PEAK When will the medication reach it’s maximum effect in the body? Some medications peak quickly, such as Xanax. Others peak several hours later, such as lisinopril. Still others take weeks to have an effect (SSRI’s for example). DURATION How long will the medication work in the body? Medications work in the body for different lengths of time. Some medications are very short lasting, such as sublingual Nitroglycerin. Others may last a few hours, such as ibuprofen. CR, LA, and XL medications last even longer! o Note that medications with two letter suffixes such as Propranolol and Propranolol LA are two distinct medications. Ensure your order matches your medication! TIMING When and how often are you giving the medication? A physician may assume that the facility is aware of the best time to administer a particular medication and does not include this on his/her order. For example: o Synthroid or Levothyroxine is ordered by the physician for administration once daily. This medication is best taken on an empty stomach, first thing in the morning and without other medications. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 24 of 98  o Potassium is best taken with food or right after the meal because it can cause stomach upset. Other medications need to be given multiple times a day in order to have a therapeutic effect. Examples include antibiotics and some blood pressure medications. SIDE EFFECTS & COMMON REACTIONS What should the client expect? Medications are prescribed for a therapeutic effect, however, like a teeter-totter, medications can have side effects and adverse reactions. Side effects are expected outcomes from taking a medication other than the therapeutic effect. For example, antibiotics kill off good gut bacteria as well as infectious bacteria. When this happens we experience cramping and diarrhea as a side effect of the antibiotic. Adverse reactions are not expected to occur, but they are possible. Most adverse reactions require some form of medical intervention and all adverse reactions should be reported to your supervisor immediately. Anaphylaxis is an example of a severe adverse reaction requiring immediate medical attention. PUTTING IT ALL TOGETHER Let’s work our way through an example. The order below has all six components and is valid. Your first thought would be to evenly space the time in which you administer this medication since it is given BID. So it would seem at first glance that it would best go with the AM med pass and again in the late evening or at HS. However, upon looking up this medication in a drug reference guide, you determine it is a diuretic which is given to increase the release of excess fluid in the body through urination. So perhaps giving this medication late in the evening or at HS may not be the best idea. Let’s keep looking through the drug reference guide! © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 25 of 98  Further inspection of the drug guide reveals the following: Contraindications: Allergy to Lasix, inability to urinate. Onset: One hour after administration. Peak: One to two hours after administration Duration: Six to eight hours after administration Timing: Administer on empty stomach. Give in the morning to prevent nocturia. Side Effects & Adverse Reactions: increased urinary frequency (expected), dizziness (occasional), syncope (rare). In this example, the first two are side effects and syncope is an adverse reaction. By looking at the client’s chart and/or MAR, you can verify they do not have an allergy to the medication, and they are able to urinate. Information related to timing and duration stands out here, and requires clarification. If we were to administer this medication too late in the evening the client would be up all night urinating since the duration of effect is up to 8 hours after administration. The side effects would tell you to inform the client about dizziness, to change positions slowly, and expect to urinate more. You would watch out for the rare possibility of syncope after administering the medication. Since the physician order is for Lasix 40 mg PO BID, the facility should contact the physician and ask to clarify when the doses should be administered; so they are not administered too close together, nor too late in the day. Follow your Facility’s policy and procedure when contacting a physician. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 26 of 98  USES & FORMS OF MEDICATIONS PURPOSE OF MEDICATION ADMINISTRATION Medications can be used to prevent, treat, and diagnose diseases, as well as restore and maintain normal bodily functions. When medications are given to a client, the purpose is to reach a desired or therapeutic effect. Prevention Immunization prevents diseases. The Green Book is one resource for immunization practices. Treatment Medications can be used to treat disease or illness, and symptoms. For example, antibiotics treat bacterial infections. Antiviral medications can treat viral diseases. Other classes of medications exist as well, such as anti-coagulants (blood thinners), chemotherapy (to treat cancer), and more. Symptoms are also treated with medication. For example, Tylenol may be administered with a physician order by a QMAP to treat a headache. The headache may be isolated by itself, or it may be a symptom of an underlying condition or disease such as dehydration, a brain tumor, or head injury. Diagnosis Medications may be used to diagnose some illnesses. For example, iodine is a medication used during the study of the thyroid gland, to aid in diagnosis of thyroid illness. It is also used as contrast for CT scans, MRI's and other imaging. Restoration and Maintenance Medications also restore and maintain normal bodily function. For example, in the short term, stool softeners or laxatives may be used to restore normal bowel function. Other medications © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 27 of 98  such as antihypertensives, hormones, insulin, and others may be used to maintain normal blood pressure, hormone and sugar levels. MEDICATION FORMS Liquids Liquids can be either solutions or suspensions. A solution is a transparent liquid that can be clear or colored but does not separate after standing and does not need to be shaken. A suspension is solid particles disbursed in a liquid. Upon sitting, the solid settles to the bottom and separates from the liquid. When administering a suspension the contents must be shaken first to ensure the medication is distributed evenly throughout the suspension. A suspension will look cloudy. Ibuprofen dispensed in liquid form is a suspension. A liquid medication may be ordered as a gargle, which means to rinse the mouth and throat by holding a solution in the open mouth and agitating it by expelling air from the lungs. This creates bubbling. Check directions with gargles to know whether or not it needs to be diluted prior to administration. Solids Tablets | Caplets - These are compressed powder and can be either scored, or un-scored. A scored tablet is a medication with a pre-formed crease or partial split in it. Medications that are scored are generally safe to be split in half. Un-scored medications cannot be split. Scored tablets cannot be split into more than two pieces. Coatings & Time-Release Enteric Coated Tablets - Abbreviated EC, it is a coating that prevents the drug from dissolving in the stomach or irritating stomach lining. It allows the medication to pass to the intestine where it is then absorbed. Enteric coated tablets cannot be cut, crushed, or chewed. Time-Release or Long Acting medications should not be cut, crushed, or chewed. If cut, crushed, or chewed, the time-release effect is destroyed, meaning the client will get too much of the medication too quickly and the client could conceivably be overdosed. XR, XL, CR, LA are a few of the double letters indicating the medication is long acting or time-released. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 28 of 98  Semisolids Capsule - has a gelatin shell container and can contain a compressed powder or liquid medication. Spansule - is a sustained time-release capsule that has tiny beads with layers of coating that will dissolve at various times. They should not be crushed, chewed, or cut. The spansule form of a capsule is often abbreviated SR for Sustained Release. Suppository - shaped like a cylinder or a cone, for insertion into the rectum or vagina. A suppository melts from body temperature when inserted. Cream - a water-based preparation that is applied to the skin or inserted. Lotions - substance applied or swabbed on the skin for antiseptic, moisturizing, or astringent effects. Liniments - substances that are vigorously rubbed into the skin to relieve soreness of the muscles and/or joints. Ointment - a fatty soft substance that has antiseptic or healing properties. They are applied directly to the skin or placed on a dressing that is then applied to the skin. A tongue-blade may be used to remove ointments from a jar or container. You may also use the tongue blade as an applicator. Transdermal Patches These are adhesive backed materials containing a medication that is dispensed slowly through the skin over a long period of time. The patch is designed to release a continuous and controlled dosage over that period of time. Transdermal medication patches are designed to deliver medication through the skin into body fat and then into the bloodstream, over a period of time, at a constant and controlled rate. The duration of time that the patch releases the medication will vary from medication to medication. Patches should never be cut. A damaged patch should not be applied to a client’s skin, because the client may receive too much or too little of the medication. Always remove the old patch before applying a new patch. Sublingual Tablets Sublingual (SL) tablets are specifically placed under the tongue in the front of the mouth to dissolve, providing rapid release of medication. They are to be given last and you must stay with the client until it has dissolved, (3 - 5 minutes). Clients cannot eat or drink until the tablet has dissolved. Sublingual tablets cannot be crushed or chewed. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 29 of 98  Buccal Buccal medications are placed between the cheek and the gum. The effect of both sublingual and buccal medications may start within one to two minutes. The difference between the sublingual and buccal medications is in their duration – or how long their effects last. For example, sublingual nitroglycerin has a duration of thirty minutes and the buccal form lasts for three to five hours. EFFECTS & TYPES OF MEDICATIONS This lesson will cover the differences between systemic and local action of medications, between side effects and adverse reactions, the differences between prescription and Over The Counter (OTC) medications, and the difference between generic and trade names. As a QMAP, you need to know need to know about the medications you administer to prevent errors and promote client safety. There are multiple resources available, including package inserts of medications and drug handbooks. Additionally, you can always ask a nurse, pharmacist, or physician if you have questions about a medication. PRESCRIPTION VS. OVER-THE-COUNTER MEDICATIONS Medications come in two varieties, prescription, and Over-The-Counter (OTC). QMAPs must have a valid order to administer either kind of medication. Additionally, it is important to know that severe patient harm and death can occur from mis-administration of OTC medications. They are still medications, and still carry risks! © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 30 of 98  PRESCRIPTION MEDICATIONS Prescription medication can only be obtained with a written prescription by a licensed provider, and must be dispensed by a pharmacist. Prescription medications can only be started and stopped on the order of a licensed provider such as a physician, Physician's Assistant (PA), or Nurse Practitioner (NP). The label information on prescription medication will include pharmacy information, the name of the client, the name of the medication, the date it was filled, directions for use and administration, the prescription number, and the prescribing physician. Pharmacists may place small stickers on the label to indicate special instructions when administering the medication, or when being treated with the medication. For example, doxycycline, an antibiotic generally comes with two special instructions: "take with a full glass of water" and "avoid direct sunlight while taking this medication." As a QMAP you would need to provide the full glass of water, and remind the client to wear sunscreen or long sleeves and pants. OVER-THE-COUNTER MEDICATION Over-The-Counter (OTC) medication is any medication that can be purchased without a prescription. Despite the fact that OTC medications are generally considered safe for people to self-administer without the advice of a licensed practitioner, significant harm and death can still occur when OTC medications are administered incorrectly. Regardless, a QMAP must still have an order to administer OTC medications. OTC meds have an expiration date printed on the bottle. If there is no expiration date listed, then the medication is good for 1 year. The Medication Administration Regulations of the Colorado Department of Public Health and Environment (Chapter 24) require the following: If brought on facility premises, OTC drugs must be labeled with client’s full name. Since OTC does not have a standard pharmacy label, client’s full name must be added to the bottle with marker or tape; it may not obscure name of the medication or instructions for dosing/use. A QMAP must have a physician’s order to monitor or administer OTC drugs to clients, even though not a prescription medication. If there is no label or the label is illegible – you must not administer the meds! The contents of a medication container having no label or with an illegible label must be destroyed immediately. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 31 of 98  o It would be acceptable in an Adult Day Facility to return improperly labeled meds to the family. GENERIC VS. TRADE NAME All medications have two names, the Trade Name, and the Generic Name. The physician may write an order in the trade name and also authorize substitution of the generic form of the medication. For example, the physician orders Seroquel (trade name) but permits the pharmacy to send Quetiapine, the generic form of Seroquel. Additionally, ibuprofen is the generic name for Advil. Both names should be written on the MAR to prevent errors! Trade Names Trade Names are chosen by the manufacturer to market the drug, and is specific to the company holding the patent. Once a patent expires, other manufacturers can also produce the drug, using its generic name. Examples: TRADE NAME - generic name BENADRYL - diphenhydramine COLACE - docusate sodium PROZAC - fluoxetine TYLENOL - acetaminophen (paracetamol outside the USA) ASPIRIN - acetylsalicylic acid LASIX- furosemide Generic Names Generic names are the "universal" name that all manufacturers can use after the patent expires. Many generic and trade names may look alike, always be careful when checking the MAR and when transcribing orders to prevent errors and promote safety. Examples of commonly mistaken medications: Docusate - Dulcolax Adderall - Inderal Advair - Advicor Benzapril - Benadryl Celebrex - Cerebryx Keppra - Keflex The Institute for Safe Medication Practices has a free resource available HERE. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 32 of 98  LOCAL EFFECT VS. SYSTEMIC EFFECT Medications have either a local effect, or a systemic effect. Local effect means the drug affects only one specific area of the body. o This is like delivering a package to just one specific house in the city. The package (or drug) only affects that one house (or part of the body). For example, if you have a cut on your hand and you put Bactroban ointment on it, the cream works only on your hand where you applied it. It’s not going to do anything to your foot or your head. That’s a local effect. Other examples include rectal suppositories to treat constipation, or antibiotic eye drops to treat conjunctivitis ("Pink Eye"). Systemic effect means the drug affects the whole body. o Systemic effects result from the drug/medication circulating in the bloodstream and affecting all areas of the body. This is like delivering a package to every single house in a city. The package (or drug) affects the whole city (or the whole body). For example, if you take a pill for a headache, it doesn’t just go to your head. It travels through your whole body. That’s why sometimes you might feel other effects, like your stomach might feel a bit funny. That’s a systemic effect. Another example is an antibiotic or antiviral medication taken to treat bacterial or viral infections respectively. THERAPEUTIC EFFECT VS. SIDE EFFECT VS. ADVERSE REACTION When administering medications, it is important to know what to expect, both when the medication works as expected, and when it doesn't. The therapeutic effect of a drug is the reason it is being given. This effect is expected. o The therapeutic effect can also be thought of as the desired effect, or what we want to happen when administering the medication. For example, if a client has a headache, and you have an appropriate order to administer Tylenol, the desired effect is relief from the pain of the headache. Side effects are expected outcomes from taking medication, but they are not therapeutic. o Side effects are reactions to medications that are expected, but are not the desired or therapeutic effect. They are not life threatening. o Side effects can occur whether the action of the medication is systemic or local. An example of a side effect from a locally acting medication would be a rash from a transdermal patch. o An example of a systemic side effect occurs when antibiotics are administered. The antibiotic's desired or therapeutic effect is to kill the infectious bacteria causing the illness. However, since the © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 33 of 98  antibiotic has a systemic effect, it will also kill the good bacteria in the intestines, causing diarrhea as a side effect. o Side effects are expected outcomes that differ from the therapeutic effect. Adverse reactions are unexpected negative reactions to a medication or treatment that happens even when used correctly! o While adverse reactions are not expected, they can occur, and as a QMAP you need to be able to spot them so you can report them! o Pretend you ordered a pizza for dinner. You were expecting a delicious meal, but instead, you got food poisoning. That’s like an adverse drug reaction. It’s an unexpected, harmful or unpleasant reaction to a drug, like getting a rash from a medicine that’s supposed to help with your allergies. It’s not what you wanted or expected. o Now, imagine you ate a super spicy taco. You knew it was going to be hot, but you ate it anyway. Then, your mouth was on fire and you needed a lot of water to cool it down. That’s like a side effect. It’s something that happens because of the drug, but it’s not the main purpose of the drug. Like when you take medicine to help with your cold, but it also makes you a little sleepy. You knew it could happen (it was written on the medicine bottle), but it’s not why you took the medicine. ANAPHYLAXIS An anaphylactic reaction is a severe allergic response which is potentially life threatening. Know and follow your facility’s policy and procedure for anaphylactic reactions! Call 911 and summon help! Epinephrine injectors (Epi-pens, AuviQ etc.) are the exception to the rule! As of 1 July, 2017, Colorado Chapter 24 Regulations for Medication Administration allow QMAPs to administer epinephrine injections when directed to do so by a 911 Emergency Operator, or if they have taken a nationally recognized, hands-on First-Aid class and have been certified in epi-pens and auto-injectors, AND have received additional documented training from their Facility. ALWAYS FOLLOW YOUR FACILITY POLICY AND TRAINING AS TO WHAT TO DO IN AN EMERGENCY! © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 34 of 98  PSYCHOTROPIC & ANTIPSYCHOTIC MEDICATIONS PSYCHOTROPIC MEDICATIONS Psychotropic medication is any medication capable of affecting the mind, emotions, and behavior. In other words, these medications alter the way the brain works and changes the way an individual acts, behaves, and feels. Informed consent is needed when these medications are used related to risk of side or adverse effects, versus the benefit of changed behavior. Informed consents must include voluntariness, comprehension, and disclosure. The individual must be agreeable to take the medication, understand what the medication will do, and also, the possible side or adverse effects. In some cases, the guardian is the one who makes these decisions, but every effort should be made to involve the individual with decisions. Psychotropic Medications are Fast Acting, Mood Altering (mood Changing) medications. They work quickly and will change someone's mood whether they wanted it to change or not. They can be considered chemical restraints and a QMAP can never give it as a PRN if the resident themselves is not able to ask for it clearly and clearly state that they understand its effects on them. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 35 of 98  NARCOTICS & CONTROLLED SUBSTANCES This lesson will cover the importance of controlled substances, drug scheduling, and the proper methods to count narcotics and destroy both narcotics and other medications. Controlled substances are chemicals that have a legally recognized potential for abuse. They include “street drugs” such as heroin or ecstasy, and prescription drugs such as oxycodone. All narcotics are controlled substances, but not all controlled substances are narcotics. Controlled substances in the USA are regulated by the CONTROLLED SUBSTANCES ACT (CSA). The CSA places all medications into five “schedules” ranging from Schedule I – the highest potential for addiction, and Schedule V – least potential for addiction. The definitions are below, available directly from the U.S. Drug Enforcement Agency, which has a resource available HERE, including a list of all controlled substances. SCHEDULE I Drugs with no currently accepted medical use and a high potential for abuse. Examples: Lysergic Acid Diethylamide (LSD) Methylenedioxymethamphetamine (ecstasy) Peyote © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 36 of 98  SCHEDULE II Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Examples: Vicodin Cocaine Methamphetamine Oxycontin Fentanyl Adderall SCHEDULE III Drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Examples: Ketamine Anabolic steroids Testosterone SCHEDULE IV Drugs with low potential for abuse and low risk of dependence. Examples: Alprazolam (Xanax) Ambien Tramadol Valium SCHEDULE V Drugs with a lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Examples: Lomotil Motofen Lyrica © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 37 of 98  PROPER HANDLING OF CONTROLLED SUBSTANCES Always follow your Facility's policy and procedure regarding proper handling of controlled substances. Controlled Substances must be double locked, meaning: a locked box in a locked medication card or medication room a locked box in a locked refrigerator a locked box in refrigerator in a locked room Note that Hospice Comfort Kits must also be double locked. Counting Controlled Substances & Narcotics Controlled Substances must be counted both when they arrive at the facility, and at every shift change. Any discrepancy must be reported to the supervisor immediately. Controlled substances must have a controlled substances count sheet. The QMAP must count the number of pills while a second QMAP or qualified manager observes and agrees that the count is correct. Shift-to-shift count for accuracy should include date, time, quantity remaining and the signatures of both staff members. If a second person is not available, the QMAP should count the pills, document and sign the record. The next QMAP on duty shall verify the count and sign the narcotic count sheet prior to administering. Follow your Facility's policy and procedure to count liquid narcotics. REPORTING DISCREPANCIES Any discrepancy must be reported to the supervisor immediately. The State of Colorado takes controlled substances very seriously. All discrepancies are investigated. If you see something or suspect something, you should, in good faith, report it to your supervisor immediately. Do not confront the person. Reporting is not 'tattle-telling'. The opiate crisis affects all walks of life. People who divert medications need help, and by diverting the medication, the client suffers by not receiving the prescribed therapy. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 38 of 98  If the State of Colorado feels you are involved with diversion, even without evidence, they can and will put this on your background check, even if charges are dismissed. If you are involved with diversion, you could lose your job, be arrested, and face prison time if convicted. DESTROYING MEDICATIONS Medications may need to be destroyed for many reasons, such as when a client refuses the medication, or the medication becomes contaminated in some manner, or expires. The method of destruction must ensure that the medication cannot be retrieved or used by anyone. Medications must be destroyed in a way that makes them irretrievable. Destruction or "wasting" narcotics must be witnessed. When medications need to be disposed of, they must be destroyed properly. Always follow your Facility’s Policy & Procedure for destroying medications. 1. Check for a drug take-back, most pharmacies that work with facilities will take back all non-controlled medications for free destruction. Controlled Medications must be destroyed by the facility. 2. Mix medicines with an unappealing substance such as dirt, cat litter, or used coffee grounds. 3. Place the mixture in a container such as a sealed plastic bag. 4. Throw away the container. 5. Remove and destroy any labels. Ensure that controlled substances are destroyed with at least two staff to witness the destruction and disposal. This must be documented. UNIT 2 REVIEW 1. Describe some of the purposes for medications: 2. Define the meaning of the following: o Liquids: - Solution: - Suspension: o Solids: - Tablets/Caplets © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 39 of 98  - Enteric Coated Tablets o Semi-Solids: - Capsule: - Spansule: - Suppository: - Ointment: - Cream: o Transdermal Patches: o Sublingual: o Buccal: 3. What is the definition of a systemic drug action: 4. What is the definition of a local drug action: 5. What is the difference between prescription and Over-The-Counter medications and their labeling: 6. What is the difference between generic and trade names: 7. What should you do if you suspect that medications are being diverted at your facility: © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 40 of 98  8. What is the definition of the Desired, or Therapeutic Effect: 9. What is the difference between side effects, and adverse reactions: 10. What is anaphylaxis: 11. What are some acceptable sources of information on medications you administer: 12. What does “Indications for Use” mean: 13. Why is it important to know the best time of day to administer medications to clients: 14. Why should you know common side effects and adverse reactions for the medications you administer: 15. What are allergy considerations: 16. Provide three examples of what you should do if you have questions about medications: 17. List one of the purposes of using medication: 18. What is the difference between a solution and a suspension: 19. What is a spansule: 20. Does an enteric coated medication dissolve in the stomach: © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 41 of 98  21. Local drug actions take place in a specific area of the body: _______True _______False 22. What is the difference between the generic name and the trade name of a medication: 23. Which of the following is an expected result of taking a medication: _______ Side Effect _______Adverse Reaction 24. What is your responsibility regarding controlled substances: 25. You should always report suspicion of drug diversion to your supervisor in good faith: _______ True _______ False 26. Mrs. Cliento returned from a doctor’s appointment with a new medication. You are not familiar with the new medication. What are three sources of information you can look up the medication: 27. Suspect drug diversion stays with you on your record: _______ True _______ False © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 42 of 98  UNIT 3 | MEDICATION ORDERS This lesson will cover the QMAP's role in translating, transcribing, starting, changing, or stopping medication orders. Every action a QMAP takes with regard to medication administration requires a physician order. Whether to administer OTC medications, or to crush medications, an appropriate physician order must always be present. QMAPs cannot take a verbal or phone order from a physician under any circumstances. All orders that a QMAP may follow must be written, faxed, or otherwise digitally available to read, such as in an electronic health record (EHR). Facilities may accept faxed orders from a physician, but not from a pharmacist unless it is a copy of a signed physician order. Read on to learn what constitutes an appropriate physician order, and how to appropriately translate and transcribe the orders onto a Medication Administration Record (MAR). THE SIX COMPONENTS OF A MEDICATION ORDER All orders must contain the following six components in order for them to be considered valid: Client’s Full Name Name of Medication Dose Route Date Physician/Provider Signature Orders may also include authorized refills and whether a substitution for generic medication is permitted or not. © 2024 Colorado QMAP Training | 1361 Francis St STE B-107 Longmont, CO 80501 | https://qmapclass.com/ QMAP Training LLC | dba Colorado QMAP Training Page 43 of 98  Clients may encounter circumstances where they are sent to the hospital for an inpatient stay. When this occurs, upon the client's return the facility must obtain new orders for each medication to be administered, including OTC and PRN medications. An order saying: "Resume previous orders" is not acceptable, and the QMAP should notify their supervisor to seek full clarification of the orders from the physician. The formal name for this process is called "medication reconciliation." DOSE VS. STRENGTH The dose is how much drug is given each time the drug is administered. Proper dosage instructions will include the amount of medication, for example: 40 mg, the frequency to administer the medication (for example: twice daily), and how lon