SMART Annual Education_2024.pdf

S.M.A.R.T Annual Education  S – Safe M – Medication What is SMART? A – Administration R – Resource T – Team What is SMART? To have a multidisciplinary team that reviews the medication management system to provide safe medicati...

S.M.A.R.T Annual Education  S – Safe M – Medication What is SMART? A – Administration R – Resource T – Team What is SMART? To have a multidisciplinary team that reviews the medication management system to provide safe medication management and to optimize effective drug therapy outcomes for Residents To develop, implement, evaluate and update policies & procedures in accordance with evidence-based Purpose: practices and, if there are none, in accordance with prevailing practices for the accurate acquisition, dispensing, receipt, storage, administration, destruction and disposal of all drugs used in the home To make recommendations to the Professional Advisory Committee in response to medication incident review including policy, procedure change and system changes To ensure an effective process is in place to respond to all medication incidents & adverse reactions Medication incidents and near misses are documented, reviewed and analyzed to support a robust quality improvement system Goals: Identification and discussion of incidents involving high-alert medications and harm incidents Assess and update policies to ensure best practices Education is developed based on the analysis of the medication incidents reviewed above & shared with Registered Staff  Do you know what medications you are administering & what they are for? Do you know what is required for cytotoxic Questions to Think precautions? About … Medication Do you know what medications are Administration considered high-alert and require an Independent Double Check? How do you know you are giving the right Medications to the right person?  There is brand new medication management policy at Woodingford Lodge! 6.687 on the W Drive The MOLTC lays out all of rules that Long-Term Care Homes must follow with Did You Know… Medication Administration Medication Administration Only Registered Staff working on the home area should have access to the Medication Rooms Medication Reconciliation is completed by the pharmacy staff when residents are admitted and/or readmitted  Medication Administration Facts Topics to be  Medication Rights Covered:   Self-Administration of Medications  Medications Not Stored at Woodingford Lodge  ISMP – Do Not Use Abbreviations  Cytotoxic Precautions  High-Alert Medications  Medication Incidents – Common Findings & Solutions  New Medication Management Policy Medication Administration Facts: Information related to a Medication carts must be specific medication can be always locked when not in Narcotics/Controlled found on the CareRX portal, sight/in reach of the Substances must be always located on each computer registered staff member, kept under double lock. found in the nursing including while in the stations/medication rooms. medication room. Many LTC residents are on Narcotics must be wasted in multiple medications, the presence of two nurses Accurate documentation of increasing the risk of and documented as waste all medications administered interactions and side effects. on the count card/surplus is essential. Regular review and binder. management are essential. Medication Rights Right Right Resident Right Dose Right Route Medication Right Right Time Right to Refuse Right Response Documentation  Resident Medication Dose Route Right Resident – verify the Right Medication – confirm Right Dose – ensure that Right Route – administer resident’s identity using at that the medication you the dosage of the the medication via the least two identifiers to are administering matches medication is accurate & correct route as ensure the medication is the prescription or appropriate for the prescribed. given to the correct medication order. This resident. This involves resident. includes checking the checking the medication medication label & order & double-checking compared to the eMAR. dose calculations. Medication Rights  Time Documentation Reason Response Right Time – Give the Right Documentation – Right Reason – Ensure Right Response - Monitor medication at the record the administration there is a clear reason and assess the resident's correct time and details accurately in the for administering the response to the frequency, as specified residents eMAR. This medication, based on medication, including in the medication order. includes the medication, the resident’s condition any side effects or dose, route, time and & treatment plan. adverse reactions. any relevant information. Document these observations appropriately. Medication Rights  Process of Self-Administration: 1. Self-Administration Assessment completed on the Resident 2. Practitioner must approve assessment & provide an order Self-Administration 3. Registered Staff to add two orders to eMAR of Meds: a. Self-Administered Medications (Each Shift) – staff to check that meds are locked & not expired b. Self-Administered Medications (Quarterly) – every 3 months a resident must be reassessed to ensure they can self-administer their medications safely 4. Update the resident’s care plan Self-Administration Assessment:  Due to requirements in the regulations the following medications are not stored at Woodingford Lodge: Fentanyl vials with dose greater than 100mcg per container Medications Not Stored Hydromorphone vials with total dose greater than 2mg at Woodingford Lodge: Morphine vials with total dose greater than 15mg Multi-dose heparin vials, unfractionated heparin greater than 10000 units/container or for IV use ISMP DO NOT USE ABBREVIATIONS: *** Do not use the abbreviations shown below, as they increase the risk of medication incident occurring*** Pharmacy will audit for these abbreviations every 3 months. Practitioners should also not use these abbreviations when writing orders.  1. Signage – symbol placed on room door, top of resident's bed & on med bin 2. PPE – caddy of PPE placed in resident’s bathroom (nitrile gloves, disposable gowns, face shields, masks) 3. Flushing Toilet – disposable bed pad must be placed over top of the toilet and flushed twice 4. Laundry – linens/clothing placed in red linen bag, laundry wears Cytotoxic 2 pairs of nitrile gloves & gown when removing items and putting into the washer (washed on site in all three locations) Precautions: 5. Cytotoxic Waste – placed in red garbage bin and emptied by wearing 2 pairs of nitrile gloves and placed into the regular garbage bag 6. Timing of Cytotoxic Requirements – resident bathroom cupboard will have a sign indicating when requirements must be in place 7. Medication Administration – nurses to wear nitrile gloves if they are coming in direct contact with a medication or providing an injection. Used medication cup to be placed in the sharps bin. High-Alert Medications: High-alert medications are drugs that have a heightened risk of causing significant Resident harm when they are used incorrectly. IDC’s alert the registered staff administering the medication that they need to double check that they are giving the right medication & the right dose to the correct resident. IDCs are required at every administration. Registered staff are responsible for implementing an IDC on the eMAR for the following medications: - Heparin & Low Molecular Weight Heparins - Insulin - Injectable Opioids - Injectable Midazolam - Injectable Benzodiazepines - Fentanyl Patches  The Resident’s eMAR will alert the registered staff that a medication is classified as a high-alert medication, as the registered staff member will need to complete an independent double check before the medication can be signed off. An independent double check alerts the registered staff administering the medication that they need to double check that they are giving the right medication and right dose to the correct resident.  Registered staff are responsible for implementing an independent double check on the eMAR for all high-alert medications listed above prior to confirming an order.  ISMP Canada does not recommend the use of IDCs for all high- alert medications and the following should be reviewed prior Independent to implementing an IDC:  Potential for the medication to cause significant Double Checks: harm if given in the incorrect dose to the incorrect resident  Previous medication incidents involving this medication at the home and/or reported in ISMP Canada safety literature  Medications that are typically administered in an amount that is less than the total dose in the container *** A detailed step by step guide on how to enter an IDC on the eMAR can be found in the new Medication Management Policy – 6.687. *** Medication Incidents: The reporting of incidents is obligatory. Medication incident reporting will occur on an electronic pharmacy platform and a progress note will be entered on the Resident’s chart in Point Click Care. The intent of reporting is to review policy and processes to improve Resident care and reduce future risk. The prompt reporting of adverse reactions to the prescriber, pharmacist and resident and/or POA is required. If directed by the Pharmacist, a Government of Canada Adverse Drug Report needs to be completed and forwarded.  How to Report an Incident:  Types of incidents can be divided into  The Manager/Supervisor will be  Reviews of all medication different categories, which include notified electronically each time an incidents are discussed quarterly processing, dispensing, medication incident report is completed. at the SMART and PAC meetings, administration and other.  The registered staff where they are analyzed.  When any incident has been discovered member/supervisor or manager will an electronic incident report needs to be  Recommendations made by the completed by the Registered Staff contact the Pharmacist with any committees following member who has discovered or made concerns that should not wait until assessments of the reports will the incident. the regular review meeting. be adopted, implemented and  When an administration medication  Registered Staff are required to evaluated. Appropriate steps will incident has occurred, the Registered review each incident they are be taken to reduce and prevent Nurse (RN) will review the incident and involved in and reflect on the cause of incidents as determined by the notify the Practitioner for follow up and the incident and how their practice analysis (education, procedure documented on the Resident record. will change to prevent a future changes etc.) occurrence. This is all documented  Disclosure to the Resident and/or SDM is within the electronic incident report.  A written record is kept of all essential and required as soon as Quality Improvement activities possible after identifying that an  All incidents are tracked electronically incident has occurred. related to incident reviews. with each Registered Staff member with the goal to review safe medication practices and recurring medication incidents. How to Prevent an Incident: Some suggestions on how to prevent an incident include:  Ensure you are checking the medications against the Resident’s eMAR to determine if anything is missing or not correct in the strip.  Sign off the bubble on the narcotic count card, as this allows you to check the time that the medication is given and show that you gave it when it was scheduled.  At the end of the medication pass check all medication bins and the narcotic/controlled substance cards to make sure that there has been nothing missed for the assigned medication pass. You can always go back & give the resident a missing medication if discovered right after the medication pass vs finding it at another medication pass and the resident missing a dose.  Limit distractions as able: let PSW’s know you will address any none emergent concerns following a medication pass, ensure your medication cart is stocked before leaving the medication room, limit conversations during this time, try to focus on medications only instead of trying to do both medications & treatments at the same time  New Medication Management Policy: POLICY 6.687 IS A NEW POLICY THAT CONTAINS INFORMATION ON THE FOLLOWING: Admission/Readmission Standard Medication Times Inventories & Auditing Practices Prescribing/Ordering Meds Reporting Incidents & Adverse Drug Record Reactions High-Alert Medications Drug Destruction Drug Dispensing & Administration Medication Recalls & Backorders Narcotic & Controlled Drugs Medications Not Stored at WDFL Resident Leave of Absence Education Medication Rooms Registered Staff Students Emergency Box Pharmacy Policies If you have any questions, please reach out to Caitlin Pogson (Chair of the SMART Committee) or another nursing Manager/Supervisor.