© HCPro, Inc. 2004, all rights reserved 800-650-6787 www.hcpro.com
Medication
Management
Teaching Plan
To use this lesson for self-study, the learner should read the material, do the activity, and take
the test. For group study, the leader may give each learner a copy of the Learning Guide and follow this
teaching plan to conduct the lesson. Certificates may be copied for everyone who completes the lesson.
Objectives
A participant in this lesson will be able to:
• Correctly assist with or administer different forms of medication.
• Document with appropriate abbreviations.
• Describe the Six Rights of medication administration.
• Respond correctly to a medication error.
Special Notes for this Lesson
Parts of this lesson will not apply in every situation because of differences in
state laws, company policies, and personnel qualifications. Use only the portions that
are applicable in your situation. Make copies of your company’s policies and procedures
about medication management to give to participants along with the Learner’s Guide.
Every company has different policies and procedures for recording medication
assistance or administration. Bring copies of your medication forms or other records to
demonstrate proper documentation procedures to participants. Distribute copies of your
company’s standard acceptable abbreviations.
“Medication of the Month” will be a semi-regular feature of this publication. You
may wish to post the page on a workroom wall or in a book for workers’ reference.
The Lesson
Since workers that assist with or administer medications should already have
received training, this lesson can be a review of correct procedures and concepts. It can
also serve as an introduction to medication training for new workers. Present the lesson
in a lecture format, demonstrating the correct techniques for the different procedures.
Be sure that every worker can recite the Six Rights out loud and explain their meaning.
Allow time for workers to practice techniques and documentation procedures with
supervision. Correct any mistakes. Ensure that workers know that medication errors
must be reported, and that there will not be repercussions for honest mistakes.
Have participants take the test. Review the answers together. Award certificates
to those who answer at least 70% (10 points) of the test questions correctly.
Test answers: 1. False; 2. False; 3. True; 4. False; 5. False; 6. Right Person, Right
Drug, Right Dose, Right Dosage Form, Right Time, Right Route; 7. c; 8. b; 9. False.
Medication Management
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Medication Management
The Process
Learning Guide
Prescribing
>
Transcribing
>
Dispensing
>
Administering
Whether you are administering medications, just reminding clients to take
medications, or assisting clients in taking medications, training is necessary. Lack of
knowledge is one of the main causes of medication errors.
Some states allow nurse’s aides or other unlicensed personal who receive extra
training to administer (give) medications under supervision. They are often called
medication aides, medication technicians, or unlicensed assistive personnel. Other
states allow unlicensed personnel to assist or remind clients. Your supervisor should
be able to explain the medication rules in your state.
Medication management is a process that involves:
ƒ
ƒ
ƒ
ƒ
Prescribing (the physician orders the medicine),
Transcribing (a nurse or pharmacist interprets the physician’s order),
Dispensing (the medicine is prepared), and
Administering (the medicine is given to the client).
Mistakes can occur at any point in this process.
The purpose of medication management is to prevent errors.
Medication errors account for 7000 deaths per year.
More than 48% of these deaths occur in people over age 60.
Medicine-related problems account for nearly 10% of all hospital admissions.
More than 50% of medication errors occur in non-hospital settings and clients’ homes.
Medicine-related problems cost the U.S. health care system up to $136 billion annually.
Medication Management
Page 2 of 11
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These are the most common types of medication errors:
1. The wrong dose (40.9% of errors).
2. The wrong drug (16% of errors).
3. The wrong route (9.5% of errors).
These are the most common causes of medication errors:
1. Human factors (65.2%)—lack of knowledge, not paying careful attention, not
following procedures correctly, not being aware of a client’s allergies.
2. Communication (15.8%)—oral and written miscommunication, transcription
errors, handwriting errors, misuse of zeroes and decimal points, confusion of
metric and other dosing units, confusing drugs with similar names, and
inappropriate or misinterpreted abbreviations.
3. Poor lighting, heat, noise, and interruptions that distract workers from their tasks.
HOW TO PREVENT ERRORS
Education—everyone who handles medications should learn:
‰
‰
‰
•
Basic techniques for administering or assisting with medications.
Proper abbreviations.
The Six Rights of medication assistance and administration.
Basic techniques for assisting with or administering medications:
This information is not intended to replace your company’s procedures.
Procedures vary, so be sure to know the guidelines in your company.
Before handling any medications, gather all needed supplies. Wash your
hands. Wash hands before any contact with each client.
Always check drug expiration dates before using.
Tablets and Capsules
√
√
Do not touch medication when opening the container.
√
√
√
√
If a tablet needs to be broken, use a tablet-splitter.
Do not crush a medication unless you have a doctor’s order. Do NOT crush
coated tablets, sustained or extended release tablets, effervescent tablets, or
tablets designed to go under the tongue.
Make sure the client swallows all the medication.
Check the client’s dietary restrictions before giving food with the medication.
If you drop a tablet or capsule discard it. Discard unused portions of tablets
according to your company’s policies.
Medication Management
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Liquid Medications
√
√
Shake medications well.
√
Pour medication away from the container’s label to
protect the label from drips.
√
Put the medication cup on a flat, level surface and
measure at eye level.
If you pour more than needed when measuring,
discard the excess. NEVER pour excess liquid back
into the original bottle.
√
When you are supposed to dilute a medication, use the correct liquid. Some
medicines must be diluted in acidic liquids to work properly, so be sure to follow the
orders and instructions. Some liquid medications might irritate the stomach if taken
without being properly diluted.
√
Liquid iron products may discolor the teeth, so it is helpful to give the client a straw
so the liquid can bypass the teeth.
√
Antacids may interfere with absorption of some medications. The order in which
medications are given and the amount of time allowed between medications is
important and must be followed exactly as instructed.
Topical Medications
These medications are applied
directly to the skin. Always use
disposable gloves when applying, and
wash hands before and after.
Patches
Rest the cap of the medication
container on a flat surface with the
inside facing up. Clean the skin if
needed. Apply the medicine with your
gloved hands or an applicator. Never
put a used applicator back into the
container. Do not let the medication tube
touch the client’s skin, in order to keep
from contaminating the product. Usually
topical medications are used sparingly.
Follow instructions about dosage
carefully.
Remove the old patch and
paste, if applicable, before
applying a new one. Rotate the
sites of application to avoid skin
irritation.
Nitroglycerin ointment
should be carefully measured on
a marked ointment pad. Squeeze
the ointment evenly on the pad
like a ribbon of toothpaste.
Do NOT allow medicines to lie around in the open. Store all medications in their proper
places at all times. Note whether drugs are out of date, should be stored in the
refrigerator, or should not be exposed to light.
Medication Management
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Subcutaneous Medications
Wash hands and put on disposable gloves. Cleanse the site with an antiseptic
wipe. Clean the vial according to your company’s policies and procedures. Draw up
medication into syringe according to the product
instructions and double check for accurate
measurement. If there is an air bubble, tap it out. Do
NOT recap the needle. Pinch a fold of skin with one
hand. With the other hand hold the syringe like a dart
and insert the needle into the skin, bevel up, at a 45 to
90-degree angle to the skin, depending on the amount
of body fat. Release the skin. Withdraw the plunger
slightly. If blood appears, remove the syringe, change
the needle, and start over. If no blood appears, slowly
inject the medication. After withdrawing the needle,
wipe the site with an antiseptic wipe. Dispose of needle and syringe in a sharps
container according to your company’s policies and procedures.
Medications via Enteral (Stomach) Tube
√
√
√
√
Dilute liquid medication and crush and dilute tablets according to orders.
√
√
√
√
√
√
Flush the tube with 20 to 30 milliliters (ml) of water.
√
Crush tablets to a fine powder and mix with warm water. Rinse the cup to get
all the medication.
√
Some medications must be diluted with water to avoid clogging the tube.
Consult with the pharmacist.
√
√
Do NOT force medication if the tube appears to be blocked.
√
With large-bore tubes, medication will flow by gravity. With small-bore tubes,
you may have to apply pressure with the plunger while shaking the syringe.
Wash hands and put on clean disposable gloves.
Check to be sure the stomach tube is open and placed correctly.
If practical, sit the client up, or follow your company’s guidelines for elevating
the client’s head.
Give one medication at a time. Flush the tube between medications.
Rinse the tube with 20 to 30 ml. of water after the final medication.
If the client is on fluid restriction, get special instructions.
NEVER add medication into the enteral feeding preparation.
NEVER mix different medications together before administering via enteral
tube; mixing may clog the tubing.
Continuous feeding must be stopped at least 30 minutes before and after
delivery of certain medications. If you are unsure, consult the pharmacist.
Medication Management
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Asthma Inhalants
There
are many
different types
of inhalers,
requiring a
variety of
procedures.
Always check
the product’s directions, and follow your
company’s policies and procedures.
Shake the inhaler well prior to
each use, if indicated. Remove the cap
from the mouthpiece and make sure the
canister is firmly in place. Hold the
inhaler, or have the client hold it, up to
his/her open mouth. Follow the
physician’s orders or your facility’s
policies and procedures regarding openor closed-mouth technique.
Ask the client to exhale
completely, then to breathe in deeply
and slowly through the mouth while fully
depressing the top of the metal canister
with the index finger, and then to hold
his or her breath as long as is
comfortable before exhaling. Rinse the
applicator and store it.
If more than one inhalation of the
same product is prescribed, wait at least
one minute between inhalations. If two
or more inhalants are ordered, be sure
to use them in the proper order. Wait at
least 5 to 10 minutes between different
inhalants. If the client has difficulty using
an inhaler, tell your supervisor. The
doctor may order a spacer to aid in the
proper drug delivery.
Documentation
Some form of tracking and documentation is essential when handling
medications. Documentation forms are called by a variety of names, but medication
administration record (MAR) is the most common. Each company and agency will have
its own rules about how to record anything you do with medications. Follow your
company’s list of standard abbreviations when documenting.
Common Abbreviations for Medication Measurements
cc = cubic centimeter (same as milliliter)
ml. = milliliter
dr. = dram
m = minim
G., g., gm. = gram
mg. = milligram
gr. = grain
mcg. = microgram
kg. = kilogram
mEq., meq. = milliequivalent
L., l. = liter
pt. = pint
lb. = pound
t, tsp. = teaspoon
oz.=ounce
T, tbls. = tablespoon
Medication Management
Page 6 of 11
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•
The Six Rights: There are six important rules to remember when providing
medication assistance or administration.
1. Right Person: Read the client’s name out loud,
checking to be sure that the medication paperwork and
the medication container match, before you hand any
medications to a client. Even when you know the client
well, it is good practice to say, “Mrs. Smith, here is your
morning medicine.” Follow your facility’s policies for
using client pictures or identifiers.
2. Right Drug: Compare the name of the drug on the
medicine container to the name of the drug on the medication paperwork and
be sure the names are the same.
3. Right Dose: Check the dosage on the medication
container and be sure it is identical to the dosage written
on the medication paperwork. Be very precise about tiny
details. The client must take exactly the right number of
pills and the correct amount of liquid medication.
4. Right Dosage Form: Medication comes in many
forms. Is the medication supposed to be a tablet, a
capsule, a suppository, a liquid, or some other
form? Check to see if the medication is supposed
to be immediate release or extended release.
Every letter and number on the medication
orders must match the medication package. If
the orders say “SR” for sustained release, the
medication package must say “SR” also.
5. Right Time: You should check and double check the
date, the day of the week, and the time of day. All three
must be the same on the medication paperwork and the
medication container, and must match the current date,
day, and time. Most company’s policies require that
clients take medications within thirty minutes before or
after the scheduled time.
6. Right Route: This means the way a drug is taken,
such as by mouth, under the tongue, injected, inhaled,
or applied to the skin. Be sure the client takes the
medicine in the manner written on the medication
container and the paperwork.
Know your abbreviations: po=by mouth (per os); sl=under the tongue (sublingual);
top.=applied to the skin; inh.=inhaled; subq. or subcu.=injected under the skin.
Medication Management
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Responding to Medication Errors
When you are involved in or find out about a medication error, report it as soon
as it is discovered. Reporting medication mistakes will save lives. Even the best
healthcare workers make errors. The important things to know are what went wrong,
how, and why. A client’s mistakes in taking medications should also be reported. When
an error is made, do not make any decisions about how to respond to the
mistake—only the doctor can decide what, if anything, should be done.
Anyone can have an unpleasant or harmful reaction to a medication at any time,
even if they have taken the drug before. Just because a client reacts to a medicine or
has a new side effect does not mean that a medication error has occurred. All reactions
to medications must be reported to the appropriate supervisor or healthcare person.
Not all medication mistakes will cause harm, but only the client’s doctor can
decide whether an error is, or will be, harmful or not. EVERY medication error must
be reported immediately so appropriate action can be taken to prevent harm.
Even when harm does not result, there may be a problem with the medication system
that must be fixed before harm comes to someone else with another mistake.
As everyone involved in medication management, from prescribing to
transcribing to dispensing to administering, works together in preventing errors at any
point, the number of medication errors will decrease.
• Avoid dangerous abbreviations that can be misread.
This table shows some actual errors that have been
made with abbreviations.
Abbreviation
o.d. or OD
TIW
q.d. or QD
sub q
IU
q hs
q.o.d.
>
<
mEq or meq
Intended Meaning
Once daily
Three times a week
Every day
Subcutaneous
International unit
Nightly at bedtime
Every other day
Greater than
Less than
Milliequivalent
5.0
5
.250
0.250
Misinterpretation
Mistaken as OD--right eye.
Mistaken as three times a day.
Mistaken as q.i.d., 4 X day.
Mistook q to mean every.
Mistaken as IV (intravenous).
Mistaken as every hour.
Mistaken as daily or q.i.d. (4 X daily)
Can be misread and confused
Can be misread and confused
Mistaken as milligram
Mistaken as 50. Never put a zero after
a whole number.
Person may read as 250. Always put a
zero in front of the decimal point to
indicate a number less than 1 (0.250)
From Medication Administration in Long-Term Care Facilities. Larry McClaugherty,
R.PH., B.S., M.P.H., FASCP, PharMerica Consultant Pharmacist.
Medication Management
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Medication of the Month
Warfarin
An Anticoagulant Drug
Warfarin is used to prevent blood clotting. Sometimes it is called a “blood
thinner.” People who have heart problems or blood clots may be on warfarin.
Other names for warfarin include: Coumadin, Sofarin, Warfilone Sodium, warfarin
sodium. It is an anticoagulant, which means “against clotting.”
Side effects and precautions:
Since warfarin prevents the blood from clotting, the main side effect to watch for
is excessive bleeding. Be aware of:
1. Bleeding gums—use a soft-bristle toothbrush.
2. Bruising or cuts—use an electric razor; avoid hazardous activities.
3. Blood in urine or stools, black or tarry stools, dark-colored urine, coughing up
blood, nose bleeds—report any of these signs to a healthcare professional.
4. Avoid unusual changes in vitamin intake, diet, or lifestyle.
5. Inform dentists and all physicians of warfarin use.
6. Elderly people and those who have had a stroke, stomach ulcers, or cancer are
at higher risk for bleeding.
7. Dosage of warfarin is regulated by laboratory studies on the blood.
Interactions:
Many common drugs can increase or decrease the effects of warfarin and should
only be taken with a doctor’s order.
1. Over the counter herbal preparations.
2. Anti-inflammatory medicines such as ibuprofen (Advil, Motrin), aspirin, naproxen
(Aleve, Anaprox), Indocin, Lodine, Feldene, and others can increase warfarin
effects and cause bleeding. These medicines are often taken for pain or arthritis.
Some can be obtained over the counter, so clients should be warned about them.
3. The anti-seizure medication phenytoin (Dilantin) can cause decreased warfarin
effects. Estrogen, steroids, and Vitamin K can also decrease its effects.
4. Antibiotics such as sulfa drugs, Bactrim, Biaxin, erythromycin, Cipro, Floxin,
Levaquin, Noroxin, EES, Zithromax, and others can increase the effects of
warfarin and cause bleeding.
Medication Management
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Medication Management Test
Name ______________________________ Date _______________ Score _________
(Must have 10 correct answers to receive a certificate)
1. You can pour liquid medicine accurately by holding the medicine cup up to the
light.
True
or
False
2. If a client needs food in order to take medication, it is always safe to give apple
sauce or pudding.
True
or
False
3. Antacids may interfere with absorption of some medications. True
or
False
4. In the event a client cannot swallow his/her tablets whole, it is okay to crush
them.
True
or
False
5. After applying a topical medication to a client’s skin, a bandage is always applied
after the medication has dried.
True
or
False
6. List the Six Rights of medication assistance/administration (6 points):
a. Right ________________
d. Right ________________
b. Right ________________
e. Right ________________
c. Right ________________
f. Right ________________
7. When you learn that a medication error has been made, you should:
a.
b.
c.
d.
Only report it if someone is, or might be, harmed.
Only report it if you are the one who made the mistake.
Report it at once to your supervisor.
Stop all medication for that person immediately.
8. Which of the following abbreviations are NOT equivalent (do not mean the same
thing)?
a.
b.
c.
d.
cc means the same as ml
ml means the same as mg
g means the same as gm
t means the same as tsp
9. If the medication record or orders say to give “Bactrim DS,” and the container
reads “Bactrim,” it is OK to give the medicine anyway—the DS is not important.
True or False
Medication Management
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Certificate of Achievement
Presented to
________________________
(Name of participant)
For completing the one-hour course
Medication Management
Date ______________________________
Company __________________________
Presented by _______________________
(Signature of presenter or write “self study”)
Medication Management
Page 11 of 11