Administration Of Medications A Self Assessment Guide

As regulated nursing professionals, LPNs have key roles in medication administration. These roles include assessment and monitoring of clients, safe medication administration, and continuous evaluation and documentation of clients’ responses to medication. An assessment of the resident's ability to safely self-administer medications. If the resident chooses to self-administer drugs, this decision should be made at least by the time the care plan is completed within seven days after completion of the comprehensive assessment. Medication Administration and Safety Practices 17-22 Chapter 3. Self-Administered Medication Use and Storage 23-25 Chapter 4. Use of Pill Organizers - 'Only for Self-Administration' 26 Chapter 5. Assistance with Self-Administration of Medication 27-31 Chapter 6. Medication Orders and Prescription Labels 32-40 Chapter 7.

Self Administration Assessment Guide
Self Administration Of Medication Training
Assessment For Self Medication Administration
Administration Of Medications A Self Assessment Guide For Eim Nc Ii

The Administration of Medications: A Self-Assessment Guide practice support tool has been reviewed and it has been determined the information contained in this tool is clinically focused and not regulatory in nature. As a result, we have removed this practice support tool and will not be updating it.
Assist in g with the self-administration of medications to complete a minimum of 4 hours of train ing pursuant to a curr iculum develop ed by t he department and provided by a registered nurse, licensed pharmacist, or DOEA staff prior to assisting with medications. This guide as developed covers most of the necessary components of.

Chapter 6. Non-Parenteral Medication Administration

In the Institute of Medicine’s often-cited book To Err Is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000), it is estimated that approximately 1.5-million preventable adverse drug events (ADEs) occur annually. The Joint Commission (TJC) defines medication errors as any preventable event that may cause inappropriate medication use or jeopardize patient safety (TJC, 2012).

Medication errors are the number-one error in health care (Centers for Disease Control [CDC], 2013). Safe and accurate medication administration is an important and potentially challenging nursing responsibility. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety.

Medication errors have a substantial impact on health care in Canada (Butt, 2010). When preparing and administering medication, and assessing patients after receiving medication, always follow agency policy to ensure safe practice. Review Table 6.1 for guidelines for safe medication administration.

Administration of medications a self assessment guide tesda

Table 6.1 Guidelines for Safe Medication Administration
Safety Considerations: Agency policy on medication administration and medication administration record (MAR) may vary. Always receive the required training on the use of the medication system for each agency to avoid preventable errors.
Principle		Additional Information
Be vigilant when preparing medications.		Avoid distractions. Some agencies have a no-interruption zone (NIZ), where health care providers can prepare medications without interruptions.
Check for allergies.		Always ask patient about allergies, types of reactions, and severity of reactions.
Use two patient identifiers at all times. Always follow agency policy for patient identification.		Use at least two patient identifiers before administration and compare against the MAR.
Assessment comes before medication administration.		All medications require an assessment (review of lab values, pain, respiratory assessment, cardiac assessment, etc.) prior to medication administration to ensure the patient is receiving the correct medication for the correct reason.
Be diligent in all medication calculations.		Errors in medication calculations have contributed to dosage errors, especially when adjusting or titrating dosages.
Avoid reliance on memory; use checklists and memory aids.		Slips in memory are caused by lack of attention, fatigue, distractions. Mistakes are often referred to as attentional behaviours where lack of training or knowledge is the cause of the error. Slips account for most errors in heath care. If possible, follow a standard list of steps for every patient.
Communicate with your patient before and after administration.		Provide information to patient about the medication before administering it. Answer questions regarding usage, dose, and special considerations. Give the patient an opportunity to ask questions. Include family members if appropriate.
Avoid workarounds.		A workaround is a process that bypasses a procedure, policy, or problem in a system. For example, a nurse may “borrow” a medication from another patient while waiting for an order to be filled by the pharmacy. These workarounds fail to follow agency policy to ensure safe medication practices.
Ensure medication has not expired.		Medication may be inactive if expired.
Always clarify an order or procedure that is unclear.		Always ask for help whenever you are uncertain or unclear about an order. Consult with the pharmacist, charge nurse, or other health care providers and be sure to resolve all questions before proceeding with medication administration.
Use available technology to administer medications.		Bar-code scanning (eMAR) has decreased errors in administration by 51%, and computerized physician orders have decreased errors by 81%. Technology has the potential to help decrease errors. Use technology when administering medications but be aware of technology-induced errors.
Report all near misses, errors, and adverse reactions.		Reporting allows for analysis and identification of potential errors, which can lead to improvements and sharing of information for safer patient care.
Be alert to error-prone situations and high-alert medications.		High-alert medications are those that are most likely to cause significant harm, even when used as intended. The most common high-alert medications are anticoagulants, narcotics and opiates, insulins, and sedatives. The types of harm most commonly associated with these medications include hypotension, delirium, bleeding, hypoglycemia, bradycardia, and lethargy.
If a patient questions or expresses concern about a medication, stop and do not administer it.		If a patient questions a medication, stop and explore the patient’s concerns, review the physician’s order, and, if necessary, notify the practitioner in charge of the patient.
Data source: Agency for Healthcare Research and Quality, 2014; Canadian Patient Safety Institute, 2012; Debono et al., 2013; Institute for Healthcare Improvement, 2015; National Patient Safety Agency, 2009; National Priority Partnership, 2010; Prakash et al., 2014

Technological Advances That Help Mitigate Medication Errors

Computerized physician order entry (CPOE) is a system that allows prescribers to electronically enter orders for medications, thus eliminating the need for written orders. CPOE increases the accuracy and legibility of medication orders; the potential for the integration of clinical decision support; and the optimization of prescriber, nurse, and pharmacist time (Agrawal, 2009). Decision support software integrated into a CPOE system can allow for the automatic checking of drug allergies, dosage indications, baseline laboratory results, and potential drug interactions. When a prescriber enters an order through CPOE, the information about the order will then transmit to the pharmacy and ultimately to the MAR.

The use of electronic bar codes on medication labels and packaging has the potential to improve patient safety in a number of ways. A patient’s MAR is entered into the hospital’s information system and encoded into the patient’s wristband, which is accessible to the nurse through a handheld device. When administering a medication, the nurse scans the patient’s medical record number on the wristband, and the bar code on the drug. The computer processes the scanned information, charts it, and updates the patient’s MAR record appropriately (Poon et al., 2010).

Automated medication dispensing systems (AMDS) provide electronic automated control of all medications, including narcotics. Each nurse accessing the system has a unique access code. The nurse will enter the patient’s name, the medication, the dosage, and the route of administration. The system will then open either the patient’s individual drawer or the narcotic drawer to dispense the specific medication. If the patient’s electronic health record is linked to the AMDS, the medication and the nurse who accessed the system will be linked to the patient’s electronic record.

Read the Top Ten Tips PDF to review the importance of medication reconciliation.

Checklist 43 outlines the steps for safe medication administration.

Checklist 43: Safe Medication Administration Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations: Plan medication administration to avoid disruption: Dispense medication in a quiet area. Avoid conversation with others. Follow agency’s no-interruption zone policy. Prepare medications for ONE patient at a time. Follow the SEVEN RIGHTS of medication preparation (see below). Check that the medication has not expired. Perform hand hygiene. Check room for additional precautions. Introduce yourself to patient. Confirm patient ID using two patient identifiers (e.g., name and date of birth) AND check against MAR. Check allergy band for any allergies, and ask patient about type and severity of reaction. Complete necessary focused assessments, lab values, and/or vital signs, and document on MAR. Provide patient education as necessary. If a patient questions or expresses concern regarding a medication, stop and do not administer.
Steps		Additional Information
1. Check MAR against doctor’s orders.		Check that MAR and doctor’s orders are consistent. Compare MAR with patient wristband. Night staff usually complete and verify this check as well.
2. Perform the SEVEN RIGHTS x 3 (this must be done with each individual medication): The right patient The right medication (drug) The right dose The right route The right time The right reason The right documentation Medication calculation: D/H x S = A (D or desired dosage/H or have available x S or stock = A or amount prepared)		The right patient: check that you have the correct patient using two patient identifiers (e.g., name and date of birth). The right medication (drug): check that you have the correct medication and that it is appropriate for the patient in the current context. The right dose: check that the dose makes sense for the age, size, and condition of the patient. Different dosages may be indicated for different conditions. The right route: check that the route is appropriate for the patient’s current condition. The right time: adhere to the prescribed dose and schedule. The right reason: check that the patient is receiving the medication for the appropriate reason. The right documentation: always verify any unclear or inaccurate documentation prior to administering medications. NEVER document that you have given a medication until you have actually administered it.
3. The label on the medication must be checked for name, dose, and route, and compared with the MAR at three different times: When the medication is taken out of the drawer When the medication is being poured When the medication is being put away/or at bedside		These checks are done before administering the medication to your patient. If taking the drug to the bedside (e.g., eye drops), do a third check at the bedside.
4. Circle medication when poured.		Pour medication. Circle MAR to show that medication has been poured.
5. Positioning: Position patient appropriately for medication administration. Ensure proper body mechanics for health care provider. Position patient safely and appropriately once medication is administered.		This ensures patient safety and comfort.
6. Post-medication safety check: Complete post assessment and/or vital signs (if applicable). Sign MAR; place in the appropriate chart. Perform hand hygiene.		This ensures patient safety. This step prevents the transfer of microorganisms.
Data source: Lilley, Harrington, Snyder, & Swart, 2011; Lynn, 2011; Perry et al., 2014

Critical Thinking Exercises

Discuss why you think medication reconciliation is important for patient safety.
List five steps you can take to ensure safe medication administration practice.

The philosophy of assisted living is one of individualizing and maximizing consumer independence, choice, privacy and dignity. Facilities often consider medication administration their responsibility and are hesitant to relinquish control. However, it is expected that assisted living residents be encouraged and allowed to maintain as much independence as possible, including the right to retain control of their medications. A resident with the mental and physical capacity to develop increased independence in medication administration should be supported with self-administration instruction.

When residents cannot self-administer medications, facility staff may need to administer medications. When staff administer medications staff and facility may have requirements for training, documentation, assessment, monitoring, packaging of medications, storage and disposal.

Self-
Administration

Self-administration of medication suggests that individuals are functionally and cognitively competent to take and manage their own medications independently. Residents who wish to self-administer medications must be assessed to determine if they have the ability to do so safely. A thorough assessment may include such factors as dexterity, comprehension, recall and visual acuity. Residents should be re-assessed at least annually, and whenever there is a change in their physical, cognitive, functional status or desire to self-administer medications.

Tools

The following websites have a listing of assessment tools. Some are readily available and others you may need to purchase or work with your consultant pharmacist to obtain:

Relevant Regulations

Adult Day Care (ADC):
Certification Standard I.F.(1)
Certification Standard I.F.(2)

Family ADC:
Certification Standard I.D.(1)
Certification Standard I.D.(2)

Adult Family Home (AFH):
Wis. Admin. Code § DHS 88.06((3)(c)
Wis. Admin. Code § DHS 88.07(3)(c)

Self Administration Assessment Guide

Residential Care Apartment Complex (RCAC):
Wis. Admin. Code § DHS 89.26(2)(c)
Wis. Admin. Code § DHS 89.26(3)(b)
Wis. Admin. Code § DHS 89.34(16)

Community-Based Residential Facility (CBRF):
Wis. Admin. Code § DHS 83.35(1)(c)2
Wis. Admin. Code § DHS 83.37(1)(c)
Wis. Admin. Code § DHS 83.37(1)(f)2
Wis. Admin. Code § DHS 83.37(2)(a)1
Wis. Admin. Code § DHS 83.37(2)(a)2
Wis. Admin. Code § DHS 83.37(2)(a)3

Staff
Training

Staff training is a vital component in the delivery of safe resident care. While regulations may differ according to provider type, it remains essential that sufficient staff training is provided to establish a successful medication management system. Inadequately trained staff increases the risk of medication errors that can lead to negative outcome, including death.

Medication administration is a core component of staff training and in many circumstances in assisted living is a task delegated to unlicensed staff by a Registered Nurse.

Resources

Relevant Regulations

ADC:
Certification Standard I.F.(1)

Family ADC:
Certification Standard I.D.(1)

AFH:
Wis. Admin. Code § DHS 88.04(5)(a)
Wis. Admin. Code § DHS 88.04(5)(b)
Wis. Admin. Code § DHS 89.23(4)(a)1
Wis. Admin. Code § DHS 89.23(4)(a)2

CBRF:
Wis. Admin. Code § DHS 83.20(1)(a)
Wis. Admin. Code § DHS 83.20(2)(d)
Wis. Admin. Code § DHS 83.21
Wis. Admin. Code § DHS 83.22
Wis. Admin. Code § DHS 83.24(6)
Wis. Admin. Code § DHS 83.25

Documentation

Documentation is an important component of medication administration. Documentation related to medication administration should include the following:

Physician’s orders
Transcription of orders
Medication administration record, including scheduled and PRN medications
Effect of medications, including the monitoring of side effects
Controlled medication records
Pharmacy reviews
Review of psychotropic medications
Disposal
Staff medication training
Medication errors

Resources

Physician Orders and Medications, P-01905(PDF, 27 KB)

Relevant Regulations

ADC:
Certification Standard I.F.(3)(f)

Family ADC:
Certification Standard I.D.(3)(f)

AFH:
Wis. Admin. Code § DHS 88.07(3)(d)
Wis. Admin. Code § DHS 88.07(3)(e)1
Wis. Admin. Code § DHS 88.07(3)(e)2

Self Administration Of Medication Training

CBRF:
Wis. Admin. Code § DHS 83.37(1)(a)
Wis. Admin. Code § DHS 83.37(1)(d)
Wis. Admin. Code § DHS 83.37(1)(g)3
Wis. Admin. Code § DHS 83.37(1)(h)1
Wis. Admin. Code § DHS 83.37(1)(i)3
Wis. Admin. Code § DHS 83.37(1)(k)1
Wis. Admin. Code § DHS 83.37(2)(d)

Communication

Communicating and reporting changes to a resident’s prescribing practitioner related to health and medication is critical. Reports to a resident’s prescribing practitioner, as well as to the resident’s guardian or designated representative could include a change in condition, medication error, adverse reaction, medication dosage change, etc. Failure to communicate and report may compromise a resident’s health, safety or welfare, and could result in negative outcome to the resident.

Relevant Regulations

ADC:
Certification Standard I.F.(3)

Family ADC:
Certification Standard I.D.(3)

AFH:
Wis. Admin. Code § DHS 88.07(2)(b)5
Wis. Admin. Code § DHS 88.07(2)(b)6
Wis. Admin. Code § DHS 88.07(3)(c)

CBRF:
Wis. Admin. Code § DHS 83.12(5)(a)
Wis. Admin. Code § DHS 83.37(1)(a)
Wis. Admin. Code § DHS 83.37(1)(e)1
Wis. Admin. Code § DHS 83.37(1)(e)2
Wis. Admin. Code § DHS 83.37(1)(e)3
Wis. Admin. Code § DHS 83.37(1)(f)1
Wis. Admin. Code § DHS 83.37(1)(f)2
Wis. Admin. Code § DHS 83.37(1)(k)2
Wis. Admin. Code § DHS 83.37(1)(L)

Resources

Administration Of Medications A Self Assessment Guide

FAQs

1. Does medication administration in a RCAC require RN delegation?

Yes. Wis. Admin. Code § DHS 89.13(21) “Medication administration” means giving or assisting tenants in taking prescription and nonprescription medications in the correct dosage, at the proper time and in the specified manner. Wis. Admin. Code § DHS 89.13(22) “Medication management” means oversight by a nurse, pharmacist or other health care professional to minimize risks associated with use of medications. Medication management includes proper storage of medications; preparation of a medication organization or reminder system; assessment of the effectiveness of medications; monitoring for side effects, negative reactions and drug interactions; and delegation and supervision of medication administration. Wis. Admin. Code § DHS 89.23(4)(a)2. Nursing services and supervision of delegated nursing services shall be provided consistent with the standards contained in the Wisconsin nurse practice act. Medication administration and medication management shall be performed by or, as a delegated task, under the supervision of a nurse or pharmacist.

2. Can a CBRF hire a nurse who only delegates injections so that the CBRF can have residents on insulin?

Regulations in a CBRF require RN delegation if injections are administered by unlicensed staff. In addition if there is a RN who meets delegation/supervision requirements the insulin can be in a vial or insulin pen. If the RN does not meet supervision requirements then medications need to be in unit dose packaging.

A CBRF could hire an RN who only delegates insulin injections. However it is likely the RN does not meet supervision requirements and therefore insulin would need to be in unit dose packaging which would be difficult to meet. So although a CBRF could hire a RN to delegate only insulin injections it is very difficult for the facility to comply with the regulations in this circumstance.

Wis. Admin. Code § DHS 83.37(2)(e) Other administration. Injectables, nebulizers, stomal and enteral medications, and medications, treatments or preparations delivered vaginally or rectally shall be administered by a registered nurse or by a licensed practical nurse within the scope of their license. Medication administration described under sub. (2) (e) may be delegated to non-licensed employees pursuant to s. N 6.03 (3).

Assessment For Self Medication Administration

Wis. Admin. Code § DHS 83.37(2)(b) Medication administration supervised by a registered nurse, practitioner or pharmacist. When medication administration is supervised by a registered nurse, practitioner or pharmacist, the CBRF shall ensure all of the following: