LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 1
LOUISIANA
DIRECT SERVICE WORKER
Medication
Administration
SAMPLE 16 Hour Program
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ACKNOWLEDGEMENTS
The Medication Administration Core Curriculum was developed for use in
Louisiana’s Home and Community Based Services (HCBS) programs and Self
Direction Programs.
The core curriculum is the outcome of a collaborative effort between the
Department of Health and Hospitals, Health Standards Section (HSS), Office of
Aging and Adult Services (OAAS), and Office for Citizens with Developmental
Disabilities (OCDD), and the Louisiana State Board of Nursing (LSBN). The goal of
this collaboration was to produce a competency-based, core curriculum that
provides non-licensed staff with the basic knowledge, skill and guidance needed to
ensure safe and effective medication administration and performance of
noncomplex tasks.
This training curriculum is not all inclusive and should in no way substitute for the
required, person-specific training and competency evaluation performed by the
Registered Nurse (RN).
Bailey’s Law
This medication administration curriculum was developed by the Office for Citizens
with Developmental Disabilities (OCDD), Office of Aging and Adult Services
(OAAS) and the Health Standards Section in conjunction with the Louisiana State
Board of Nursing as directed by House Bill 185 (ACT 507) of the 2014 Legislative
Session. The legislation also known as Bailey’s Law was initiated by Mr. Jason
Durham whose daughter Bailey Caroline Durham was a recipient of waiver
services through the Department’s Self-Direction Program. It recognizes the
advocacy efforts on behalf of persons with disabilities to have the right to direct
their own care and services. All direct service workers who provide supports and
services to waiver clients in the Self-Direction Program and administer
medications as part of the client’s plan of care, must receive this training.
Rule: LAC 48:Chapter 92.
R.S. 37:1031-1034 and R.S. 40:2179-2179.2 Chapter 92 Subchapter D.
Medication Administration and Noncomplex Tasks in Home and Community Based
Settings:
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Medication Administration for Direct Service Workers
TABLE OF CONTENTS
Cover Page
1
Acknowledgements
2
Introduction to Course: Training Process
4
Medication Administration and Noncomplex Tasks in Home and Community Based
Settings: Rule: LAC 48:Chapter 92.
R.S. 37:1031-1034 and R.S. 40:2179-2179.2 Chapter 92 Subchapter D.
R.S. 37:1031(A) and 1033(A) (Bailey’s Law)
5
Medication Administration Training: Course Overview 6
Module 1: Legal aspects, Policies and Procedure 9
Module 2: Infection Control Measures 23
Module 3: Classification of Medications & Terminology; 39
Module 4: Medication Preparation, Administration, Storage &
Six Rights of Medication Administration
57
Module 5: Vital Signs 69
Module 6: Documentation
99
Competency Tests follow each module.
Appendix A
RN Competency Assessment of the DSW to Perform Medication Administration
and/or Noncomplex Task(s) Sample Form.
108
Appendix B
Test Answer Keys
111
Certificate of Completion
117
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Introduction
The Louisiana Department of Health and Hospitals (DHH) is committed to assuring
that individuals receiving Home and Community-Based Services (HCBS) receive
safe, quality care. The Louisiana DHH recognizes the roles of both licensed nursing
and trained, unlicensed personnel in the provision of care, including the
administration of medication and performance of approved noncomplex tasks to
HCBS Waiver participants. In recognition of these roles, the DHH shall insure that
guidelines for a system of competency based training for unlicensed personnel are
developed and implemented in accordance with in all applicable rules and
regulations. These guidelines are designed to foster and enhance a uniform and
consistent means of safe medication administration and the performance of
approved noncomplex tasks by unlicensed d Direct Service Workers (DSW’s)
working in a HCBS Waiver and Self Direction settings.
Scope:
This training curriculum shall apply to unlicensed DSW personnel in the HCBS
Waiver setting who administer medications and who perform approved,
noncomplex procedures in HCBS Waiver programs.
The training is intended to encompass the components of the direct service
registry rule published in the Louisiana Register, vol. 38 #12 December 20, 2012,
Section 9245
In certain circumstances however it may be necessary for additional, supplemental
training to be performed. This will be dependent on the waiver participant’s specific
condition and needs which may require approved noncomplex tasks not included in
the basic medication administration course. The RN will determine if additional
training is appropriate.
Course Participant Minimal Requirements:
Minimal requirements to successfully complete this training program include:
• DSW must be a least 18 years of age;
• DSW must have the ability to read, write and carry out directions
competently as assigned and;
• DSW must have no finding on the registry that he/she has abused or
neglected an individual being supported or misappropriate the individual’s
property or funds.
Goals of the Instruction Program:
1. Introduce the learners to concepts related to administering medications and
the performance of approved noncomplex tasks
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2. Provide learners with experiences in administering approved medications.
3. Provide consistency of basic medication administration and performance of
approved noncomplex tasks by unlicensed DSW personnel throughout the
state.
Evaluation:
The learner is required to pass the test following each training module with 80%
accuracy. A certificate will be provided upon successful completion of the course
and must be kept in the DSW’s personnel file at the support coordination agency,
the DSW may also have a copy of his/her certificate. This documentation must be
readily available for inspection by the DHH or its designee.
Initial competency and subsequent annual competency evaluations will be
performed by the delegating RN with documentation of ongoing competency also
maintained and available for inspection by DHH or its designee.
Rule: Rule: LAC 48:Chapter 92.
R.S. 37:1031-1034 and R.S. 40:2179-2179.2 Chapter 92 Subchapter D.
Medication Administration and Noncomplex Tasks in Home and Community Based
Settings: Allows for the Person Specific Training of DSW’s by an RN who has
assessed the health status of the person and who has determined that the DSW
can competently perform the tasks in a safe, appropriate manner.
R.S. 37:1031(A) and 1033(A) (Bailey’s Law)
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Medication Administration Curriculum for Direct Service Workers
Training Process
• Online Internet Based training-Explanation of training and testing
process for Internet training will be according to agency policies and
procedures related to Self Direction
• On Line training is only available for Self Direction Program, this
sample may be used in all HCBS programs.
• Modules
•
Modules are consecutive
•
Each module ends with test questions
•
Staff must score 80% on each module before they may proceed to the
next module
•
••
• Skills demonstration – RN will evaluate or monitor skills, proficiencies
and competency.
Medication Administration Curriculum for Direct Service Workers
Course Objectives:
•
To train DSW (non-licensed personnel) in:
Methods of delivering medication
•
Safely and accurately administering medication to ensure the safety of
those individuals in your care
•
Understanding intended effects of medications, as well as, the potential
for adverse side effects
•
Recognizing and differentiating side effects
•
Properly reporting adverse side effects
•
Following instructions given in response to adverse side effects
•
Demonstrating competency
Course Goal:
This course is intended for non-licensed personnel who provide direct care of
individuals receiving supports or services in the HCBS Waiver and Self Direction
programs.
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Upon successful completion of this course the non-licensed personnel would
prove competency, as determined by a registered nurse, in administration of an
individual’s medication.
COURSE DESCRIPTION
This course is designed to include:
online internet based:
(if used for Self Direction
Program
Competency Skills
testing
RN oversight
Each module will contain a post examination to determine competency in
understanding the information. A passing score of 80% is required on Module I,
II, III and IV exams.
With successful completion of this course, non-licensed personnel will have
increased knowledge of the following:
1. Accurate transcription of medication from the order/prescription on to the
appropriate Medication Administration Record
2. Reviewing individuals history on Medication Administration Record (allergies
and other co-existing medical conditions)
3. Using proper hygiene/universal precautions in medication preparation.
4. Accurate individual/medication identification by comparing medication label
to the transcribed Medication Administration Record:
a. Right Client
b. Right Medication
c. Right Time
d. Right Dose
e. Right Route
f. Right Documentation
5. Educating individual on medications being administered
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6. Application/Administration of:
a. Oral Medications
b. Eye Drops
c. Ear Drops
d. Topical Ointments/Creams
7. Correct use of oral and nasal inhalers
8. Observation of individuals during/after medication administration:
a. For cheeked medication
b. How to observe and report adverse effects
9. Taking vital signs as applicable:
a. blood pressure
b. temperature
c. respirations
d. and pulse
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MODULE 1:
Legal Issues, Policies and
Procedures
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To the Non-Licensed Personnel
As a direct staff person working in the HCBS waiver program and Self Direction
Programs, part of your duties may require that you assist with medication
administration. It will be your responsibility to create an environment in which
medications can be given safely. It will also be your responsibility to observe the
people you support and report your observations to help determine if medications
are working. This training will help you learn to administer/assist with
medications in a safe, error-free manner.
Medications are given to treat or prevent health problems. Many of the
medications taken by people you support are given to eliminate or decrease
symptoms of a disease or behavior rather than to cure it. The goal of medication
is to improve quality of life.
It is important to follow standard steps when administering medications. You
must also remember to create a home- like environment for the people you
support. In addition to following standard steps, you must get to know the
people you support. This will allow you to recognize changes in their physical
condition or behavior. It is recommended that you learn about their personality,
physical conditions, current medications, and capabilities. Some of the people
you support may not be able to communicate with you verbally. This will require
you to communicate in ways that they recognize and understand.
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Liability Issues Related To Medication Administration
Only physicians, dentists and advanced registered nurse practitioners may "prescribe”
medication. Physicians, dentist and pharmacists, are licensed to “dispense” medications.
Nurses are licensed to “administer” medications and may delegate the task to administer
oral and topical medications to persons who have completed a course such as this.
While there are similarities in the registered nurse (RN) practice and the licensed
practical nurse (LPN) practice, the degree of educational preparation and the
responsibilities of each differ.
In order to be eligible for either license, the candidate must have completed the required
amount of education from either an RN or LPN accredited program. Once the accredited
program has been successfully completed, the candidate is eligible to sit for the National
Council Licensure Examination (NCLEX).
After successfully passing that first exam, ongoing education is required to ensure
competency. Each nurse is required to complete approved continuing education each
year, or provide documentation of the State Board approved alternative.
Registered nurses may work directly under the direction of physicians, dentists and
advance practice nurses, while licensed practical nurses must also work under the
direction of a registered nurse.
These and other laws are in place to govern the practice of nurses in the state of
Louisiana, to ensure the health and welfare of those served. The law that pertains to
non-licensed persons working under the authority of a licensed nurse.
This regulation explicitly spells out how tasks may be delegated to a non-licensed
individual by a licensed nurse. In keeping with this regulation, it will be the responsibility
of the Provider agency to ensure a registered nurse trains
this course, and evaluates the
competency of the individuals who have completed the
course.
A registered nurse will also be responsible for ongoing training and competency
evaluations of the non-licensed persons to safeguard the health and welfare of the
individuals in care. This is a safe and prudent practice on behalf of the employing
agency, as well as, the nurse. Each Provider agency must have policies in place to
identify how and when this will take place.
Upon completion of this training, the non-licensed personnel will receive a certificate of
completion which will be kept with the support coordination agency and available for
inspection by the DHH or its designee.
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Role of Non-Licensed Personnel in Medication Administration:
Where delegation is required the non-licensed personnel will perform medication
administration as
a delegated function under nursing supervision in accordance with LAC 48:Chapter 92. R.S.
37:1031-1034 and R.S. 40:2179-2179.2
Chapter 92 Subchapter D.
The following cannot be delegated:
o conversion or calculation of medication dosage
o assessment of an individual's need for or response to medication
o nursing judgment regarding the administration of PRN (medications given as
ordered) medications
Non-licensed personnel will be permitted to follow a specific physician protocol for
PRN
medication and document effectiveness or ineffectiveness of the medication.
Example: if the physician wrote an order for Tylenol 350 mg for fever >100.0 F and
the
non-licensed personnel administered Tylenol for a fever of 101.0 then
documented a
decrease in the temperature or no decrease in temperature. The non-
licensed staff is
simply collecting information and documenting, not using nursing or
medical judgment
about an action or intervention.
The non-licensed personnel shall not perform a task that involves an individual who is
not in a
stable condition.
The non-licensed personnel should never accept a delegation that he/she knows is
beyond
his/her skill set or knowledge. Non-licensed personnel have the right and are
encouraged to
ask for assistance and/or additional training.
The non-licensed personnel has the responsibility to ALWAYS follow procedures of the self
direction program and to report to the nurse if they have any reason to believe they have made
a
medication error. This should be reported as soon as possible.
The non-licensed personnel has the responsibility to ALWAYS report the following:
•
signs or symptoms that appear life-threatening
•
events that appear health threatening
•
medication that produces no results or undesired
results
Other Legal Considerations in Medication Administration
A. Packaging of medications:
Pharmacies have the responsibility of dispensing medications in a way that will ensure
an
individual's safety. Medications prescribed for individuals are often packaged in
what are
called unit doses (one dose of medication in each area of package).
The original manufacturer’s label on over the counter medication has to be maintained
to
ensure legibility for accurate administration.
It is illegal to transfer ANY medication from one container to another container
This
includes both controlled and non-controlled
substances.
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B. Storage of medications:
ALL medications will be kept locked in accordance with agency policies and
procedures following Drug Enforcement Agency (DEA) requirements.
Medications requiring refrigeration will be kept in a refrigerator. Medications must be stored in
accordance with manufacturer’s recommendations.
Medication Errors
A medication error occurs when one of the “six client rights” has been violated.
Examples of
these would be:
•
Administering wrong medication
•
Administering wrong dose of medication
•
Administering medication at the wrong time (Medications may be administered
per
agency policy prior to or past the time ordered, and still be considered to be
on time).
•
Administering the medication in the wrong route (i.e. dermatological ointment
administered to eye)
•
Administering medication to wrong individual
•
Failing to document medication was given or inaccurate documentation of
medicine given
Medication errors may result in adverse reactions to the individual. These reactions
could
range from a rash to death.
Always Check the Rights of Medication
•
When removing the medication from storage
•
When removing the medication from its container
•
When returning the medication to storage
Six Rights
a.
Right Person
b.
Right Medication
c.
Right Time
d.
Right Dose
e.
Right Route
f.
Right Documentation
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Refusal of Medications
It is an individual’s right to refuse medications. Individuals should understand, to the
best of
their ability, the symptoms that medications are prescribed for and any common
side effects.
Non-licensed staff should explain that these medications are considered a
part of their
individualized treatment plan. Remember that each person may
communicate in different ways
and staff must be trained on how to communicate with
each person they support.
Refusing medications is NOT considered a medication error, and should be documented
on the
Medication Administration Record as a “refusal of medication”. This
documentation ensures
the individual has been offered the medication as ordered, and
also proves staff competency in
management/administration of medications. DSW must notify family and support
coordination agency as soon as possible after the occurrence.
Missed Medications
Clients will occasionally miss a dose of medication. This may cause a problem because missing a
dose may make the medicine less effective, but taking subsequent doses too close together
increases the risk of side effects. Reasons clients may miss a medication dose may include:
• Has forgotten to take or to be given the medication
• Has missed the correct time for a dose because they were at an appointment or away from
home longer than expected
• Was asleep at the time the medication was due.
A missed medication does not include a client who refused to take their medication or has vomited
their medication.
If a medication is missed, the DSW must document this on the medication administration record
(MAR) by initialing and circling their initials. There should be documentation regarding why the
medication was missed. The DSW should seek follow up instructions from the RN in the event a
medication is missed.
Preventing and Reporting Medication Errors
Knowing the following before administering medications will help prevent medication
errors:
•
Name (generic and trade)
•
Purpose
•
Effect
•
Length of time to take effect
•
Side effects
•
Adverse effects
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•
Interactions
•
Special instructions
•
Where to get help
•
Six rights of medication
There is a printable handout located on the handout page at the end of this module
titled
Preventing and Reporting Medication Errors.
Errors occur when staff
•
Do not follow the doctor’s orders exactly
•
Do not follow manufacturer’s directions
•
Do not follow accepted standards for medication administration
•
Do not observe the "six rights" of medication administration
When an error occurs
•
DSW must contact the family and the support coordination agency immediately.
Handouts attached:
•
RN vs. LPN
•
Sample MAR
•
Preventing and Reporting Medication Errors
•
What is a Medication Error
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Registered N
u
What
B
o
P
r
The Registered Nu
rse:
•
Must complete a higher degr
ee
•
Has greater responsibilities
•
Works directly under the dir
e
or advance practice nurses
The License Practic
a
•
Must complete a lesser degr
ee
•
Has a lesser degree of respo
n
•
Works both independently
of
by physician, dentists or adv
a
a Registered Nurse
DIRECT SERVICE WORKER MEDICATION CURRICULUM
u
rse and Licensed Practica
l
What
’s the Difference?
Similarities
o
th the Registered Nurse and th
e
r
actical Nurse
•
Must complete education requireme
nt
accredited program
•
Must pass the National License Exam
•
Must have ongoing education to ens
ure
competence and complete the requir
ed
Continuing Education Credits each ye
ar
Differences
rse:
ee
of educational preparation
e
ction of physicians, dentists,
a
l Nurse:
ee
of education preparation
n
sibilities
of
and performs acts prescribed
a
nce nurse practice nurse AND
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l
Nurse:
e
Licensed
nt
s from an
ure
ed
number of
ar
LOUISIANA
DIRECT SERVICE WORKER M
Preventin
g
Knowing the following be
f
medication errors:
•
Name (generic an
d
•
Purpose
•
Effect
•
Length of time to
ta
•
Side effects
•
Adverse effects
•
Interactions
•
Special instruction
s
•
Where to get help
Errors occur when staff:
•
Do not follow the
d
•
Do not follow man
u
•
Do not follow acce
pt
When an error occurs:
•
Complete a medic
a
DIRECT SERVICE WORKER M
EDICATION CURRICULUM
g
and Reporting Medication E
rror
f
ore administering medications will help
pr
d
trade)
ta
ke effect
s
d
octor’s orders exactly
u
facturer’s directions
pt
ed standards for medication administra
t
a
tion error report
Page 17
rror
s
pr
event
t
ion
Report
Medication
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What is a Medication Error?
A medication error occurs when one of the “six client
rights” has been violated.
•
Administering wrong medication
•
Administering wrong dose of
medication
•
Administering medication at the
wrong time
•
Medication errors may
result in adverse
reactions to the
individual. These
reactions could range
from a rash to death.
•
Medications may be administered per agency policy prior or
per agency policy past the time ordered, and still be
considered to be on time.
•
Administering the medication in the wrong route (i.e.
dermatological ointment administered to eye)
•
Administering medication to wrong individual
•
Failing to document medication was given or inaccurate
documentation of medicine given
Refusal of Medications:
It is a person’s right to refuse medications. Individuals should
understand the
symptoms that medications are prescribed for, and also
should be made aware of any common side effects. He/she
should also be able to verbalize understanding that these
medications are considered a part of treatment and that the
Licensed Practitioner will be notified should he/she refuse the
medication
Refusing medications is NOT considered a medication error.
End of Module 1
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MEDICATION ADMINISTRATION
TEST - MODULE 1
Legal Issues, Policies and Procedures
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
1. The Medication Administration Course for HCBS and Self Direction Programs is intended to be
taken by:
A. non-licensed personnel who provide direct care to individuals receiving supports in
the HCBS Waiver and Self Direction programs
B Registered Nurse
C. Licensed Practical Nurse
D. Individual receiving HCBS Waiver services
2. As a direct staff person (non-licensed person) working in the HCBS and Self Direction
Programs, part of your responsibilities is that you may be required to assist with medication
administration
A. True
B. False
3. HCBS stands for:
A. Home and Community Based Services
B. Health Care Basic Services
C. Home Care Best System
D. None of the Above
4. As a direct staff person (non-licensed person) part of your responsibility when working will be
to:
A. Create an environment in which medications can be given safely
B. Observe the people you support and report your observations to determine if
medications are working.
C. Follow standard steps when administering medications
D. All of the above
5. As a direct staff person (non-licensed person) you may only administer those medications that
the Registered Nurse can legally delegate you to administer
A. True
B. False
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6. Medications that the Registered Nurse CANNOT delegate you to administer and are
considered Complex tasks include:
A. IM medications: medications given by injection in the muscle
B. SC medications: medications given by injection in the subcutaneous tissue
C. IV medications: medications given by injection in the veins
D. All of the above
7. It is illegal to transfer ANY medication from one container to another container
A. True
B. False
8. Medication errors occur when one the “SIX RIGHT of medication administration” has been
violated:
A. True
B. False
9. Which of the following lists the “SIX RIGHTS of medication administration”
A. Right Person; Right Medication, Right Time, Right Dose, Right Route, Right Documentation
B. Right Day, Right Month, Right Person, Right House, Right Order, Right Physician
C. Right Person, Right Parent, Right Home, Right Date, Right Reactions, Right Chart
D. None of the above
10. Medication errors occur when one the “SIX RIGHTS of medication administration” has been
violated: Which of the following can result in a medication error?
A. Administering wrong medication, Administering wrong dose of medication
B. Administering medication at the wrong time, Administering medication in the wrong
route (i.e. skin ointment administered to eye)
C. Administering medication to the wrong individual, Failing to document medication was
given or inaccurate documentation of medicine given
D. All of the above
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MODULE 2:
INFECTION
CONTROL MEASURES
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MEDICATION ADMINISTRATION
TEST - MODULE 2
INFECTION CONTROL MEASURES
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
2. Infection control is defined as a set of methods used to control and prevent the spread of disease:
A. True
B. False
2. The best ways to prevent the spread of disease is:
A. Good hand washing
B. Using alcohol-based hand cleaner in place of washing when soap and water not available
C. Avoid touching your eyes, nose or mouth
D. All of the above
3. When must you wear gloves?
A. When you come in contact with blood
B. When you come in contact with body fluids; secretions and excretions
C. When you come in contact with broken or open skin, human tissue or mucous
membranes
D All of the above
4. When should you change gloves?
A. When touching surfaces that may be contaminated
B. Right before contact with mucous membranes or broken skin
C. Immediately if they become wet, worn, soiled or torn
D. All of the above
5. Contaminated means: dirty, soiled, unclean
A. True
B. False
6. Disinfection means: cleaning so germs (pathogens) are destroyed
A. True
B. False
7. Mucous membranes are: membranes that line body cavities that open to the outside of the body
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A. True
B. False
8. Which of the following are MODES of transmission (the way germs are passed from one person to
another)
A. Body fluids – tears, saliva, sputum (mucus coughed up), urine, feces, semen, vaginal
secretions, pus or other wound drainage, blood
B Touching the infected person or their secretions – Droplets, coughing, sneezing,
laughing , spitting, talking
C. Touching something contaminated by the infected person
D. All of the above
9. Universal Precautions:
A. Infection control guidelines designed to protect workers from exposure to
disease spread by blood and certain body fluids
B. State you must always treat blood, body fluids, broken skin and mucous
membranes as if they were infected
C. Are to be followed because you cannot tell by looking at a person whether they
have a contagious disease
D. All of the above
10. Common methods you can do to help prevent spread of disease
A. Cover your nose and mouth with a tissue every time you cough or sneeze
B. Throw used tissue in a wastebasket
C. If you do not have a tissue, sneeze or cough into your sleeve
D. Always clean your hands after coughing or sneezing
E. All of the above
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 39
MODULE 3:
Classification of Medications &
Terminology
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 40
Prescribed Medications
Prescribed medications are those medications that a licensed practitioner (physician,
dentist, and advanced registered nurse practitioner) has ordered for treatment of an
individual’s particular diagnosis or symptoms. These medications may include
controlled/scheduled, non-controlled/scheduled and or over-the-counter.
Prescribed medications may be ordered on an as needed basis (PRN), on a routine basis,
or as a one-time only order. How the prescribed medication is ordered will determine the
Medication Administration Record that will be used to transcribe the order.(i.e. Routine
prescribed medications and one time only orders will be transcribed onto the Routine
Medication Administration Record. Medications prescribed on a PRN basis will be
transcribed on to the PRN Medication Administration Record).
Controlled/scheduled Medications
“Controlled/Scheduled medications” are those medications potentially addictive and
regulated under the Controlled/Scheduled Substance Act of 1970. Controlled/Scheduled
medications CANNOT be obtained without a written prescription from a licensed
practitioner.
When controlled/scheduled medicines are prescribed on an as needed basis (PRN) (i.e.
hydrocodone) they will be transcribed and documented as given on the PRN Medication
Administration Record.
When a controlled/scheduled substance is given on a routine basis (i.e. Ritalin) it will
be transcribed and documented as given on the Routine Medication Administration
Record.
Non-controlled/scheduled medications are all other (both prescribed and over the
counter) medications that are not regulated by the DEA, but still require an order from a
licensed practitioner.
All non-controlled/scheduled medications require an order from a licensed practitioner
(physician, dentist, or ARNP).
Over the Counter Medications
Over the counter medications must be administered and documented at the time they are
administered.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 41
Classification of Medications
It is very important that the person administering medications read the licensed
practitioner’s prescribed orders on medications as to determine:
•
name
•
time
•
route
•
accurate dosage
Those medications that are given over-the-counter must be given according to specified
time limits. OTC medications must be given in accordance with the licensed
practitioner’s order which must not require non-licensed staff to use judgment.
Non-licensed personnel will be responsible for educating themselves on medications prior
to administration. This can be done by review of the drug education sheet received from
the pharmacy with the prescription. This sheet comes from the pharmacy with the
medication, and will explain why the medication is given and common side effects of the
medication. It is recommended that all DSWs have an updated drug
information/education sheet accessible at all times for review of any prescribed
medications and/or over-the-counter medication.
Individual information is imperative to individual safety in medication
administration/management.
This includes but is not limited to the following:
•
individual’s name
•
date of birth
•
sex
•
height
•
weight
•
allergies
Controlled/Scheduled Medications
Those medicines that have been deemed potentially addictive are regulated under the
Controlled Substance Act of 1970. Controlled medications are classified according to
addiction potential with Schedule I being the highest potential and Schedule V being the
least potential for addiction.
Non-Controlled/Non-Scheduled Medications
All other medications prescribed, including over the counter medication are not considered
to be potentially addictive by the DEA.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 42
Handouts:
•
Controlled/Scheduled Medications and Non-Controlled/Non-Scheduled
Medications: What’s the Difference?
•
Common Medications
•
Brand Names and Generic Names for Various Medications Used Frequently in
Behavioral Health
•
AVOID CONFUSION OF DRUGS WITH SIMILAR NAMES
•
Glossary of Terms.
References:
ISMP List of Error-Prone Abbreviation, Symbols, and Dose Designations
http://www.ismp.org/Tools/errorproneabbreviations.pdf
ISMP list of Confused Drug Name List
http://www.ismp.org/Tools/confuseddrugnames.pdf
ISMP list of High Alert Medications
http://www.ismp.org/Tools/highalertmedications.pdf
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Controlled
/
Contro
lle
W
Co
n
•
•
Non-Controlled/Non-
Sch
•
Any medications
pr
medications that a
r
by the DEA.
DIRECT SERVICE WORKER MEDICATION CURRICULUM
/
Scheduled Medications and
Non
lle
d/Non-Scheduled Medicati
ons
W
hat’s the Difference?
n
trolled/Scheduled Medications:
Have been deemed potentially addictiv
e
regulated under the Controlled Subs
tan
•
Are classified according to addiction po
t
Schedule I being the highest potential
an
V being the least potential for addicti
on
Sch
eduled Medications:
pr
escribed, including over the counter
r
e not considered potentially addictive
Page 43
Non
-
ons
:
e
and are
tan
ce Act of 1970
t
ential with
an
d Schedule
on
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 44
Common Medications
* THIS IS NOT AN ALL INCLUSIVE LIST
Medication
Classification
C
o
m
m
on
U
se
C
o
m
m
on
N
a
m
e
s
Common Adverse
Effects
A
ntibioti
c
s
*Pay close attention to
an y client allergies.
I
n
fec
tions
c
a
us
e
d b
y
bact eri a. N ot
comm onl y us ed
for viruses.
A
m
o
x
i
c
i
l
l
i
n
;
Ampicillin;
Penicillin; Cefaclor (ceclor);
Ceftin; Biaxin; Zithromax;
Erythromycin; Doxycycline;
Cipro; Levaquin; Keflex;
Bactrim DS
Na
us
ea
; di
a
rr
h
e
a
;
ra
sh;
y
e
a
s
t
infections; fever; sun
sensitivity
A
nti
-
A
sthma
Agents
A
sthm
a
;
respiratory
distress;
Bronchitis; COPD
A
dv
a
i
r
;
A
lbut
er
ol;
Singulair;
Ipratropium; Combivent;
Triamcinolone;
Flunisolide
Ner
vous
f
ee
li
n
g
;
sweating; nausea;
vomiting;
A
ntihist
a
mi
n
e
s
A
ll
er
g
i
c
r
e
ac
tions
(
i.e
hay fever)
Ta
vist
-
D
; Cl
ar
itin;
Singulair; Zyrtec; Allegra;
Benadryl; Chlortrimeton
Dr
o
w
sin
e
ss; insomni
a
;
weakness;
A
nti
f
ung
a
l
A
g
e
nts
F
u
n
g
a
l in
f
e
c
tions;
N
y
st
a
tin;
D
i
f
lu
c
a
n;
N
i
z
o
ra
l;
Miconazole; Lotrimin;
Tinactin
Hea
d
a
c
h
e
; n
a
u
s
ea;
diarrhea; vomiting
A
nti
-
tub
erc
ulosis
P
re
v
e
nt
tuberculosis;
I
N
H
; Ri
fa
mpin;
P
y
r
ido
x
ine
(vitamin B-6)
Hea
d
a
c
h
e
;
f
a
ti
g
u
e;
dizziness; seizure;
A
ntivi
ra
l
A
g
e
nts
V
i
ra
l in
fec
tions;
Z
i
a
g
e
n;
S
y
mm
e
t
r
e
l;
Z
ov
i
ra
x
;
Mood diso
r
d
er
s;
nausea; diarrhea;
A
n
a
lg
e
si
cs
P
a
in
re
li
ef
;
T
y
l
e
no
l
;
A
dvil
;
A
spi
r
in;
Na
prosyn; Lortab, Diclofenac;
Tylenol with codeine; Percocet;
Myoflex; Analgesic Cream;
Capsaicin; Icy Hot
Stom
ac
h ups
e
t; tinnitus;
nausea;
A
nti
c
o
a
g
ul
a
nt/
A
nti
-
platelet
B
lood thinning
W
arfar
in
(
c
oum
a
din
)
;
Lovenox; Plavix; Asprin
D
e
r
m
a
to
l
o
g
i
c
a
l
,
B
r
ui
s
in
g
;
Cramping; Nausea; Dizziness;
Abn ormal liv er labs;
Drug Interaction; Abnormal
Bleeding;
Allergy/hypersensitivity
reactions
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 45
A
nti
c
onvuls
a
nts
N
e
u
r
ol
o
gi
c
a
l
disorders; seizures
Ph
e
nob
ar
bit
a
l;
Va
lpo
r
ic
Acid; Tegretol; Dilantin;
Lamictal; Keppra;
Gabapentin;
D
i
zz
in
e
ss; d
r
o
w
sin
e
ss;
confusion; fainting;
G u m / d e n t a l
abnormalities; hypertension;
weight gain; abdominal pain;
sun sensitivity
A
ntidi
a
b
e
ti
c
s
T
o t
rea
t di
a
b
e
t
e
s;
I
nsulins;
G
lu
c
a
g
on;
Glucophage;
Glipizide; Glyburide
Na
us
ea
; h
e
ar
tbu
r
n;
fatigue; dizziness;
A
ntip
ar
kinsoni
a
ns
T
o t
reat
Parkinsons
disease;
L
e
vodo
p
a
; Sin
e
m
e
t
(carbidopa/levodopa); Eldepryl
(Selegine); Mirapex; Comtan;
Permex
D
iso
r
i
e
nt
a
tion;
c
on
f
usion;
depression
C
ar
diov
a
s
c
ul
ar
H
i
g
h
bl
o
od
pressure; irregular
heart beat; heart
failure;
Te
no
r
min; C
a
pot
e
n; C
a
top
re
s;
Digoxin; Lis ino pril ,
Meto prolol; V als art an;
Verapamil; Amlodipine;
N
itroglycerin; Isosorbide
D
i
zz
in
e
ss; d
r
o
w
sin
e
ss;
ch est p ain; loss o f
appetite; leg pain;
C
er
e
b
ra
l Stimul
a
nts
A
tt
e
nt
i
o
n
D
e
f
i
c
it
Disorder;
Narc
olepsy;
“
C
ONT
R
O
L
L
ED”
Adderall; Ritalin;
I
nsomni
a
; i
rr
it
a
bili
t
y
;
decreased growth;
Cont
race
ptiv
es
P
re
v
e
nt
Pregnancy;
Birth Control Pills
Or
tho
-
C
e
pt;
Z
ov
i
a
; P
r
ov
era
;
Ovral
De
p
re
ssion; blood
c
lots;
weight gain; Migraine
headaches
Cou
g
h/
A
nti
-
tussives
Cou
g
h
Suppression;
Expectorant
Robitussin
(
g
u
a
i
fe
n
e
sin
)
;
Muci nex ;
Dextromethorphan
Na
us
ea
;
V
omitin
g
;
Dizziness; Headaches;
Drowsiness
Dec
o
n
g
e
st
a
nts
R
e
liv
e
s
c
ong
e
stion
Ta
vist
-
D
; Cl
ar
itin;
F
lon
a
s
e
;
Rhinocort; Sudafed
N
ose
bl
ee
d; n
a
s
a
l i
rr
it
a
tion;
Hypertension; Hyperactivity
Der
m
a
tol
o
g
i
cal
Skin in
fec
tions;
B
u
r
ns;
anti- inflammatory;
protectants; anti-
irritants
B
ac
it
r
ac
in;
Z
ovi
ra
x
;
Ne
osporin; Silvadene;
Hydrocortisone cream;
Triamcinolone
cream; Flunisolone cream;
Hydrophor; Hydrophil’
R
a
sh; skin i
rr
it
a
tion;
burning
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 46
Ga
st
r
oint
e
stin
al
1.Antacid
2.Anti-Ulcer
3.Anti-Diarrhea
4.Stool Softeners
5. Laxatives
1.
Hear
tbu
r
n;
Acid Reflux;
2.To treat ulcer
condition.
3.To stop
diarrhea.
4.To relieve
constipation.
5.To relieve
constipation
1.
T
ums;
M
y
l
a
nt
a
; M
aa
l
ox
;
2.Tagamet; Pepcid; Zantac;
Prevacid; Prilosec
3.Imodium;
Lomotil;
PeptoBismol
4.Colace; Surfak
5.Magnesium Citrate;
Senna; Fleets; Metamucil
(bulk laxative)
1.Constip
a
tion;
bloating;
2.Dizziness;
mild diarrhea;
3.Fatigue; dry
mouth; nausea;
4.Cramping;
dependency;
5.Cramping; dependency
Ne
u
r
op
a
t
h
y
P
a
in/dis
c
om
f
o
r
t due
to
neuralgias
Te
g
e
t
r
ol;
Ga
b
a
p
e
ntin
(Neurontin)
D
i
zz
in
e
ss;
Dr
o
w
sin
e
ss;
Na
usea; Vomiting;
Personality Changes; Blood
Disorders; Food/drug
Interaction;
Hypersensitivity Reactions
O
pth
a
lmic
I
r
r
it
a
tion/in
fec
tion;
inflammation of the
eye.
Po
l
y
sp
o
r
in;
Ne
osporin; Liquifilm;
Maxitrol; Acular; Tobrabex;
Bacitracin; Polymyxin
B
u
r
ni
n
g
s
e
ns
a
tion;
I
t
c
hi
n
g
;
blurred vision;
O
tic
E
x
t
er
n
a
l
Ear
infections; wax
removal
B
o
r
ic
A
c
id;
De
b
r
o
x
;
Cortisporin
Ea
r
i
rr
it
a
tion; it
c
hing
P
s
y
c
hoth
e
r
a
p
e
utic
Agents:
1. Antidepressants
2. Antipsychotic
3. Anti-mania
1.
De
p
re
ssion;
2.Psychosis;
behavior disorder;
1. Mood
Disorders
1.
W
e
llbut
r
in; P
a
x
i
l
;
Zoloft; Celexa;
Lexapro
2. Abilify; Risperdal;
Haldol; Seroquel, Zyprexa
3. Lithium; Eskalith;
1.
W
e
i
g
ht g
a
in;
insomnia; nervous
feeling;
2. Tardive dyskensia;
sedation;
3. Tremors;
drowsiness; thirst;
T
h
y
r
oid
H
y
pot
h
y
r
oidism
L
e
vot
h
y
r
o
x
ine
(
S
y
nth
r
o
i
d,
Levoxyl)
D
i
arr
h
e
a
; bu
r
ni
n
g
in
mouth; sore throat;
headache; depression
V
it
a
min/Min
era
l
N
ut
r
ition
a
l
Deficiencies
Multivit
a
min;
Vitamin A; Vitamin
B/ Riboflavin;
Vitamin C/Ascorbic
Acid; Vitamin D;
Vitamin E; Iron;
Zinc; Magnesium; Selenium;
thiamine
Folic Acid; Calcium
T
hi
r
st; li
g
ht h
ea
d;
discolored urine
Faintness; diarrhea
Black Stools; stained teeth
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 44
Frequently Used Medications
This list is not all inclusive
B
r
a
n
d
N
ame
G
e
n
e
ri
c
N
ame
B
r
a
n
d
N
ame
G
e
n
e
ri
c
N
ame
Abilify Aripiprazole Meladate ER, Metadate
CD
Methylphenidate
Actifed Pseudoephedrine/Triprolidine Mellaril Thioridazine
Adderall Amphetamine Mixture Motrin Ibuprofen
Advil Ibuprofen Neurontin Gabapentin
Atarax Hydroxyzine Paxil Paroxetine
Ativan Lorazepam Prozac Fluoxetine
Benadryl Diphenhydramine HCL Remeron Mirtazapine
Buspar Buspirone Risperdal Risperidone
Catapres Clonidine Ritalin, Ritalin SR,
Ritalin EC
Methylphenidate
Celexa Citalopram Robitussin DM Guaifenesin
Dextromethorphan
Hbr
Claritin Loratadine Seroquel Quetiapine
Cogentin Benztropine Singulair Montelukast
Colace Docusate Sodium Strattera Atomoxetine
Concerta Methylphenidate Synthroid Levothyroxine
DDAVP Desmopressin acetate Tegretol, Carbitrol Carbamazepine
Depakote, Depakote ER,
Depakene
Valproic Acid derivatives Tenex Guanfacine
Desyrel Trazodone Tofranil Imipramine
Dexadrine Dextroamphetamne Sulfate Thorazine Chlorpromazine
Effexor Venlafaxine Tinactin Tolnaftate
Eskalith Lithium Topamax Topiramate
Gabitril Tiagabine Desyrel Trazodone
Gas-X Simethicone Trileptal Oxcarbazepine
Geodon Ziprasidone Tylenol Acetaminophen
Haldol Haloperidol Valium Diazepam
Imipramine Hcl Imipramine Wellbutrin, Wellbutrin
SR
Bupropion
Imodium Loperamide Xanax Alprazolam
Lamictal Lamotrigine Zantac Ranitidine
Lexapro Escitalopram Zoloft Sertraline
Lithobid Lithium Zyprexa Olanzapine
Lotrimin Clotrimazole
Luvox Fluvoxamine
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 45
Glossary of Terms:
Abrasion - Superficial scraping away of the skin
Acute – A sudden onset, the opposite of chronic
ADD - Attention Deficit Disorder. A disorder from childhood manifested by poor
impulse control, distractibility and forgetfulness
ADHD - Attention Deficit Hyperactivity Disorder. ADD with added symptoms of
hyperactivity.
Adverse Effects – An unexpected or unwanted reaction to a medication. It may
be sudden or develop over time.
Allergic reaction – An immune response to a foreign substance resulting in
inflammation and/or organ dysfunction. Symptoms may occur immediately or
over time, such as redness, rash, hives, itching, swelling, and yellowing of skin
and fever.
Analgesic - A medication for relief of pain.
Anaphylaxis – The most dangerous type of allergic reaction. Anaphylaxis is a
life-threatening event that may include symptoms such as falling blood
pressure, respiratory distress and unresponsiveness.
Angina – Chest pain
Angioedema – Large welts below surface of skin
Antianxiety - A medication that reduces the feelings of worry or apprehension.
Antibiotic - A medication that kills or slows the growth of bacteria.
Anticoagulant - A medication that hinders or slows the clotting of blood.
Antidepressant - A medication used to relieve or prevent depression.
Anti mania – A medication used to relieve the mental state of extreme
excitement and activity (Manic or Bipolar disorders).
Antiparkinsonian - Medications that reduce the symptoms of Parkinson
Syndrome such as slurred speech, shuffling gait, loss of facial expression, hand
tremors.
Antipsychotic – A medication that reduces the symptoms of psychosis, such as
delusions, hallucinations and distorted reality.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 46
Antiseptic - Substance that stops or prevents growth of various
microorganisms on the skin.
Ataxia - Unsteady clumsy motion, poor muscle coordination, and staggering
gait.
Bacteriocidal – Substance that kills bacteria; usually refers to a substance
used for cleaning the environment
Bacteriostatic – Substance that slows the growth of bacteria; usually refers to
a substance used on person.
Binging - A period of excessive indulgence as in eating or drinking.
Bipolar Disorder – any of several mood disorders characterized usually by
alternating episodes of depression and mania or by episodes of depression
alternating with mild nonpsychotic excitement—called also bipolar affective
disorder, bipolar illness, manic depression, manic-depressive psychosis.
Broad Spectrum Antibiotics - Medication used to treat a wide range of
disease causing bacteria.
Cerebral stimulants - Medications prescribed for youth with ADD or ADHD
often resulting in calmer behavior and better impulse control.
"Cheeked" - Refers to medication or other substance that has been hidden or
attempted to be hidden inside the mouth, generally either in the cheek or under
the tongue.
Chronic - A persistent or lasting health condition, or one that has developed
slowly; opposite of acute.
Color Disturbances – Side effect of medication that may cause a distortion in
how certain colors (usually yellow, green, or red) are seen.
Confidentiality – treated with privacy
Conjunctivitis - Itchy swollen eyes that may be caused by allergies, foreign
body or bacterial or viral infection. Highly contagious. Also called ‘pinkeye’.
Controlled Substances – Potentially addictive medications regulated by
Federal laws.
Corticosteroids – (also called ‘steroids’) Medications prescribed to quickly
reduce inflammation and pain. To maximize benefits, but minimize potential side
effects, corticosteroids are usually prescribed in low doses or for short durations.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 47
Cushing Syndrome – Set of symptoms caused by over activity of certain
glands in the body or prolonged administration of large doses of some
hormones; symptom may include weakness, fatigue, edema, excess hair
growth, diabetes, or skin discoloration
Decongestant – A broad class of medications used to relieve nasal congestion.
Generally, they work by reducing swelling of the mucous membranes in the
nasal passages.
Dehydration - A condition in which the body contains an insufficient amount of
water for functioning.
Delousing Solution – Substance applied to skin or hair to kill lice and their
eggs (nits); may be toxic if left on skin too long or used too often – use caution.
Delusion - A false belief with no basis in reality.
Depreciation – To make remarks that devalue oneself or another person.
Dermal - Refers to skin
Dermatitis - Inflammation of the skin, the skin inflammation varies from mild
irritation and redness to open sores, depending on the type of irritant, the body
part affected, and sensitivity.
Diluents – Chemical or filler which, when added to a substance, makes it less
concentrated or less potent
Disinfectant - Chemical used to kill bacteria or microorganisms on inanimate
surfaces such as furniture or equipment (not skin!)
Disintegration - The process of breaking down into smaller particles, falling
apart.
Duodenum - First part of small intestine, just after the stomach.
Dyspnea - Difficulty in breathing.
Dysurea - Difficult or painful urination.
Dyspepsia - Indigestion, heartburn
Dystonia - Severe contraction of the muscles of the neck, jaw or tongue; may
be seen as a side effect of some antipsychotic medications.
Edema - Swelling
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 48
Enteric Coating - A substance covering a tablet or capsule that will not
dissolve until reaching the small intestine.
Epi-Pen - A disposable pre-filled injectable medication prescribed for treating
severe allergic reactions causing respiratory distress (anaphylaxis).
Epilepsy – A neurological disorder that causes recurrent seizures.
Euphoria – Exaggerated feeling of well being or mild elation
Excretion - The process of elimination of waste products from the body,
through urine, feces, sweat, tears, etc.
Expectorant - Medication that loosens mucous from the respiratory tract.
Expectoration - Removal of mucous or phlegm from the throat or lungs,
usually by coughing.
Extrapyramidal Symptoms (EPS) - Side effect/adverse reaction to
medication. Characterized by involuntary movement, changes in muscle
tone, or abnormal posturing.
Feces - Body waste, discharged from the intestine through the rectum; also
called stool.
Finger cot - A close fitting sheath worn at the end of a finger as a device
for the protection of the finger.
Flat Affect - Lack of emotional response; no expression of feelings; talking
in monotone voice or having lack of facial expression.
Fungicidal – A medication used to kill fungus.
Fungistatic - Agent that slows growth of fungus.
Gait - Manner of walking, i.e., "staggering gait".
Gingival hypertrophy - Irreversible enlargement of gums, side effect of
some medication.
Grandiosity – False or exaggerated belief in one’s own worth
Grand Mal Seizure - A major epileptic seizure involving the entire body.
Granule - A small grain or pellet, often found in a capsule.
Hallucinations - Perceived sights, sounds, tastes, smells, or sensations
that are not actually there.
Hiatal Hernia – Protrusion of the stomach above the diaphragm
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 49
HIPAA -The federal privacy act that protects the right of any patient in the
US to have their medical information maintained in confidentiality and
protected from being accessed by anyone outside the physician's office or
treating facility.
Hypertension- High blood pressure readings above the ‘normal’ range
appropriate for age.
Hypoglycemia - Abnormally low level of sugar (glucose) in the blood.
Hypotension - Blood pressure readings that are below the normal range and
that may produce symptoms of lightheadedness, fainting, etc.
Hypothyroidism - A condition of the thyroid gland characterized by low
energy, weight gain, and often can mimic depression.
Inflammation - A response of the immune system to injury or
destruction of cells. Symptoms may include redness heat, pain and
swelling.
Inhibitory Effect – Action caused by a substance or agent in which the
activity or growth of another agent or substance is slowed or stopped
Insomnia - Decreased sleep caused by inability to fall asleep or frequent
awakening at night.
Jacksonian Seizure – Type of seizure in which fine tremors begin in toes
or fingers and spread up the extremity toward the body
Jaundice - (Icterus) Yellowing of the whites of the eyes, skin and body fluids.
Lacerations - Cuts or scratches on the body.
Laxatives - Medications that will cause evacuation of feces (stool) from
the body.
Lethargic - Drowsy or sluggish; difficult to stay awake.
Maceration – The softening of a solid by soaking
Mania - Mental state of extreme excitement and activity. (Manic)
Medication Errors - Term used to describe the violation of any of the Six
Rights in Medication Administration.
Microorganisms - Germs, bacteria, viruses, etc.
Narcolepsy - A condition characterized by uncontrollable periods of sudden
deep sleep.
Nebulizer - A device used to administer medication in forms of a liquid mist
to the airways.
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Neurologic - Having to do with the nervous system.
Non-controlled medications - Medications with no history of addictive
potential; not governed by the same laws and storage requirements as for
controlled medications.
Obsessive thoughts - Unwanted, persistent ideas.
Ophthalmic - Pertaining to the eyes.
Oral Medications - Drugs given by mouth.
Orthostatic hypotension - A change/drop in blood pressure when rising
from a sitting or lying down position to standing position; may result in a
fall or loss of consciousness (fainting).
Otic - Pertaining to or concerning the ear.
Over the Counter (OTC) Medications - Medications that may be purchased
without a prescription, such as Tylenol or Advil.
Palpitations of the Heart – Fluttering feeling of the heart
Paralytic Ileus - Paralysis or lack of passage of intestinal wall with
extreme pain and bloating; can be serious side effect of psychotropic
medications.
Paranoid disorder - An excessive anxiety or fear concerning one's own
well being.
Paresthesia – Tingling sensation due to damaged nerve
Parkinson-like – Refers to having symptoms that mimic Parkinson’s
disease such as tremors of extremities, loss of facial expression, altered
gait. Parkinson-like symptoms are potential side effect of psychotropic
medications.
(See Pseudoparkinsonism) (Also see Psychotropic Agents in the Common
Medications chart).
Peak Flow Meter - A device used to manage asthma by monitoring airflow
and the degree of restriction in the airway.
Petit Mal Seizure - Used to describe a mild form of a seizure; may also be
referred to as absence seizure.
Pharynx - Throat
Photosensitivity - Easily sunburned, often caused by medication or allergy.
(Even eyes can be photosensitive with some medications).
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Pill-rolling – A tremor in which the fingers and wrist move in a rhythmic
manner; manipulation of small objects or pills in the hand.
Polydipsia - Excessive abnormally high intake of fluids by mouth.
Polyurea - Excessive production of urine.
Potentiate - Increase the strength or action of a drug.
Pressured Speech – Stressed, rapid speech
PRN medications – Medications ordered to be given only on an “as needed”
basis, such as Tylenol for a headache.
Pseudoparkinsonism - A condition that mimics symptoms of Parkinson's
disease; may include tremors of extremities, loss of facial expression, altered
gait. Potential side effect of psychotropic medications.
Psoriasis - Chronic skin disease with scaly red patches.
Psychomotor Seizure - Episode of possible mental confusion, aggressive
behavior, or impulsive outburst
Psychosis/Psychotic Episode - A condition characterized by a loss of
contact with reality; may have delusions and hallucinations.
Psychotropic Medication – Medications used to treat mental disorders,
may be prescribed to treat depression, psychosis or bipolar disorders.
Route of Administration – How a medication is to be given, such as by
mouth, in the eye, in the ear, on the skin, etc.
Secondary Infection – Invasion of the body by a different organism than
the one being treated.
Scabies - Highly contagious skin condition caused by the itch mite.
Scheduled medications – (Controlled Substances) - Medications with abuse
potential, whose distribution, record keeping, and storage are controlled by
law
Schizophrenia - Psychosis characterized by loss of contact with reality and
breakdown of personality.
Sedation - Calming, soothing or tranquilizing effect brought on by
medication.
Seizure – A brief, excessive discharge of electrical activity in the brain that
alters one or more of the following: movement, sensitive, behavior,
awareness.
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Somatic Complaints - Reports about body functions that have no basis in
fact.
Sphincter - A circular muscle that normally maintains constriction of a
natural body passage or orifice and which relaxes as required by normal
physiological functioning. While there are at least 42 different sphincters in
the body, the most commonly discussed are: Anal Sphincter (rectum);
Urethral Sphincter (urinary bladder); Pyloric Sphincter (lower end of
stomach); Cardiac Sphincter (upper end of stomach).
Sputum - Substance ejected from the mouth containing saliva and mucous.
Steroid - Certain hormones, either manufactured in the body or the
laboratory, that reduce inflammation.
Stool - Waste matter/ feces discharged from the bowels.
Tardive Dyskinesia (TD) - A neurological disorder that may be due to long
term and/or high doses of some antipsychotic medications; characterized by
abnormal repetitive, involuntary movement of the face, such as grimacing, lip
smacking, or rapid eye blinking.
Therapeutic Level - The attaining of a concentration of a drug in the blood,
that is high enough to control symptoms.
Tinnitus - A perception of sound, usually described as "ringing in the ear".
Topical medication - Medication applied to the skin or mucous membranes
(eyes, nose, ears, etc.).
Tourette Syndrome - A neurological disorder characterized by unusual,
involuntary movements or sounds, called tics. Common tics are throat-clearing
and blinking. May occur with other neurological disorders such as ADHD,
Obsessive-Compulsive Disorder (OCD), anxiety or depression.
Toxic level - Blood concentration of a drug that has become high enough to
cause harm.
Transient Hypotension – Episode of low blood pressure that may be
characterized by feelings of light headedness, dizziness, or weakness
Urinary Retention – When the bladder does not empty properly and holds
urine.
Urticaria - Hives as a result of an allergic reaction.
END OF MODULE 3
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MEDICATION ADMINISTRATION
TEST - MODULE 3
Classification of Medications & Terminology
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
1. Medications are classified according to what they are commonly used for
A. True
B False
2. Classification: Antibiotics are used for
A. Infections caused by a bacteria
B. Infections caused by a antibody
C. Infections caused by a virus
D. Infections caused by fungal infections
3. Classification: Psychotherapeutic Agents are used for:
A. Depression
B. Psychosis, behavior disorders
C. Mood disorders
D. All of the above
4. Classification: Cardiovascular agents are used for:
A. High Blood Pressure
B. Irregular heart beat
C. heart failure
D. All of the above
5. It is very important for you to ALWAYS read the label on the medication container; you
must assure you are administering the right medication to the right person at the right
time, the right dose, it is given by the right route and that you document the medication
correctly, this is a statement of following the “SIX Rights of medication administration”
A. True
B. False
6. It is very important that any OTC (over the counter medications) be given as directed by
the delegating RN; you as the non- licensed staff are not required to use your own
judgment when deciding to use any OTC medications
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A. True
B False
7. When administering or assisting with the administration of any medication you MUST
ALWAYS know what the medication is used for and what adverse effects to look for
A. True
B. False
8. Adverse effect means:
A. An unexpected or unwanted reaction to a medication, which may be sudden or
develop over time
B. False effects you were told about
C. Doing what the person wants it to do
D. The action the medication is intended to do
9. Anaphylaxis is defined as the most dangerous type of allergic reaction. It is life-
threatening event that may include symptoms such as falling blood pressure, respiratory
distress and unresponsiveness
A. True
B. False
10. Epi Pen is defined as a disposable pre-filled injectable medication prescribed for treating
severe allergic reactions causing respiratory distress – and the only injectable medication
allowed to be given by direct service workers in EMERGENCY situations only, and must be
written in plan of care and reviewed by delegating RN.
A. True
B. False
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MODULE 4:
Medication Preparation,
Administration & Storage
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Various Forms of Medication Administration
Medications are delivered for administration in many different forms.
1. Oral
A. Capsules:
Medication within a capsule may be in powder, granules, oils or liquids other than oil.
Capsules may be coated with substances that permit delayed absorption of the
content. This coating may also allow the medication to be released in small amounts
over a prolonged period of time. The outer shell on the capsule is usually made of a
gelatin substance. Once the gel substance mixes with stomach fluids, it
disintegrates, therefore, releasing the medication inside. Sometimes contents of the
capsule are quickly and easily absorbed into the system but when capsule content
are micro-encapsulated they may have different absorption times.
Gel coated capsules are not to be broken. Do NOT break or crush any medications
considered extended or controlled release (XR, ER, or CR).
Oral medication should not be crushed without a licensed practitioner's
order.
B. Tablets:
Compression or molding (depending on content of tablet) creates the shape of
tablets.
Tablets are delivered in either enteric coated or un-coated form. Un-coated tablets
can be scored to allow for splitting; however, enteric coated tablets should not be
scored or split due to not being able to ensure accurate dosage of medication.
NOTE: Unscored tablets should not be split without a licensed practitioner’s order.
Only a tool designed for splitting tablets should be used for this purpose. This device
should be cleaned after each use.
C. Liquid Medication:
Some medications come in liquid form. The major concern with liquid medications is
measuring accurate dosage. To ensure accurate dosage of liquid medications using a
plastic marked cup, oral syringe or dropper, pay close attention to the order and the
markings on the container to ensure accurate dosage.
When using a measuring cup, place the cup on a solid, level surface and then bend
to look at it at eye level to ensure the correct amount has been poured. The
medication should be poured away from the label (to do this hold the bottle so the
label is in the palm of your hand) to prevent spillage to the label causing it to be
illegible.
When pouring liquid medications, place the cap of the bottle upside down on a
surface to avoid contaminating the inside of the cap.
Some liquid medications are suspensions and require shaking before being
administered.
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2. Topical
Note: Gloves should be worn when administering any of the following
medications.
A. Ointments:
Medications delivered in ointment form are most often prescribed for dermal or
ophthalmic conditions. Ointments are used to retain body heat and/or provide
prolonged medication contact. Use standard precautions at all times when applying
ophthalmic or dermal ointments. Cleanse skin prior to application of dermal
ointment. As always, observe for any adverse effects such as worsening of the
condition.
B. Creams
Cream is a more semi-solid form, and is used to lubricate dry or diseased skin as
well as to prevent water loss. When applying cream, make sure the skin is clean and
dry before thoroughly massaging into the skin, and observe for any adverse effects
such as irritation to the area.
3. Ophthalmic (application of eye drops)
Prior to applying eye drops, wash your hands. The individual should be sitting up
straight and looking at the ceiling with eyes open. Pull down on the lower lid with a
gloved hand not holding the bottle. Place one drop inside the lower eyelid. If you are
unsure a drop went in, wait five minutes before instilling another drop.
4. Otic (application of ear drops)
DO NOT USE EAR DROPS IN THE EYE. Store ear drops at room temperature.
Prior to applying ear drops, wash and completely dry hands. Gently shake the bottle
before using. Hold the bottle in your hands for a few minutes to warm it. The
dropper should be held with the dropper tip down at all times. This prevents the
medicine from flowing back to the bulb where there may be germs. Avoid touching
the dropper against anything else.
Have the individual lie down or tilt his/her head to one side. In adults, the earlobe
should be held up and back. Holding the ear with one hand and the dropper in the
other, place the correct number of drops into the ear.
DO NOT SQUEEZE THE DROPPER TOO HARD.
Replace the dropper in the medicine bottle right away. Do not rinse off.
Press the ear flap and have the individual keep their head tilted back for several
minutes to give the drops ample time to coat the ear. Wash your hands.
5. Inhalers and Nebulizers
A. Nasal Inhaler – Before using a nasal inhaler, the individual should blow
the nose. Block one nasal passage with a finger on one side of the nose,
gently insert the nozzle of the inhaler into the other nostril and aim the
inhaler so that the spray is directed 45 degrees upward and slightly
outwards and away from the mid line.
B. Aqueous Nasal Inhalers – Gently insert the nozzle as far as possible
into the nose before spraying. Wait 30 seconds and then lean forward with
your head between your knees for one minute, while pinching your nose.
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If nose bleeding starts to occur after starting nasal spray treatment, clean
the inside of the nostrils with a cotton swab to remove excess drug after
each use of the spray.
C. Metered Dose Inhalers – Wash your hands, shake the inhaler several
times. Ask the individual to hold their head up straight and exhale out.
Assist with placing the mouthpiece of the inhaler between their teeth and
ask them to close their lips around the mouthpiece. Staff should ask the
individual to inhale, then press down once on the canister to release a
dose. Ask them to continue to breathe slowly through an open mouth over
4 to 5 seconds, until the lungs are full of air. The individual should then
breathe for 10 seconds. If more than one puff is required, repeat the
above for each required puff.
D. Spacer Devices for Metered Dose Inhalers – Spacer devices have
a chamber that receives the aerosol before it is inhaled. They serve two
functions: 1) to overcome difficulties in coordinating the timing of the
inhaler actuation and inhalation and 2) to slow down the speed of delivery
of the aerosol into the mouth so that less of the drug impacts in the
throat.
There is a printable handout located on the reference page at the end of this module
that explains how to use inhalers and spacers.
E. Peak Flow Meter – A peak flow meter is a tool that measures how well
air moves out of the lungs. To use a peak flow meter, place the indicator
at the base of the numbered scale. Ask the individual to stand up or sit
up straight and take a deep breath. Place the meter in their mouth and
ask
them to close their lips around the mouthpiece. Remind them not to
put
their tongue inside the hole. Ask them to blow out as hard and fast as
they can. Write down the number you get. Repeat two more times. Write
down the highest of the three numbers achieved. The doctor will give you
the numbers to instruct you what to do based on the peak flow results.
6. Suppositories
A. Rectal Suppository – A rectal suppository is a medicine shaped like a
cone or cylinder that is inserted into the rectum. It is made of a waxy
substance that melts easily. To administer a rectal suppository, wash your
hands thoroughly. If the suppository is soft, hold it under cool water to
harden it before removing the wrapper. Remove the wrapper. If you are to
use half of the suppository, cut it lengthwise. Put on a finger cot or a
disposable glove. Lubricate the suppository tip with a water-soluble lubricant
such as KY Jelly. Assist the individual to lie on their left side with their lower
leg straightened out and upper leg bent forward toward their stomach. Lift
upper buttock to expose the rectal area. Insert the suppository, pointed end
first, with your finger until it passes the muscular sphincter of the rectum,
about 1 inch in adults. If not inserted past the sphincter, the suppository may
pop out. Hold buttocks together for a few seconds. Ask the individual to
remain lying down for about 15 minutes to avoid having the suppository come
out. Discard used materials and wash your hands thoroughly.
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B. Vaginal Suppository – To use vaginal cream or suppository, first wash
your hands thoroughly. To use the cream, fill the applicator that comes with
the cream to the level indicated. To use the suppository, unwrap it, wet it
with lukewarm water, and place it on the applicator shown with the
accompanying instructions. Assist the individual to lie on their back with
knees drawn upward and spread apart. Insert the applicator high into the
vagina (unless they are pregnant), and then push the plunger to release the
medication. If they are pregnant, insert the applicator gently. If you feel
resistance (hard to insert), do not try to insert it further; notify the doctor.
Withdraw the applicator. Pull the applicator apart and clean it with soap and
warm water after each use. Wash your hands thoroughly.
NOTE: The dose should be applied when you lie down to go to bed. The
medicine works best if you do not get up again after applying it. You may
wish to provide a sanitary napkin to protect clothing against stains.
7. Epi Pen
Epi Pen is defined as a disposable pre-filled injectable medication prescribed for
treating severe allergic reactions causing respiratory distress – and the only
injectable medication allowed to be given by direct service workers in
EMERGENCY situations only, and must be written in plan of care and reviewed
by delegating RN.
The Provider agency/ Support Coordinator Agency is responsible for ensuring that
non-licensed staff is trained
to address the individualized needs of each person they
support or assist.
Observation and administration of an individual’s medications is a procedure that
should be completed in the best of environmental circumstances. In order to avoid
errors and confusion it is recommended that a designated area be used to prepare
and administer medications.
These areas must be, clean, free from clutter and well lighted.
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Proper Hand Washing: Infection Control
Good hand washing techniques include washing your hands with soap and water or
using an alcohol-based hand sanitizer.
Hand washing steps:
•
Remove rings
•
Wet your hands with warm, running water and apply liquid soap
•
Lather well
•
Scrub all surfaces, including the backs of your hands, wrists, between your
fingers and under your fingernails
•
Rub hands together for 20 seconds (sing “Happy Birthday” twice)
•
With water running, dry hands with a paper towel
•
Use paper towel to turn of the faucet
•
Dispose of paper towel.
Alcohol-based hand sanitizers are an excellent alternative to hand washing.
However, if your hands are visibly soiled, wash with soap and water.
Alcohol-based hand sanitizer:
•
Apply ½ tsp of the sanitizer to the palm of your hand
•
Rub hands together, cover all surfaces of your hands until they are dry
Use gloves when instilling eye or ear medications. Make sure you have verified
whether the individual is allergic to latex prior to using a latex glove. (Be sure to
wash off powder from gloves)
There is a printable handout located on the reference page at the end of this module
explaining proper hand washing.
Oral Medications
All oral medications should be given with at least four ounces of water or other liquid
that allows for easy swallowing. A medication dispensing device or oral syringe
should be available to prepare liquid medications. Remember to pour the medication
away from the label, and to have container eye level when measuring to ensure
accurate dosage.
NOTE: Pay close attention to the order on the container and markings used
for measurement to ensure accurate dose.
After the individual has taken the medication it is very important that you make sure
he/she has swallowed the medication. This practice will ensure they are not hoarding
or ‘cheeking’ medications.
This is especially important for someone who has a history of choking or aspiration.
Offering a snack, something additional to drink, or spending extra time with this
person to allow for increased monitoring will assist the non-licensed staff to ensure
that the medication has been safely swallowed.
There is a printable handout located on the reference pages explaining the Heimlich
maneuver.
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Medication Administration
Knowing the following before administering medications will help prevent
medication errors:
• Name (generic and trade)
•
Purpose
•
Effect
•
Length of time to take effect
•
Side effects
•
Adverse effects
•
Interactions
•
Special instructions
•
Where to get help
For disposal of unused medication or expired medication:
•
For pills: pour glue into pill container, after glue is hardened,
container may
be thrown into garbage can
•
For liquids: pour cat litter or sand into container and wait for it to set-
up, after it becomes hardened, it may be thrown into garbage can
Disposal of medication must be documented on the medication record
to
verify it was destroyed, sign, date and have a witness also sign and
date.
•
Items such as inhaler canisters may be placed in a sharps
container or
disposed of according to OSHA.
Do not flush the meds or pour down drain.
Contact the RN to identify the process for disposing of unused,
damaged, or expired
medications.
Ensuring Accurate Administration of Medication
Six Rights of Medication Administration
To safely manage and administer individuals medications one must fully understand
the “six rights of medication administration”. These six rights are as follows:
1.
Right Person
2.
Right Medication
3.
Right Dosage
4.
Right Route
5.
Right Time
6.
Right Documentation
Right person:
It is important to identify the right person when administering medications. An
example of this might be referring to the photograph inside the record, and/or
having the person state his/her name if possible. It is imperative that the “right
person” has been identified prior to administering medications.
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Right medication:
Giving the right medication to the right person is imperative for safety. Ensure that
the medication label coincides with the Medication Administration Record.
Agencies must have in place policies and/or procedures regarding how medication
errors are handled. Research has proven that medication errors are more readily
reported if the action taken is weighted with education as opposed to strict
disciplinary measures. The agency’s policies must be in accordance with current
regulations for reporting medication errors.
Right dose:
Read the label on the medication container and compare it to the transcribed order.
Pay close attention to the dosage amount.
Right route:
Read the label on the medication container and compare it to the transcribed order.
Pay close attention to the route. Ensure that ear (otic) drops are never given in the
eye.
Right time:
Your agency should have a policy in place that provides a time frame for which it is
acceptable to give medications (example: 60 minutes before or 60 minutes after the
scheduled time).
Right documentation:
Each medication must be documented when it is given. If a medication has been
given, and it has not been documented that it was given, the process for
administration is incomplete. This has the potential of causing a serious medication
error, (overdosing) if the medicine were to be re-administered. This could cause a
very serious medication error of overdosing. It is very important to remember once
the medication has been administered you should initial in the area indicated on the
Medication Administration Record. Inaccurate medication counts are also considered
as incomplete documentation, which constitutes a medication error.
Always Check the Rights of Medication
• When removing the medication from storage
•
When removing the medication from its container
•
When returning the medication to storage
Note: Medications are not to be preset for all individuals. Only set up and
administer one individual's medication at a time.
Medication Errors:
A medication error occurs when one of the “six client rights” has been violated.
Examples of these would be:
•
Administering wrong medication
•
Administering wrong dose of medication
•
Administering medication at the wrong time (medications may be
administered per agency policy prior to or past the time ordered, and still be
considered to be on time).
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•
Administering the medication in the wrong route (i.e. dermatological ointment
administered to eye)
•
Administering medication to wrong person
•
Failing to document medication was given or inaccurate documentation of
medicine given, including inaccurate pill counts
•
Medication errors may result in adverse reactions to the person. These
reactions could range from a rash to death.
Refusal of Medications:
It is a person’s right to refuse medications. Each individual should be told why the
medication is being used, and also any common side effects.
NOTE: Follow the agency’s policy/ contact the RN for notifying the licensed
practitioner of
refused medications.
Refusing medications is NOT considered a medication error, and should be
documented on the Medication Administration Record as a “refusal of medication”.
This documentation ensures the individual has been offered the medication as
ordered, and also proves staff competency in management/administration of
medications.
Understanding Effects of Medications/Adverse Drug Effect
It is very important to familiarize yourself with any medication that is being
administered. Pharmacies are required to provide a “medication” education sheet
with each drug dispensed. The sheet contains the most common side effects of that
medication. Another way to learn the side effects of medications is to review the
medication in a current drug handbook. These books are updated on an annual basis
and contain the most current information on medications.
Observing the individual after a medication has been administered is crucial in
identifying any adverse reactions to that medication. Any and all reactions should be
reported according to agency policy. Severe reactions should be treated as
emergencies and staff should be familiar with agency protocol regarding how
emergencies are handled within that agency.
Medication Education
Education of each individual should be performed per agency policy and should
include:
•
Name of prescribing practitioner
•
Trade and generic name of medication.
•
Reason medication was prescribed (diagnosis or symptoms)
•
Dosage of the medications
•
Time the medication will be given
•
How long the medication is prescribed for
•
Most common side effects of medication
Each individual should be encouraged to ask for and receive information regarding
the medications prescribed. Education is to be documented in the agency specific
manner.
END OF MODULE 4
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MEDICATION ADMINISTRATION
TEST - MODULE 4
Medication Preparation, Administration & Storage
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
1. Medications are delivered for administration in many different forms: The following are
the forms the non licensed staff MAY ADMINISTER after proper training and delegation by
a Registered Nurse
A. Capsules, Tablets, Liquid Medications
B. Ointments, Creams, Eye Drops, Ear Drops
C. Inhalers, nebulizers via a premeasured dose system, suppositories
D. IM injections, SC injections, IV injection
E. A, B, and C ONLY
2. You must use gloves when administering (instilling) eye or ear medications
A. True
B. False
3. Before you administer any medications you must:
A. Know what the medication is used for
B. Know what the main side effects/ adverse effects of the medication are
C. Read carefully any and all directions on the bottle
D. Follow the “Six Rights of Medication Administration”
E. All of the above
4. After you administer any oral medication it is very important that you make sure
A. The medication has been swallowed
B. The individual is not “cheeking” the medication
C. The individual is not trying to hoard the medication
D. All of the above
5. A major concern when administering medication in a liquid form is measuring accurate
dosages: to ensure accurate dosage you must make sure you use a plastic marked cup,
oral syringe or dropper and pay close attention to the order and the markings on the
container to ensure accurate dosage
A. True
B. False
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 68
6. Enteric coated Tablets may be broken in half
A. True
B. False
7. If a liquid medication is the form of a suspension what must you do before
administering it?
A. Shake it
B. Stir it
C. Pour it
D. None of the above
8. Before a person uses a nasal inhaler you should have them
A. Lay down
B. Blow his/her nose
C. Squeeze the inhaler
D. Insert the nozzle of the inhaler into one nasal passage
9. Rectal Suppositories are usually kept in the refrigerator.
A. True
B. False
10. An Epi Pen is a premeasured dose of epinephrine and is only used for
EMERGENCY, Life threatening conditions
A. True
B. False
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 69
MODULE 5:
VITAL SIGNS
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
VITAL SIGNS
Vital signs are measurable life signs. The term “vital signs” usually refers to the person’s
temperature, pulse, res
pirations, and blood pressure.
Vital signs are key indicators used to determine the person’s overall condition.
Temperature:
Measures the amount of heat in the body. The 3 locations normally used in
determining the body temperature are the mouth (o
(axillary), and the ear (tympanic).
If you measured a person’s body temperature using all three of these methods, you
would obtain three slightly different temperatures. The axillary (armpit) temperature
would be slightly low
er than the oral (mouth) temperature while the tympanic (ear)
temperature would be slightly higher than the oral temperature.
For safety of the consumer we will use digital ear thermometers for
measuring temperatures in community settings.
The followin
g measurements apply:
Average normal range for infants less than 3 months
Average normal range for infants over 3 months:
Average normal range for adults:
The average body temperature of a healthy adult is 98.6ºF. This does not mean that
everyone should always have a tempera
temperature may be slightly higher or slightly lower. A body temperature between
96.8ºF and 100ºF is considered to be within the normal temperature range unless
otherwise specified. A person can have a body temperatu
below 98.6ºF and still be normal and healthy. People have different “normal”
temperatures.
What is normal for the person you support?
When a person becomes ill, one of the first things that must be done is to determine
what di
sease, injury, or other factor is responsible. Some problems, such as
pneumonia and heatstroke, cause the body to become warmer than normal. Some
problems, such as generalized hypothermia and some forms of shock, cause the body
to become cooler than normal
normal, higher than normal, or lower than normal can be important in determining
what is wrong with the person.
Why is it important to know a person’s temperature?
•
TO DETERMINE the CAUSE of the PERSON’S
•
TO DETERMINE the EFFECTIVENESS of TREATMENT
Factors affecting Temperature:
•
Drinking/eating hot/cold liquids or food
• Smoking
• Infection
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Vital signs are measurable life signs. The term “vital signs” usually refers to the person’s
pirations, and blood pressure.
Vital signs are key indicators used to determine the person’s overall condition.
Measures the amount of heat in the body. The 3 locations normally used in
determining the body temperature are the mouth (o
ral temperature), the armpit
(axillary), and the ear (tympanic).
If you measured a person’s body temperature using all three of these methods, you
would obtain three slightly different temperatures. The axillary (armpit) temperature
er than the oral (mouth) temperature while the tympanic (ear)
temperature would be slightly higher than the oral temperature.
For safety of the consumer we will use digital ear thermometers for
measuring temperatures in community settings.
g measurements apply:
Average normal range for infants less than 3 months
98.6˚F – 100.4 ˚F
Average normal range for infants over 3 months:
98.6 ˚F - 101 ˚F
Average normal range for adults:
98.6 ˚F - 100 ˚F
The average body temperature of a healthy adult is 98.6ºF. This does not mean that
everyone should always have a tempera
ture of 98.6ºF. An individual’s normal
temperature may be slightly higher or slightly lower. A body temperature between
96.8ºF and 100ºF is considered to be within the normal temperature range unless
otherwise specified. A person can have a body temperatu
re that is slightly above or
below 98.6ºF and still be normal and healthy. People have different “normal”
What is normal for the person you support?
When a person becomes ill, one of the first things that must be done is to determine
sease, injury, or other factor is responsible. Some problems, such as
pneumonia and heatstroke, cause the body to become warmer than normal. Some
problems, such as generalized hypothermia and some forms of shock, cause the body
to become cooler than normal
. Determining whether the person’s temperature is
normal, higher than normal, or lower than normal can be important in determining
what is wrong with the person.
Why is it important to know a person’s temperature?
TO DETERMINE the CAUSE of the PERSON’S
CONDITION
TO DETERMINE the EFFECTIVENESS of TREATMENT
Factors affecting Temperature:
Drinking/eating hot/cold liquids or food
Page 70
Vital signs are measurable life signs. The term “vital signs” usually refers to the person’s
Vital signs are key indicators used to determine the person’s overall condition.
Measures the amount of heat in the body. The 3 locations normally used in
ral temperature), the armpit
If you measured a person’s body temperature using all three of these methods, you
would obtain three slightly different temperatures. The axillary (armpit) temperature
er than the oral (mouth) temperature while the tympanic (ear)
For safety of the consumer we will use digital ear thermometers for
The average body temperature of a healthy adult is 98.6ºF. This does not mean that
ture of 98.6ºF. An individual’s normal
temperature may be slightly higher or slightly lower. A body temperature between
96.8ºF and 100ºF is considered to be within the normal temperature range unless
re that is slightly above or
below 98.6ºF and still be normal and healthy. People have different “normal”
When a person becomes ill, one of the first things that must be done is to determine
sease, injury, or other factor is responsible. Some problems, such as
pneumonia and heatstroke, cause the body to become warmer than normal. Some
problems, such as generalized hypothermia and some forms of shock, cause the body
. Determining whether the person’s temperature is
normal, higher than normal, or lower than normal can be important in determining
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 71
• Dehydration
• Exercise
• Constipation
• Coughing or hiccupping
• Dyspnea ( difficulty breathing)
• Environment
• Emotions
• Time of day
Fever can be caused by infection or illness; this is the body's way of fighting the
infection. Certain diseases, such as arthritis, hyperthyroidism and leukemia may also
cause elevated body temperature.
Exposure to extreme heat or cold can change body temperature. Hot weather,
especially with high humidity, can result in heat exhaustion and even heat stroke,
which elevates temperature to dangerously high levels. Sunburn can also cause fever.
Exposure to cold temperatures can result in hypothermia, or a body temperature that
is dangerously low.
Body temperature is at its lowest point early in the day. As the day progresses, body
temperature rises
Signs of Fever
When a person’s body temperature is not within the normal range, the cause is usually
an infection or a dangerous environmental condition.
Signs of a fever include:
Flushed face
Bright glistening eyes
Hot skin
Thirst
Restlessness
Methods of Obtaining the Temperature:
There are several methods of obtaining a temperature:
• Oral ( by mouth)
• Axillary (Under the arm)
• Rectal
• Tympanic Membrane – (The tympanic membrane is the ear drum)
Procedure for using Ear Thermometer
There are many kinds of ear thermometers. Carefully read the instructions before
using your thermometer.
• Explain to the person what you will be doing.
• Wash hands.
• Position person in upright sitting position with head turned to side, away from you
(Infants and children can be held in arms or on lap)
• Remove thermometer from container and attach probe cover to ear thermometer.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 72
• Turn person’s head to one side: For an adult, pull outer part of the ear upward and
back; for a child, pull down and back. Gently insert probe into ear canal.
• Leave in place until beep is heard (usually2 seconds).
• Remove probe after reading is displayed on digital unit.
• Discard used probe cover in trash, do not reuse.
• Return ear thermometer to storage unit.
• Share your finding with the person.
• Wash hands
• Document reading on progress note or vital sign record.
The DSW will now demonstrate the appropriate method of taking a temperature using
an ear thermometer during this time and again at the end of the course.
The DSW will use the appropriate form for documenting the temperature that is
required by their agency.
When to notify your supervisor:
Inform your supervisor if:
• Temperature is very high or very low. Above or below what the norm is for the
person you support
• If earwax is seen on the probe cover.
• If you are unable to get a temperature due to:
◦ Person refuses
◦ Person is uncooperative
◦ There is a machine malfunction
PULSE:
The rhythmical throbbing of arteries produced by the regular contractions of the heart.
The pulse measures how fast the heart is beating and is known as the rate. It should
be counted for one full minute.
A pulse is created when the left upper chamber (ventricle) of the heart contracts.
When this happens, blood is suddenly pushed from the ventricle to the main artery of
the body (aorta). This sudden forcing of blood from the heart into the arteries causes
two things to happen.
• The artery expands: The sudden rush of blood increases the volume of blood in the
arteries. In order to accept this increased volume, the arteries expand (stretch). As
• the arteries quickly contract (go back to normal size), blood is forced from the
arteries, through the capillaries, and into the veins.
• In addition to the expansion of the arteries, a “wave” travels through the arteries.
This wave is the pulse and can be felt at various locations in the body. All arteries
have a pulse, but the pulse is easier to feel (palpate) when the artery is near the
surface of the body.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 73
The Pulse Measures how fast the heart is beating.
Normal Results for resting heart rate:
• Newborn infants: 100 - 160 beats per minute
• Children 1 to 10 years: 70 - 120 beats per minute
• Children over 10 and adults (including seniors): 60 - 100 beats per minute
• Well-trained athletes: 40 - 60 beats per minute
Factors affecting Pulse:
• Age: Before birth 140 – 150
At birth 130 – 140
Childhood 80 – 115
Adult 72- 80
Later years 60 -70
• Height: generally a tall person’s pulse is slower.
• Sex: a female’s pulse is usually faster.
• Exercise: exercise increases the need for oxygen and therefore increases the pulse.
• Fever: increases the pulse.
• Medication: can increase or decrease the heart rate.
• Acute pain: increases the pulse and chronic pain decreases the pulse.
• A failing heart: increases the heart rate as the heart has to pump faster to circulate
oxygen to the body.
• Hemorrhage and blood loss: increases the pulse, but the pulse is weak.
• Brain injuries: e.g. stroke – may slow the pulse.
Fear , worry, anxiety: increases the pulse
Pulse Points: There are several sites on the body where a pulse is normally taken. All
arteries have a pulse, but it is easier to palpate (feel) the pulse at certain locations.
The three most common sites are:
• Radial Pulse (wrist)
• Carotid Pulse (throat)
• Brachial Pulse (inside of elbow)
Radial – The radial pulse (using the radial artery) is taken at a point where the radial
artery crosses the bones of the wrist. If the person’s hand is turned so that the palm is
up, the radial pulse is taken on the thumb side of the top side of the wrist.
Carotid – The carotid pulse is taken on either side of the trachea (wind pipe). The
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 74
best locations are in the grooves located to the right and to the left of the larynx
(Adam’s apple).
Brachial – The brachial pulse is taken in the depression located about one-half inch
above the crease on the inside (not the bony side) of the elbow. This site is also used
when taking the person’s blood pressure.
Procedure for Counting a Pulse:
• Explain to the person what you will be doing
• Wash hands.
• Place your index and middle fingers on the inner aspect of person’s wrist over the
radial artery (the wrist point)
• Apply light but firm pressure until pulse is felt. (Do not use thumb)
• Count for one full minute using second hand on watch.
• Share your finding with the person.
• Document reading on progress note or vital sign record.
The DSW will now demonstrate the appropriate method of counting pulse during this
time and again at the end of the course.
The DSW will use the appropriate form for documenting the pulse that is required by
their agency.
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Documenting the Pulse:
•
Document the rate: number of beats per minute
•
Document the rhythm: regular or irregul
•
Document the volume (strength): weak or strong
Example:
Pulse 100, irregular, weak
RATE
: The normal adult has a pulse rate of about 72 beats per minute. Infants have
higher average pulse rates. The normal pulse rate ranges are based upon age and
physical condition.
RHYTHM
: A regular pulse will have the same interval between beats. An irregular
pulse (uneven pattern) will have a skipped or missed beat or it may have an additional
beat.
Volume or Strength:
The strength (force) of the pulse is deter
blood forced into the artery by the heartbeat. A normal pulse has a normal strength.
You will be able to identify a normal strength pulse with practice.
Terms used to describe the strength of a pulse are:
•
Bounding (very strong)
•
Weak
(weak, feeble, thready)
•
Strong
(stronger than a normal pulse but less than a bounding pulse)
Documenting all of these factors is essential when recording the pulse. It provides a
more accurate description of the person’s cardiovascular status.
It
is important for the DSW to use the appropriate agency form for documentation.
RESPIRATION
: the process of inhaling and exhaling (breathing).
Measures the number of times in one minute that the
• Normal-
Adults: aged 18 a
12-
20 beats per minute
• Normal-
Children: 6
22-
30 beats per minute
Normal-
Infant: birth
30-
60 beats per minute
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Document the rate: number of beats per minute
Document the rhythm: regular or irregul
ar
Document the volume (strength): weak or strong
: The normal adult has a pulse rate of about 72 beats per minute. Infants have
higher average pulse rates. The normal pulse rate ranges are based upon age and
: A regular pulse will have the same interval between beats. An irregular
pulse (uneven pattern) will have a skipped or missed beat or it may have an additional
The strength (force) of the pulse is deter
mined by the amount of
blood forced into the artery by the heartbeat. A normal pulse has a normal strength.
You will be able to identify a normal strength pulse with practice.
Terms used to describe the strength of a pulse are:
(weak, feeble, thready)
(stronger than a normal pulse but less than a bounding pulse)
Documenting all of these factors is essential when recording the pulse. It provides a
more accurate description of the person’s cardiovascular status.
is important for the DSW to use the appropriate agency form for documentation.
: the process of inhaling and exhaling (breathing).
Measures the number of times in one minute that the
chest rises and falls
Adults: aged 18 a
nd over
20 beats per minute
Children: 6
-12 years of age
30 beats per minute
Infant: birth
– 1 year
60 beats per minute
Page 75
: The normal adult has a pulse rate of about 72 beats per minute. Infants have
higher average pulse rates. The normal pulse rate ranges are based upon age and
: A regular pulse will have the same interval between beats. An irregular
pulse (uneven pattern) will have a skipped or missed beat or it may have an additional
mined by the amount of
blood forced into the artery by the heartbeat. A normal pulse has a normal strength.
Documenting all of these factors is essential when recording the pulse. It provides a
is important for the DSW to use the appropriate agency form for documentation.
chest rises and falls
.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 76
WHAT IS BREATHING?
Basically, breathing is ventilation. Ventilation is the mechanical act of moving air in
and out of your lungs. When you inhale (breathe in), fresh air enters your lungs, the
lungs take oxygen from the air.
When you breathe out (exhale) you add carbon dioxide to the air. When you exhale,
you force the air from your lungs back into the environment. You do not however,
force all the air out of your lungs when you exhale. A person takes in about 500 ml. of
air when he inhales normally and exhales the same amount. After a normal exhale, the
lungs will still contain about 2300 ml. of air. This is referred to as residual air.
Factors affecting Respirations:
• Body position
• Exercise
• Smoking
• Acute pain
• Anxiety
• Medication
• Disease conditions
• Brainstem injury
Procedure for counting Respirations:
The cycle for respirations: one inhalation and one exhalation equals one respiration, =
the rise and fall of the chest (this can be done by counting each time the chest or the
abdomen rises)
• Person should be lying down, or in sitting position.
• Make sure chest movement is visible.
• Do not let the person know you are counting the respirations (it will affect their
Breathing rate)
• Count with the first breath in while looking at the second hand of a watch.
• Count for one full minute.
• Document results on progress note or vital sign record.
The DSW will now demonstrate the appropriate method of counting respirations during
this time and again at the end of the course.
The DSW will use the appropriate form for documenting the respiratory rate that is
required by their agency.
Documenting Respirations: The DSW will use the appropriate form required by their
agency to document the individual’s respirations.
It is important to document the following:
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 77
• Rate – number of respirations per minute.
• Rhythm – regular or irregular
• Quality – type of breathing noted: labored (noisy, difficult respirations) or
unlabored: (quiet, without effort)
Example:
Respirations – 12, irregular; labored
ASSESSING A PERSON’S RESPIRATIONS
You normally assess the person’s breathing when you are taking the pulse. Take the
pulse in such a manner that you do not need to move in order to observe their
breathing also. When you finish counting the person’s pulse rate, count the person’s
breaths (the rising and falling of their chest) before recording their pulse rate.
Continue to hold their wrist as though you were still counting their pulse rate. Count
the number of complete breaths (the sequence of inhalation and exhalation is one
breath) that occur during a 60 second period.
As you count the person’s breaths, look and listen for abnormalities (rapid or slow
breathing, shallow or deep breathing, irregular breathing, noises, indications of pain,
coughing, and so forth). If you are not taking their pulse, observe their breathing
when they are at rest (usually sitting or lying down) and not aware that you are
observing their breathing.
Breathing should be effortless and barely noticeable. If it is labored or noisy, too fast,
or
too slow, then it is not normal and should be REPORTED immediately so that it can be
treated immediately.
BLOOD PRESSURE:
Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of the
blood vessels. During each heartbeat, BP varies between a maximum (systolic ) and a
minimum (diastolic ) pressure. Systolic pressure is when the heart is contracting
(working) and Diastolic pressure is when the heart is at rest.
All blood vessels – large or small, artery or vein- have blood pressure. However, the
term blood pressure normally refers to the blood pressure of a major artery. Unlike the
other vital signs discussed previously, the blood pressure involves two numbers, the
systolic pressure and the diastolic pressure, to describe this vital sign.
Basically, the systolic pressure is the greatest pressure that the blood exerts against
the walls of the blood vessel (and will be noted as the top number of the reading)
while the diastolic is the lowest pressure that the blood exerts against the walls of the
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 78
vessel (and is indicated by the bottom number of the reading).
A person’s blood pressure depends upon:
• The force of the heart’s pumping action
• The degree to which the blood vessel will stretch
• The amount of blood in the blood vessel
The arteries are under the greatest pressure when the heart pumps blood into them.
The extra blood that is forced into the arteries make them stretch. The arteries are
under the least pressure from the blood when the heart is at rest (between pumps or
beats) and the arteries have returned to their normal size.
Factors affecting Blood Pressure:
• Asleep or awake – usually lower when sleeping
Body position – lying down, sitting or standing can either increase or
decrease Blood Pressure
• Emotional state – such as stress and anger can increase BP
• Activity level – from not moving to extreme exertion can increase or
decrease Blood Pressure
• Smoking – increases BP
There are many factors that can affect a person’s blood pressure. Some are only
temporary, others are long-term effects. A condition in which the blood pressure is
considerably above normal is called “hypertension”. If the blood pressure is too
low, it is called “hypotension”. A primary factor influencing a person’s blood
pressure is the condition of their cardiovascular system (heart and blood vessels).
Other factors affecting blood pressure include the following:
• Age: A person’s blood pressure readings tend to increase as they grow
older.
• Gender: men tend to have higher blood pressure than women of the same
age.
• Physical illness: People who are physically fit tend to have more normal
blood pressure than people who are out of shape.
• Obesity: People who are very overweight usually have higher blood pressure
than people who are within their ideal weight range.
• Disease: any disorder that affects the arteries or kidneys will result in a higher
blood pressure. Diseases that weaken the heart will usually result in a lower
blood pressure.
Blood Pressure Ranges:
Normal B/P Range 90/60 to 119/79
Pre-Hypertension 120/80 to 139/89
Hypertension Stage 140/90 to 159/99
Hypertension Stage 2 > 160/100
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 79
Average B/P Range for children: 80/34 to 120/75
Remember, it is important for the DSW to know what is normal for the person they
support.
High Blood pressure, which is called hypertension, is a condition in which the force
of the blood is high enough against the artery walls that it may eventually cause
health problems such as heart disease and stroke.
Blood pressure is determined by the amount of blood the heart pumps and the amount
of resistance to blood flow in the arteries. The more blood the heart pumps and the
narrower the arteries, the higher the blood pressure. Uncontrolled high blood pressure
increases the risk of serious health problems, including heart attack and stroke.
High Blood Pressure = Hypertension
Most people with high blood pressure have no signs or symptoms, and the reason this
condition is known as the SILENT KILLER.
Possible Early Signs and Symptoms of Hypertension may include:
• Above normal blood pressure reading
• Dull headaches
• Dizzy Spells
• Nosebleeds
Early detection and treatment may save a person’s life!
Low Blood Pressure = Hypotension
Low blood pressure (hypotension) is pressure so low it causes symptoms or signs due
to the low flow of blood through the arteries and veins.
When the flow of blood is too low to deliver enough oxygen and nutrients to vital
organs such as the brain, heart, and kidney, the organs do not function normally and
may be temporarily or permanently damaged.
Many people with low blood pressure have dizziness and fainting or serious heart,
endocrine or neurological disorders. Severely low blood pressure can deprive the brain
and other vital organs of oxygen and nutrients, leading to a life- threatening condition
called shock.
Although blood pressure varies from person to person, a blood pressure reading of 90
or less systolic (the top number) or 60 or less diastolic (bottom number) is generally
considered low blood pressure.
The causes of low blood pressure can range from dehydration to problems with the
way the brain signals the heart to pump blood. Low blood pressure is treatable, but it’s
important to find out what’s causing the condition so that it can be properly treated.
Unlike high blood pressure symptoms, which are poorly defined and often totally
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 80
absent, low blood pressure has several classic, easily recognized symptoms.
The development of symptoms is considered an indicator that the person should be
evaluated to discover the cause of the low blood pressure and to rule out any
underlying problems. Generally, blood pressure must fall to a fairly low value before
symptoms develop.
Signs and Symptoms of Hypotension (low blood pressure) may include:
• Below normal blood pressure reading
• Dizziness, or feeling like you’re standing on a rocking boat
• Fainting
• Changes in mental status (difficulty concentrating, confusion) or a sense of
"impending doom” or anxiety
• Changes in breathing patterns (fast, shallow breathing is common during an
episode of low blood pressure)
• Nausea
• Suddenly feeling cold or clammy, or a rapid onset of pale skin
Early detection and treatment may save a person’s life!
Types of Blood Pressure Monitors:
The majority of home monitors are digital blood pressure monitors. These monitors are
easier to use than the manual monitors. The technology of digital monitors has
improved rapidly and now they are considered only very slightly less accurate than
manual blood pressure monitors.
Digital blood pressure monitors have sensors that detect the sounds of blood in the
artery in the cuff. Therefore, generally, for home use, digital monitors are
recommended. Most of the popular models are automatic and inflate the cuff. This
leads to less variability and more accurate readings.
It will be important for you to carefully read the directions on the monitor that you will
be using for the individual that you support, as each monitor is different.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 81
Using a Digital Blood Pressure Monitor:
There are many kinds of B/P Monitors. Carefully read the instructions before using
your B/P Monitor.
• Person should sit with back supported or lying with arm stretched out, level
with the heart.
• Person should sit with legs uncrossed.
• The person should avoid eating, drinking alcohol, smoking, exercising or
bathing for 30 minutes before taking their blood pressure.
Procedure for Measuring Blood Pressure:
• Wash hands and gather equipment: automated digital blood pressure cuff, pen
note pad or log to write on.
• Position the person, or have the person position arm in desired appropriate
position
• Blood pressure is normally taken in the upper arm. The person can stand, sit or
lie down. Normally the person will sit with the arm resting on table or lie down
with arm resting on bed.
• Expose the site; move clothes above elbow, assist the person if needed.
Have the person extend his/her arm in a palm up position. The arm should be
about the same level as the heart. Support the arm on the bed, table, etc. If
the person is sitting upright, feet should be flat on the floor, legs uncrossed.
Encourage the person to remain still.
• Wrap the cuff comfortably, and securely around the upper arm, just above the
elbow
• Press the ON/OFF START Button to turn machine on. Reading begins
automatically.
• Document reading. Record the systolic and diastolic readings. The systolic is
written first and is separated by a diagonal line: Ex “120/80” Both readings are
documented.
• Press the ON/OFF START Button again to turn machine off.
• Remove cuff from around the person arm.
• Assist the person if needed with clothes.
• Return equipment to the proper storage.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 82
The DSW will now demonstrate the appropriate method of taking a blood pressure
using a Digital B/P Monitor during this time and again at the end of the course.
The DSW will use the appropriate form for documenting the Blood Pressure that is
required by their agency.
Documentation of Blood Pressure Measurement
The DSW will use the appropriate form required by their agency to record the blood
pressure reading.
• Systolic number (top number)
• Diastolic number (bottom number)
• Time and date
• Site
Example:
120/80 (Systolic # / Diastolic #)
Left arm
11 AM on 3/5/2011
When to Check Vital Signs:
• When given instruction by your supervisor or by the health care provider.
• When you notice the person is not feeling well or may be ill.
• After someone has had a seizure.
When to Report Vital Signs
• When vital signs are out of the normal for the individual
• When instructed by the health care professional (doctor, nurse, etc.)
DOCUMENT and REPORT to your supervisor.
Your supervisor will report to the RN. The Nurse will report to the physician.
Handouts:
•
Preparing for Medication Administration
•
Six Rights of Medication Administration
•
Proper Hand Washing
•
How to Apply Cream or Ointment
•
How to Use Inhalers/ Spacers
•
How to Apply Eye Drops
•
How to Apply Ear Drops
•
How to use an Epi Pen
•
How to Use Suppositories
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 83
•
How to Perform the Heimlich maneuver
•
How to Check Vital Signs (Skills Procedure Review)
Preparing for Medication Administration
A. Use a designated area to prepare and administer
medications. The area must be:
•
Clean & free from clutter
•
Well lit
•
Have adequate supplies available
B. Practice good hand hygiene and/or universal precautions
•
Wash your hands prior to preparing medications and anytime there has been any
physical contact
•
Use gloves when instilling eye or ear medications
•
Be aware of allergies to latex
•
Wash your hands to remove powder from gloves
C. Educate Yourself on the Medication
•
Provide adequate amount of water for easy swallowing
•
Review medicines that require checking of vital signs
D. Follow the Six Client Rights When
•
Removing the medication from storage
•
Removing the medication from it’s container
•
Returning the medication to storage
E. Identify yourself and what you are doing
F. When measuring liquid medications
•
Have available a medication dispensing device or oral syringe
•
Pour the medication away from the label
•
Have the container eye level when measuring
•
Pay close attention to the order and the measurement markings on the container
G. Give the medication and observe the client taking it
•
Monitor for cheeking ( holding meds on side of mouth, not swallowing meds)
H. Document
I. Observe the client after they have taken the medication &
report to the Nurse:
•
As soon as possible, any change in the patient’s normal condition
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
Six Rights
1. Right Client
Always have at least
t
medications.
2. Right Medication
Verify that the medi
ca
Administration Reco
r
3. Right Dose
Read the label on the
transcribed order.
Pay close attention to
Never give ear
(otic) drops in the
eye.
scheduled time).
6. Right Documentat
ion
Each medication mus
t
is given.
DIRECT SERVICE WORKER MEDICATION CURRICULUM
of Medication Administrati
on:
t
wo (2) client identifiers when administer
i
ca
tion label coincides with the Medication
r
d.
medication container and compare it to t
he
the dosage amount.
4. Right Route
Read the label on the medication contai
n
compare it to the transcribed order.
Pay close attention to the route.
5. Right Time
Follow directions for when to give the
m
Refer to agency policy for the time fra
m
acceptable to give medications (exampl
e:
minutes before or 60
minutes after the
If a
m
bee
n giv
docu
m
ion
t
be documented when it
is po
te
over
dosing.
Page 84
on:
i
ng
he
n
er and
m
edication.
m
e
e:
60
m
edication has
n giv
en, but not
m
ented there
te
ntial for
dosing.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 85
Proper Hand Washing
Good hand washing techniques include washing your hands
with soap and water or using an alcohol-based hand sanitizer.
Washing Hands Using Soap and Water
•
Remove rings
•
Wet your hands with warm, running water and apply liquid soap
•
Lather well
•
Scrub all surfaces, including the backs of your hands, wrists, between
your fingers and under your fingernails
•
Rub hands together for 20 seconds (sing “Happy Birthday” twice)
•
With water running, dry hands with a paper towel
•
Use paper towel to turn of the faucet
•
Dispose of paper towel
Washing Hands with an Alcohol-Based Hand
Sanitizer
•
Apply ½ tsp of the sanitizer to the palm of your hand
•
Rub hands together, cover all surfaces of your hands until they are dry
Alcohol-based hand sanitizers are an excellent alternative to hand washing.
However, it your hands are visibly soiled, wash with soap and water.
LOUISIANA
DIRECT SERVICE WORKER MEDICATI
How t
o
When applying cream
or o
and the following:
•
Wash hands thorough
l
•
Put on gloves
•
Cleanse the skin with
•
When opening the co
nta
•
Apply the cream or o
int
NOTE: When transcri
b
indicate where the oin
t
•
Notify the nurse if y
ou
or odor of the draina
g
DIRECT SERVICE WORKER MEDICATI
ON CURRICULUM
o
Apply Cream or Ointment
or o
intment, follow the directions on
th
l
y
warm water and soap
nta
iner, place the cap so that the grooved
int
ment as directed by the label or the d
oc
b
ing orders for applying ointments, b
e
t
ment should be applied.
ou
notice: a change in the amount, color, c
o
g
e or if there is any swelling or redness
Page 86
th
e label,
side is up
oc
tor’s order
e
sure to
o
nsistency,
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
H
Aqueous Nasal Inhal
ers
•
Blow the nose
•
Wash hands
•
Block one nostril with
•
Insert the nozzle of t
h
•
Aim inhaler so the s
pra
outwards and away fr
om
•
Client should not inha
l
•
Squeeze the inhaler q
u
•
Repeat as directed an
d
Metered Dose Inhalers
•
Wash hands
•
Shake the inhaler sev
e
•
Stand and hold hea
d s
•
Exhale all the way
•
Place the mouthpiece
•
Breath through the m
o
the canister to relea
se
•
Breath slowly throug
h
of air
•
Hold breath for 10 se
co
•
Repeat as directed
Peak Flow Meter
•
Wash hands
•
Place the indicator at
th
•
Stand up
•
Take a deep breath
•
Place the meter in th
e
•
DO NOT PUT TONG
UE
•
Blow out as hard and
fa
•
Record the reading
•
Repeat two more tim
es
•
Record the highest of
•
The doctor will instru
c
DIRECT SERVICE WORKER MEDICATION CURRICULUM
H
ow to Use Inhalers
ers
a finger
h
e inhaler into the other nostril
pra
y is directed 45 degrees upward and sli
g
om
the mid line
l
e
u
ickly and firmly
d
for the other nostril
e
ral times
d s
traight up
between teeth and close lips around it
o
uth and immediately press down on
se
the medicine
h
open mouth for 4 to 5 seconds, until
lung
co
nds
th
e base of the numbered scale
e
mouth and close lips around the mouthp
i
UE
INSIDE THE HOLE
fast as you can
es
the three numbers achieved
c
t you what to do given your peak flow r
es
Page 87
g
htly
lung
s are full
i
ece
es
ults
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 88
How to Use Inhaler Spacers
Sit up straight, or stand up, and lift the chin to open the airways.
•
Remove the cap from the mouthpiece of the inhaler and shake the inhaler
vigorously.
•
If you haven't used the inhaler for a week or more, or it is the first time
you have used the inhaler, spray it into the air before using it to check
that it works.
•
Insert the inhaler mouthpiece into the hole in the end of the spacer (the
inhaler should fit snugly and without difficulty - see below).
•
Take some deep breaths and then put your teeth around the spacer
mouthpiece (not in front of it and do not bite it), and seal your lips around
the spacer mouthpiece, holding it between your lips.
•
Press down on the canister in the inhaler to spray one puff of medicine
into the spacer.
•
Breathe in slowly and deeply, then hold your breath for 10 seconds or as
long as is comfortably possible.
•
Breathe out, then breathe in deeply again through the mouthpiece of the
spacer and hold your breath. You should take two deep-held breaths from
the spacer for each puff from your inhaler.
•
If you need another dose, wait 30 seconds, shake your inhaler again then
repeat steps 4 to 8.
•
Don't spray more than one puff at a time into the spacer. This makes the
droplets in the mist stick together and to the sides of the spacer, so you
actually breathe in a smaller dose.
NOTE: Follow manufacturer’s instructions for cleaning all of the above.
LOUISIANA DIRECT SER
VICE WORKER MEDICATION CURRICULUM
H
o
When applying eye dro
ps
NEVE
R
• Wash hands thoro
ugh
• Client should be sitti
n
• Pull down the lower
lid
• Place one drop insid
e
• If you are not sure
tha
instilling another d
ro
VICE WORKER MEDICATION CURRICULUM
o
w to Apply Eye Drops
ps, follow the following guidelines:
R
USE EAR DROPS IN THE EYE
ugh
ly
n
g up straight and looking at the ceili
ng
lid
e
the lower lid
tha
t a drop went in, WAIT 5 minutes be
ro
p.
Page 89
ng
f
ore
LOUISIANA DIRECT SER
VICE WORKER MEDICATION CURRICULUM
How
t
When applying ear dro
ps
•
Wash hands and dr
y
•
Gently shake the b
o
•
Hold the bottle in y
o
•
Hold the dropper ti
p
•
Tilt the head to one
•
In adults, hold the
e
•
In children, hold th
e e
back
•
Place the correct nu
mb
ear – DO NOT SQ
UEEZ
TOO HARD
•
Return the dropper
t
•
Press the ear flap a
n
•
Insert a cotton plug
•
Wash hands
VICE WORKER MEDICATION CURRICULUM
t
o Apply Otic (Ear) Drops
ps
, follow these guidelines:
y
completely
o
ttle
o
ur hands for a few minutes to warm
th
p
down at all times
side
e
arlobe up and back
e e
arlobe down and
mb
er of drops in the
UEEZ
E THE DROPPER
t
o the medicine bottle right away
n
d keep head tilted for several minut
es
Page 90
th
e drops
es
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 91
How to use an EpiPen
Epinephrine stops anaphylaxis very nicely. Anaphylaxis can be fatal if not treated quickly
and properly, and epinephrine is the first line of defense. Many patients of anaphylaxis
carry automatic injectors of epinephrine -- the most common brand is an EpiPen.
Depending on laws in your state and the level of training a first aid provider has, it may be
permissible for a first aid provider to administer an EpiPen to a victim of anaphylaxis. The
EpiPen must already be prescribed to the patient in order for it to be used.
1. Remove the EpiPen
Unscrew the yellow cap from the container and slide out the EpiPen.
2. Remove the Gray Safety Cap
Take off the gray safety cap from the back of the EpiPen. It won't work unless this cap is
removed.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 92
3. Inject the Epinephrine
Grasp the EpiPen in a fist and press the black, rounded tip hard into the thigh. Hold the
EpiPen in place while slowly counting to 10. The pen can inject right through clothing.
4. Call 911 and Discard the EpiPen
Once the EpiPen is used, call 911. Anaphylaxis is a life-threatening condition, and using
epinephrine is only a temporary fix. It may be necessary to give a second dose of
epinephrine.
The EpiPen now must be properly discarded. The ambulance crew will be able to throw the
used EpiPen away in their sharps container or you may need to discard it in its original
container.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 93
How to Use Suppositories
To Use a Rectal Suppositories
•
Wash your hands
•
If the suppository is soft, hold it under cool water to harden it before
removing the wrapper
•
Remove the wrapper.
•
If you are to use half of the suppository, cut it lengthwise.
•
Put on a finger cot or a disposable glove.
•
Lubricate the suppository tip with a water-soluble lubricant such as KY
Jelly
•
Lie on your side with your lower leg straightened out and your upper leg
bent forward toward your stomach
•
Lift upper buttock to expose the rectal area
•
Insert the suppository, pointed end first, with your finger until it passes
the muscular sphincter of the rectum, about ½ to 1 inch in infants and 1
inch in adults
•
Hold buttocks together for a few seconds
•
Remain lying down for about 15 minutes
•
Discard used materials
•
Wash hands
To Use Vaginal Suppository or Cream
•
Wash your hands thoroughly
•
To use the cream, fill the applicator that comes with the cream to the
level indicated
•
To use the suppository, unwrap it, wet it with lukewarm water, and place
it on the applicator
•
Lie on your back with your knees drawn upward and spread apart
•
Insert the applicator high into the vagina (unless you are pregnant), and
then push the plunger to release the medication
•
If you are pregnant, insert the applicator gently. If you feel resistance
(hard to insert), do not try to insert if further; call your doctor.
•
Withdraw the applicator
•
Pull the applicator apart and clean it with soap and warm water after each
use
•
Wash your hands
LOUISIANA
DIRECT SERVICE WORKER MEDICATION CURRICULUM
How to P
e
Step One
Ask the choking person to
Step Two
Place yourself slightly behi
n
Step Three
Reassure the victim that
yo
going to help.
Step Four
Place your arms around th
e
Step Five
Make a fist with one hand
a
belly button.
Step Six
Grab your fist with your ot
he
Step Seven
Deliver five upward squee
z
Step Eight
Make each squeeze-thrust
Step Nine
Understand that your thru
s
lungs, creating a kind of a
r
Step Ten
Keep a firm grip on the vi
c
ground if the Heimlich ma
n
Step Eleven
Repeat the Heimlich mane
u
Tips & Warnings:
•
If a victim is coughin
g s
foreign body using hi
s
•
If the choking victim
d
air exchange is mini
m
•
To avoid breaking bo
n
breastbone or lower
ri
•
If choking persists cal
l
End of Module 5
DIRECT SERVICE WORKER MEDICATION CURRICULUM
e
rform the Heimlich Maneuv
er
stand if he or she is sitting.
n
d the standing victim.
yo
u know the Heimlich maneuver and are
e
victim's waist.
a
nd place your thumb toward the victim, just
he
r hand.
z
e-thrusts into the abdomen.
strong enough to dislodge a foreign body.
s
ts make the diaphragm move air out of the v
i
r
tificial cough.
c
tim, since he or she can lose consciousness a
n
n
euver is not effective.
u
ver until the foreign body is expelled.
g s
trongly or able to talk, let the person tr
y
s
or her own efforts.
d
isplays a weak or ineffective cough, this
i
m
al and that you should start the Heimli
ch
n
es, never place your hands on the victim
's
ri
b cage when performing the Heimlich m
an
l
911 immediately.
Page 96
er
above his or
her
i
ctim's
n
d fall to the
y
to expel the
i
ndicates that
ch
maneuver.
's
an
euver.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 97
MEDICATION ADMINISTRATION
TEST - MODULE 5
Vital Signs
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
1. The term “Vital Signs” refers to the person’s
A. Temperature
B. Pulse
C. Respirations
D. Blood Pressure
E. All of the above
2. It is important to know a person’s temperature to determine the cause of the person’s
condition and or to determine the effectiveness of treatment
A. True
B. False
3. All of the following are factors that affect temperature EXCEPT:
A. Drinking/eating/ hot/cold liquids or food
B. Smoking
C. Infection or illness
D. Exposure to extreme heat or cold
E. Driving a car
4. When counting a pulse, which is the rhythmical throbbing of arteries produced by the contractions of
the heart, and tells how fast the heart is beating, you must always count the pulse for
A. 1 full minute
B. ½ a minute
C. 5 full minutes
D. None of the above
5. The three most common Pulse points are the: Radial Pulse (wrist), Carotid Pulse
(throat), and Brachial Pulse (inside of elbow)
A. True
B. False
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 98
6. How do you document the Pulse rate
A. Document the rate: number of beats per 1 full minute
B. Document the rhythm: regular or irregular
C. Document the volume (strength): weak or strong
D. All of the above
7. Respiration is the process of inhaling and exhaling ( breathing)
A. True
B. False
8. Which Factors affect Blood Pressure (BP):
A. Asleep or awake – usually lower when sleeping
B. Body Position – lying, sitting, standing can either increase or decrease BP
C. Emotional state – stress and anger can increase BP
D. Activity level – not moving to extreme exertion can increase or decrease BP
E. All of the above
9. High Blood Pressure is called HYPERTENSION, and is known as the Silent Killer
A. True
B. False
10. Low Blood Pressure is called HYPOTENSION, and can cause the brain, heart, and
kidney to not function normally which may cause permanent damage
A. True
B. False
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 99
MODULE 6:
Documentation
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 100
OBJECTIVES:
Explain the purpose of reporting and documentation.
Describe the purpose of care and support plans.
Explain the importance of correctly documenting information during a physician
visit.
Prepare written documentation following guidelines.
Purpose and Importance of Observing and Reporting
MAR – MEDICATION ADMINISTRATION RECORD
The purpose of observing, reporting, and documenting is to communicate any changes
or status that may be occurring with the person we are serving and/or the family.
Since the person we are serving may even be unaware of changes, it is vitally
important for all staff to communicate with other team members including the family as
appropriate.
This can be accomplished through observing and monitoring for any changes, and
reporting and documenting those changes.
Proper reporting and documenting can save the person you are serving’s LIFE!
Recognizing Changes OBSERVATION:
Early identification of changes in an individual’s daily routine, behavior, ways of
communicating, appearance, general manner or mood, or physical health can save his or
her life !
You get to know a person by spending time with him or her and learning what is usual
for them.
If you do not know what is normal for a person, you will not know when something has
changed.
Care Plans and Support Plans:
A care or support plan (ISP), is a written plan created to meet the needs of the
consumer.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 101
The plan is usually created during an in-home assessment of the consumer’s
situation; the strengths, the weaknesses and care being provided by family and
friends is reviewed.
The plan defines the needs and objectives/goals for care.
The plan lists the actions to be provided by the DSW.
Care Plans and Support Plans:
Any deviations from a care or support plan may put the Direct Service Worker at
risk for disciplinary actions, Therefore, any changes need to be approved by the
supervisor.
Care/support plans are reviewed by the care team. The DSW working with the
consumer may be asked for input as to how the plan is working. Reporting and
documenting are very critical in evaluation whether the plan is working or if it
needs revision.
REPORTING:
Reporting is the verbal communication of observations and actions taken to the
team or supervisor, usually in person or over the phone. A verbal report is given to
a supervisor when the need arises, or for continuity of care, e.g. giving a verbal
report to the next shift.
It is always better to report something than to risk endangering the consumer, the
agency, and yourself by not reporting it.
Reporting helps your supervisor act accordingly.
DOCUMENTING:
Documenting is the written communication of observations and actions taken in the
care of the consumer.
REMEMBER:
If it was not documented, it was not done
Your job is not over until the paperwork is finished!
The consumer’s record is a legal document!
Significance of Documentation:
A record of what was done, observed, and how the consumer reacted.
Used for evaluation by other team members working on the care plan.
Used to clarify complaint issues.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 102
Documentation Guidelines:
Always use ink.
Sign all entries with your name and title, and the date and time.
Make sure writing is legible and neat.
Use correct spelling, grammar and abbreviations.
Never erase or use correction fluid. If you make an error, cross out the incorrect
part with one line, write error over it, initial it and rewrite that part.
Documentation Guidelines:
Do not skip lines. Draw a line through the blank space of a partially completed
line or to the end of the page, this prevents others from recording in a space with
your signature.
Be accurate, concise, and factual. Do not record judgments or interpretations.
Make entries in a logical and sequential manner.
Documentation Guidelines:
Be descriptive. Avoid terms that have more than one meaning.
Document any changes from normal or changes in the consumer’s condition. Also
document what you informed the consumer’s physician or your supervisor as
indicated.
Do not omit any information.
Specific Forms
Your agency will tell you about policies and procedures you need to know. Some
agencies have specific forms you need to use for daily documentation.
You will also need to learn other specific rules for reporting information regarding
incidents that your agency will give you more information on.
COMMUNICATING WITH THE PHYSICIAN
Tips for talking with Health Care Professionals
Communication is a two-way street, you may find that at times the only good
solution is to clearly state the problem, however with the way some health care
providers may be interacting with you or the person you support, you may need to
seek services elsewhere.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 103
In most cases, when what appears to be miscommunication, a few
strategies/tips that may help you clearly and efficiently communicate concerns
and questions are as follows:
List of Strategies and Tips:
It is best to support self-advocacy rather than advocating for someone.
In emergency situations, it is not always possible to take the time to prepare and
plan for self-advocacy, but it is a desirable approach for most appointments.
List of Tips:
Make sure you ALWAYS know why you are with the consumer, Why are going to
see this physician, What is the reason for this visit?
Call the office prior to the appointment if accommodations may be necessary, e.g.
some consumers have great difficulty waiting for their appointment, and may
become agitated as time goes by in the waiting room. Some consumers may have
physical impairments that may require special accommodations for exams or tests.
Tips:
Role-play asking questions and expressing concerns. This helps you or the person
you support to feel more familiar and comfortable with the process, and may
enable you to identify barriers to clear communication before the appointment
takes place.
If you or the person you support has a great deal of anxiety about the visit, a pre-
visit can be helpful. During a pre-visit the person has the opportunity to meet the
office staff and see the clinic so that it is not unfamiliar at the time of the
appointment.
Try to stay calm. Sometimes this is very difficult, particularly if the physician or
office staff just does not seem to get your message, or if someone in the office
makes an offensive statement. IT is important to remain firm and be clear in what
it is you are doing there.
Tips:
If you feel rushed into making a decision, or if the person you support appears to
feel pressured, it is okay to ask for some private time to discuss the options.
You may even need to call back with an answer at a later date. This is a perfectly
acceptable way to ensure that you or the person you support has freely been
provided informed consent.
Always make sure that you understand the physicians orders and know what
was done at the visit so that it can be documented in the consumers record.
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 104
It is OK to ask the physician or the office staff for clarification, it is the only
way to ensure that you will be communicating the proper information to your
supervisor.
Tips:
Most importantly, know that you have resources if you feel that you or the
person you support has been unfairly or even abusively treated due to a
disability status.
All states have a Protection and Advocacy agency – see the National Disability
Rights Network website at www.napas.org to find out more information.
REVIEW: The TOOLS to Use
Observation – Use all of your senses; sight, hearing, touch and smell.
Communication – Ask questions and listen to answers. A good listener hears the
words and notices other ways of communication, including noticing changes in
behavior.
Written Forms – Document on Forms designed to help you address needed
information that you need to share with other staff and or agencies.
WHAT WOULD YOU DO?
What would you do if you are new and do not know the person you are
serving well?
How can you assure that you are reporting and documenting correctly?
What If only a Family Member goes on a Physician Visit?
It is important that we, who provide services to our consumers know that the
person we serve was seen by a physician and what was done or ordered.
It is still our responsibility to document any changes so that the plan of care can be
updated. Case managers cannot do their proper job without proper communication
of any changes that may indicate a need for additional services.
Document what the family tells you about the visit to the physician, and or
emergency room, and report this to your supervisor.
End of Module 6
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 105
MEDICATION ADMINISTRATION
TEST - MODULE 6
Documentation
KEEP COMPLETED TEST ON FILE
Staff:________________________________ Test Date:_______________ Score: _______
1. The purpose of observing, reporting and documenting is to communicate any changes or status that
may be occurring with the person you are serving and/or the family
A. True
B. False
2. Early identification of changes in an individual’s daily routine, behavior, ways of
communicating, appearance, general manner or mood, or physical health can save
his or her life
A. True
B. False
3. Documentation is the written communication of observations and actions taken in the care of the
person you are working with
A. True
B. False
4. Your job is not over until the paperwork is finished, if it was not documented it was not done
A. True
B. False
5. What is the Significance of Documentation
A. A record of what was done, observed, and how the consumer reacted
B. Used for evaluation by other people who will be working with the person
C. Used to clarify complaint issues
D. All of the above
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 106
6. Which of the following are Documentation Guidelines
A. Always use ink
B. Sign all entries with your name, date and time
C. Make sure writing is legible and neat
D. Never erase or use correction fluid, if you make an error, cross out the incorrect part with one line,
write error over it, initial it and rewrite that part
E. All of the above
7. There may be a time that you accompany the person you are working with when they
visit a Health Care Professional: What is important to remember during the visit
A. It is best to support self-advocacy rather than advocating for someone
B. Always know why you are with the person on the visit – what is the reason for
the visit
C. Make sure you understand the Health Care Professional orders when leaving
D. All of the above
8. The person you are working with may not be aware of changes going on with them, it is vitally
important for you to communicate changes you observe with the family as appropriate
A. True
B. False
9. Proper Documentation on the MAR – (Medication Administration Record) is an important part of
communication
A. True
B. False
10. If you do not know what is normal for the person you are working with, you will not
know when something has changed, it may take some to learn what is usual for them,
do not be afraid to ask questions
A. True
B. False
LOUISIANA DIRECT SERVICE WORKER MEDICATION CURRICULUM Page 107
COMPENTENCY SKILLS CHECKLIST
and Test Answer Keys
This section is for the RN oversight
Please note that the following pages will be for
the nurse only.
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Appendix A
RN Competency Assessment of the DSW to Perform Medication Administration
and/or Non-Complex Task(s)
Date: _____/_____/_________
DSW: __________________________________
Participant Name: _____________________________
Participant-Specific Task:
_____________________________________________________________
_____________________________________________________________
RN: ____________________________________
I. Participant Assessment
After assessing the above-named participant’s condition, I have determined
that his/her condition is stable and predictable.
I have considered the complexity, risks, and the skill necessary to perform this
task.
This participant’s condition will be reassessed each time there is a change in
health status.
RN Signature: _______________________________________________
Date: _____/_____/_________
II. Teaching Process - Rationale – Evaluation/Teaching Outcomes
Teaching Process used includes (check all methods used):
DSW completion of on-line training in medication administration and
infection control
Client specific training
Return demonstration by the DSW
Time for further discussion, including question and answer time
Other: ___________________________________________________
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The rationale for determining that the skill of the DSW is appropriate to the
participant’s condition is based on the following:
The participant’s condition is stable and predictable.
The DSW has a good understanding of the task, its risks and side effects and
how to manage them.
The DSW can safely and accurately perform the task.
Evaluation/Teaching Outcomes
1. Level of understanding of task, risks and side effects and how to manage
them:
_____ Acceptable _____ Needs Improvement _____Unacceptable
2. Return demonstration of task:
_____ Acceptable _____ Needs Improvement _____Unacceptable
3. Written test, if applicable: ________N/A
_____ Acceptable _____ Needs Improvement _____Unacceptable
Comments: ___________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________
III. RN Determination of Competency
The DSW has been instructed in the correct method of performing the above
task and has successfully demonstrated understanding of the task, its
risks/side effects and how to manage them. It is my determination that
he/she can safely perform the task
for (participant’s name): _______________________________________
I assure that I will provide oversight of the above-named DSW’s performance
of this task. RN Signature: ________________________.
IV. DSW Statement
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I understand that there are potential risks/side effects involved in the
performance of this task and I am prepared to effectively deal with the
consequences of them.
I have been instructed that performing this task is specific to (participant’s
name): ________________________________________
and is not transferrable to other persons or DSW’s.
DSW Signature: ____________________________________________
Date: _____/_____/_________
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Appendix B
Answer Keys for Test Modules
MEDICATION ADMINISTRATION
TEST - MODULE 1
Legal Issues, Policies and Procedures
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. A
2. A
3. A
4. D
5. A
6. D
7. A
8. A
9. A
10. D
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MEDICATION ADMINISTRATION
TEST - MODULE 2
INFECTION CONTROL
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. A
2. D
3. D
4. D
5. A
6. A
7. A
8. D
9. D
10. E
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MEDICATION ADMINISTRATION
TEST - MODULE 3
CLASSIFICAITON OF MEDICATION & TERMINOLOGY
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. A
2. A
3. D
4. D
5. A
6. A
7. A
8. A
9. A
10. A
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MEDICATION ADMINISTRATION
TEST - MODULE 4
MEDICATION PREPARATION, ADMINISTRATION & STORAGE
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. E
2. A
3. E
4. E
5. A
6. B
7. A
8. B
9. A
10. A
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MEDICATION ADMINISTRATION
TEST - MODULE 5
VITAL SIGNS
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. E
2. A
3. E
4. A
5. A
6. D
7. A
8. E
9. A
10. A
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MEDICATION ADMINISTRATION
TEST - MODULE 6
DOCUMENTATION
ANSWERS
Staff:________________________________ Test Date:_______________ Score: _______
1. A
2. A
3. A
4. A
5. D
6. E
7. D
8. A
9. A
10. A
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DEVELOP INDIVIDUAL CERTIFICATE
THAT CAN BE KEPT IN DSW FILE
RN DELEGATION FORMS ARE ALSO TO BE KEPT IN THE DSW’S FILE AS
WELL AS A COPY FOR THE RN TO ASSURE DELEGATION HAS
BEEN COMPLETED
