Medication
Administration
Program
Administering Medication
the Right Way
Successful Completion
 100%

Attendance
Pre-Test
D&S Diversified Technologies
Three Components
1. Computer Based Test-75 min.
50 questions (40/50 is passing)
Must pass CBT to be eligible to take skills
Skills
2. Transcription-15 min.
3. Med Administration-10 min.
Apply knowledge of 5 Rights while verbally
demonstrating 3 checks
Medication Certification
 Meds
may be administered to
adults only in DDS/DMH funded,
operated or licensed programs
 Good for 2 years
Fictional Characters
Melissa
 Chip
 Freddy

Community Resources
MAP Consultant
Registered Nurse
 Pharmacist
 Licensed Practitioner

Learning Strategies
 Objectives
 Terms
to Study
 Apply What You've Learned
 Exercises
Required for Medication
Administration
 Health
Care Provider (HCP) Order
 Pharmacy Label
 Medication (med) Sheet
Medication Book
Includes:
 HCP orders
 HCP visit form (if it
includes an order)
 Med sheets
 Medication
Information sheets
Countable Substances Book
Three sections:
 Index
 Count sheets
 Shift count sheets
Basics of
Medication
Administration
Safe Medication Administration
 Standardization
Knowing the People You Support
Helps to recognize changes
 Helps when reporting
 Helps when documenting

Respecting Rights
To be treated with respect and dignity
 To be free from too much medication
 To know what meds they are taking
 To know about risks and benefits
 To refuse medication

Principles
 Mindfulness
 Maximizing
Capabilities
 Communication
Safe Medication Administration
 Cycle
of Responsibility
Cycle of Responsibility
Observe
Document the Med Administration
Report changes
Administer Medication
Store Medication
Support Visits to HCP
Communicate with Pharmacist
Record Information
Daily Routine
Come to work ready to:
 Talk with other staff
 Greet person
 Ask how person is doing
 Pay attention to behavior
How to Prevent and
Control Infection
Prevent and Control Infection
 Hand
washing
When
How
Prevent and Control Infection
 Wearing
When
How
Gloves
The Cycle of
Responsibility
General Guidelines
Medication Administration
The Five Rights
Right Person
 Right Medication
 Right Dose
 Right Time
 Right Route

The Right Person
If not certain get help
 Ask other staff
 Check picture
The Right Medication
If brand name
written on
prescription,
pharmacist will
usually
substitute
generic
 If unsure, ask
pharmacist

The Right Medication
If familiar with
med but notice
a change in
color, size,
shape,
markings, etc.
 Ask the
Pharmacist

The Right Dose
HCP orders dose
 Usually written in “mg”

The Right Time
Particular time of day
 Number of times per day
 Time between doses

The Right Time
 Most
meds can be given safely
one hour before and up to one
hour after time on med sheet
 If unsure, ask pharmacist
The Right Route
The form of med determines the route:
 tabs, caps, liquids (usually oral)
 ointment to skin (topical)
General Guidelines
 Three
cross checks of the
Five Rights before
administration
How to Administer
Medications
The Process
Medication Administration
Process
 Prepare
 Administer
 Complete
Med Pass Instructions
Chip
Brown
8pm med
Sept. 3, yr
Med Pass Instructions
Chip
Brown
8am meds
Sept. 4, yr
Support Plan for use of PRN
Medication for Anxiety
Specific behaviors that show us Chip is anxious:
1.
Pacing in a circle for more than 4 minutes.
2.
Head slapping for longer than 30 seconds or more than 5 times
in 4 minutes.
A.
B.
Staff will attempt to engage Chip in one on one conversation re:
current feelings and difficulty.
Staff will attempt to direct and involve Chip in a familiar activity such
as laundry, meal preparation, etc.
If unsuccessful with A or B staff may suggest/offer Chip:
Ativan 0.5mg once daily as needed by mouth. Must give at least
4 hours apart from regularly scheduled Ativan doses.
(Refer to HCP order)
If anxiety continues after the additional dose, notify HCP.
Med Pass Instructions
Chip
Brown
PRN med for anxiety
Sept. 4, yr
3pm
Document Med Administration
Place initials in box that directly
corresponds to time and date given
 Initials and signature at bottom of med
sheet (if first time giving)
 PRN medication time/initials in same
box and write a progress note

Oral Medication
 HCP
order required to crush and
mix a med with food or liquid
Oral Medication
 MUST
have
HCP order to:
empty
contents of a
capsule
Oral Medication
 May
give half
tabs ONLY if
halved by the
pharmacy
Liquid Med Administration
Oral Med Cup:
 Place on flat surface
at eye level
 Use thumbnail to
mark correct
measurement
 Shake bottle of med
well, if needed
 Pour slowly
Liquid Med Administration
 Oral
dosing
syringe
Liquid Med Administration
Dropper
Other Routes of
Medication Administration
Never administer a
med by any route
unless you have
received training in
that route
General Cautionary Guidelines
Administering meds if:
Unable to read HCP order
 Missing any piece of info
 Unable to read label
 Label is missing
 Med was prepared by another staff

General Cautionary Guidelines
Administering Meds If:





You have any doubts about the five rights
If person has a serious change
If person has difficulty swallowing
If person refuses
If med seems to be tampered with
Medication Refusals
Dealing With Refusals
 Offer 3 times
 wait 15-20 minutes in-between
 Contact HCP for recommendation
 Notify Supervisor
 Document
Documenting a Refusal
 Circle
initials
 Medication progress note
Refusal
description
Who was notified
HCP
Supervisor
Medications
What You Need to Know
Medication
Used to treat health problems
 Taken to eliminate or lessen symptoms
 Improves quality of life

Medication

Chemicals that enter the body and change
one or more of the ways the body works
Categories of Medications
 Prescription
 Over
the Counter (OTC)
 Brand name
 Generic name
 Countable substances
 Holistic/Herbal Compounds
Prescription Medications
Written by HCP
 Uses a small
prescription
notepad
 May not
photocopy to use
in place of a HCP
order

OTC Medications
 Must
have HCP order
 Administered, documented and
stored just as prescription meds
 Label requirement options
 Medication occurrence (mistake)
if not given as ordered by HCP
Brand Name Medications
 Made
by a
specific
pharmaceutical
company
Generic Medications



Basically same as
brand name meds
Made by different
companies
Usually less
expensive
Countable Substances

1.
2.
3.
4.
Specific Requirements for:
Storing
Packaging
Tracking
Counting
Holistic/Herbal
Compounds



Very popular
HCP order required
Administered,
documented and
stored just as
prescription meds
Other Substances
Alcohol
Nicotine
Caffeine
Medication Sensitivity



How a person responds to a
med depends on:
age
weight
health
Effects of Medication
Three outcomes:
 Desired or Therapeutic Effect
 No Apparent Desired Effect
 Unwanted Effects
Desired Effect
Examples:
 Tylenol helps a headache
 Dilantin helps reduce seizures
No Apparent Desired Effect
Examples:
 Could be because it may take time
before full effect of med can occur
 Even after enough time passes for med
to work, it does not
Unwanted Effects
Meds can cause effects that are not
intended or wanted. Also known as
side effects.
Examples:
 Allergic reaction
 Anaphylactic reaction
 Paradoxical effect
 Toxicity
Medication Interactions
 Mixing
of Meds in the Body
 May increase or decrease the
effect of another med
Medication Interactions
 The
more meds taken at one time
increases the possibility
 Changes observed could be
caused by a med interaction
Resources for Obtaining
Information about Meds
Prescribing HCP
 Pharmacist
 Package Inserts
 Reputable Online sources
 Medication Reference books

The Cycle of
Responsibility
Basic Responsibilities
Observe
 Report
 Document

Observation
 Objective
Information
(Factual)
Observation
 Subjective
Information
Reporting
Immediate reporting
 Certain time
reporting
 Routine reporting

Reporting
 If
unsure…
REPORT
Forms for Documenting
Info Observed/Reported
Reporting Information to
the Right People
Med Pass Instructions
Melissa
Sullivan
8pm meds
Sept. 3, yr
Med Pass Instructions
Melissa
Sullivan
8am meds
Sept. 4, yr
The Management of
Med Administration
Transcription
Certified staff copy info from
HCP order and pharmacy label
on to med sheet
Documentation






Complete
Accurate
Clear
Ink only
Include date and time
Sign your name
Correcting Documentation



Draw a single line
through mistake
Write the word
“error” and initial
No scribbling,
“marking over”,
erasing or using
“white out”
Medication Sheet
Name:
Dates
Month/Year:
Medication
Start:
Generic:
Brand:
Strength:
Amount:
Stop:
Dose:
Frequency:
Route:
Hour
SPECIAL INSTRUCTIONS/REASON:
Allergies:
1
2
3
4
5
6
Abbreviations
 Is
safer not to use
abbreviations
Abbreviations
DC
 mg
 Cont
 tab
 cap
 mL
 tsp

(discontinue)
(milligram)
(continue)
(tablet)
(capsule)
(milliliter)
(teaspoon)
Frequency
•Number of times per day to be given
•Specific hour chosen
Examples:
HOUR
HOUR
HOUR
8am
8am
8am
12pm
4pm
4pm
4pm
8pm
8pm
Discontinuing an Order
1.
2.
3.
Mark COMPLETELY through all
boxes next to where med was
scheduled to have been given
Mark a diagonal line through left
section of med sheet, write D/C and
date
Mark a diagonal line through grid on
med sheet, write D/C and date
Step 1
Medication Sheet
Month and Year: DECEMBER (year)
Medication or Treatment
Start:
Generic:
12/3/yr Brand:
Clozapine
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Clozaril
8am X X X DS DS
Stop:
Strength: 25mg tabs
Cont.
Amount:
3 tabs
Frequency:TID
Dose: 75mg
4pm X X ES ES
Route: by mouth 10pm X X ES ES
Special Instructions:
Start:
Generic:
Amoxicillin
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
12/3/yr
Brand:
Amoxil
8am X X X DS DS
Stop:
Strength: 250mg caps
12/13/yr Amount:
2 caps
Frequency:QID
Special Instructions:
X X
12n X X DS DS
X X X
4pm X X ES ES
X X X
Route: by mouth 8pm X X ES ES
X X X
Dose: 500mg
Take with meals for 10 days
Step 2
Medication Sheet
Month and Year: DECEMBER (year)
Medication or Treatment
Start:
Generic:
12/3/yr Brand:
Clozapine
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Clozaril
8am X X X DS DS
Stop:
Strength: 25mg tabs
Cont.
Amount:
3 tabs
Frequency:TID
Dose: 75mg
4pm X X ES ES
Route: by mouth 10pm X X ES ES
Special Instructions:
Start:
Generic:
12/3/yr
Brand:
Stop:
Strength:
12/13/yr Amount:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Amoxicillin
D
Amoxil
/
250mg caps
2 caps
Frequency:QID
Special Instructions:
8am X X X DS DS
X X
12n X X DS DS
X X X
4pm X X ES ES
X X X
Route: by mouth 8pm X X ES ES
X X X
Dose: 500mg
Take with meals for 10 days
Step 3
Medication Sheet
Month and Year: DECEMBER (year)
Medication or Treatment
Start:
Generic:
12/3/yr Brand:
Clozapine
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Clozaril
8am X X X DS DS
Stop:
Strength: 25mg tabs
Cont.
Amount:
3 tabs
Frequency:TID
Dose: 75mg
4pm X X ES ES
Route: by mouth 10pm X X ES ES
Special Instructions:
D
Amoxil
/
Start:
Generic:
12/3/yr
Brand:
Stop:
Strength: 250mg caps
12/13/yr Amount:
Amoxicillin
2 caps
Frequency:QID
Special Instructions:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
8am X X X DS DS
X X
12n X X DS DS
X X X
4pm X X ES ES
X X X
Route: by mouth 8pm X X ES ES
X X X
Dose: 500mg
Take with meals for 10 days
Transcription Workbook
Dose
Found in HCP order, usually in “mg”
Health Care Provider Order
Chip Brown
No Known Allergies
Zantac 150mg twice a day by mouth
Signature:
Dr. Jones
Date: 6/11/yr
The dose is: ___ mg
Strength and Amount
Found on pharmacy label
Rx# 135
ABC Pharmacy
20 Main Street
Any Town, MA 09111
555-555-1212
Chip Brown
Ranitidine HCL 75mg
I.C. Zantac
Take two tablets by mouth twice a day
6/11/yr
Lot#323-5
Refills: 3
ED: 6/11/yr
Qty: 120
Dr. Jones
The strength per tablet is: ___ mg
The amount of tabs to give: ___ tabs
PRACTICE SKILLS-TRANSCRIPTION
INSTRUCTIONS
You have taken Chip Brown to the doctor and have
received medication from the pharmacy. Pretend that
the date is June 11, year. It is 1 pm.
Use the health care provider’s order, pharmacy label
and generic equivalents to discontinue the order and
transcribe the new order on to the Medication Sheet.
Please Note: Do not place your initials in the
medication box. You are not administering a
medication at this time. This is transcription only.
HEALTH CARE PROVIDER ORDER
S
T
A
F
F
Name: Chip Brown
Date: 6/11/yr
Health Care Provider: Dr. Jones
Allergies: no known allergies
Reason for Visit: Chip states he has a burning feeling in his throat during the day.
Current Medications:
Pantoprozole 40mg by mouth every evening
Staff Signature:
Date: 6/11/yr
John Smith, Program Manager
Health Care Provider Findings:
Medication/Treatment Orders:
D
O
C
T
O
R
D/C Pantoprozole
Zantac 150mg twice a day by mouth
(dose)
(frequency)
(route)
Instructions:
Follow-up visit:
Signature: Dr.
Lab work or Tests:
Jones
Date: 6/11/yr
Pharmacy Label
Rx#135
ABC Pharmacy
20 Main Street
Any Town, MA 09111
555-555-1212
6/11/yr
Chip Brown
Ranitidine HCL 75mg (strength)
I.C. Zantac
Qty. 120
Take two tablets by mouth twice a day
(amount)
Lot# 323-5
ED: 6/11/yr
Dr. Jones
Refills: 3
Generic Equivalents
Brand Name
Generic Equivalent
Zantac
Ranitidine HCL
Loram
Loramine
Loxaprill
Loxaprilline
Tylenol
Acetaminophen
Amoxil
Amoxicillin
EES
Erythromycin
Depakote
Divalproex
Haldol
Haloperidol
Tegretol
Carbamazepine
Pen VK
Penicillin
MEDICATION INFORMATION SHEET: SAMPLE ONLY
Zantac is a stomach acid reducing medication used to treat and prevent ulcers, to treat GERD (gastro esophageal reflux
disorder) and excessive acid secretion conditions.
How to take: Take orally, with or after meals. If you are taking antacids, separate the dose of Zantac and the antacid by 30
minutes.
What to do if you miss a dose: Take the dose as soon as you remember except if it is close to the time for the next dose.
Never double the dose.
Side effects: Nausea, diarrhea, headache until the body adjusts. Call HCP if you have unusual bleeding or bruising, chest
pain, rash, weakness, trouble sleeping, mental changes or any other change.
Interactions: Tell your HCP about all the medications you are taking, especially triazolam, itraconazole or Ketocanozole.
Special precautions: Tell your HCP about any medical problems you have especially heartburn with lightheadedness, sweating
or dizziness.
Overdose reaction: Symptoms of overdose may include dizziness, fatigue, weakness, tremors, and an increase in heart
rate or trouble breathing. If an overdose is suspected, call your local poison control center or emergency room. US residents
can call the national poison control hotline at 1-800-222-1222.
Medication Administration Sheet
Month and Year: June (year)
Medication or Treatment
Start:
Generic:
Pantoprozole
2/7/yr
Brand:
Protonix
Stop:
Strength: 40mg
Cont.
Amount:
1 tab
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Dose: 40mg
Frequency: every eve Route: mouth
8pm KB KB KB KB ST ST KB KB KB KB
Special Instructions:
Start:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Generic:
Brand:
Stop:
Strength:
Amount:
Dose:
Frequency:
Route:
Special Instructions:
Medication Administration Sheet
Month and Year: June (year)
Medication or Treatment
Start:
Generic:
Pantoprozole
2/7/yr
Brand:
Protonix
Stop:
Strength: 40mg
Cont.
Amount:
1 tab
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Dose: 40mg
Frequency: every eve Route: mouth
8pm KB KB KB KB ST ST KB KB KB KB
Special Instructions:
Start:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Generic:
Brand:
Stop:
Strength:
Amount:
Dose:
Frequency:
Route:
Special Instructions:
Medication Administration Sheet
Month and Year: June (year)
Medication or Treatment
Start:
Generic:
Pantoprozole
2/7/yr
Brand:
Protonix
Stop:
Strength: 40mg
Cont.
Amount:
1 tab
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Dose: 40mg
Frequency: every eve Route: mouth
8pm KB KB KB KB ST ST KB KB KB KB
Special Instructions:
Start:
Generic: Ranitidine HCL
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
6/11/yr
Brand: Zantac
8am
Stop:
Strength: 75mg
Dose: 150mg
Cont.
Amount: 2 tabs
Route: mouth
Frequency: twice a day
Special Instructions:
8pm
“Post” HCP Order
Completed for new orders after
transcribing
 Agency may choose certain ink color
 Written on order sheet
 Write:  “posted”
 signature
 date
 time

HEALTH CARE PROVIDER ORDER
Name: Chip Brown
Date: 6/11/yr
Health Care Provider: Dr. Jones
Allergies: no known allergies
Reason for Visit: Chip states he has a burning feeling in his throat during the day.
Current Medications:
Pantoprozole 40mg by mouth every evening
Staff Signature:
Date: 6/11/yr
John Smith, Program Manager
Health Care Provider Findings:
Medication/Treatment Orders:
D/C Pantoprozole
Zantac 150mg twice a day by mouth
Instructions:
Follow-up visit:
Signature:
Dr. Jones
Posted John Smith 6/11/yr 1pm
Lab work or Tests:
Date: 6/11/yr
PRACTICE SKILLS-TRANSCRIPTION
INSTRUCTIONS
You have taken Chip Brown to the doctor and have
received medication from the pharmacy. Pretend that
the date is June 20, year. It is 1 pm.
Use the health care provider’s order, pharmacy label
and generic equivalents to discontinue the order and
transcribe the new order on to the Medication Sheet.
Please Note: Do not place your initials in the
medication box. You are not administering a
medication at this time. This is transcription only.
HEALTH CARE PROVIDER ORDER
Name: Chip Brown
Date: 6/20yr
Health Care Provider: Dr. Jones
Allergies: no known allergies
Reason for Visit: complaint of pressure on forehead, mild fever, dizziness, increase in
head slapping behavior
Current Medications:
Synthroid 0.125mg by mouth once a day in the morning
Staff Signature:
Paula Jones, Program Manager
Date: 6/20/yr
Health Care Provider Findings: sinus infection, elevated blood pressure
Medication/Treatment Orders:
D/C Synthroid
Armour Thyroid 30mg by mouth once a day in the morning on an empty stomach
Inderal 20mg by mouth once a day in the morning
Amoxil 500mg by mouth three times a day for 10 days
dose
Instructions:
Follow-up visit: 2 weeks
Lab work or Tests:
Signature: Dr. Susan Smith
Date: 6/20/yr
Rx#139
ABC Pharmacy
20 Main Street
Any Town, MA 09111
555-555-1212
6/20/yr
Chip Brown
Armour Thyroid 30mg
Qty. 30
Take one tablet daily in the morning on an empty stomach
by mouth
Dr. Smith
strength
Lot# 659
ED: 6/20/yr
Rx#285-97226
ABC Pharmacy
20 Main Street
Any Town, MA 09111
Refills: 3
555-555-1212
6/20/yr
Chip Brown
Propanolol 10mg
I.C. Inderal
Qty. 60
Take two tablets daily in the morning by mouth
Dr. Smith
Lot# 323-334
ED: 6/20/yr
Rx#285-97227
ABC Pharmacy
20 Main Street
Any Town, MA 09111
Refills: 3
555-555-1212
Chip Brown
Amoxicillin 500mg
I.C. Amoxil
6/20/yr
Qty. 30
Take 1 tablet three times a day for ten days by mouth
Dr. Smith
Lot# 323-335
ED: 6/20/yr
Refills: 0
Answer
Answer
Answer
Answer
Answer
Answer
Answer
Transcription of HCP Orders
Strength (supplied by pharmacy)
Amount (#tabs, caps, teaspoons,etc.)
Dose
(mg doctor wants person to
receive each time med given)
Strength X Amount = Dose
New Orders
 If
the medication has not changed
but the dose, frequency, or route
(or symptoms if PRN) is changed,
it is considered a NEW order
 D/C old order
 Transcribe new order
“Post” HCP Order
Completed for new orders after
transcribing
 Agency chooses ink color
 Written on order sheet
 Write:  “posted”
 sign your name
 date
 time

“Verify” HCP Order
Second certified staff double-checks
 Agency chooses ink color
 Write:  “Verified”
 sign your name
 date
 time
 OK to give meds if not verified yet

Telephone Orders



Check your agency
policy
Remind HCP to call
pharmacy
Must be signed by
HCP within 72 hrs.
Fax Orders
 Legal
 Signed
by HCP
 Preferred
Liquid Med Review
HCP: 100mg
 Label: 50mg per 4mL

4 mL
3 mL
2 mL
1 mL
= 50mg
Liquid Med Exercises
1.
2.
3.
4.
5.
6.
7.
Dose
Strength
Amount
150mg
100mg
100mg
150mg
200mg
150mg
100mg
75mg/10mL
50mg/6mL
50mg/2mL
75mg/4mL
100mg/5mL
50mg/3mL
25mg/2mL
____
____
____
____
____
____
____
The Cycle of
Responsibility
Continues
Visiting the Health Care
Provider
 Advocacy
 Respect
and
dignity
 Ask questions
Encourage Participation
Redirect HCP’s questions to the person
 Encourage person to give own
description first. Then explain any
additional symptoms and changes

Communicating with the Pharmacist




Prescription can be
given to person to bring
to pharmacy
HCP can send directly
by fax or electronically
HCP can call
prescription into
pharmacy
Staff can bring
prescription to
pharmacy to be filled
Pharmacy Label
Rx#284-9726
Rose Garden Pharmacy
20 Main Street
Any Town, MA 01969
Freddy Connors
781-555-1231
1/1/yr
Amoxicillin 250mg
IC: Amoxil 250mg
Qty.-20
Take one tablet twice a day for ten days by mouth.
Drink lots of water when taking.
Dr. T. Smith
Lot#323-3333 Exp. Date: 1/1/yr
Refills: 0
Ensure Pharmacy Provided Right
Medication
Compare HCP order with label
 If familiar with med, open and look at
 If not, look up or ask

Med Pass Instructions
Vi
Lee
8pm med
Sept. 3, yr
Med Pass Instructions
Vi
Lee
8am med
Sept. 4, yr
Med Pass Instructions
Vi
Lee
4pm med
Sept. 4, yr
Countable Substances
Countable prescription
medications require extra:
counting
tracking
documenting
special packaging
double-locked storage
Countable Substances

Higher incidence of abuse
Count requirement:

Each time staff changes, 2 certified staff
count together
Documentation requiring 2 signatures:
1.
2.
3.
4.
5.
When beginning a new count sheet page
Adding a refill onto count sheet
Page transfer (bottom of old page/top of new)
Refusal
Disposal
Sample Index Page
Name
Sarah
Brown
Mike
Stone
Joseph
Smith
William
Mitchell
Joseph
Smith
Medication Name
and Strength
Page Number
Phenobarbital 100mg
1
4
Ativan 1mg
2
5
Ativan 0.5mg
3
6
Percocet 5-325mg
8
Ativan 0.5mg
11
Karen Mason
7
9
Signature of person
responsible for
removing medication
from count
10
See below KM
Sample Count Sheet
Name:
Doctor:
Pharmacy:
Medication
& Strength:
Directions:
Page 11
q Original Entry
x Transfer from
frompage
page210
Prescription Number: D388857
Prescription Date: 11/22/yr
Ativan 0.5mg
Prescription Number:
Take 1 tab by mouth every morning Prescription Date:
Take 2 tabs by mouth at bedtime
Joseph Smith
Paula Whiten
Cornerstone
Date
Time
Amount
on Hand
Amount
Used
Amount
Left
12/19/yr
Signature
8:00 AM
9
Transfer
9
K aren Mas on/Lisa
12/19/yr
8:00 AM
9
One
8
K aren Mas on
12/19/yr
8:00 PM
8
Two
6
Lisa Long
12/20/yr
8:00 AM
6
One
5
K aren Mas on
12/20/yr
11:00 AM
5
received 60
65
K aren Mas on/Reggie
12/20/yr
8:00 PM
65
two
63
Lisa Long
Long
Newton
Sample Shift Count Sheet
Date
3/2/yr
Time
8:15am
Count Correct
Yes
Staff coming on duty
K aren Mason
Staff Going off duty
Sarah Torrney
3/2/yr
4pm
Yes
Lisa Long
K aren Mason
3/2/yr
11pm
Yes
Sarah Tourney
Lisa Long
3/3/yr
3/3/yr
3/3/yr
8am
4:30pm
11pm
Yes
Yes
Yes
K aren Mason
Sarah Tourney
K aren Mason
3/4/yr
3/4/yr
8am
4pm
3/4/yr
3/5/yr
Lisa Long
Sarah Tourney
Lisa Long
Yes
Yes
K aren Mason
Sarah Tourney
K aren Mason
11pm
8:15am
Yes
Yes
Sarah Tourney
K aren Mason
Sarah Tourney
3/5/yr
3/5/yr
4pm
10:30pm
Yes
Yes
Lisa Long
K aren Mason
Sarah Tourney
Lisa Long
3/6/yr
3/6/yr
7am
2pm
Yes
Yes
K aren Mason
Sing le Person Count
Sarah Tourney
K aren Mason
3/6/yr
3/6/yr
4pm
11pm
Yes
Yes
Lisa Long
Single Person Count
Lisa Long
Lisa Long
Sarah Tourney
Lisa Long
Non Suspicious Count
Discrepancy




Count is off
Can be easily
resolved by
checking addition,
subtraction
Report
Document in
count book
Count Discrepancy
Count is off
 Suspicion of
tampering, theft,
unauthorized use
of drugs
 Report to DPH

Medication Storage
Storage of Medications
Locked/double locked
 Labeled storage containers per
person
 Separate oral meds from other routes
 Must remain in original packaging
 Rules for refrigerated medications
 Restricted access (medication keys)

Medication Disposal




Two certified staff,
one must be a
supervisor
Proper disposal of
medication
Document
Do NOT return
medications to the
pharmacy
DPH Disposal Form
Leave of Absence (LOA)

1.
2.
Meds must be prepared by the
pharmacy if the:
LOA is planned/scheduled
Person will be away from their
residence for more than 72 hours
Leave of Absence (LOA)
If pharmacy cannot
 Certified staff may
only package meds
for an unplanned
absence of less than
72 hours

Day Program Medication
Staff at the home responsible to:
 Photocopy HCP order for day program
 Provide a pharmacy labeled container
of meds
 Remember to contact and fax HCP
order if med is DC’d
Medication Errors
 One
of the five rights went wrong
Medication Occurrence (Error)
 Wrong
Individual
 Wrong Medication
 Wrong Dose
 Wrong Time (includes omission)
 Wrong Route
Medication Errors
An opportunity to
improve
procedures that
put people at risk
 Focus on the
cause rather than
who made the
mistake

Medication Error
Reporting
 Self
reporting
system
Medication Errors
 Safety
of the person is the
primary concern
What To Do
 Check
to see if
individual is
okay
What To Do
 Know
Emergency
Procedures
What To Do
IMMEDIATELY
contact MAP
Consultant
 Follow
recommendation
and document

Medical Intervention
 Lab
work, medical tests,
physician visit, clinic visit,
emergency room visit,
hospitalization or other medical
care provided
HOTLINE Medication
Occurrence
 If
medical intervention,
illness, injury or death
follows an occurrence fax
MOR to DPH within 24 hours
What To Do
Notify
your
supervisor
Department of Public Health
Medication Administration Program
MEDICATION OCCURRENCE REPORT (side one)
HOTLINE
Agency Name
Date of Occurrence
Individual’s Name
Time of Occurrence
Site Address (street)
Site Telephone No.
City/Town
DPH Registration No.
Zip Code
A)
Type Of Occurrence (As per regulation, contact MAP Consultant)
1
Wrong Individual
2
Wrong Medication (includes medication given without an order)
3
Wrong Time (includes a ‘forgotten’ dose)
B)
Medications(s) Involved
Medication Name
Dosage
As Ordered:
4
5
Wrong Dose
Wrong Route
Frequency/Time
Route
As Given:
For Hotlines
ONLY, this
DPH form is
required in
addition to
HCSIS data
entry.
As Ordered:
As Given:
As Ordered:
As Given:
C)
MAP Consultant Contacted (Check all that apply)
Type
Name
Registered Nurse
Date Contacted
Time Contacted
Registered Pharmacist
Licensed Practitioner
D)
Hotline Events
Did any of the events below follow the occurrence?
Yes
No
If yes, check all that apply below, and within 24 hours of discovery fax this form to DPH (617) 524-8062 or call to notify DPH at
(617) 983-6782 and notify your DDS/DMH MAP Coordinator.
For All Occurrences, forward reports to your DMH/DDS MAP Coordinator within 7 days.
Medical Intervention (see Section E below)
Illness
Injury
Death
E)
MAP Consultant’s Recommended Action
Medical Intervention
Yes
No If Yes, Check all that apply.
Health Care Provider Visit
Lab Work or Other Tests
Clinic Visit
Emergency Room Visit
Hospitalization
Other: Please describe
F)
Supervisory Review/Follow-up
Contributing Factors: Check all that apply. If none apply, check none (7)
1
Failure to Properly Document Administration
4
2
Medication not Available (Explain Below)
5
3
Medication Administered by Non-Certified Staff
6
(includes instances of expired or revoked Certification)
7
Medication Had Been Discontinued
Improperly Labeled by Pharmacy
Failure to Accurately Record and/or
Transcribe an Order
None
Narrative: (If additional space is required, continue in box F-1)
Print Name
Print Title
Contact phone
number
E-mail
address
Date
Medication Occurrence
Report (MOR) Form/Data
Entry