Administering Medicationsrcgnc.com/WellnesLibrary/Managing Medications/Administering Med… · 5...

AdministeringMedicationsIn Home Support

First Edition

The Elizabeth M. Boggs Center on Developmental Disabilities

University of Medicine & Dentistry of New Jersey • Robert Wood Johnson Medical School 2002 2

ADMINISTERING MEDICATIONS - A GUIDE FOR IN HOME SUPPORTS

AcknowledgmentsThis guide was developed from a much more extensive training module, Administering Medications, whichis used in preservice training for all residential staff working with people with developmental disabilities. Ithas been developed and produced with financial support of the New Jersey Division of DevelopmentalDisabilities. Its goal is to provide some basic information on medications for respite care workers, personalassistants, and others who work directly for people with developmental disabilities and their families.

This guide cannot be substituted for The Boggs Center and Division of Developmental Disabilitiespreservice Medication Training. Review of the material in the guide will not satisfy New Jersey Office ofLicensing and Inspections requirements for certification. Families and consumers who want their personalassistants or direct support workers to get more extensive medication training should contact a localprovider agency.

Thanks to the following for their work on this Guide:

Bill GaventaTraining Network Coordinator

Robyn RisleyCoordinator of Communications

Mimi LencovichEpilepsy Foundation of New Jersey

Donna TothLead Trainer, Arc of Bergen/Passaic

335 George Street • P.O. Box 2688 • New Brunswick, New Jersey 08903-2688Voice (732) 235-9300 • TDD (732) 235-9328 • Fax (732) 235-9330

.Copyright 2002 The Elizabeth M. Boggs Center on Developmental Disabilities. All rights reserved.




Table of ContentsADMINISTERING MEDICATIONS -

A GUIDE FOR IN HOME SUPPORTS

Chapters1 Medications and Related Issues ................................................. 5

2 Categories and Effects of Medications ..................................... 15

3 Observing and Reporting .......................................................... 23

4 Documentation .......................................................................... 31

5 Administering Medications ........................................................ 43

This guide and manual for use by in home personal assistants and respite workerswas adapted from The Boggs Center training manual used by agencies for directsupport staff in group home and other residential settings. This guide cannot besubstituted for The Boggs Center Preservice Medication Training. Review of thiswill not satisfy the New Jersey Office of Licensing requirements for MedicationCertification and therefore no certificate will be awarded.

Families, respite workers, and personal assistants who want more extensivetraining can contact coordinating agencies to participate in the agency basedtraining on medication administration.

The suggestions and guidelines in this manual should be checked by bothfamilies and in home support workers to make sure they conform to thespecific directions and instruction developed by families for use in theirown homes.

Families may wish to attach specific instructions on medications and medicalemergencies to this manual, and/or highlight particular sections which apply totheir son, daughter, or relative.

In home workers must also check with their coordinating agency for any specificrequirements and reporting procedures.

Any suggestions for changes in this guide should be sent to:

The Boggs Center on Developmental DisabilitiesUMDNJP.O. Box 2688New Brunswick, NJ 08903




Chapter 1MEDICATIONS

ANDRELATED ISSUES

Objectives

This guide will help direct support workers do the following:

1. understand why specific procedures for administering medications are necessary;

2. understand the use of medication to alter behavior;

3. view medication administration as an opportunity for learning.

Introduction

Among the many duties of a provider of direct support, the administration of medications requires specificunderstanding of the need for attention to detail for the safety of the individual. It is most important that staffapply themselves diligently in acquiring a basic knowledge of medications, their use or abuse, correctdosage, methods of administration, signs of overdosage, and adverse reactions which may arise in thetreatment of various conditions.

The attitude of the staff towards the use of medications is an important factor. Ideally, the body functionsbest when given adequate food, rest, relaxation, and freedom from undue emotional stress. However,because of challenges of a physical or emotional nature, it is necessary at times to utilize medications toproduce a more stable condition.

The staff person who combines diligent and intelligent observation with moral integrity and plain commonsense in their administration of medications will make lasting contributions.




Why Have a Medication Guide?Almost all adults in our society are familiar with doctors and pharmacists, and have used a variety ofmedications. However, there are some important reasons for the training offered in this module:

1. Many of the individuals you teach will need prescribed medications which you may not be familiarwith and which are potentially dangerous.

2. A service system can not always use typical, everyday procedures. For example, most parentsadminister medications without using formal rules and regulations. However, when a program, such asthe one you work in, assumes responsibility for the support and protection of the individuals theyserve, it is required by law to make special efforts to protect their safety. Serious medication errors areoften made even in relatively uncomplicated family settings. Given the complexity of services (manydifferent staff, people with developmental disabilities, and staff turnover, etc.), you can see that asystematic set of rules and regulations is necessary to ensure that appropriate procedures are carriedout on a consistent basis. You need to be thoroughly familiar with those rules and procedures.

3. In addition to protecting the health and well-being of the people you teach, your knowledge ofappropriate medication procedures will serve to protect you and your agency from errors which couldhave serious legal consequences.

The Medication Cycle

Safe AdministrationAs you see in the diagram, safe medication administration can be looked at as a cycle which proceeds fromobservation, to reporting changes, to administering and documenting, and back to observing.




Medications Must be Used CorrectlyAspirin, penicillin, vitamins, phenobarbital, dilantin . . . when used cautiously and correctly, these chemicals,or medications, can have a number of desirable effects. When used incorrectly or carelessly, these samechemicals can result in many undesirable and potentially dangerous effects.

You Will Have Several RolesAs an individual’s support worker, you may be required to help him/her use necessary medications safely.Depending on your specific job, you will function in some or all of the following ways:

• observe individuals with developmental disabilities for changes in physical symptoms and/orbehavioral signs.

• report any changes to the right person at the right time by the right means.

• record medication information on appropriate forms

• actually supervise the administration of medications.

Consumer involvement and participation are important, no matter how much support is required.

All Functions Are NecessaryIt is important to understand that safe medication administration involves all of these job functions, and thatit is much more than simply handing out medications.

• Individuals with developmental disabilities usually first go to a doctor because someone has reported achange in physical symptoms or behavioral signs. An individual with developmental disabilities maynot receive needed medical attention unless you conscientiously observe him or her and report anysignificant changes.

• Reporting must be both in written and verbal form according to agency and family policy.

• A person with developmental disabilities may receive the wrong amount of a medication or the wrongmedication unless you administer the medication correctly.

• A person with developmental disabilities may suffer a fatal or other undesirable medication effect . . .unless you observe and report significant physical symptoms or behavioral changes to the right personat the right time by the right means.




Why are Medications Prescribed?It is clear that medications can be used to treat a variety of physical problems. However, medication usage isnot limited to the prevention or treatment of physical illness. Medications are used by so many people in somany different ways that it seems we live in a drug-oriented society.

The use of medications as a treatment procedure to influence behavior problems has increased dramaticallyin the last 20 to 30 years. For example, pharmaceutical advertisements in magazines oriented toward humanservice professionals often represent certain behavior-controlling medications as easy solutions for a widerange of problems.

• Depressed? Take a mood enhancer.

• Manic? Take a depressant.

• Aggressive? Take a tranquilizer.

Medications are Not Complete SolutionsUndeniably, behavior-controlling medications can be used appropriately and effectively in specificcircumstances. For example, lithium seems to effectively control “manic-depressive” cycles in some people;amphetamines can reduce hyperactivity, etc. However, most of the time medications do not serve as long-term, complete solutions to behavior problems. Look at the following example:

Betty Mixon has just started work at a sheltered workshop. The table she works at was adapted to fitboth Betty and her wheelchair, and for the first couple of weeks she has a good work record. Recentlyshe has seemed to become much more irritable. She gets upset if she is criticized in any way, and if shemakes a mistake, she yells and throws things. The staff have no idea why she has shown such adramatic change in behavior. They have decided to meet and discuss what to do.

Would some type of medication be appropriate in this situation? Based on our limited information, weobviously can’t decide, but there are a few considerations we can address.




Consideration 1 — Are Medications a First Choice?Look for Other Answers FirstAre medications a first choice? Almost never. It would be much more appropriate for staff to look at Betty’sphysical health, work environment, changes in her life or major relationships for possible cause(s) for thebehavior changes. Have they given her work assignments that she cannot complete and which frustrate her?Have they inadvertently paid too much attention to her (reinforced her) when she acts agitated? Anenvironmental change which can be designed to change a specific behavior would almost always bepreferable to the use of a medication. A medication:

• may also affect behaviors other than the one intended.

• requires a more complicated procedure involving doctors, nurses, etc.

• has the potential of reinforcing an image of the individual as sick or diseased.

Conclusion —

• Medication intervention is not usually a “first choice” solution.

Consideration 2 — Are Medications a PermanentSolution?Effects are Not PermanentAre medications a permanent solution? Not always. Medications can be effective in controlling orinfluencing a problem behavior only as they are taken. Unlike medications such as antibiotics, which mayactually eliminate the cause of the problem (kill germs or eliminate the infection), behavior-controllingmedications only temporarily control behavior. Even if a tranquilizer might decrease Betty Mixon’saggressive behavior, we should not be surprised to see the aggressive behavior increase after the medicationis removed.

Conclusion —

• Medication intervention is not a “permanent” solution.




Consideration 3 — Are Medications a “Complete”Solution?Medication Alone is Not EnoughAre medications a “complete” solution? Again, not always. A medication might be prescribed in an attemptto decrease Betty’s irritability and aggressive behavior. Even if the medication were effective, it would notserve as a complete solution to the problem. Betty must also learn appropriate and effective ways of dealingwith criticism and failure. Betty should also be taught how to advocate for herself. Is her job boring? Is shebeing treated poorly by the staff or by her coworkers? The most we can expect of the medication is that itmight decrease the behavior; however, we cannot expect appropriate adaptive behaviors to “automatically”appear.

Conclusion —

• A “complete” solution to most problem behaviors involves a number of strategies. First, listen carefully,and explore the reasons and contexts in which that behavior is occuring, and what someone may betrying to communicate through that behavior. Second, the environment may need to change in waysthat give more positive supports to the individual and teach the individual to learn new, more adaptivepatterns of behavior.

What is the Staff’s Role?About now you may be asking “What does all this have to do with the staff? We don’t prescribemedications.”

Be Objective: Your Information is EssentialIt's true that only medical doctors can prescribe medications. However, doctors' decisions about prescribingbehavior-controlling medications are often based, to an extent, on information provided by staff. Becauseyou are in close contact and must deal with the problem behavior on a frequent basis, your observations anddescriptions of that behavior are important.

Remember Who It’s ForYou have already learned that to bring about behavior change, medications are not a first choice, nor arethey a complete and permanent solution to the problem. There are times, however, when medicationsappear to be an “easy” solution to a difficult problem. For example, suppose a medication is prescribed forBetty Mixon in an effort to decrease her angry outbursts. It succeeds in doing that, but the medication alsoseems to generally suppress her activity level, leaving her somewhat lethargic. The medication has veryeffectively solved the problem that the staff were experiencing in trying to handle her outbursts. Betty,however, is worse off than she was before.




Teaching IndependenceThe medication process or cycle can and should be used as a learning opportunity. Learning experiencesthat can be linked to the medication process will increase skills in all other areas of life (e.g. learning time,colors, counting, etc.). Involvement and participation are important, no matter how much support isrequired. Obviously, individuals will differ greatly in their ability to participate — but even persons with themost severe disabilities should be involved in some way.

Self-Medication — Teaching Independence1. All individuals should be given the opportunity to learn to be self medicating (e.g., type, time, amount,

purpose) and to become more knowledgeable about their own medication.

2. Some individuals can learn to become self-medicating. This must be identified in the IHP as a goal(e.g., pouring, initialing) before the individual can administer their own medication.

3. Families usually have their own procedures for individuals who are learning to be self-medicating. Thefollowing is a list of topics that could be included.

4. When individuals are learning to self-medicate, your role may change in the medication process. Youare still responsible to make sure all procedures are followed properly.

5. If an individual is capable of taking medication without assistance, no daily medication administrationsheet/record is required.




Summary

Whenever you create opportunities for people to become involved in taking care of their own daily needs,you support their sense of having some control over their environment, rather than merely being a passivepart of it.

You should understand:

• the medication cycle.

• the responsibility associated with its operation.

• how medications may be used to alter behavior.

• how important it is to integrate learning opportunities with the administering of medications asdirected by the family.




Chapter 1APPENDIX

This page is provided so individuals and families may add specific instructions or information.

Additional Information About

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Chapter 2CATEGORIES

ANDEFFECTS OF MEDICATION

Objectives

The support staff member will be able to . . .

2. describe medication responsibilities and be able to report its effects;

a. describe the difference between controlled and noncontrolled medications;

b. name the person(s) responsible for reporting possible effects of medication;

c. describe the three primary effects of medication; and

d. list the three possible medication interactions.

Categories of MedicationsFor purposes of administration, medications, which are sometimes referred to simply as “drugs” can bedivided into two main categories:

1. Prescription medicationsThis category includes all medications which must be prescribed by a physician and dispensed by apharmacist.

Prescription medications can be broken down into two subcategories:

a. Controlled medications

Controlled medications are medications which have been legally designated “controlledsubstances.” The medications in this category are considered (by medication control agencies) tohave a high potential for abuse. Examples might include narcotics, such as morphine or certainmedications prescribed for sleep.




b. Noncontrolled medications

Noncontrolled medications include all prescription medications which do not appear on the listof controlled substances.

This does not mean that all medications not on the controlled substances schedules have beentested and determined free from potential for abuse. They should be used with caution accordingto instructions from the prescribing physician.

2. Nonprescription, or Over-the-Counter (OTC), MedicationsOTC medications include any medication that can be purchased without a prescription. Common OTCmedications include pain relievers such as aspirin and certain cold remedies.

Effects of MedicationMedication may be prescribed for a number of reasons. Some of the most common reasons are to prevent anillness, eliminate an illness, or reduce the symptoms related to a physical or psychological condition. Inprograms such as the one you work in, medication can also be prescribed to alter a person’s behavior.Examples of medication being used for each of these reasons are:

• polio and tetanus vaccines for preventing illness

• antibiotics, such as penicillin, for eliminating illness

• cold suppressants or aspirin for reducing symptoms of an illness

• mood elevators and tranquilizers for altering behavior

The Staff are Responsible for Reporting Any ChangesThe most important thing to remember is that any change (physical or behavioral), especially during thefirst few days when a new medication is introduced, may have been caused by that medication. As a supportworker, you are able to observe for any behavioral or physical changes. In fact, it is up to you to observeand report any and all suspected effects of medications immediately.

The human body does not always function perfectly. Most of us at one time or another will use some type ofmedication. Medications, when properly prescribed and administered, can have several outcomes. The threeprimary outcomes are: desired effect, no effect, unwanted effect.

Whenever a physician prescribes a medication he or she must weigh the potential benefits of the desiredeffect and the potential dangers. Only physicians may prescribe medications; only registered pharmacistsmay dispense medications. Everyone should follow their instructions for administering medication properly.

1. Desired EffectWhen the prescribed medication is working correctly, we say that the medication is producing the desiredeffect. The desired effect is the beneficial effect of the medication. It is what we want the medication toaccomplish. Reducing seizure activity with Dilantin, eliminating a headache with aspirin, and preventingpolio with Sabin oral vaccine are all examples of desired effect.




2. No EffectDifferent medications require different amounts of time before their full benefit is expected. However, dueto the specific body chemistry of some individuals, there is sometimes no effect at all from taking themedication. The term “no effect” means an absence of any effect. After allowing sufficient time for themedication to be fully effective, there has been no change.

For example, aspirin may be prescribed to be administered every four hours for a fever. After 24 hours, thefever has remained unchanged. Since there was a reason for prescribing a medication in the first place, it isimportant for the physician to know if there is no effect. The physician may then prescribe an alternatemedication with the same potential desired effect, or change the dosage of the present medication.

3. Unwanted EffectMany medical professionals and medication reference books refer to unwanted effects as side effects. Othersdistinguish between side effects and adverse effects. For the purpose of this instruction, we have labeled allof these possibilities as unwanted effects.

Whether or not the desired effect occurs, there is always the possibility that unwanted effects will also occur.Unwanted effects are the effects produced by the medication other than the desired ones. They may beexpected and predictable (such as drowsiness when taking phenobarbital) or completely unexpected andunpredictable. Unwanted effects can be relatively harmless (such as urine discoloration from Dilantin) orpotentially fatal (such as a severe allergic reaction to penicillin).

You must always be aware of possible unwanted effects. They may show up as physical or behavioralchanges. These changes may be readily observable, such as a rash, diarrhea, vomiting, or fainting. Or thechanges may be harder to discern, such as lightheadedness, blurred vision, dryness of the mouth, confusion,irritability, agitation, or lethargy.

Medication InteractionsWhenever one person is taking two or more medications, an effect is possible. Every medication has thepotential to interact with another medication. Medication interactions are the result of taking two or moremedications at the same time.

The resulting interaction may:

• Increase the effects of one or more of the medications. This is called medication potentiation.

• Decrease the effects of one or more of the medications. This is called medication antagonism.

• New and unique unwanted effects.

There are two important points to remember concerning medication interactions.

1. The greater the number of medications taken at one time, the greater the possibility that a medicationinteraction will occur.




2. By being aware of what medications a person is now taking, the physician can prescribe a newmedication that has the best chance of being compatible with current medications.

In addition to medication effects previously described, there are additional terms to be familiar with whendiscussing medication effects.

• Medication Allergy — A response which may be immediate and life threatening or delayed and slowto appear.

• Cumulation— The body does not eliminate one dose of a medication before another dose is given.

• Tolerance — Resistance to the effect of a medication.

• Addictive Effect — The physical or emotional dependence on certain medications.

• Toxicity — When medication levels are dangerous and/or poisonous to the body.

• Medication Elimination — The effects of a medication cease when the medicine has beeneliminated from the body. Medications are eliminated by the lungs, kidneys, intestines, skin, or saliva.However, bear in mind that many medications build up in the body and when the medication isstopped the effects may continue for several days until it is completely eliminated from the body.

In addition to medications interacting, there may also be food interactions. Depending on the medicationsprescribed, some foods may be limited and others suggested. An example would be to avoid foods high inacid when taking antibiotics because antibiotics are destroyed by stomach acid. The reverse of this: increasefoods high in acid when taking urinary antiseptics, as these medications work best when the body has ahigh acid content.




Summary

A. There are three potential outcomes of taking medication:

1. Desired effect

2. No effect

3. Unwanted effect

B. There are three potential interactions:

1. Increase

2. Decrease

3. New and Unique

C. In later lessons, you will learn how to observe and report any physical or behavioral changes in thepeople with whom you work. Your observations may provide the parent/relative with importantinformation concerning the possible effects of medication.




Chapter 2APPENDIX



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Chapter 3OBSERVING

ANDREPORTING

Objectives

The support worker and/or personal assistant will. . .

3. observe changes and make the appropriate reports;

a. list the types of physical symptoms and behavioral changes that require reporting and give anexample for each;

b. state what, when, to whom, and how any changes should be reported;

c. list the three reporting categories;

d. name six conditions that are reported as emergencies and the action to be taken;

e. name some conditions that are reported as a nonemergency health threatening situation and theaction to be taken; and

f. name some conditions that are reported as other changes and the actions to be taken.

When Changes OccurObserving and reporting physical and behavioral changes of individuals is an important responsibility for allstaff. These changes may be dramatic, such as a high fever or a sudden increase in overall activity level.They may be more subtle, such as a minor cut which doesn’t appear to be healing, or a gradual unexpecteddecrease in work production.




Types of Physical SymptomsObjective SymptomsA change which can be clearly seen (e.g., cough, loss of weight, loss of appetite, vomiting, diarrhea, flushingor reddening of skin, rash, etc.). Objective symptoms are easily observed.

Subjective SymptomsA change which is only experienced by the individual (e.g. pain, dizziness, nausea, noises in the ear, spotsbefore the eyes, itching of the skin, tenderness or pain).

In order to acknowledge subjective symptoms, you will have to ask the individual specific questions andobserve their behavior which is inferred through “body language” (e.g. shaking head, gestures, handmovements, facial expressions, body position, expressing interest and disinterest).

It is clear that medications can be used to treat a variety of physical problems. However, there are manyinstances where other methods can be utilized to alleviate a physical symptom.

Exploring some of the possible reasons for a physical change will help in your explanation to the doctorwhen you seek direction.

Behavioral ChangesA change in an individual’s typical behavioral pattern, which is observable (e.g. withdrawal, excessivetalking, irritability or outbursts, changes in eating habits). The use of medications as a treatment procedureto influence behavior problems has increased dramatically in the last 20 years. Prior to the discovery oftranquilizers, behavior problems were treated with sedatives and electric shock therapy. Straightjackets andpadded cells were used for “violent clients”, and last but not least, prefrontal lobotomies were performed.Tranquilizers, a classification of one type of psychotropic medication, are “mind altering” and affectbehavior, emotions, and intellectual processes. Although psychotropics can be useful, they are to be usedwith proper diagnosis and other methods, treatment such as counseling and behavior management.

Report Changes to Parent/RelativePhysical and behavioral changes are often difficult to interpret. There may be many different reasons for thesame symptom. For instance, a runny nose and fever may be the first symptoms of a cold, or they may berelated to a more serious infection. An increase in general activity level may be an unwanted effect of a newmedication, or it may be related to some environmental change.

Thus, it is extremely difficult to accurately interpret physical and behavioral changes. Diagnosis,interpretation, and treatment are the responsibility of trained specialists. Your responsibility is to consistentlyobserve and report any changes to the correct persons, at the correct time, according to your agency’spolicies and procedures and those of the family/individual.

In order to do this, you need to know:

• What to report• When to report it• To Whom it should be reported• How to report it




Report CategoriesThree reporting categories are:

1. Emergency conditions

2. Nonemergency, health-threatening conditions

3. Other changes

1. Emergency ConditionsEmergency conditions may arise from a great number of different causes: injuries, illnesses, andcomplications, including unwanted effects of medication. It is not your responsibility to attempt to diagnosewhat has caused the condition.

It may not always be clear what is and what is not an emergency situation. However, the most commonexamples are the following:

1. Excessive bleeding which you are unable to control.

2. Accidents involving severe injury.

3. Breathing difficulties, such as obstruction/choking, no breathing.

4. Circulatory system difficulties, such as heart attack or no pulse.

5. Loss of consciousness unrelated to predictable seizure activity.

6. Behavior which is a danger to themselves and others and not controllable.

Action!!1. Report immediately to emergency medical services — 911 or local emergency number.

2. Contact family member.

CPR/First Aid Trained Staff Are The Staff In ChargeThere are a variety of tasks that the staff person are responsible for:

1. Call 911 or your local emergency number.

2. Administer aid.

3. Assure that the individual is supervised, reassured and safe.

4. Collect the medical records, e.g. emergency consent form and insurance card, so that the physicianwho will see the person will have all the necessary and current information (e.g. current medications,what was administered that day, etc.).

5. Go to the hospital, making sure to take the medical records with you.




If you are the only staff person present, you will obviously have to deal with the emergency independently.Remember that your primary responsibilities are to call 911, or the local emergency number and to providewhatever assistance you can until help arrives.

After All Emergencies1. As soon as the emergency situation is under control, follow your agency’s procedure for emergency

situations and inform the designated agency staff of what happened.

2. Follow up your call to the designated agency staff with a written report.

3. Each staff member involved should write an independent report of the incident as soon as possibleand make sure that the supervisor gets it as soon as possible.

Special training is required in order to know when a person’s circulatory or respiratory system is failing, ormight be about to fail. Failure of these systems is the major cause of death. The survival rate of personswhose circulatory and/or respiratory systems have failed is very good, IF the call to 911 is madeimmediately, and a trained person gives appropriate aid. Therefore, your agency will schedule you forAmerican Red Cross CPR/First Aid training. It is mandatory and must be successfully completed within 120days of employment.

2. Nonemergency, Health-Threatening ConditionsNonemergency, health-threatening conditions are those physical or behavioral symptoms which lead you tobelieve that the individual’s health or safety is threatened. This definition is very broad. You know thepeople you serve better than almost anyone else; you know what their normal behavior patterns andphysical signs are like; you have to make an interested and caring professional judgement as to when ahealth-threatening condition exists. It is not your responsibility to attempt to diagnose what has caused thecondition.

Common sense is important here. Think of those situations or conditions which would lead you to call theparent, guardian, or relative, but not 911. Some common examples are:

1. A fever which is not reduced by normal procedures, such as aspirin, etc.

2. Diarrhea which is not affected by approved nonprescription relief medicines.

3. A rash which lasts for several days or a rash which appears to be getting worse.

4. A persistent or painful sore throat.

5. An increase in seizure activity.

6. Repeated episodes of angry or aggressive behavior which, while controllable, are not typical of theperson.

7. Unusually withdrawn behavior on the part of a person who ordinarily has frequent interactions withothers.




Action!!Report the change immediately when the condition is observed, both verbally and in written form.Whenever a health-threatening condition arises, follow your agency’s procedure. Report your observationsand reasons why you feel this is a health-threatening situation. Follow up your phone call immediately witha written report of your observations. Continue to observe for any further changes in his or her condition.

Report the change immediately:

1. Verbally, according to your agency policy.

2. Follow the instructions given to you.

3. Follow-up the phone call with a written report of observations and your actions.

4. Continue to observe for further changes.

3. Other ChangesAny physical or behavioral changes other than those already covered are included in this category. Anychanges in an individual’s physical condition or general behavior could be important. Therefore, they mustbe recorded so that later they can be used to make decisions in planning. It is not your responsibility toattempt to diagnose what has caused the condition. Some common examples are the following:

1. Changes in sleeping patterns (especially sleeping too much or too little).

2. Changes in eating habits.

3. Seemingly minor problems such as colds, low fevers, mild diarrhea, etc.

4. Minor cuts and/or bruises.

5. Changes in motor coordination (e.g. tripping, spilling, etc.).

6. Slight rash.

Action!!Report both verbally and in written form as soon as the condition is observed. Continue to observe theperson for any further changes in his or her condition. There are many more examples which could havebeen listed. The important thing to remember is to report anything which could possibly be of significance.




Forms to UseYour agency or family/individual will supply you with the forms to be used in observing and reporting.Some examples of such forms are:

• Incident reports

• Daily training records

• Medication Sheets

• Medication Logs

• Seizure records

• Case notes

• General logs

• Individual logs

• Staff logs

Your conscientious observation and reporting of physical and behavioral changes can help to ensure thehealth and safety of the individuals you serve.

Summary

Sometimes you may not be certain whether a situation is an emergency, or a nonemergency, health-threatening condition. Likewise, the boundary between nonemergency, health-threatening condition and“other” is not always going to be crystal clear. Your best bet is to be on the safe side and report any concernsto your designated agency staff immediately.




Chapter 3APPENDIX



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Chapter 4DOCUMENTATION

Objectives

The staff member will . . .

describe the correct medication documentation and storage procedures;

a. describe what documentation should be maintained;

b. record the information received from the parent and agency;

c. understand the difference between OTC and prescription PRN.

Introduction

Information Needed for Safe AdministrationDocumentation is CriticalOnce you have obtained the necessary medication(s) from the parent/relative, and the directions foradministering them, you must record certain information on appropriate forms. You will be using theinformation received from the parent and agency for performing the critical documentation process. Correctdocumentation is an important part of administering medications safely.




Medication Administration Sheet/RecordEvery prescribed and OTC medication administered to the individual must be documented. Each time themedication is administered, you must document the date, time, dosage, name of the person and by whom itwas administered. A form is used for this purpose and is often labeled Medication Administration Sheet.Your agency may call this form something else, such as Medication Record, Administration Chart, DailyLog, etc. The important thing is that the document allows you to keep a record of each medicationadministration.

You will be provided with actual copies of a Medication Administration Sheet/Record/Log and additionalinstructions for filling them out. This form may differ slightly from the one in your agency, but the basicinformation must be included. Some agencies use pharmacy generated medication records, these will bediscussed later.

Make sure your agency or the parent/relative has provided you with the form they use.

See a sample on the next page.




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PRNSome medications will be prescribed by the physician to be given only on an as-needed basis. Thesemedications are called PRN (pro re nata). PRN medications can be over-the-counter (OTC) such as Tylenol,Robitussin, etc. or prescriptions such as Valium or Xanax.

PRN OTCEach individual will have either a Standing Order Form or a separate OTC prescription. (See Sample.)

This form or prescription is reviewed and/or updated annually by each individual’s parent or guardianor relative.

If an individual exhibits any signs or symptoms of an illness that might require an OTC PRN medication,check his/her standing order form or OTC prescriptions to find which specific medication has beenprescribed.

No substitutions may be made unless indicated from the parent/relative/guardian. If one type of medicationis prescribed for more than one complaint, the medication must be written for each individual PRN (e.g.Tylenol is to be given at 7 am for a headache, it cannot be given at 9 am for a fever if the instructions state“only to be given every 4 hours”).

An OTC medication (e.g. iron tablet, potassium, or calcium) that has been prescribed for a specificsymptom, is considered a prescription and treated as all prescriptions.

PRN PrescriptionIf an individual exhibits any signs or symptoms that might require a PRN prescription medication check his/her medication administration sheet/record to find which specific medication has been prescribed.

Some PRN prescriptions are to be administered only with authorization from physicians, nurses, behaviorspecialists or supervisors. Your agency will train you in these procedures.

StoragePrescription PRN medications can be stored and documented with other prescription medications.

Follow storage directions and procedures as directed by the family member.




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Resource InformationThere are several resources available for obtaining supplemental medication information. These manualscan be used to construct a simple but complete medication information sheet each time a medication isprescribed.

These manuals index medications by generic and brand name and describe important information abouteach medication. If a prescribed medication is not listed, you should call your doctor or pharmacist to obtainthe information.

Following is a sample page from The Pill Book and a description of items of information.

The Pill Book is one of several medication information manuals.

Your agency is required to provide you access to a medication reference book written for the lay person andwhich is current within three years and that includes information on side effects and drug interactions.




Generic Name

Phenytoin

Brand Names

Dilantin (extended)Diphenylan Sodium (prompt)Ditan (prompt)

Type of Drug

Anticonvulsant.

Prescribed for

Control of epileptic seizures.

General Information

Phenytoin is one of several drugs of the samechemical group used to control convulsions. Allthese drugs act by the same mechanism, althoughsome patients may respond to some and notanother.

Cautions and Warnings

If you have been taking Phenytoin for a long timeand no longer need it, the dosage should bereduced gradually over a period of about a week.Stopping abruptly may bring on severe epilepticseizures. Pregnant women who use anticonvulsivemedicine are said to tend to give birth to childrenwith birth defects, but the data available aresomewhat questionable. If you become pregnantand you are taking this medicine, consult yourdoctor immediately.

Possible Side Effects

Most common: slurred speech, mental confusion,nystagmus (a rhythmic, uncontrolled movementof the eyebal ls), dizziness, insomnia,nervousness, uncontrollable twitching, doublevision, tiredness, irritability, depression, tremors,head aches. These side effects will generallydisappear as therapy continues and the dosage isreduced.

Possible Adverse Drug Effects

Nausea, vomiting, diarrhea, constipation, fever,rashes, balding, weight gain, numbness of thehands and feet, chest pains, retention of water,sensitivity to bright lights, especially sunlight,conjunctivitis, changes of the blood systemincluding anemia, swollen glands. Phenytoin cancause an abnormal growth of the gumssurrounding the teeth, so good oral hygieneincluding gum massage, frequent burshing, andappropriate dental care is very important.

Occasionally Phenytoin produces unusual hairgrowth over the body, and liver damage, includinghepatitis.

Drug Interactions

A barbiturate taken with Phenytoin may increasethe rate at which Phenytoin is excreted from thebody; then if the barbiturate is discontinued thepatient may show an increased response toPhenytoin, and the dose may have to be reducedslightly.

Warfarin, Isoniazid, Chloramphenicol,Disulf i ram, Phenylbutazone, andOxyphenbutazone can cause Phenytoin to remainin the body for a longer time, increasing theincidence of Phenytoin side effects. Folic acid orhigh doses of tricyclic antidepressant drugs mayincrease seizures. The dose of Phenyoin mayhave to be adjusted by your doctor.

Usual Dose

Adult: initial dose, 300 milligrams per day. if thisdoes not result in satisfactory control, graduallyincrease to 600 milligrams per day. (The mostfrequent maintenance dose is 300 to 400milligrams per day.) Only Dilantin may be takenonce daily. The other brands of Phenytoin mustbe taken throughout the day, as convenient.

Child: initial dose, 2 1/2 milligrams per pound ofbody weight per day in 2 to 3 equally divideddoses; then adjust according to needs andresponse of child (normal maintenance dose, 2 to4 milligrams per pound of body weight per day).Children over age 6 may require the same doseas an adult, but no child should be given morethan 300 milligrams per day.

Overdosage

Symptoms are listed in "Possible Side Effects"and "Possible Adverse Drug Effects" above. Thepatient should be taken to a hospital emergencyroom immediately. ALWAYS bring the medicinebottle.

Special Information

If you get upset stomach after taking Phenytoin,take the medicine with meals. If you develop arash, sore throat, fever, unusual bleeding, orbruising, contact your doctor immediately.Phenytoin sometimes produces a pink-brown colorin the urine; don't worry about it. Do not changebrands of Phenytoin without notifying your doctor.




Summary

Because many different staff are involved in the medication cycle, it is essential that each staff memberworks with the same information. The various forms your agency might use help organize the collection andrecording of that information so that the medication may be administered in a safe and standardized way.




Chapter 4APPENDIX



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Chapter 5ADMINISTERINGMEDICATIONS

Objectives

The staff member will . . .

6. administer medications properly;

a. list and describe the six rights of medication administration;

b. list the conditions under which medications must not be administered;

c. describe the procedure to follow for administering prescription medications and over-the-counter(OTC) medications.

Introduction

There are six checkpoints to verify every time you administer a medication. These, too, should be conductedwith a concern for normalization. This lesson also covers when not to give medication, what to do if amedication error occurs, and how to dispose of medications.

Normalization Issues for Administering MedicationsOne More ConsiderationAfter the medication information has been recorded on the appropriate forms and stored in the correctplace, you are almost prepared for actual administration of the medication.

Encourage IndependenceHowever, before you actually administer any medication, you should ask yourself: Is the individualfunctioning as independently as possible in the administration process? You should always encourageindividuals to take as much responsibility for their own medication administration as possible — keeping inmind that your primary concern is the proper administration of medications, whether by you orthe individual.




Six R’s of Administration6 RightsEach time you administer a medication, you need to be sure to have the

• right individual

• right medication

• right dosage

• right time

• right route

• right documentation

Check Each Of The RightsEach time a medication is given, you must systematically and conscientiously check your procedure againstthese six rights. You must be certain you are administering the right amount to the right person at the righttime using the right method (route), with the right documentation.

This procedure is essential each time you administer any medication—including those which a person hasbeen taking for a long time and will probably continue to take for a long time. There is always a possibilitythat some change has been ordered that you are unaware of or that you accidentally removed the wrongcontainer. You must check for all six rights each and every time you administer any medication to anyindividual.




Right IndividualIn order to make sure that you have the right person, you have to know the individuals. If you are notcertain “beyond a shadow of a doubt” that you are administering a medication to the right person, STOP!Seek assistance from a family member who is more familiar with them. You must know each individual wellto be able to make this process a learning experience. This should also be done one-on-one.

Right MedicationTo insure that you administer the right medication, there is a specific procedure to follow.

1. Compare the medication administration sheet/record, the pharmacy label and copy of theprescription.

2. Double check them. MAKE SURE THAT THEY MATCH EXACTLY.

3. If they do not match, contact the family, immediately.

4. If they do match, continue to the next step.

Right DosageBe sure you give the right dosage by comparing the medication administration sheet/record, the pharmacylabel and copy of the prescription to make sure they match. Carefully measure or count the correct dosage,AND compare this amount with the pharmacy label.

Right TimeWhen a physician prescribes a medication, he or she will specify how often the medication is to be taken.

Some medications must be administered only at very specific times of the day; for instance, before meals, orone hour after meals, or at bedtime, etc. It is very important that a medication be administered as prescribedand not simply administered to meet the agency’s general administration time schedule.

The time a medication is to be given should be based on the individual’s life and not for the convenience ofthe staff.

If an individual is asleep during a prescribed medication time, you must wake the individual to administerthe medication unless otherwise specified in writing by the doctor.




Right RouteWhen a physician prescribes a medication, he or she will prescribe it in a certain form (tablets, capsules,ointment, liquids, etc.). The method is referred to as the route. Capsules and tablets are usually swallowed(oral route). Ointments are usually applied externally (topical route).

Before administering a medication, double check to be sure the medication is in the form ordered by thephysician. If the medication sheet/record says capsules, be sure you have capsules and not tablets. The copyof the prescription and pharmacy label should state the route (method) by which the medication should beadministered.

For instance, you might be instructed to externally apply an ointment to a rash. Follow the route directionscarefully.

Check Anything That’s DoubtfulIf you have any doubt as to whether the medication is in the correct form as ordered, or can be administeredas specified, call the family or guardian before you give the medication. For instance:

• if the medication is in tablet form and the instructions say “apply externally,” call your designatedfamily member or relative.

• if the individual has difficulty swallowing and the medication is in capsule form, call your designatedfamily member or relative.

• if the medication is in a suppository form and the instructions say “take orally 3 times a day,” call yourdesignated family member or relative.

Right DocumentationImmediately after you correctly administer the medication, you must initial in the box on the medicationsheet/record that corresponds with the right medication, right time, right date.

After you have administered the medication and initialed in box, assure that your full signature and initialsappears in the designated area on medication record/sheet.




Administering MedicationsGeneral Rules• Following universal precautions guidelines, staff members should wash their hands before

administering medications. However, medication should still not be touched.

• Medication should not be placed directly into the individual’s hand.

• Medication should be given with a full glass of water, unless otherwise prescribed.

• Tablets may be crushed into applesauce, ice cream, etc., with written authorization from the physicianor pharmacist only. Capsules also should only be opened with written authorization from thephysician or pharmacist.

• No medication can be signed for prior to administration.

• Try your best to minimize distractions for both yourself and the individual receiving medication (e.g.taking turns, etc.).

• Try to make this process as private as possible (e.g. one to one, speaking quietly) with the preferenceof the individual’s needs and dignity as priority.

• Do not leave medication unattended.




How to Properly Administer Pills/Capsules1. Wash your hands. Request individual wash his/her hands also. (This

teaches individuals a sense of responsibility for his/her own medicationsand cleanliness.)

2. Gather all necessary supplies (e.g. medication sheet/record, smalldisposable cup, water, individual, etc.).

3. Using the medication administration sheet/record, find the correctmedication to give.

4. Find the correct pharmacy bottle or card/blister pack.

5. Compare the pharmacy bottle or card/blister pack and the copy of theprescription with the medication administration sheet/record.

6. If using a pharmacy bottle, pour the correct dosage from the pharmacybottle into the pharmacy bottle cap.

7. Then pour medication from the pharmacy cap directly into the disposablecup. If using a medication card, pop the correct dosage directly into thedisposable cup.

8. Put the pharmacy cap back onto the pharmacy bottle and put the bottle orcard away.

9. Hand the cup to the individual receiving medication. Encourageindividuals to put medication directly in mouth from cup.

10. Offer full glass of water unless otherwise prescribed.

11. Watch for the person to swallow the medication.

12. Initial the medication administration sheet/record for that medication, day,and time.

13. Remember to both sign and initial the medication administration sheet/record if administering medications the first time that month.

14. Repeat the process for each type of medication.




How to Properly Administer Liquid Medication1. Check label of bottle against medication administration sheet/record and the copy of the prescription

and/or physician’s orders to assure the right medicine is being given to the right individual.

2. Shake bottle, unless directions state otherwise.

3. Carefully pour medication from the bottle so the label remains legible and intact. Measure the exactdosage prescribed into a measuring spoon obtained from the pharmacy, measuring spoons used forbaking or a medication cup made for this purpose. Do not use a kitchen teaspoon.

4. Wipe the bottle with a moist paper towel and replace the cap.

5. Again compare the medication record with the label on the bottle before administering.

6. Liquid medication may be diluted or followed by liquid with physician’s authorization only.

Note: If the individual coughs, spits, or vomits the medication, DO NOT repeat. Follow your agency’sprocedure for handling this situation.




How to Properly Administer Ear Drops1. Wash hands thoroughly with soap and water.

2. Wear latex/vinyl gloves.

3. Check the dropper to make sure it is not chipped orcracked.

4. The eardropper must be kept clean. Avoid touching thedropper against the ear or anything else.

5. Warm the bottle to near body temperature by holding it in yourhands for a few minutes.

6. If the drops are a cloudy suspension, shake well for ten seconds.

7. Draw the medicine into the dropper.

8. Have the individual tilt the affected ear up or lie on their side.

9. To allow the drops to run in:

Adult — Hold the earlobe up and back.

Child — Hold the earlobe down and back.

10. Place the prescribed amount of drops in the ear.

11. To avoid injury, do not insert the dropper into the ear.

12. Keep the ear tilted up for a few minutes, or insert a soft cotton ball, whichever has beenrecommended.

13. Take off gloves and wash hands.

Remember —

• Follow instructions carefully.

• Do not miss doses.

— Adapted from the Michigan Pharmacists Association’s Patient Education Program




How to Properly AdministerEye Drops1. Wash hands thoroughly with soap and water.


3. If a dropper is supplied, make sure there are no chips orcracks at the end of the dropper.

4. If a dropper is supplied, hold the dropper tip down all thetime. This prevents the drops from flowing back into the bulbwhere they may become contaminated.

5. The dropper must be kept clean. Avoid touching the dropper against theeye or anything else.

6. If the eye drops are a cloudy suspension, shake them for ten seconds.

7. Individual should be lying down or have his/her head tilted back

8. With your index finger, pull the lower lid of the eye down to form a pocket (see drawing A).

9. Hold the dispenser with the opposite hand and place as close to the eye as possible, without touching it.

10. Brace the remaining fingers of this hand against the nose or cheek.

11. Drop the prescribed amount into the pocket made by the lower lid. Placing the drops on the surface ofthe eyeball (cornea) may cause stinging.

12. Replace the cap or dropper right away. Do not wipe or rinse it off.

13. Press your finger against the inner corner of the eye for one minute. This prevents medication fromentering the tearduct (see drawing B).

14. Close eye gently and wipe off any excess liquid with a tissue.

15. Remove gloves and wash hands.

Remember —

• Follow instructions carefully

• Use the exact number of drops prescribed.






How to Properly AdministerEye Ointments1. Wash hands thoroughly with soap and water.


3. This ointment must be kept clean. Avoid touching the tip ofthe tube against the eye or anything else.

4. Hold the tube between the thumb and forefinger. Place thetube as near to the eyelid as possible, without touching it.

5. Brace the remaining fingers of this hand against the cheek or nose.

6. Tilt the head back and up.

7. With your index finger, pull the lower lid of the eye down to form a pocket.

8. Place the ointment into the pocket made by the lower lid.

9. Ask the individual to blink their eye gently.

10. With a tissue, wipe any excess ointment from the eyelids and lashes.

11. Replace and tighten cap right away.


Remember —


• Eyesight may be cloudy after using the ointment.






How to Properly AdministerNose Drops1. Ask individual to blow their nose gently.

2. Wash hands thoroughly with soap and water.


4. Check the dropper tip for chips or cracks.

5. The nose drops must be kept clean. Avoid touching thedropper against the nose or anything else.

6. Draw the medicine into the dropper.

7. Individual should be lying down or have their head tilted back.

8. Place the prescribed number of drops into the nose.

9. To allow the medication to spread in the nose, ask the individual to remain in this position for a fewminutes.

10. Replace dropper in bottle right away.


Remember —


• Use only as long as prescribed.





How to Properly Administer Topicals1. Wash hands thoroughly with soap and water.


3. Before applying more medication, clean the area thoroughly by washing the area gently with soap andwater, or soaking an involved site.

4. Spread evenly, cover well, without applying an overly thick layer.

5. Lotions and creams — smear lightly. Do not rub.

6. Liniment — rub gently.

7. Powder — light dusting to cover affected area.

Remember —

• Often there is a gauze dressing to cover and protect.

• Check the directions for specific amounts of application (e.g. size of a dime, etc.).

• Liniment — Preparation usually containing alcohol, oil, or soapy emollient that is applied to skin.

• Lotion— Drug in liquid suspension applied externally to protect skin.

• Ointment (salve) — Semisolid, externally applied preparation usually containing one or moredrugs.

• Paste — Semisolid preparation, thicker and stiffer than ointment; absorbed through skin moreslowly than ointment.




How to Properly Administer a Metered-Dose NebulizerDon’t• Don’t teach the individual how to use the nebulizer when they are short of breath — they’ll be too

distracted to give you their full attention.

• Ask them not to exhale immediately after inhalation or the aerosol spray won’t reach their airway’sdeeper branches. Instead, they should hold their breath approximately ten seconds after inhalation.

• Don’t let them repeat inhalations before the next scheduled dose.

• Don’t let residue accumulate around the mouthpiece since residue can prevent the medication frombeing properly distributed when the individual operates the nebulizer. Show them how to clean themouthpiece with warm water.

Do• Assess their ability to hold and manipulate a metered-dose nebulizer.

• Ask them to remove the mouthpiece cover and shake the nebulizer well. If they don’t shake it, fineparticles won’t be aerosolized. Tell them to spray a new nebulizer once into the air before using it.

• Show them how to place the mouthpiece into their mouth with the opening toward the back of theirthroat. (With some models, the mouthpiece should be held one to two inches (2.5 cm to 5 cm) fromthe open mouth.)

• Tell them to fully exhale through their nose, then grasp the mouthpiece with teeth and lips to preventmedication from escaping through their mouth. They should inhale slowly and deeply through theirmouth as they press down on the medication canister to release the dose. If they inhale or sprayincorrectly, droplets of medication may land on their pharynx or tongue and cause them to gag.

• Teach them to exhale slowly using pursed-lip breathing to keep the small airways open. Tell them towait five minutes (or as prescribed) between medication inhalations.




How to Properly AdministerRectal Suppositories1. Wash hands throughly with soap and water.


3. Store suppositories in a cool place to avoid melting.Refrigerate them if so labeled.

4. If necessary, suppositories may be held under cool water toharden them prior to insertion.

5. Remove wrapper if present.

6. Lubricate tip of suppository with a water soluble lubricant such as K-Y Jelly,not petroleum jelly (Vaseline). If not available, moisten the rectal area with tap water.

7. Have individual lie on side with lower leg straightened out and upper leg bent forward toward thestomach.

8. Lift upper buttocks to expose rectal area.

9. Insert suppository with finger until it passes the mascular sphincter of the rectum, about one-half toone inch in infants and one inch in adults. If not inserted past this sphincter, the suppository may popback out.

10. Hold buttocks together for a few seconds.

11. Have individual remain lying down for about 15 minutes to avoid having the suppository come backout.

12. Discard used materials and wash hands thoroughly.

Remember —


• Use suppositories only as often as directed.

• The person should be assessed for their ability to administer rectal suppositories.

• Maintain privacy.





When Not to Give MedicationStop In These CircumstancesThere may be unusual circumstances which require that you DO NOT administer medication at theappropriate time.

1. If any of the following required items are missing or incorrect:

• written directions from the family

• your agency’s medication administration sheet/record

If you do not have, or cannot find, any one of these for the medication you are going toadminister, STOP! Contact the family.

2. Individual exhibits a dramatic change in status. If the individual has a seizure, is vomiting, is havingdifficulty breathing or any other change which appears to be health-threatening, DO NOT administerthe medication. Follow the instructions given for reporting an emergency or a nonemergency health-threatening situation.

3. If you have any doubt that you have the right individual, right medication, right dosage, right timeright route or documentation get assistance from, or call, the family before giving the individual themedication.

4. Individual refuses to take medication. Explain to the individual why it is important to take themedication as prescribed by the physician and encourage cooperation. Do not bribe, nag, lecture, orthreaten. If the individual still refuses, do not force him or her to take the medication. Call the familyand follow his or her instructions. Immediately document the incident. If the person does not take themedication within the hour, document an “R” in the box and follow any other procedures your agencyrequires.

5. If the medication administration sheet/record/log is already signed for that dosage.

ErrorsError = Violation Of Any RightAn error occurs when any one or more of the six rights of medication administration are violated.

An error has occurred if:

• the wrong individual was given the medication.

• the wrong medication was given to an individual.

• the wrong dosage was given to an individual.

• a medication was administered at the wrong time to an individual, or a medication was not given at all.

• a medication was administered by the wrong route.




• wrong documentation.

• missing medication.

Beyond the 6 R’sBeyond the six rights of medication administration, there are some additional safeguards to follow that willhelp to minimize medication risks. These have been divided into three DO’S and three DONT’S.

• DO give your full attention to the task.

• DO remain with the individual until the medication has been taken.

• DO prepare medication for only one individual at a time.

• DON’T give a medication from a container which has a label that cannot be read.

• DON’T give a medication from another person’s container.

• DON’T try to hide an error.

General Information• Ask your family or agency if any additional documentation is necessary for your program.

Summary

Knowing the six rights of medication administering is essential for the safety of the person receiving themedication. It is also important to know what to do when a documentation or medication error occurs.Remember to maintain your concern for normalization and learning opportunities while you areadministering the medication properly.

Agency Follow-Up

Agencies may differ in their internal procedures regarding medication (e.g., locationof medication sheets, storage and key maintenance, reporting procedures, etc.). It isstrongly recommended that each agency, family, and/or individual who uses inhome support workers be very clear about the difference between reading this guideand completing the Medication Certification Training required for residential staff(group homes, supported living, etc.). That training is more extensive, and is highlyrecommended for all direct support professionals.




Chapter 5APPENDIX



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