Basi c Heal t h and Medi cat i ons

The Ri ght D oor f or H ope, Recover y, and W el l ness Compiled by Jessica McDowell, RN BSN What we will be covering the first half of this course…...

➔Vital Signs ➔Infection Control/Universal Precautions ➔M edi cal Emer genci es ➔Sei zur es Vital Signs Accurate measurement of vital signs is an i mpor t ant r esponsi bi l i t y of a heal t h car e worker. Vi t al si gns i ncl ude: Temper at ur e, Pul se, Bl ood Pr essur e and Respi r at or y Rat e. Temperat ure

➢ M easur es t he amount of heat i nsi de a per son’s body. ➢ I ncr eases wi t h exer ci se. ➢ W hen heal t h st at us changes, t emper at ur e may al so change. ➢ M et hods of t emper at ur e r egul at i on i ncl ude: ○ Perspiration ○ Shivering

Ensure you are cleaning your thermometers with alcohol between uses! Ways t o obt ai n a t emperat ure Axi l l ar y ( under ar m) T empor al ( f or ehead) -N or mal r ange 95 t o 98 degr ees F. -N or mal r ange i s 96 t o 99 degr ees F -gl ass/di gi t al t her momet er . -N ewest met hod, r eads t emp of t empor al -minimum 10 minutes. ar t er y. -W at ch f or cover ed head or H eavy per spi r at i on. Orally -Most common. Tympani c ( ear ) -N or mal r ange i s 96 t o 99 degr ees F. -N or mal r ange i s 96 t o 99 degr ees F. -Digital only, disposable tip for each use. -M er cur y t her momet er s ar e not of t en used, -Pull ear up for adults, pull ear down for kids. t hey ar e t oxi c i f br oken. Rect al -Shake down bef or e use, 3 mi n. M i ni mum. -N or mal r ange i s 97 t o 99 degr ees F. -No food or drink for 15 min. before taking -N ot of t en used. or al t emper at ur e! -Minimum of 3 minutes, lubricate thermometer, only insert 1 ½ inches. Troubl eshoot i ng Temperat ure Di screpanci es

➢ Know your thermometer! Procedures vary by brand! ➢ Check/change bat t er i es. ➢ M ake sur e gl ass t her momet er i s shaken down. ➢ Double check unusual readings. ➢ Ver i f y wi t h anot her t her momet er . Pul se

➢ I ndi r ect measur e of hear t r at e. ➢ Normal range is 60 to 100 bpm. ➢ Do not use your thumb (you will feel your own pulse). ➢ Take pul se f or 30 seconds and doubl e. ➢ I f pul se i s i r r egul ar , t ak e f or a f ul l 60 seconds. Measuri ng Pul se rat e met hods

Radi al Ar t er y Car ot i d Ar t er y

You can al so use a st et hoscope t o l i st en f or t he hear t r at e ( auscul t at i on) ! Respirations

➢ Respirations are usually collected in conjunction wi t h obt ai ni ng t he pul se r at e. ➢ W or ks best i f t he per son you ar e col l ect i ng respirations on, doesn't know (they will change t hei r r at e i f you t el l t hem you ar e count i ng r espi r at i ons) . ➢ To count , 1 r i se and f al l of t he chest = 1 r espi r at i on. ➢ Count for one full minute. ➢ N or mal adul t r at e i s 12 t o 28 br eat hs per mi nut e. ➢ Ei t her wat ch chest r i se and f al l f or count , or pl ace hand on chest or stomach to count. Bl ood Pressure

M easur es t he f or ce of bl ood i nsi de of t he ar t er y.

Syst ol i c: Top number- Pr essur e while heart is pumping (or cont r act i ng) . N or mal adul t r ange i s 90 to 140 mmHg.

Diastolic:Bottom number- Pr essur e while heart is filling with blood ( r el axi ng) . N or mal adul t r ange i s 60 to 90 mmHg. Bl ood Pressure Success Tips

➢ Ensur e cuf f si ze i s appr opr i at e ( l i nes on cuf f t o measur e) . ➢ Pr oper cuf f pl acement i s vi t al ! U se br achi al ar t er y as mar ker . Agai n cuf f wi l l have an indicator. ➢ Fi r st t hump= syst ol i c pr essur e. ➢ Last thump= diastolic pressure. ➢ Record (ex: 120/60). ➢ I f unusual r eadi ng: Tr y ot her ar m, check bat t er i es, cont act super vi sor , cal l doct or ’s office, call 9-1-1 if dangerously high! Practice Obtaining Vital Signs Pl ease copy and past e i nt o your br owser for a demonstration on obtaining a full set of vi t al si gns. https://youtu.be/F16AHU9SPm8

You wi l l need t o demonst r at e a bl ood pr essur e and pul se wi t h a nur se t o r ecei ve your cer t i f i cat e of compl et i on. Sei zures

“ A br i ef di st ur bance i n t he el ect r i cal act i vi t y of t he br ai n t hat causes t empor ar y changes i n movement , awar eness, f eel i ngs, or behavi or ” ( Epi l epsy foundation, 2006). During a seizure…..

A person is unable to control activity.

Per son may exper i ence an aur a bef or e sei zur e occur s.

Sei zur e may l east f r om seconds t o mi nut es.

M ake sur e t o t i me sei zur e.

NEVER put anything in a person's mouth during seizure activity! Types of Sei zures

-Tonic-Clonic: AKA convulsive/grand mal.

-Absence: AKA pet i t mal .

-Si mpl e Par t i al : AKA Jacksoni an/Sensor y.

-Compl ex Par t i al

-Atonic: AKA Drop Attacks.

-Myoclonic: Most common in children.

-I nf ant i l e Spasms Providing First Aid & Document ing a Seizure

First Aid for a Seizure D ocument i ng a Sei zure

➢ KEEP CALM ! ➢ D ur at i on of Sei zur e ➢ Loosen anything around person’s neck. ➢ Event s pr ecedi ng sei zur e ➢ D o not r est r ai n t hem. ➢ Behavi or dur i ng sei zur e ➢ Do not put anything in their mouth. ➢ Cl ear t he ar ea ar ound t hem. ➢ St ay wi t h t hem unt i l sei zur e has st opped. ➢ Goal i s t o keep t hem saf e dur i ng t he sei zur e. When i s a Sei zure an Emergency?

W hen shoul d you cal l 9-1-1?

➢ N o hi st or y of sei zur es. ➢ Pr egnant or a di abet i c. ➢ Sei zur e occur r ed i n wat er . ➢ Longer than 5 minutes. ➢ Seizures occur rapidly without returning t o nor mal st at e. ➢ Br eat hi ng does not r esume af t er sei zur e has ended. ➢ Injury occurs. Anaphylactic Shock

➢ ALW AYS a medi cal emer gency! ➢ Occurs within minutes of exposur e t o al l er gens. ➢ Fr equent l y Fat al ! ➢ I t i s a syst emi c al l er gi c r eact i on. Anaphylact ic Causes and Prevent ion

Possi bl e Causes Pr event i on

➢ Medications (Commonly ➢ KNOW YOUR CONSUMER’S antibiotics). ALLERGIES! ➢ D yes f or di agnost i c t est s. ➢ Monitor closely when giving new ➢ Bee/wasp st i ngs. medi cat i on. ➢ Foods ( N ut s, eggs, seaf ood) . ➢ Al l er gi c r eact i ons can happen t o ➢ Blood products. anyone, but some peopl e ar e mor e pr one ( e.g. H ay f ever , ast hma, f ood al l er gi es) . Anaphylact ic Signs/ Sympt oms & Treat ment

Signs and symptoms include: Treatment:

➢ Itching ➢ CALL 9-1-1! ➢ Hives ➢ Commonly used medications ➢ GI cramping/vomiting include: Epinephrine (epipen), ➢ Swelling in face or throat. diphenhydramine (benadryl), ➢ Thready pulse. hydrocortisone, hydroxyzine ➢ Extreme drop in blood pressure. (Atarax), and aminophylline. ➢ Difficulty breathing. Inf ect i on Cont rol

W A SH YO U R H A N D S! Transmi ssi on of Disease

T r ansmi ssi on of di sease can happen by indirect or direct exposur e.

D i r ect : Vi a cl ose cont act bet ween peopl e.

Indirect: Airborne, Food, Water, Sur f aces, I nsect . Transmi ssi on of Disease To pr event spr ead of di sease, you need t o br eak a link in the chain of infection! What causes di sease?

Communi cabl e D i sease ar e caused by:

➢ Bacteria ➢ Fungi ➢ Viruses ➢ Parasites GERMS ARE EVERYWHERE!

Most are not harmful and some are even beneficial to us! Vi r uses

➢ Smal l er t han bact er i a. ➢ Non-cel lul ar . ➢ Antibiotics do NOT help. ➢ Ex: Common cold, influenza, pol i o, measl es, mumps, r ubel l a, hepat i t i s, chi cken pox, her pes, shi ngl es, W est ni l e, H I V …... Bact er i a

➢ M icroscopic, single celled or gani sms. ➢ Can be t r eat ed wi t h antibiotics. ➢ Ex: I mpet i go, gastroenteritis, Staph, strep throat, tonsillitis….. Parasi t es

➢ Or gani sms whi ch exi st at t he expense of ot her or gani sms. ➢ M ust be el i mi nat ed f r om t he body. ➢ Ex: M al ar i a, Sl eepi ng si ck ness, head l i ce, scabi es, w o r m s …. Fungi

➢ Low form of plant life. ➢ U sual l y mi l d di seases. ➢ Persistent and difficulty to cur e. ➢ Ex: Nail infections, yeast infections, ringworm, athlete’s foot. Inf ect i on Cont rol Termi nol ogy

Incubation Period: Per i od bet ween acqui r i ng t he i nf ect i on and devel opi ng sympt oms. T hi s can l ast f or H OU RS, D A YS, M ON TH S, or even YEARS- it all depends on the pathogen!

I nf ect i ous: D escr i bes t he abi l i t y t o spr ead pat hogens t o anot her individual.

Contact: Persons exposed to infectious individual. Increased risk of likelihood of disease transmission

➢ Sociologic: Crowding/ Cl oseness ( nur si ng homes, pr i son, school s) . ➢ Bi l ogi c: D ecr eased r esi st ance ( compr omi sed immune system). ➢ Physi cal : St r ess, f at i gue, et c. Chai n of Inf ect i on To pr event spr ead of di sease, br eak a link in the chain of infection! Chai n of Inf ect i on

➢ Carrier:A per son/ani mal t hat har bor s and spr eads di sease t o ot her s, but may not exhi bi t sympt oms of di sease. ➢ Chain of Infection: Ser i es of f act or s/event s necessar y f or t he t r ansmi ssi on of a communi cabl e di sease. ➢ M ode of t r ansf er : By i ndi r ect /di r ect cont act ( hands, sur f aces, i nsect , i nt er cour se, sneezi ng) . ➢ Mode of Entry: W ay t o ent er new host ( br eat hi ng dr opl et s, hand t o mout h, broken skin). ➢ Causat i ve Agent : Fungus, vi r us, bact er i um, par asi t e. ➢ M ode of Escape: A way t o l eave t he r eser voi r ( sal i va, ski n l esi on, semen, bl ood) . WASH YOUR HANDS!

Viruses Signs you may have an infect ion

➢ Red/Runny Eyes ➢ Swollen lymph nodes ➢ Sneezing/Runny Nose ➢ Fever ➢ Cough ➢ N ausea/Vomi t i ng ➢ Sor es on Ear s, Scal p, Face, Body ➢ Pain/Stiffness in Neck ➢ Sore Throat ➢ H eadache ➢ Sudden changes i n Behavi or ➢ Jaundice ➢ D i ar r hea/Abdomi nal pai n When Should You Wash Your Hand (at a minimum)?

➢ After any body contact. ➢ After handling personal ar t i cl es. ➢ Bef or e and Af t er f ood pr ep. ➢ Bef or e and af t er eat i ng, ➢ A f t er usi ng t i ssue/handker chi ef . ➢ After using the toilet. ➢ Bef or e and af t er smoki ng. More i nf ect i on cont rol t i ps!

➢ W ash your hands :) ➢ Cover coughs/sneezes. ➢ Wash linens and clothing. ➢ Proper food preparation. ➢ Vacuum/dust. ➢ N o shar i ng of per sonal car e i t ems ( t oot hbr ush, gl asses, hai r br ush, et c.) . Proper Handwashing Technique ● Wet your hands with warm running water. ● Apply liquid, bar or powder soap to a cupped hand. ● Lather well. ● Rub your hands, palm to palm, vigorously for at least 20 seconds (Sing Happy Birthday). Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails. ● Rinse well. ● Dry your hands with a clean towel. ● Use the towel to turn off the faucet.

*Note: When using alcohol based hand sanitizers- let it dry com pletely after use! Universal Precaut ions

OSHA 1991

➢ Applies to blood and body fluids. ➢ Blood is the most important source of HIV, HBV, and other blood-borne pathogens. ➢ Proper practices can reduce/prevent exposure. Universal Precaut ions- Disposable Gloves

W ear di sposabl e gl oves when exposur e t o blood/body fluids is possible or when t ouchi ng pot ent i al l y cont ami nat ed sur f aces.

➢ Not a substitute for handwashing. ➢ Do not reuse gloves. ➢ Discard gloves if torn/discolored. ➢ Wash hands before and after gloving. Universal Precaut ions-continued

➢ Wear gowns when splashes to skin or clothing is likely. ➢ W ear masks and eye pr ot ect i on i f spl ashes or f i ne mi st may occur . ➢ W ash hands bet ween cont act s. ➢ Wash hands immediately if soiled with blood/body fluids. ➢ W ear di sposabl e gl oves when handl i ng soi l ed l i nens. ➢ Wear utility gloves when cleaning spills of blood or body fluids. ➢ Dispose of gloves in biohazard if visibly soiled. ➢ H andl e soi l ed l aundr y and equi pment as l i t t l e as possi bl e. ➢ Remove pr ot ect i ve cl ot hi ng f or di sposal or l aundr y i mmedi at el y af t er pr ocedur e. ➢ W A SH YO U R H A N D S! Universal precaut ions- continued

➢ Gloves are not indicated when contact with blood or body fluid is unlikely. ➢ Do not eat, drink, smoke, touch face or mouth in areas of potential exposur e. ➢ Keep Envi r onment s neat and or der l y. ➢ Ensur e t o use pr oper r emoval t echni que when changi ng di sposabl e gl oves. ➢ D i spose of needl es i n shar ps cont ai ner s- Do not recap, bend, break or r emove needl es. Universal Precaut ions cont inued

Clean Spills ASAP! Simple Disinfectant Solution Recipe ➢ Use paper towel-> Biohazard disposal. ➢ Use household bleach. ➢ Flood Area with disinfectant, let ➢ Mix daily. stand for 20 minutes, absorb ➢ Discard after 24 hours. with paper towel -> Biohazard ➢ Mix 9 parts cool water disposal. to 1 part bleach.

Reusable Equipment must be disinfected immediately with an approved solution! What to do if you fall victim to a needle stick

WASH SITE OF NEEDLE STICK OR EXPOSURE SITE IM M EDIATELY!

➢ Report incident to supervisor. ➢ Seek out appropriate Follow-up care. ➢ Incident Report. ➢ OSHA mandates availability of the HBV vaccine. Universal Precaut ions Terminology Pot ent i al l y I nf ect i ous M at er i al s: Semen, vagi nal secr et i ons, CSF, sal i va, et c. M ay be di f f i cul t t o di scer n t he di f f er ence bet ween some f l ui ds.

Source individuals: Any individual, living or dead, whose blood or other potentially i nf ect i ous mat er i al may be a sour ce of occupat i onal exposur e t o t he empl oyee.

Blood-bor ne pat hogens: M i cr oor gani sms t hat ar e pr esent i n human bl ood and can cause di sease t o humans ( H BV, H CV, H I V, et c.) .

Occupat i onal Exposur e: H i gher r i sk of i nf ect i on due t o exposur e….t hat may r esul t f r om performing your job duties.

Exposure incident: A specific contact with blood or other potentially infectious mat er i al s t hat r esul t f r om t he per f or mance of empl oyee dut i es. Universal Precaut ions: Significant Exposure Significant Exposure Significant Exposure Follow-up procedure: ➢ Needle Stick Injury. Splash into eye or mouth. ➢ ➢ Immediately wash exposed skin with soap and water. ➢ Prolonged exposure between blood and broken skin. ➢ Immediately rinse exposed mucous membranes with warm water. Does NOT include exposure to ➢ ➢ Notify supervisor. saliva, tears, sweat, urine, etc. ➢ Follow agency policy/procedures.

If a resident is exposed to body fluids: ➢ Notify Primary care physician ➢ Follow Significant exposure follow-up plan. ➢ Document. HIV/AIDS HIV Antibody ➢ Develops within 1 to 6 months of infection. HIV ➢ This is what is detected by HIV test. ➢ Human Immunodeficiency Virus. Presence of virus often goes unknown. ➢ Causes Aids (Acquired Immune Deficiency USE UNIVERSAL PRECAUTIONS! Syndrome). Assume all body fluid is contaminated with ➢ Blood, semen, vaginal secretions, CSF, disease! synovial fluid, pericardial fluid, and amniotic High Risk Factors fluid. ➢ Interpersonal sharing of blood, tissue, or ➢ Not transmitted via fecal-oral route or casual other body fluids (ex: Unprotected sex, IV contact. drug use). Source individual AIDS Any individual, living or dead, whose body Failure of immune system to defend against ➢ ➢ fluids may be a source of occupational disease. exposure to an employee or individual living Virus attacks the immune system. ➢ in the residential community. HBV (Hepatitis B Virus) Symptoms: Loss of appetite. Means of contracting HBV: ➢ Nausea/vomiting. Use of contaminated needles. ➢ ➢ Fatigue. Contact of broken skin/mucous membranes ➢ ➢ Headache. with contaminated blood/fluids. ➢ Jaundice. Contact with saliva contaminated with ➢ ➢ Can cause chronic liver disease. infected blood. ➢ ➢ Transfer of blood from obviously soiled HBV cannot spread via: surfaces. ➢ Air, coughing, or sneezing, ➢ Contact with feces of infected person. ➢ Drinking fountains, swimming pools, or toilet seats. ➢ Social contact.

ALWAYS USE UNIVERSAL PRECAUTIONS! HBV (Hepat it is B Virus) cont inued

Chronic HBV carrier If exposure occurs ➢ Have virus, but exhibit no symptoms. ➢ Needle stick, bite, scratches, Can pass virus to others. mucous membranes, broken skin. ➢ Wash area thoroughly. ➢ Most prevalent among those living ➢ in group settings (Prison, nursing ➢ Notify Supervisor. homes, etc.) and those receiving ➢ Consult with physician. multiple blood products. ➢ May recommend Hepatitis B Immune Globulin. ➢ 3/1000 of the general population. ➢ 7 to 35% of institutionalized people. HBV (Hepat it is B Virus) cont inued

Get Vacci nat ed! ➢ Ser i es of 3 injections. ➢ Pr ot ect i ve f or 90% of r eci pi ent s. ➢ Boost er s may be r equi r ed af t er 7 year s. Tuberculosis

➢ M ycobact er i um Tuberculosis ➢ Respi r at or y i nf ect i on, can af f ect ot her syst ems. ➢ Transmission: Inhaled droplets (cough, sneeze) . ➢ M ay wal l of f , l at ent now- act i ve l at er . Kear ney T B H ospi t al Tuberculosis cont inued The number of infections are increasing and some forms of TB are becoming resistant to treatment! Si gn s & Sym pt om s High risk groups include: HIV, Homeless, Coughing (Thick, sometimes blood sputum). ➢ Substance users, Immigrants, and those living in Weakness. ➢ crowded conditions. ➢ Night sweats. Weight Loss. ➢ Testing to Confirm diagnosis: ➢ Decreased appetite. Fever. ➢ ➢ Skin test (can be false positive). Hoarseness. ➢ ➢ S&S. Chest Xray (Cannot distinguish active If you detect symptoms, make appt with primary ➢ versus inactive). care physician ASAP. Any positive test results Stains and sputum cultures. must be reported to the local health department, ➢ CT/MRI (detects lung damage). they will follow case. ➢ Tuberculosis cont inued

Car i ng f or t he i nf ect ed per son Treatment ➢ Drug combinations (Rifampin, Isoniazid, ➢ Follow physician’s orders. Pyrazinamide, Ethambutol, Streptomycin). Encourage good diet and rest. ➢ ➢ 9 to 12 month treatment process. Teach good pulmonary toilet. ➢ ➢ May require surgery. Keep physician appointments. ➢ ➢ Compliance is crucial to preventing ➢ Proper hand washing. resistance! Know medications and side effects. ➢ ➢ Contagion ends 3 to 4 weeks on medication. ➢ Weigh person, as ordered. Documentation ➢ Medications and treatments. ➢ S&S, Diet, Weight ➢ Appointments ➢ Notification of health professional if problems occur. Grab a snack, use t he bat hroom, st ret ch your l egs! Basi c Heal t h and Medi cat i ons

For the last half of this cour se, we wi l l be cover i ng:

➢ Medications (Use, administration, orders, rights, d isp osal, et c.) . Medi cat i on Cat egori es/ Use of medi cat i ons

U se of medi cat i ons Medication categories

➢ Disease prevention. ➢ Prescription. ➢ Disease diagnosis. ● Prescribed by a doctor, ➢ Disease treatment. dentist, NP, or PA. ➢ Pain relief. ● Dispensed by pharmacy. ➢ Maintenance of function. ➢ Non-prescription. ● Can be purchased at store without a prescription. ● All drugs in residential setting require written order. Drug Abuse

D r ug abuse i s t he use of a medi cat i on i n a manner ot her t han f or what i t i s i nt ended.

Effects of drug abuse

➢ Physical Dependence (addiction) ➢ Psychological Dependence (habituation) ➢ Functional Impairment (ex: laxatives) Controlled medications

➢ H i gh pot ent i al f or abuse. ➢ Requi r e speci al handl i ng and pr ecaut i ons. ➢ Extensive list: Narcotics, CNS st i mul ant s, CN S depr essant s, mind-al t er i ng dr ugs. ➢ Ot her meds st i l l have t he pot ent i al f or abuse. Legal and ethical implications/Your responsibility

ALL medication, including Your Responsi bi l i t y as a car egi ver : T o assi st t he per son i n usi ng over -the-count er medi cat i on medi cat i ons as or der ed. must be pr escr i bed by a person licensed to do so by M or e l egal and et hi cal t i ps! Ensure informed consent. t he depar t ment of Li censi ng ➢ ➢ Know policies and procedures. and Regul at i on! ➢ Know about meds you're giving. ➢ Training- use only procedures you have been trained to do. Ref usal s

➢ AN Y per son has t he r i ght t o r ef use Still refusing? medi cat i on. Repor t and Recor d. ➢ NEVER force a per son t o t ake a ➢ medi cat i on. ➢ Physi ci an may deci de t o f or ce medi cat i on ( ver y r ar e) . ➢ WHAT if a per son r ef uses? ➢ Monitor individual. Tr y Agai n! ➢ D ocument at i on i s key! ➢ Expl ai n i mpor t ance of medi cat i on. ➢ Tr y appr oach f r om anot her st af f member . ➢ Contact your supervisor. Medi cat i on Saf et y

EVERY medication is potentially danger ous i f not gi ven pr oper l y!

Get your quest i ons answer ed f i r st !

➢ Nurse consultant ➢ Pharmacist The “ Five Ri ght s” 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Right Dose Effects of Medication Local Side Effect ➢ Drug is applied directly to tissues ➢ Any effect of a drug other than for or organ. which it is prescribed. ➢ Ex: Hydrocortisone for itching Adverse Effect Systemic ➢ A negative side effect. ➢ Drug circulates in blood stream. ➢ Can range from minor rash to life- ➢ Affects whole body. threatening allergic reaction. ➢ Ex: Antibiotic for UTI. Contraindication Therapeutic Effect ➢ Any reason, symptom or ➢ The desired effect of the drug on circumstance that would make the the body system for which it was use of a medication inadvisable prescribed. (allergies, pregnancy). Routes of Medication Administration

Oral is the most commonly ➢ Or al Injectable and convenient route of ➢ administration. ➢ T opi cal ➢ Rect al ➢ Vagi nal Important Note!!!!! This training program DOES NOT qualify you to administer a medication by injection or to perform other pr ocedur es not cover ed! Forms of Medi cat i ons

Capsules ➢ Small containers of gelatin. Tablets ➢ Pressed preparation of powdered drugs. ➢ May have coating. Ointment/Cream ➢ External application to skin/mucus membranes. Suppositories ➢ Insert into rectum or vagina. ➢ Melt at body temp for absorption. Elixirs ➢ Liquid Preparations. Splitting tabs/crushing meds

N EV ER cr ush t abl et s or open capsul es wi t hout f i r st consul t i ng a phar maci st !

The ONLY time it is ok to split a tablet is when it is scor ed! I f ever i n doubt - ask your phar maci st ! Wri t t en Medi cat i on Orders

Physi ci an pr escr i bes based on: Know about the medications you are giving: ➢ Medical history. Purpose and therapeutic effect. ➢ Drug allergies. ➢ What to expect from medication. ➢ Current medications. ➢ Adverse effects. ➢ Medical/dental conditions. ➢ Drug interactions. ➢ Documentation of recent ➢ physical/behavioral changes. ➢ Administration/storage instructions.

IF YOU HAVE QUESTIONS, GET THEM Practitioner writes RX for pharmacy. ANSWERED BEFORE GIVING MEDS! Home must keep a copy of prescription on file! ➢ Pharmacist. ➢ Ordering Practitioner, ➢ Nurse Consultant. ➢ Current Drug Book. Tel ephone Medi cat i on Orders

A physi ci an may f or get t hat you ar e not l i censed t o t ake an or der f or a medi cat i on over the phone. It is YOUR responsibility to remind him/her to call the pharmacy directly.

1. Ask t he physi ci an t o cal l phar macy di r ect l y. 2. D ocument on t he per son’s r ecor d- Ti me/dat e of emer gency, det ai l ed descr i pt i on, and name of physician contact and instructions given. 3. Obt ai n medi cat i on f r om phar macy. 4. Get copy of pr escr i pt i on f r om phar macy. 5. Tr anscr i be i nf o f r om phar macy l abel t o per son’s r ecor d. Other Tel ephone Orders

D i r ect car e st af f M AY r ecei ve ot her or der s ( N OT FOR M ED I CATI ON S) f r om a physician over the phone. Physi ci an may or der medi cat i on t o be hel d/di scont i nued vi a t el ephone. I t i s ACCEPTABLE f or home st af f t o t ake t hese or der s. Cont act nur se t o not i f y of hel d medi cat i on. 1. Repeat or der back t o conf i r m. 2. Understand instructions before hanging up. 3. Tr anscr i be t o r ecor d i mmedi at el y. 4. Notify supervisor and nurse consultant. Pharmacy Label s

Always check labels for information you need to Pharmacy labels MUST include: safely give medication! They must match the prescription exactly! Special instructions may be ➢ Pharmacy name and address. present, including- r ef r i ger at e, t ake wi t h f ood or ➢ Prescription number. milk, Do not take with dairy products, etc. Make ➢ Person’s name. sur e phar macy knows about al l OT C meds t aken ➢ Date dispensed. by t he per son. ➢ Name of prescriber. ➢ Directions for use. Pharmacy labels MAY include: ➢ Medications name (Brand and generic). ➢ Pharmacy phone number. ➢ Amount dispensed. ➢ Refill instructions. ➢ Strength. ➢ Pharmacist initials. ➢ D osage. ➢ Special instructions. Medi cat i on St orage

➢ Al ways st or e i n t he cont ai ner f r om phar macy. ➢ Locked box i n t he r ef r i ger at or .. ➢ M edi cat i on cabi net s ● Away from heat, only for medications, clean & orderly, sufficient space & lighting, and kept locked at all times. ➢ Store topical medications separately. ➢ Keys to be kept by person responsible for medications during that shift. The Five Ri ght s 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Ri ght D ose Abbreviat ions The Five Ri ght s 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Ri ght D ose Ri ght Per son

➢ N ame on phar macy l abel and or der must mat ch name of per son. ➢ A sk N ame. ➢ Ask Date of Birth. ➢ Ask st af f f ami l i ar wi t h per son. Right Medication

➢ Compare MAR to phar macy l abel . ➢ Tr i pl e check. ➢ They MUST match. ➢ If they do not agr ee…..Cont act phar maci st and Supervisor for clarification. Ri ght Dose

➢ Compar e M AR t o phar macy label. ➢ Tr i pl e check. ➢ They MUST match. ➢ If they do not agr ee…..Cont act phar maci st and Supervisor for clarification. Right Time ➢ 30 mi nut e gr ace per i od. ➢ N eed appr opr i at e amount of t i me bet ween doses. ➢ M ay need t o t ake wi t h/wi t hout f ood. ➢ M ay depend on pur pose/si de ef f ect s of medi cat i on. ➢ St andi ng Or der s/ M i nor i l l ness M eds ● P.r.n. (as needed) ● Give only under certain conditions. ● Follow instruction specifically. ● Document on MAR. ➔ Include reason for giving. ➔ Document effectiveness. Ri ght Rout e

➢ St at ed on phar macy l abel i f di f f er ent r out e t han p.o. ➢ Al ways ask phar maci st or nurse consultant if you have quest i ons about administration method. The Five Ri ght s 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Ri ght D ose Don’t give the medication, if…...

➢ You cannot verify all 5 rights! ➢ Missing required information. ➢ Change i n st at us ● Seizures ● Unconsciousness ● Difficulty Breathing ● Low Blood Pressure ● Bradycardia ➢ Follow instructions for reporting emergencies, if a change in status happens! Steps for med administrations

1. Check 5 rights. 14. Circle errors on MAR. 2. Good lighting. 15. U se onl y appr oved abbr evi at i ons. 3. Work in a clean environment. 16. Document IMMEDIATELY after giving 4. One t ask at a t i me. medications. 5. Know about your medications. 17. Avoid interruptions. 6. Wash hands before beginning. 18. Keep al l meds l ocked and i n cor r ect 7. Cl ean t echni que. t emper at ur e. 8. Give only meds you prepared. 9. Give as prescribed and on time. 10. A ssess f or unusual appear ance/col or . 11. Red drug allergy label on chart. 12. Refill prescription before running out. 13. N ot e di scr epancy bet ween M AR and phar macy l abel . The Five Ri ght s 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Ri ght D ose Medi cat i on DON’ Ts

➢ N EVER r el abel a phar macy bot t l e. ➢ NEVER give a person medication from ➢ N EVER f or ce a medi cat i on. anot her per son's bot t l e. ➢ NEVER give medication without an order. ➢ NEVER pour medication from one bottle ➢ N EVER gi ve medi cat i ons set up by anot her into another. per son. ➢ NEVER return unused medication to the ➢ N EVER change a phar macy l abel . bottle. ➢ NEVER mix together medications unless ➢ NEVER cut an unscored tablet. di r ect ed t o do so by a pr escr i ber . ➢ N EVER l eave medi cat i ons ➢ N EVER gi ve any medi cat i on not pr escr i bed inlocked/unattended. f or t he per son. ➢ NEVER refer to medication as “candy”. ➢ N EVER gi ve one per son anot her per son's ➢ N EVER t ake a t el ephone or der f or a medications. medication. Giving a medication

~PREPARE ONLY ONES PERSON’S M EDICATIONS AT A TIM E~

1. Positively identify patient. 2. N ever f or ce a medi cat i on. 3. Explain what medication is and how it will be given. 4. Provide privacy. 5. A ssi st - cor r ect head posi t i on, adequat e wat er . 6. Remain with person until medication is swallowed. 7. Gi ve onl y medi cat i ons you pr epar ed your sel f . 8. Obser ve and document r esponse- report if unusual. Document at i on

➢ Always use ink (usually black). ➢ N ever er ase or whi t e out . ➢ N ame of per son t r eat ed must be on al l f or ms. ➢ All medications (including OTCs) must be documented. ➢ M ust be done by per son gi vi ng medi cat i on. ➢ Signature, title and initials at bottom of MAR. ➢ Explain codes at bottom of MAR. ➢ STAT, p.r .n., and si ngl e dose medi cat i ons must al l be document ed. Document at ion cont inued

➢ Signs and symptoms can be caused by a number of things, including medi cat i ons. ➢ I t i s your r esponsi bi l i t y t o accur at el y obser ve, r epor t , and r ecor d any change i n physical conditions or behavior. ➢ I t i s al so your r esponsi bi l i t y t o gi ve appr opr i at e car e t o t he per son i n an emer gency or pot ent i al l y l i f e t hr eat eni ng si t uat i on. ➢ D o not di spense or t r ansf er medi cat i ons f r om one cont ai ner f or anot her t o gi ve. ➢ Consumers should NOT transport medications unless proper approval has been gi ven. Medication Errors

➢ M UST BE REPORTED IM M EDIATELY! ● Complete incident report. ● Notify physician. ● Nurse consultant. ● Pharmacist. ● Follow organization procedure. ➢ When has one occured? ● Wrong person or medication? ● Wrong dose or time? ● Wrong route? ● Missed entirely? Ti ps t o avoi d errors!

➢ Be al er t and at t ent i ve. ➢ Obser ve t he 5 r i ght s! ➢ Know the medications. ➢ A sk f or hel p. ➢ N ever be af r ai d t o l ook somet hi ng up or ask quest i ons. The Five Ri ght s 1. Ri ght Per son 2. Right Medication 3. Right Time 4. Right Route 5. Ri ght D ose Discont inuat ion

➢ If a physician wishes to discontinue medi cat i on or change dosage….. ➢ N ew pr escr i pt i on r equi r ed. ➢ Discard old medication per procedure. ➢ D ocument . ➢ Note on MAR. ➢ M ake ot her st af f awar e of change. Local Medication Disposal Sites

➢ Al l M ei j er Gr ocer y st or es now di spose of unused/expi r ed medi cat i ons. ➢ Al so most l ocal pol i ce depar t ment s have a medi cat i on dr op box, bel ow ar e our local drop box locations and hours of operation. Disposal of medications

➢ M ust be done by 2 st af f member s, one act i ng as wi t ness. ➢ Fol l ow agency pr ocedur e. ➢ M ai nt ai n saf et y, dest r oy beyond poi nt of r ecl amat i on! ➢ N ever di spose wher e humans or ani mal s have access t o medi cat i on. ➢ I f you must di spose of meds i n t r ash, meds must be r emoved f r om or i gi nal cont ai ner s. M eds must be mixed with KITTY LITTER or COFFEE GROUNDS and pl aced i n an i mper meabl e nondescr i pt cont ai ner , then throw in the trash. Flushing Medications Flushing medications down the toilet is ONLY appropriate if t he accompanyi ng pat i ent information specifically i nst r uct s i t i s saf e t o do so! Thank you!

Thank you for completing our Basic Health and Medications Cour se- Pl ease pr act i ce t aki ng a pul se and Bl ood pr essur e, complete your written test, and schedule an appointment with a nur se i n medi cat i on ser vi ces at The Ri ght D oor For H ope Recover y and W el l ness t o r ecei ve your cer t i f i cat e of compl et i on!