MEDICATION MONITORING IN ADULT CARE FACILITIES

1 1 MEDICATION MONITORING IN ADULT CARE FACILITIESP resented byNC Division of Health Service RegulationAdult Care Licensure SectionDrug ManagementObjectives:Access and utilize the MEDICATION administration and pharmaceutical care regulations for ADULT Care and encourage MEDICATION administration rule compliance in ADULT Care FACILITIES using a systematic Materials needed Licensure Rules & General Statutes MONITORING Report Corrective Action Report MEDICATION Aide Qualifications Worksheet Med MONITORING Work Sheet Resources Resources ACLS Consultants RN, RPh, SW, or RD Drug Reference Manuals PDR, Drug Information Handbook, Complete Guide to Prescription and Non Prescription Drugs, The Pill Book, MEDICATION Administration 10A NCAC 13F / 13G.

2 0403* 10A NCAC 13F / 13G .0503* 10A NCAC 13F / 13G .0505 10A NCAC 13F / 13G .1000 10A NCAC 13F / 13G .1211 * & ** Legislative changes in 2013 MEDICATION Aides and SupervisorsWho must meet these qualifications? Staff who administer medications, including staff who only prepare Staff who directly supervise the administration of medications Exemption: Persons authorized by state occupational licensure laws to administer medications4 MEDICATION Aide 131D Training Programs 5 hour training program 10 hour training program Instead of 5 hr &10 hr training programs option available to complete a 15 hr training program Website for training programs.

3 Carolina Department of Health and Human ServicesDivision of Health Service Regulations Division of Public HealthCenter for Aide Regulation and EducationAdult Care Licensure SectionMedication Administration5 Hour Training Course forAdult Care HomesInstructor 131D does it apply to? All licensed ADULT care homes under 131D New staff hired on or after 10/01/2013 to perform MEDICATION duties & does not have verification of prior employment per 131D and passed the written MEDICATION exam Any current staff with new responsibilities of MEDICATION duties/tasks on or after 10/01/2013 What changed October 1, 2013?Prior to 10/01/2013 competency Validation by a RN or RPh prior to administration of medications (Non transferable)Within 90 days of competency validation Pass the written State MEDICATION exam for unlicensed staff in ADULT care homesEffective 10/01/2013 Verification of employment as a MEDICATION aide in an ACH within past 24 months; competency validation prior to administration of medications & passed the State written exam prior to 10/01/2013OR 5 hour training developed by DHHS competency validation by a RN or RPh.

4 Within 60 days of hire: 10 hour training developed by DHHS Pass the written State MEDICATION exam for unlicensed staff in ADULT care homes7 Who is exempt from training?Refer to Guide for Determining MEDICATION Training Requirements Employee A Employee B Employee C Employee D Employee ECompetency EvaluationClinical Skills Validation Completed prior to staff being assigned to administer medications The MedicationAdministration Skills Validation Form Non transferable between licensed facilitiesWritten Exam Administered by theDepartment of Healthand Human Services Completed within 60 daysof hire as MEDICATION staff A score of at least 90%for passing Transferable8 The MEDICATION Administration Clinical Skills Checklist Validation by RN or RPh Only form used for competency validation Certain tasks

5 May only be validated by RN Is to be completed for all tasks the employee will be responsible for performing Required for all new staff whether staff was required to complete training or not Maintained in the facility for review (whether staff has completed MEDICATION training or not)Revalidation of MEDICATION Staff No revalidation required of employees who remain employed by new ownership. No revalidation required of employees rehired by the facility. However, facility is responsible for assuring that staff is competent to administer medications & oriented to facility s policies and Testing Questions and Materials Center for Aide Regulation & Education (CARE) MEDICATION Testing Unit 919 855 3793 DHSR Website: MEDICATION Testing Website: :8598 COLLECTION Observations of staff & residents Interviews with staff & residents Documentation / Resident Records11 Resident Record Review Sample size based on survey protocol.

6 New admissions, re admissions, residents receiving insulin, Coumadin, or multiple changes in MEDICATION orders. MEDICATION MONITORING Form begin with FL 2 or discharge summary and follow subsequently dated orders. Observation & Interview of Residents Sometimes necessary to confirm how / if MEDICATION was / is given. Helpful in determining staff s procedures within the facility. Use open ended questions during interviews12 Observation & Interview of Staff Indirectly observe staff during MEDICATION passes Ask staff to tell you procedures in home Determine if staff is following proper procedures for: pre pouring & infection control reordering of medications MEDICATION administration techniques administering within 1 hour grace period documentation on the MARP olicies and Procedures Individualizedprocedures in the facility Who is responsible for doing what?

7 How is it done? When is it done? Where is it done? If there are inconsistencies among staff, refer to policy and procedure manual MAR documentation, reordering of meds, Orders FL 2 or Discharge Summary Physician Progress Notes Telephone Order Slips Prescriptions Physician s Order Sheet Other Lab Reports, MEDICATION ReviewsMedication OrdersComplete MEDICATION name & strength Dosage of MEDICATION to be administered Route of administration Specific directions for use, including frequency, and if ordered PRN, an indication for use If any order is incomplete, staff should clarify the order with the MD and document this Administration Record (MAR)CURRENT AND ACCURATE.

8 Each dose administered Resident s name Name, strength, & dosage administered Instructions for administering Date & time MEDICATION is administered Reason for omissions Reason and resulting effect of PRN s Name/initials & equivalent MARs Are there omissions, blanks? Is the reason / effect documented for administration of PRN s? Is the MEDICATION scheduled for administration at appropriate times? Is staff documenting immediately after administration to 1 resident prior to administering medications to the next?15 DRUG STORAGE Drugs should be stored in an area that is clean, orderly, well lighted, & well ventilated. External / Internal stored separately Refrigerated agents: 36 46 F.

9 Security Expired / DC d drugsLabeling Prescription Medications Non prescription medications (OTCs) Direction Changes Samples Leave of Absence16 Prescription Label Requirements Resident s name Dispense date Prescriber s name Name/strength of the MEDICATION Instructions for administration Generic equivalency statement Expiration date Name of dispensing RPh & pharmacyControlled Substances Accountability / Retrievable record Receipt Administration Disposition Storage Disposition / DestructionIs the MAR documentation sufficient as the controlled substance record, too?????????17 MEDICATION Errors Error an act or belief that unintentionally deviates from what is correct, right or error occurs when a MEDICATION is not administered, asprescribed.

10 ALL errors, including documentation errors, entered on appropriate form Omissions and unavailability of medications ARE ERRORS!Pharmaceutical Care and Services Components of MEDICATION review: On site At least quarterly Responsibilities of LHP & follow up by facility Summary report Maintain on file in facility not necessarily in resident s record ACH (7+) versus FCH (<7)18 Evaluating Scope and Severity Pre Exit The scope of the How many residents were affected? The severity of the How bad was it? MONITORING report, corrective action, or penalty?EXERCISESEXERCISE MEDICATION Aide Qualifications The following checklist was completed during routine MONITORING of MEDICATION aide qualification at Fruitful Living Rest Home of Raleigh.