The medication aide takes care in setting up and preparing medications, including limiting distraction and interruptions, which may increase error rates, prior to administration to the resident. There are several things that should be done to make passing medications efficient and accurate.
1. Check the medication room or cart, and restock any supplies needed. These supplies may include soufflé and plastic medicine cups, water pitcher and drinking glasses, gloves, pill crusher, and any foods or juices used to give medications to residents.
2. Check the medication administration record to see if there are any questions. Ask the nurse, pharmacist or supervisor to clarify any questions.
3. Verify the narcotic count per facility policy.
There are three safety checks built into setting up medications. Each of these safety checks must be completed prior to the resident receiving medications. This provides three opportunities to ensure the correct medications are provided according to the five rights. Safety checks are identical each time they are performed and should not be skipped. Standard precautions should be maintained throughout the process of providing medications.
Some residents may have difficulty swallowing tablets whole. The physician may order the medication to be crushed. Not all medications can be crushed. Check the facility’s policy or with the nurse, pharmacist or person providing direction and monitoring before crushing any medications.
To crush a tablet, place it between two soufflé cups and pull down the handle on the crusher. Just before giving the drug, mix the powder with a small amount of soft food such as applesauce. The facility may use other crushing methods, or each resident may have his or her own personal pill crusher. Follow the facility’s policy.
Some tablets must be cut. A tablet must be scored in order to be cut correctly. A sharp knife or pill cutter may be used.
Some liquids are mixed with a juice to cover a bitter taste. Others may need to be given through a straw to prevent staining the teeth. Liquid medications are measured into a specially marked cup or spoon held at eye level. Measure liquids to the lowest level of the meniscus. The meniscus is where liquid and air meet. To measure a liquid, your eye should be level with the meniscus for accuracy. When pouring a liquid, keep the palm of the hand over the label in order to protect the label. Some liquids are measured in a syringe, especially if the dose is five ml or less. For liquids that should be kept sterile such as eye or ear drops, wipe the outside of the container only after closing it.
Granules are often mixed with a liquid just before giving them to the resident. Do not delay in providing the medication to the resident, or the liquid may begin to solidify and become difficult to drink. An example of a medication that comes in the form of a granule is Miralax.
A controlled substance must be signed out on the narcotic sheet or other form during the setup procedure. Follow the facility’s policy. An example of a controlled substance is morphine sulfate.
The Beginning Five and Ending Five
Many of the procedures that follow begin and end with the same basic steps. To simplify your training, we will discuss these first. In the rest of the procedures, they will be called the “Beginning Five” and the “Ending Five.”
The beginning five:
1. Knock on the door, and request permission to enter if the resident is in his or her room. Introduce yourself to the resident and explain what you plan to do.
2. Identify the resident. Ask the resident to say his or her name, or use the facility’s policy for correct resident identification. Current standards may require two methods of identification such as name and birth date.
3. Provide privacy. Some residents will want more privacy with their medications than others. There may be a note on the resident’s record as to how much privacy he or she wants. Some residents may want to return to their rooms for medication. Others will not mind taking medications in the dining room with other residents present. Also be sure other residents are not bothered by watching the procedure. Remember to pull window drapes if the resident’s room can be viewed from the outside and this is what the resident wants. When in doubt, ask the resident.
4. Wash and dry hands thoroughly using the proper technique.
5. Maintain safety. Evaluate equipment for safety concerns, maintain standard precautions and use proper body mechanics. If the resident is changing position, lower the bed to its lowest position. If the resident is remaining in bed, raise the bed to a comfortable working height.
The ending five:
1. Position the resident. Assist the resident to a comfortable position. Make sure frequently used items such as call lights, water or safety devices are within reach.
2. Open the room if appropriate. Pull the curtains open and open the door if the resident wishes.
3. Wash and dry hands thoroughly using the proper technique.
4. Record and report. Record the procedure according to facility policy. Report any observations to the person providing direction and monitoring.
5. Maintain safety. This includes placing bed in the lowest position, locking wheels and using side rails appropriately.