MEDICATION
ADMINISTRATION
2022
LENAWEE COMMUNITY MENTAL
HEALTH AUTHORITY
Contoso
Pharmaceuticals
page 2
To be eligible to pass medications, you must:
• Have a current Medication Administration
Certificate
Certificates expire one year after the date on
the certificate.
To renew a current certificate:
• Pass a Refresher test – must present current
certificate or
• Full class and pass full test
You may NOT pass medications if:
• Your certificate has expired or
• You do not have a copy of the current
certificate
If you do NOT have a current certificate:
• Full class and full test
Welcome to
Medication Training
After completion of this course, you will
take a 2-part exam and need to pass
with 90% or higher
Contoso
Pharmaceuticals
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• Glucometer testing
• Monitoring subcutaneous injections
• Tube feedings
• Special diet changes
• Simple wound care
Additional training
may be required (not
provided in this course)
All home staff will need additional
training to be able to do:
Contoso
Pharmaceuticals
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• Michigan State Department of Community
Health & Human Services governs
medication administration
• Most settings require newly medication
trained staff to pass medications with
supervision a certain number of times
before passing independently
• Prior to passing medications staff must
know the purpose of each medication and
its side effects
• Approved resources for medication
information:
• Registered Nurse
• Medical provider
• Pharmacy
• Medication book/app
• Poison Control – 1.800.222.1222
• www.dailymed.nlm.nih.gov
Things to know before
administering
medications
Contoso
Pharmaceuticals
page 6
Medication errors are a serious matter and
must be reported to:
• Recipient Rights, by completing an Incident
Report
• The doctor who prescribed the medication
• Your Supervisor
Safety when
administering
medications
Policies and procedures
Staff need to know and follow relevant
policy
Contoso
Pharmaceuticals
page 7
• People receiving services have a wide range
of needs related to medication
administration
• The IPOS will help determine your role
• The needs could range from:
• Assisting with self-medication
• Monitoring self-medication
• Administering medications (full support)
Know the goals from
the IPOS
Contoso
Pharmaceuticals
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• Ask if medications were taken
• Prompt to take medication
• Check if medications were taken
• Know the medication side effects
• Make sure enough medication is available
• Document any side effects or other items
identified in the IPOS
Assisting with self-
medication
Contoso
Pharmaceuticals
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• Perform medication counts to ensure they
are taken properly
• Know the medication effects and side
effects
• Observe for any side effects
• Make sure all supplies or equipment are
available
• Document effects and/or other items
identified in the IPOS
Monitoring self-
medication
Contoso
Pharmaceuticals
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• Know the medication effects and side
effects
• Know how to set up medications accurately
and safely
• Observe for any side effects
• Make sure all supplies or equipment are
available
• Document effects and/or other items
identified in the IPOS
Providing full support
If a client expresses an interest in
learning more about their medications
or becoming more independent,
contact the Case Manager
Contoso
Pharmaceuticals
Medications
page 11
Contoso
Pharmaceuticals
page 12
• A doctor’s order and prescription are
required for over the counter medications.
Example: Tylenol, triple antibiotic ointment,
Benadryl, MOM
• Over the counter medications do not
require a pharmacy label
• Over the counter medications do need the
following information on the bottle, in
permanent ink, be sure to write in an open
area:
• Date the bottle was opened
• Initials of the client whose medication it is
Over the counter
medications
Contoso
Pharmaceuticals
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• Over the counter medications expire 1 year
from the time they are opened
• Or, if it is before the one year after the
bottle was opened – follow the expiration
date on the bottle
• Over the counter medications and
prescription medications (all meds) are
disposed of in the same manner.
Over the counter
medications
Contoso
Pharmaceuticals
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• Prescription medication is dispensed only by
licensed pharmacies
• Prescription medication expires on the date
indicated on the bottle
Prescription
medication
Requires a prescription ordered by a
licensed physician, dentist, nurse
practitioner or physician’s assistant
Contoso
Pharmaceuticals
Controlled Drugs
Controlled drugs are counted because
they have a high potential for abuse
Ex. Ativan; Ritalin, Ambien/Diastat
page 15
Contoso
Pharmaceuticals
page 16
• Controlled medications MUST be counted
and documented:
• When they are received from the pharmacy
(med passer and witness)
• At shift change (on-coming and off-going med
passers count at the same time)
• When the medication is passed (med passer
and witness)
• Two staff ALWAYS count the medications and
document at the same time
• If a controlled drug has been discontinued, it
must still be counted until it is disposed of
Controlled drugs
Must be stored in a “double locked” area
Contoso
Pharmaceuticals
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• If the count is not correct the staff MUST:
• Check the standing and PRN med sheets
• Check the disposal log
• If it is not correct, notify your Supervisor, who
will notify the Case Manager, complete an
Incident Report, and follow providers policy
Controlled Drugs
Contoso
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Control Medication Count Sheet
page 18
DATE
AMOUNT
AVAILABLE
AMOUNT
PROVIDED
AMOUNT
REMAINING
SIGNATURE #1 SIGNATURE #2
Contoso
Pharmaceuticals
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• Correctly document on the Controlled Count
Sheet that you passed 2 tablets on the 1
st
of
the month (shown on the next slide)
• Refer to p.8 in the Medication
Administration booklet.
Control Medication
Count Sheet
You have Ativan 0.5mg with 30 tablets in
the bottle and you need to pass 2
tablets.
(Ativan o.5mg, Take 2 tablet PRN for
agitation).
Contoso
Pharmaceuticals
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Controlled Medication Count Sheet
(must accompany each prescription kept on-site for each client)
Client Name: Billy Bob ID: 4065
Medication: Ativan 0.5mg Dose: 2 tablets
Directions: Take 2 tablets PRN for agitation (every 4 hours PRN)
Prescriber: Dr. Pepper Original Order Date: 12/1/2017
Pharmacy: CVS RX Number: 322
DATE
AMOUNT
AVAILABLE
AMOUNT
PROVIDED
AMOUNT
REMAINING
SIGNATURE #1
SIGNATURE #2
12/1/2017
30
0
30
Sandy Pines
Kim Sonew
12/6/2017
30
2
28
Your Signature
A witness
12/1/2017
Contoso
Pharmaceuticals
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• A copy of the prescription from the most
recent:
• Doctor appointment
• Hospital Discharge
• Other appointment
MUST be kept onsite to reference when
transcribing the medication onto the medication
sheet, checking the transcription or passing
medications
This applies to ALL prescription medication and
over-the-counter medication
• Prescriptions must state the exact dose of
medication ordered for prescription and
over the counter medications
Prescription copies
All medications require a prescription
Contoso
Pharmaceuticals
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• Should be taken whole unless a physician
order states that it should be sprinkled into
two ounces or less of food
• Always inform the client that their
medication is in the food. Never try to trick
a client into taking their medication.
Forms of medication
Capsules
Contoso
Pharmaceuticals
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Forms of medication
Enteric Coated
(cannot crush)
True or False?
The medication below is enteric coated?
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Pharmaceuticals
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• Which tablet below is scored?
Forms of medication
Scored Tablets
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Pharmaceuticals
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Forms of medication
Dissolvable Tablets
(keep in original package)
The package will indicate if the tablet
dissolves on top of, or under, the tongue
Contoso
Pharmaceuticals
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Forms of medication
Topicals
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Pharmaceuticals
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Forms of medication
Suppositories
Melt at body temperature
For insertion into the vagina or rectum
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Pharmaceuticals
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• Syrups
• Suspensions
• Elixirs
• Measured at eye level on a flat surface
• Pour from unlabeled side
• Use only appropriate measure devices
• If medication comes with a measuring device
– use only that
Forms of medication
Liquids
Contoso
Pharmaceuticals
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In Lenawee County ONLY professional staff or
the client, after special training, will administer
injections.
• Intramuscular – injected into a muscle
- Antibiotics
• Subcutaneous “Sub Q” – injected under the skin
- Insulin
Forms of medications
Injections
Contoso
Pharmaceuticals
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Forms of medication
Inhaler
Delivers medication to the lungs
Read and follow directions for the specific
inhaler
Contoso
Pharmaceuticals
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Forms of medication
Patch
Placed on the skin to deliver medication
into the body for controlled release of
medication
Contoso
Pharmaceuticals
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Forms of medication
Drops (Eye, Ear & Nose)
Ointments for the eyes
Keep the tip and
lid sterile to
reduce
contamination or
injury, wear gloves
Contoso
Pharmaceuticals
HANDOUTS
in your manual
Pages 14-16
• Topical medications
• Eye drops and ointment
• Rectal and vaginal suppositories
page 33
Contoso
Pharmaceuticals
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• Local action
• Targets a specific area of the body
• Systemic action
• Can potentially affect the whole body
Can you think of examples for each?
How medications work
in the body
Contoso
Pharmaceuticals
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• Therapeutic effects – desired response
• Side effects – unintended response
• Adverse effects – harmful response
• Contraindication – inadvisable for use
Response to
Medication
Contoso
Pharmaceuticals
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• Children and aging people may react more
sensitively to medication and should be
monitored closely for possible side effects
• Children may have a paradoxical (opposite)
effect to a medication, especially the first
time it is taken
• Benadryl ordered to decrease anxiety or help a
child sleep, may cause hyperactivity or
hallucinations
Response to
Medication
Contoso
Pharmaceuticals
POP QUIZ!
page 37
Contoso
Pharmaceuticals
Which term is being described below?
1. Benadryl, ordered to relieve allergy symptoms, also caused mild drowsiness is an example of a
_________ _______________
2. Jimmy will never take an antibiotic, he had a serious allergic reaction which means the antibiotic is now
________________.
3. Tylenol is ordered to bring a fever down. The _______ ________ of the Tylenol is fever reduction.
4. Zyprexa caused a whole body rash and difficulty breathing, this is an example of an ____________
effect.
5. Benadryl ointment resolved an itchy bee sting. The Benadryl had a ____________ ____________.
6. When a medication is swallowed, enters the blood stream and is circulated to all of the cells in the body,
it is having a ___________ action.
Terms to pick from:
Local Action
Therapeutic Action
Side Effect
Contraindicated
Systemic
Adverse
page 38
Contoso
Pharmaceuticals
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• All medications must be in the original
container in a locked med box
• Meds requiring refrigeration need to be in a
locked box in the refrigerator
• External medications such as ointments and
creams, drops, shampoo, need to be stored
separately from oral medication in the
locked medication cabinet.
Storage of medications
Locking Medication Boxes
Contoso
Pharmaceuticals
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• Should never be placed over heated areas
(temperature extremes change the
properties of medications)
• Should only be used for medications
• Should be kept locked at all times and be
organized and clean
• Should have adequate lighting
Storage of medications
Medication Cabinets
Remember – controlled drugs,
narcotics, must be double locked
The key to medication boxes and cabinets
must be kept by the person passing
medications
Contoso
Pharmaceuticals
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• Right Person
• Right Medication
• Right Dosage
• Right Time
• Right Route
• Right Documentation
The 6 Rights of
Medication
Administration
Contoso
Pharmaceuticals
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• Look at a picture of the client
• Ask an experienced staff
• Ask client their name
• Ask client their birth date
• Client shows you a photo ID
Right Person
You must use two ways to positively
identify the client before you administer
medication
Contoso
Pharmaceuticals
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• When transcribing a transcription:
• Compare a copy of the prescription with the
written physician order, and the bottle label –
all three must match before you can do the
transcription
• When double checking a transcription:
• Compare the copy of the prescription with the
written physician order, the medication bottle
label and the transcription. All four must
match before you can document that the
transcription is accurate
• When setting up a medication to pass:
• Compare the transcription with the
medication bottle label and the most current
copy of the prescription. All three must match
before you can set up the medication
Right Medication
Contoso
Pharmaceuticals
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• Oral medication
• The strength of medication in one pill/capsule
is measured in:
• Milligrams (mg)
• Grams (gm)
• International units (IU)
Right Dosage
The dosage of a medication is how
much is given at one medication time
Contoso
Pharmaceuticals
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The strength is measured in:
• Milligrams (mg)
• Grams (gm)
IN
• Milliliters (ml)
Example:
you put one:
• aspirin 325mg tablet in 5ml of water and stir
until it dissolves
• You will have – aspirin suspension 325mg/5ml
Both mg and ml are needed to know how
much medication to give.
Right Dosage
Liquid Medication
Contoso
Pharmaceuticals
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• It is very important that medications are
administered as close as possible to the
prescribed time
• This will ensure a constant therapeutic level
of medication in the blood stream;
therefore, the client will be receiving the
most benefit from the medication.
Right Time
The right time is when the medication is
due to be administered
What is the medication administration
window?
Contoso
Pharmaceuticals
page 47
• Medications must be given by the route
indicated in the doctors order and on the
medication label.
• How the medication is given determines the
amount of the medication that reaches the
bloodstream or other body systems within a
specified time.
Right Route
The way the medication is administered
into the body is called the route
Contoso
Pharmaceuticals
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Check the med book – what medication
does the client get now?
Check the date and initial box to be sure the
medication has not already been passed
Clear and clean the area
Wash hands
Check the MAR for allergies and compare
with medications to be given
Check one medication bottle label with the
most recent copy of the prescription and the
transcription
You are checking/comparing the 6 Rights:
Person
Medication (including the strength)
Dose
Route
Time
Documentation
Medication
Administration
Procedure
Home staff administration of
medication
Contoso
Pharmaceuticals
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Repeat the checking/comparing THREE
times:
1. When the med bottle is taken from the
cabinet
2. When the med is put from the bottle to the
bottle lid
3. Right before the med bottle is returned to the
cabinet
Dump the medication from the bottle lid
into the med cup
Return medication to the cabinet
Repeat for all medications consumer is
ordered to receive at this time
Be sure all bottles of medications are in the
medication cabinet and lock it
Positively identify the client – using 2
methods
Check that the client has 8 ounces of water
to take pills with
Stay with the client and observe while they
swallow the medication
Medication
Administration
Procedure
Contoso
Pharmaceuticals
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Document on the med sheet (MAR)
Clean hands
Set up next consumers medications
Medication
Administration
Procedure
Contoso
Pharmaceuticals
page 51
• Never touch any medication with your bare
hands.
• Pour pills/capsules into the lid, get the
correct number of pills in the lid, and then
pour them into the med cup
• If medication falls onto the clean counter,
trained staff may pick up the pill with a gloved
hand
• If medication falls onto the floor, it must be
disposed of in the approved manner.
• Pour liquids from the unlabeled side of the
bottle at eye level
• Put a dot in the box to indicate you have put
the pill in the med cup.
• Always wear gloves to pass rectal, vaginal,
eye drops, nose drops, ear drops or topical
medications
Medication
Administration
Contoso
Pharmaceuticals
page 52
• Minimize distractions – do not take phone
calls or have casual conversations
• Prepare and administer one consumer’s
medication at a time
• Follow any special directions on the bottle
label
• Offer the client privacy
• Explain to the consumer that this is the
medicine that the doctor ordered for them
• Consumers have the right to refuse any
medication or treatment
• Never give one client’s medication to
another client
• Only administer medication that is in the
original container
• Only administer medication that you have
prepared
• Never take your eyes off the medications
Medication
Administration
Always provide for the client’s privacy
Contoso
Pharmaceuticals
page 53
• Put your initials in the appropriate box after
you observe the consumer swallow the
medication or complete the treatment
• Your initials in the date box indicate the
medication was passed in the medication
window (1/2 hour before and after the time on
the med sheet).
• You must have a written physician order to
change the medication administration
window (1/2 hour before and after the time
on the medication sheet).
• Put a star in the initial box, flip the med sheet
over and write the date, what meds were due
at what time, why they weren’t passed at the
scheduled time, what time they were passed
and sign.
• If a medication is not passed, for any reason:
• Star the initial box
• Write on the back of the med sheet:
• Date, time the med should have been
passed, what happened, why, and sign.
• Complete an Incident Report and inform
your Supervisor who will inform the
LCMHA Case Manager
MAR
Documentation
Contoso
Pharmaceuticals
page 54
• Sign all of the medication sheets with your
signature and initials
• If you make an error when documenting
• Never use white-out or try to scribble out
anything on a med sheet
• Put one line through the mistake and write
“error” above it with your initials
• Never throw away a med sheet that has
initials from when medications were passed
already filled in
• Only use pen to document on a med sheet.
It is a legal record, so it must be
documented in a permanent manner
• Only the person who set up and
administered the medication can put their
initials in the appropriate box on the
medication sheet
MAR
Documentation
Contoso
Pharmaceuticals
Missed Medication Form
page 55
Contoso
Pharmaceuticals
page 56
• Make sure the client has enough
medications at all times!
• It is the responsibility of staff passing meds
to obtain refills or new medication
• Update MAR’s as needed for new meds
Not enough Medication to pass?
If there are refills indicated on the bottle label,
call the pharmacy
If no refills indicated on the bottle, call the
physician’s office and explain that you need a
refill
Complete an Incident Report
Contact your Supervisor
Obtain the meds ASAP
Refills and New
Prescriptions
Meds given for only a specific amount of
time, such as antibiotics, need to be
counted when received, to be sure there
are enough for the complete dose
Contoso
Pharmaceuticals
page 57
• Seizures
• Unconsciousness
• Difficulty breathing
• Any other life-threatening situation
Do Not Give the
Medication If:
A client shows a dramatic change in
status such as:
Contoso
Pharmaceuticals
page 58
• Offer encouragement, give honest
information
• Offer up to three (3) times in the medication
time-frame, before documenting as
“refused”
• It is not a “medication error” if the client
refuses
If the client refuses the medication and the
medication window is over:
Put a star in the initial box and write on the
back of the med sheet
Date; time meds were due; why medications
were not passed; your initials
9/1/19 8:00am; meds not passed.
Consumer refused. S.L.
Complete an Incident Report. The Home
Manager will inform the Case Manager
Refusal of Medications
Never force someone to take
medication
Clients do have the right to refuse
Contoso
Pharmaceuticals
page 59
• Call Poison Control and follow their
directions
• For all medication errors:
• Inform the Home Manager, who will inform
the Case Manager
• Complete an Incident Report
• Inform the prescribing doctor
Medication Errors
If it is an emergency situation –
someone took another persons
medication:
Contoso
Pharmaceuticals
page 60
!!REMEMBER!!
Home staff may not take verbal orders from
anyone, You may:
Ask them to fax the order to the
home/apartment if a fax machine is
available
Ask them to call the order in, or transmit it
electronically, to the pharmacy and you can
get a copy of the order from the pharmacy
Follow the provider policy if needed
Medical Orders
If the doctor, dentist, PA, Nurse
Practitioner, or Nurse calls your home to
give you a new order:
Contoso
Pharmaceuticals
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• Pharmacy name and address
• Client’s name
• Name of the medication and strength
• Dosage
• Date the prescription was most recently
dispensed
• Directions for use
• Physician’s name
• Amount dispensed
Pharmacy Label
Must be legible
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Pharmaceuticals
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• Put the sample medications in a zip lock bag
• Write, on the zip lock bag, in permanent ink:
• The consumer’s name
• Medication name
• Amount of medication (number of pills in the
baggie)
Example: client name; Penicillin; 20 pills
• Put a copy of the doctor’s order in the zip
lock bag. This will serve as the label the staff
must check three times
Sample Medications
Must be prescribed by a doctor, dentist,
PA or Nurse Practitioner
Contoso
Pharmaceuticals
page 63
1. You could do a label change if:
A med goes from standing to prn
The number of times it is taken during the day
changes
The number of pills taken changes
2. Take a copy of the order or prescription and
the medication bottle, including any extra
back stock bottles, to the pharmacy
3. Medication bottle labels MAY ONLY BE
APPLIED BY THE PHARMACY
4. Never write on the medication label
5. If the pharmacy cannot do a label change
you will need to fill the new script.
Medical Appointments
Label Changes
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Pharmaceuticals
page 64
• Treat the bottle of medication you have like
a sample medication
• On the outside of a zip lock bag, write:
Consumer’s name
Name of medication
# of pills in baggie
• Leave the medication in the original med
bottle
• Place a copy if the new doctor’s order in the
baggie
If a label change is not
possible
The pharmacy does not do them, and
the insurance will not pay for a new
bottle of medication:
Contoso
Pharmaceuticals
page 65
Brand Name &
Generic Medication
DAW = Dispense as Written
Contoso
Pharmaceuticals
page 67
*Know the required method for your work
site (policy) – return to pharmacy, etc.
• A physician’s order for any discontinued
medication should be on file in the person’s
record
• Contaminated, or expired medications do
not require a physician’s order, but do need
to be replaced as necessary
• Document the discontinuation of a
medication on the MAR: starting where the
next dose would have been recorded
• Make other staff aware of the
discontinuation of the medication
Disposing of
Medications
Disposal protocol for discontinued,
contaminated or expired medications:
Contoso
Pharmaceuticals
page 68
• Separate all medications that need to be
disposed of in a separate lock box away
from active and current medications until
able to dispose
Controlled Medication
• Use a Controlled Medication Form
• Need to have 2 signatures on the Controlled
Medication Form for disposal
• Form is to be kept with the medication that
needs to be disposed of, once medication is
disposed, the form needs to be kept on site
Disposing of
Medications
Remember that discontinued
medication can occur during any
hospitalization or appointment,
remember to update the MAR
Contoso
Pharmaceuticals
page 69
• Psychotropic medications include
medications for:
• Anti-Anxiety
• Anti-Depression
• Anti-psychotics
• Mood stabilizers
• Medications intended to sedate for
medical/dental visits
• A “Consent to Treat with Psychotropic
Medication” must be obtained, signed by the
guardian or client and be on file prior to
passing.
Psychotropic
Medications
Psychotropic medications change the
behavior of a person
Contoso
Pharmaceuticals
Medication Consent
page 70
WASHTENAW COUNTY COMMUNITY MENTAL HEALTH
CONSUMER MEDICATION CONSENT
Consumer Name Consumer ID
I understand that my doctor/nurse practitioner recommends the use of medication as part of my Person-
Centered Plan. I understand that all medication may produce side effects, and that some side effects may be
serious or permanent. I understand the importance of reporting side effects or unusual reactions to my
prescriber. I have read and understood the written material explaining the medication I will be taking. I have
had an opportunity to ask questions and have received full and complete answers.
Medication(s)
Dose range
Reason for Medication (place number(s) next to the proper symptom)
1. ______________________
___________________
____Depression
____Mania
____Stabilize Mood
2. ______________________
___________________
____Anxiety
____Attention or
Cognition Problems
____Insomnia
3. ______________________
___________________
____Paranoia
____Hallucinations
____Disorganized
____Thoughts
4. ______________________
___________________
____Stiffness or
____Restlessness
____Agitation
____Other: ___________
An information sheet was provided to the consumer: Y / N/ Declined _____
See Prescriber note for more information: Initial _____
---------------------------------------------------------------------------------------------------------------------------------------
I understand that medications like these have been used successfully in the treatment of conditions similar to
mine but that no guarantee can be made that the medication will be equally effective for me. I am aware of the
risks of not taking medications. I understand that my Doctor/Nurse Practitioner will inform me if my medication
dosages increase beyond recommended levels. I have informed staff about my medical problems, current
medications, and history of reactions to medications.
I understand that there are risks to taking these medications during pregnancy, and I should consult my
obstetrician and my mental health prescriber about whether to stop or continue medications while pregnant. I
agree to notify my prescriber immediately if I do become pregnant.
I understand that simple blood tests, cardiograms or other tests may be necessary to monitor my condition.
I understand that I will be informed if the dose of my medication is outside the recommend dose range.
___ _ _I have considered the benefits and consequences of the medication and freely consent to its use in my
treatment. I also understand I can withdraw my consent for the use of this medication at any time and
that it would be desirable to first speak to my doctor/nurse practitioner before doing so.
______I have/am at risk for tardive dyskinesia, and I will be monitored at least every three months.
______I have/am at risk for metabolic syndrome, a precursor of diabetes, and I will be assessed once or twice
per year for the presence of high sugar levels and high cholesterol in my blood.
______I understand that I have been court ordered to take this medication. I acknowledge receiving this notice.
_____________________________ __________________________________
_____________
Consumer Signature Parent/Guardian Signature Date
___Consumer Refuses to Sign _____________________ __ ______________________
______________
Prescriber Name Prescriber Signature Date
I am revoking my consent for the following medication(s).
______________ __________________ ______ ______________ __________________
________
Medication Name Consumer Signature Date Medication Name Consumer Signature Date
______________ __________________ ______ ______________ __________________
________
Contoso
Pharmaceuticals
page 71
• Examples of psychotropic medications:
Anti-Psychotic
Medication Side
Effects
Haldol
Geodon
Clozaril
Abilify
Risperdal
Invega
Zyprexa
Seroquel
Side effects usually are mild and most will
go away within the first few weeks of
treatment, these may include:
• Drowsiness
• Weight Gain
• Constipation
• Rapid Heartbeat
• Restlessness
• Pacing or Shuffling Walk
Contoso
Pharmaceuticals
page 72
Tardive Dyskinesia (TD)
• A movement disorder that results in unusual
and uncontrollable movements
• Usually of the tongue and face, but can
move to the rest of the body if not treated
in time
• Caused by long term use of anti-psychotics
Neuroleptic Malignant Syndrome (NMS)
• Onset first 2 weeks of treatment
• Severe muscle rigidity, high fever, sweats,
delirium
• Call 9.1.1. if you suspect NMS
Anti-Psychotic
Medication
Severe Side Effects
Contoso
Pharmaceuticals
page 73
Agranulocytosis
• Common with Clozaril (clozapine)
• Decreases white blood cells
• Protocol for special monitoring, need lab
draws!
• Staffing will be responsible for transport
• No blood – No Drug
Anti-Psychotic
Medication
Severe Side Effects
Contoso
Pharmaceuticals
page 74
Anti-Depressant Side Effects
• Example: Paxil, Wellbutrin, Zoloft
• Nausea, dizziness, dry mouth, high blood
pressure, weight gain
Anti-Anxiety (controlled) Side Effects
• Example: Valium, Klonopin, Ativan
• Risk of addiction so not desirable for long
term use. Sedation, drowsiness, poor
concentration, irritability
Mood Stabilizer Medications Side Effects
• Example: Lithium, Depakote, Tegretol
• Increased thirst, increased urination, diarrhea,
vomiting, weight gain, drowsiness, poor
concentration, impaired memory.
Medication Side
Effects
Contoso
Pharmaceuticals
page 75
• Diuretics (water pill) Hydrochlorothiazide,
Furosemide(Lasix)
• Common side effects: extra urination; for this
reason to be given in the morning, low blood
pressure
• Beta Blockers – metoprolol (Lopressor,
Toprol XL)
• Common side effects – cold hands and feet,
headaches, GI upset, dizziness, low blood
pressure
• ACE inhibitors – Lisinopril (Zestoril, Prinivil)
• Common side effects – dry persistent cough,
dizziness, skin rash
• Channel blockers – amlodipine(Norvasc),
diltiazem, Procardia
• Common side effects – constipation,
dizziness, low blood pressure, headache
Heart Medications
Contoso
Pharmaceuticals
page 76
• Digoxin (Lanoxin) is used to treat congestive
heart failure and atrial fibrillation. It helps
the heart beat stronger and with a more
regular rhythm. It can also cause a slower
pulse.
Heart Medications
(continued)
Contoso
Pharmaceuticals
page 77
Nitroglycerin is used to prevent chest pain
• Common side effects – feeling faint, dizzy,
lightheadedness, feeling of warmth or heat,
flushing or redness of the skin, headache
• Dissolved under the tongue
• Five minutes apart, up to 3 pills (15 minute
period)
• CALL 9.1.1 if no relief after the 3
rd
pill
Anti-Coagulants – Lovenox, Heparin,
Warfarin (Coumadin)
• Decrease the clotting ability of the blood,
sometimes called blood-thinners
• Frequent lab work must be done in order to
obtain a therapeutic level of drug and
dosing changes. Dietary restrictions may
apply
Heart Medications
(contd)
Contoso
Pharmaceuticals
page 78
*Examples: Carbamazapine (Tegretol),
Depakote, Lamictal, Dilantin
• Common side effects – fatigue, dizziness,
weight gain, speech problems
SPECIAL CONCERNS
• Take medications exactly as prescribed
• Try to take at the same time each day
• Could have “break through” seizure if
missed dose. Do not miss doses.
Anti-Seizure
Medications
Contoso
Pharmaceuticals
page 79
NSAIDS (Non-Steroidal Anti-Inflammatory
drugs)
Ibuprofen, Motrin, Aleve, Advil, Aspirin
• Common side effects: GI upset, bleeding
after long term use, constipation
Acetaminophen (Tylenol)
• Liver damage usually after long term use or
high doses
• The brand name Tylenol has a different
maximum daily dose than the generic form
(acetaminophen)
• Make sure that the daily total does not
exceed the recommended daily dose
• Also note that acetaminophen can be found
in many over the counter (OTC) and
prescription pain relievers, cold medicines
and sleep aids. Be sure to check the labels to
know what is included in these medications
Pain Medications
Contoso
Pharmaceuticals
page 80
• Some medications, OTC and prescription,
are made specifically for children.
• Be sure you have the correct over the counter
medication for the child’s age and weight
• The physician’s order must indicate the
specific medication and exact dose
• The order cannot be:- “per label directions”
Medications
formulated for children
Contoso
Pharmaceuticals
page 81
All Diabetes medication can produce too low
of blood sugar which can be a medical
emergency!
Oral Medications – Metformin (glucophage),
Actos, glipizide
• Common side effects: diarrhea, upset
stomach, gas, low blood sugar, weight gain,
swelling
Insulin - injection
Staff cannot administer insulin injections
Diabetes Medications
Goal blood glucose: 60-120 or
individualized to the client
Contoso
Pharmaceuticals
page 82
Symptoms include:
• Drowsiness
• Headache
• Double vision
• Confusion
• Faintness or pale
• Increased heart rate
• Chills or sweating
• Change in behavior or mental status
Low blood sugar
(Hypoglycemia)
Contoso
Pharmaceuticals
page 83
• Check blood sugar level if possible!
• Drink ½ cup of fruit juice, regular soda or a
cup of milk (do not give diet soda)
Typical protocol: (could vary depending on
client)
If blood sugar less than 50 – DOUBLE these
amounts
• Wait 15 minutes and retest blood sugar
If blood sugar is still less than 70 – treat again
• If 70 or above, follow with the next meal or
have a snack
Low blood sugar
How to treat: (follow all orders)
Contoso
Pharmaceuticals
page 84
What to Bring
• MAR & Med book
• Consultation Form
• Reason for the appointment; chief
complaint; with signs/symptoms
• Record of seizures, menses, sleep logs,
behavioral if applicable
• KNOW WHY YOU ARE THERE
During the Appointment
• Enable the client to be a part of the
appointment as much as possible
• Obtain hard copies of all medication orders
and prescriptions
• Clarify any orders or directions you have
questions about BEFORE you leave the
doctor’s office.
• All directions and medications from the
physician must have a written order. For
example: diet orders, holding medications,
dressing changes, physical therapy,
prescription medications, etc.
Appointments
Contoso
Pharmaceuticals
page 85
• Medication changes may occur – pick up any
new medications
• Document the MAR with new meds, D/C
any changes
• Dispose of any discontinued meds and
update all staff
Appointments
After the appointment
Contoso
Pharmaceuticals
page 86
• Explain to the pharmacist that the client will
be taking the medication in two different
locations, for example…in the apartment,
and at Goodwill or Daybreak.
• The client will need two pharmacy-labeled
containers, one for each location
• Both locations need a prescription copy and
a copy of the written physician order
Leave of Absences
(LOA)
Contoso
Pharmaceuticals
page 87
CHECK – CALL – CARE
No permission is required to call 9-1-1
Emergency Situations
Remember your First Aid & CPR Training
Contoso
Pharmaceuticals
page 88
All MAR’s must have the following:
Client’s name
Date of Birth
Allergies listed
Site or house name
Signatures of staff next to initials
Medication
Administration Record
(MAR)
The medication bottle, the prescription
copy, and the MAR must all match, any
differences need to be corrected
Note: there are potential legal
consequences if not documented properly
Contoso
Pharmaceuticals
page 89
1. Name of medication with strength goes on
line one
2. Dose, Route, Frequency – lines two and
three
3. Any other information (example: take with
food, etc)
4. AM medications on top 2 rows
5. PM medications on bottom 2 rows
MAR Documentation
(200mg)
Contoso
Pharmaceuticals
page 90
MAR’s should be checked
within 3 business days of a
new month
or
If any changes of
medications throughout
month by Supervisor, Home
Manager or Medication
Coordinator
MAR Documentation
Contoso
Pharmaceuticals
page 91
• No white out
• Correct any errors with a line through the
error
error MD
Celexa 100mg Colace
100mg
• Blue or black ink only No red Ink and no
pencil
• Write clearly (if you can’t read it, get
clarification)
• Only document medication that YOU pass
• No abbreviations, except for PRN
MAR Documentation
Document immediately after passing
medications!
Contoso
Pharmaceuticals
page 92
• The date/initial box must be starred
• Explain what happened on the back of the
med sheet and sign
• Failure to document or, document correctly
is a medication error.
MAR Documentation
If a medication is missed, refused, or
passed outside the one hour medication
administration window (a physician
order is required)
Contoso
Pharmaceuticals
Look at different types of MAR’s in
your manual
P 39 - 48
page 93
Contoso
Pharmaceuticals
MAR COMPREHENSION ACTIVITY
Turn to the MAR on p. 43-48 to answer the
questions on the next slide
page 94
Contoso
Pharmaceuticals
page 95
1. What time of day does client take
Trazodone?
2. Who passed Metformin at 8am on the 3
rd
?
3. Why is Seroquel at 8pm starred on the 5
th
?
4. What are this client’s allergies?
5. Why was Digoxin not given on the 1
st
?
6. Why did the client take Colace on the 3
rd
?
7. Why is Colace not given every day?
8. Document on the MAR that the client was
LOA on the 6
th
properly
Understanding of the
MAR
First you will properly sign the MAR
and initial your signature
Contoso
Pharmaceuticals
FRONT OF MAR
page 96
MONTH & YEAR ____12/19________________________ CLIENT NAME: _Mickey Mouse D.O.B. _3/2/71________________________
LOCATION: ___Riverside___________________ ID# __________________________
Initials
Signature
Initials
Signature
Initials
Signature
DL
Deanna Lees
CM
Catherine Miller
CW
Cheri Warren
JB
Janet Best
Medications:
Allergies: NKDA
Aspirin 81mg
take one tablet
by mouth every
morning (81mg)
Time
8am
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
DL
DL
CW
CW
DL
Seroquel 200mg
Take two
tablets by
mouth at
bedtime
(400mg)
8pm
CM
CM
JB
JB
*
Metformin
500mg take 1
tablet by mouth
twice a day
(500mg)
8am
DL
DL
CW
CW
DL
8pm
CM
CM
JB
JB
*
Risperidone
4mg Take one
tablet by mouth
every evening
(4mg)
8pm
CM
CM
JB
JB
*
Checked by: ______Deanna Lees________________________ Date Checked: _12/1/19
Contoso
Pharmaceuticals
Back of MAR
page 97
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
CM
Catherine Miller
NURSE’S NOTES
DATE
HOUR
INIT.
MEDICATION/TREATMENT
REASON
RESULT
HOUR
INIT.
12.5.19
8pm
CM
Seroquel
Client LOA with family
Med given by family
8pm
CM
12.5.19
8pm
CM
Risperdone
Client LOA with family
Med given by family
8pm
CM
12.5.19
8pm
CM
Metformin
Client LOA with family
Med given by family
8pm
CM
Contoso
Pharmaceuticals
Front of MAR
page 98
MONTH & YEAR ____12/19___________________________ CLIENT NAME: Mickey Mouse D.O.B. 3/2/71________________________
LOCATION: ___Riverside________________________ ID# __________________________
Initials
Signature
Initials
Signature
Initials
Signature
DL
Deanna Lees
JB
Janet Best
CW
Cheri Warren
CM
Catherine Miller
Medications:
Allergies: NKDA
Trazadone 100mg
take one tablet by
mouth at bedtime
(100mg)
Time
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
8pm
CM
CM
JB
JB
*
Digoxin o.25mg
take two tablets by
mouth - daily
(Check pulse & hold
if less than 60)
(0.50mg)
8am
*
DL
CW
CW
DL
Pulse
58
62
65
71
60
Checked by: _Deanna Lees Date Checked: 12/1/19
Contoso
Pharmaceuticals
BACK OF MAR
page 99
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
DL
Deanna Lees
CW
Cheri Warren
CM
Catherine Miller
NURSE’S NOTES
DATE
HOUR
INIT.
MEDICATION/TREATMENT
REASON
RESULT
HOUR
INIT.
12.1.19
8am
CL
Digoxin
Pulse under 60
Med held per parameter
8am
DL
12.5.19
8pm
CM
Trazadone
Client LOA with family
med given by family
8pm
CM
Contoso
Pharmaceuticals
FRONT OF MAR
page 100
MONTH & YEAR ____12/19___________________________ CLIENT NAME: _Mickey Mouse D.O.B. ___3/2/171
LOCATION: ___Riverside ID# __________________________
Initials
Signature
Initials
Signature
Initials
Signature
CW
Cheri Warren
Medications:
Allergies: NKDA
Colace 100mg take
one capsule daily –
as needed for
constipation
(100mg)
Time
PRN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
P
R
N
Checked by: __Deanna Lees Date Checked: 12/1/19
Contoso
Pharmaceuticals
BACK OF MAR
page 101
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
INIT.
NURSE’S SIGNATURE
DL
Deanna Lees
CW
Cheri Warren
CM
Catherine Miller
NURSE’S NOTES
DATE
HOUR
INIT.
MEDICATION/TREATMENT
REASON
RESULT
HOUR
INIT.
12.3.19
8am
CW
Colace
Client said she was constipated
BM passed at 10am
10am
CW
Contoso
Pharmaceuticals
Activity (Pass or Fail)
page 102
Contoso
Pharmaceuticals
Activity (Pass or Fail)
Left of the table go to the left of the room, right of the table go to the right.
• Find a partner, select a new table
• You will be grading your partner and vice versa
One person will pass AM meds, the other will pass PM meds
• Verbalize what you are doing….Ex. “I am washing my hands”
• Some directions on instruction sheet may not apply to the activity
Turn in paperwork with Nurse when you are finished
page 103
Contoso
Pharmaceuticals
TIME TO TRANSCRIBE
page 104
Contoso
Pharmaceuticals
Problems to practice together:
Seroquel 50 mg, 1 tab P.O.
BID for 5 days
(ordered on the 2
nd
)
page 105
Contoso
Pharmaceuticals
Practice Problem:
• Seroquel 50 mg, 1 tab P.O. BID for 5 days (ordered on the 2
nd
)
page 106
For 5 days
(50mg)
Contoso
Pharmaceuticals
Practice Problem
Ativan 1 mg, take 1 Tablet P.O.
in the morning and 2
Tablets H.S.
page 107
Contoso
Pharmaceuticals
Practice Problem
Ativan 1mg, take 1 Tablet P.O. In the morning and 2 Tablets H.S.
page 108
8 AM
8 PM
Ativan 1mg
Take one
tablet by
mouth every
morning
(1mg)
Ativan 1mg
Take two
tablets by
mouth daily at
bedtime (2mg)
This is documented correctly. Why is this written as two separate orders?
.
Contoso
Pharmaceuticals
Practice Problem:
Clozaril 25 mg take 1 Tablet P.O.
BID for three days, then take 2
tablets P.O. BID (start on day 11)
page 109
Contoso
Pharmaceuticals
Answer to Practice Problem:
Clozaril 25 mg take 1 tablet P.O. BID for three days, then take 2 tablets P.O. BID (start on the 11
th
)
page 110
Clozaril 25mg
Take one
tablet by
mouth twice
a day for three
days (25mg)
Clozaril 25mg
Take two
tablets by
mouth twice a
day (50mg)
8 AM
8 AM
8 PM
8 PM
Any time the strength or dose changes in an order you will need 2 separate
transcriptions for each order, as shown above (the tablets changed from 1 tablet to 2
after day 3)
Contoso
Pharmaceuticals
Practice Problem:
Morphine 5 mg, take 1 Tab P.O.
every 6 – 8 hours for back pain
PRN
page 111
Contoso
Pharmaceuticals
Answer to Practice Problem:
Morphine 5 mg, take 1 Tab P.O. every 6 – 8 hours for back pain PRN
page 112
Morphine 5mg
Take one tablet
by mouth every
6-8 hours as
needed for back
pain (5mg)
P
R
N
PRN
Do not assign a time for a PRN in the Time column
Simply write in PRN instead, two different way to write PRN are shown above
Contoso
Pharmaceuticals
Practice Problem:
Amoxicillin 500 mg, take 3
tablets P.O. BID for 10 days
(start on the 12
th
)
page 113
Contoso
Pharmaceuticals
page 114
(1,500mg)
Contoso
Pharmaceuticals
Tylenol 500mg/15ml, take 15ml every 4 hours as needed
for headache.
page 115
Contoso
Pharmaceuticals
page 116
MONTH & YEAR ____January 2020__________________ CLIENT NAME: ____Sally Heart D.O.B. ______5/5/95_
LOCATION: ___ S. Main ID# ____________________________
Medications:
Allergies: NKDA
Tylenol 500mg/5ml
Take 15ml every 4
hours PRN by mouth
for headache (500mg)
Time
P
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
R
N
PRN
Contoso
Pharmaceuticals
Practice Discontinuing a Med
You must have a written order (from the doctor, dentist, NP or PA)
to discontinue an order.
After medication is discontinued it will not be passed again. If the
medication is time limited, for example an antibiotic that is
ordered to be given for 2 weeks, it will not be given after the two
weeks is completed.
Drawn an arrow from the right wide of the medication sheet to
the date the discontinue order takes effect – for all times in the
“Time” column. Write above the arrow: DISCONTINUE
Yellow out the entire transcription except for the initials of the
med passers.
page 117
Contoso
Pharmaceuticals
Now the order states you must Discontinue this medication after2
weeks, simply add an arrow, write “discontinue” and yellow out
everything but the initials.
page 118
Ativan 1mg
Take one tablet
by mouth every
morning (1mg)
Ativan 1mg
Take two
tablets by
mouth daily at
bedtime (2mg)
An arrow indicates the date that the discontinue order begins (after
taking it for 2 weeks) is the 15th
8 AM
8 PM
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND ND
ND
ND
ND
ND
ND ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
ND
Contoso
Pharmaceuticals
Practice more on your own at home!
• Celexa 20mg. Give 1 tab P.O. for 5 days, then
give 2 tabs after that. Start the 3
rd
of the
month
• Keppra 500mg, give 2 tabs P.O. BID. Start the
3
rd
of the month
• Discontinue Keppra above after 14 days.
page 119
Contoso
Pharmaceuticals
Try these type of problems:
• Antibiotic given for X amount of days:
Amoxicillin 200 mg, 2 tabs P.O. TID for 5 days
• PRN medication
Tylenol 500 mg, 1 tab P.O. PRN for fever
• More 2 part questions:
Zyprexa 15 mg, 1 tab .O. for 3 days, then take 2 tabs after that (ordered the 3rd)
Discontinue a medication after X amount of days
page 120
Contoso
Pharmaceuticals
Try a 2 part problem
Trazodone 50mg, 1 tablet P.O. in
am. And 2 tabs at H.S. (ordered
the 2
nd
)
page 121
