Living in the Community: Medication - State of Indiana

338 Pages·2009·11.5 MB·English

Project Information
Title: Living in the Community: Medication Administration Manual
(Revised)
Grantor: Division of Disability, Aging and Rehabilitative Services,
Bureau of Developmental Disabilities
402 W. Washington St.
Indianapolis, Indiana 46207-7083
Grantee: Education and Training Resources
School of Education
Indiana University
W.W. Wright Education Building, Room 2230
201 North Rose Avenue
Bloomington, Indiana 47405-1006
Telephone: [phone]
Project Staff Project Director James A. Pershing, CPT, Ph.D.
and Editors: Project Coordinator Barbara A. Stork, M.S.
The Community Residential Facilities Council and Education and Training Resources comply
with all regulations prohibiting discrimination on the basis of race, religion, national origin, sex,
age, handicap, sexual orientation, or veteran status in matters pertaining to admissions,
employment, and access to programs.
The contents herein are solely the responsibility of Education and Training Resources and should
not be considered official policy or stance of the Community Residential Facilities Council.
Copyright 2004
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Table of Contents
Project Information Sheet i
Directions to the Licensed Nurse Instructor v
. CoreA
Lesson 1: Asepsis, Universal Precautions, and Infectious Diseases 01
Lesson 2: Responsibilities in the Area of Medication Administration 21
Lesson 3: Principles of Administering Medications 27
Lesson 4: Documentation 35
Lesson 5: Administering Medications 45
CoreB
Lesson 6: Fundamentals of Pharmacology 85
Lesson 7: Inflammation and Infection 101
Lesson 8: Psychotropic Medications 107
Lesson 9: Developmental Disabilities 123
Supplemental Lessons
Lesson 1: Self-Medication 133
Lesson 2: Diabetes 139
Lesson 3: Substance Abuse 145
Lesson 4: The Nervous System and Seizure Disorders 149
Lesson 5: Nutritional Deficiencies 159
Lesson 6: The Gastrointestinal System 169
Lesson 7: The Musculoskeletal System 179
Lesson 8: The Skin and Sensory System 187
Lesson 9: The Urinary and Male Reproductive System 199
Lesson 10: The Cardiovascular System 209
Lesson 11: The Respiratory System 219
Lesson 12: The Endocrine and Female Reproductive System 229
Lesson 13: The Immune System 239
Glossary 245
Resources 267
Vocabulary Activities 277
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Directions to the Licensed Nurse Instructor
The safety of the individuals being served is of utmost importance. You have the
responsibility to teach staff(most of whom will have had no formal medical training) to safely
discharge the responsibility of administering medication or observing individuals self-administer
medication. Staff must be taught to observe each individual's health related signs prior to
reporting their observations to you or other medical personnel. They must also be able to
recognize when to independently and immediately seek necessary medical treatment for the
individual. Living in the Community is designed to teach staff how to administer medication and
observe Individuals self-administering medication in Supervised Group Living Homes (Group
Homes) and in Supported Living settings (supporting individuals whose services are provided
through Indiana's Medicaid Waivers).
Originated with the primary focus on medication administration within residential
facilities (group homes) per Article 1.1 Community Residential Facilities for Persons with
Developmental Disabilities, Rule 3 Conditions of Licensure 431 lAC 1.1-3-6, this curriculum
has been in use for 10 years in the same form. It is being revised for the purpose of bringing the
material up-to-date, correcting errors, strengthening weak areas, and providing an improved
format and teaching tool. It is what is considered essential for all Staff. Education and Training
Resource (ETR) has received suggestions from licensed nurse instructors across the state. Based
on this information, portions of the curriculum have been revised. Staff persons must be
thoroughly trained to meet the unique needs of each individual in their care. In some cases, that
will mean that you will have to teach certain staff more than this minimum core of material.
When individuals living in a group home setting are present, there must be a staff
member present who is at least trained in Core A of this curriculum and has demonstrated
competence as outlined below. This also includes times when the individuals living in the group
home are not scheduled to take prescribed medications.
The Living in the Community curriculum must be taught, in person, by a licensed nurse.
The curriculum is divided into two parts: Core lessons and Supplemental lessons. The Core
lessons are further divided into Core A and Core B.
Core A must be passed with a minimum score of 85% before a staff member may
administer medication or observe individuals self-administering medication. In addition, staff
must demonstrate all steps of medication administration (tablets and liquids) with 100%
accuracy. Training on administering any other fonn of medication must be given to each staff
member prior to administering that form of medication. Observation of satisfactorily
administering that fonn of medication is also required. See lesson 5. Core A consists of the
following lessons:
1. Asepsis, Universal Precautions, and AIDS
2. Responsibilities in the Area of Medication Administration
3. Principles of Administering Medications
4. Documentation
5. Administering Medications
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Core A must be passed before taking Core B. Core B must be passed with a minimum
score of 85% within the first 120 days of employment for a staff member to continue to
administer medications or observe individuals self-administering medications. Core B consists of
the following lessons:
6. Fundamentals of Pharmacology
7. Inflammation and Infection
8. Psychotherapeutic Medications
9. Developmental Disorders
Most of the Core lessons are divided into two parts: core information, which is required
material, and supplemental information that is important. There is a final Core A test and a final
Core B test that each staff member will be required to take and pass with a score of 85%. Each
Core must be passed with a score of 85%. The scores from Core A and Core B may not be
combined for a total score.
The Supplemental Lessons 1 through 13 are provided for use according to agency
discretion. The information is provided so that the staff may be trained on material that is
pertinent to the needs of each individual receiving medication. If the individual receiving the
medication has needs that are not addressed by the Core or Supplemental Lessons, then you will
have to find other supplemental material to use to train the staff.
Only those group home and supported living providers who are authorized by the Bureau
of Developmental Disabilities Services (BDDS) can purchase a packet of testing materials from
ETR. The security of the test is entrusted to the licensed nurse instructors of the group home or
supported living provider agencies. Copies of all completed tests must be destroyed. Only test
scores may be retained by the staff member, agency, or licensed nurse instructor.
In order to achieve, as nearly as possible, complete understanding of the Core materials,
the licensed nurse instructor should review the material missed on the test with each student staff
member or with the class. The completed tests should not be passed back and specific questions
should not be reviewed.
Others who purchase the curriculum, that are not BDDS approved group home or
supported living providers, will not be permitted to purchase the test packet. Because it is
recognized that staff working with individuals in community settings other than group homes can
also benefit from training in this curriculum, it has recently been decided that approved providers
who provide supported living services, but not group home services, may also use this
curriculum and purchase the competency testing materials. Group home providers who also
provide supported living services are encouraged to train all of their staff in this curriculum. This
would achieve uniform medication administration training for all staff working in community
residential settings and the staff would be prepared to work in any setting.
Provider agencies in states other than Indiana are also welcome to purchase this
curriculum. However, they will not be permitted to purchase the test packet regardless of the
programs they operate.
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A staff member may take the test two times (alternate test forms are provided). If the staff
member fails after the second time, the course must be repeated.
No assistance can be given to the student staff member taking the tests. No one may read
the test to a student staff member or write any answers for them. The ability to read and write
adequately in English is crucial for administering medication or observing individuals self-
administer medications.
A certificate of completion is to be given by the group home or supported living provider
agency if a score of at least 85% is achieved on the final tests for Core A and B and if
observation by the licensed nurse instructor verifies that the student staff member can
satisfactorily, with 100% accuracy, administer oral tablets, capsules, and liquids. The scores
should be recorded on the back of the certificate. Never place the scores on the front of the
certificate. Record the test scores in this manner.
Core A: Number of correct divided by number of questions = the score expressed in a
percentage
Core B: Number of correct divided by number of questions = the score expressed in a
percentage
Observation of 100% satisfactory medication administration of oral tablets, liquids, and
capsules (signature of licensed nurse instructor and date)
A copy of the front and back of the certificate will be kept in the personnel file ofthe
staff member. The certificate is to be kept by the staff member and may be used in the case of a
change of employment to another group home provider to let the licensed nurse instructor know
that the materials have been completed.
If a BDDS approved group home or supported living provider accepts the training
provided by a previous BDDS approved group home or supported living provider, instead of
requiring that a new employee be trained again in the curriculum at their agency, the new
provider employer should copy the certificate and scores for the personnel file as indicated
earlier. The new provider employer should still train the staff member on their own forms and
policies and do any other training needed to work with each individual for whom they will be
caring.
There is no specified requirement for keeping staff competent in the area of medication
administration after their initial training. Each agency must decide what training, in-servicing,
observations and so on are necessary to maintain staff skills, resident health, and to prevent
injury.
END
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Vlll
Living in the Community
CoreA
Lesson 1
Asepsis, Univers .•.•.•. cautions, and
I.· .• ·'~~. ~ous Diseases
1
Core Lesson 1: Asepsis, Universal Precautions, Infectious Diseases
ASEPSIS, UNIVERSAL PRECAUTIONS, AND INFECTIOUS
DISEASES
• after touching objects that are likely
Key Terms to be contaminated by body fluids or
AIDS Aseptic excretions;
Antiseptic Disinfectant
• before giving or applying
Friction Hepatitis
medication or ointment;
Medical asepsis Rotary motion
Tuberculosis • after removing gloves used for any
Universal precautions purpose.
Universal precautions are to be
Precautions must be taken to ensure observed when coming in contact with
that both individuals and staff remain an individual's body fluids.
healthy. The spread of disease can be cut
Aseptic.hand washing requires
dramatically by insisting that both
attention to the method and manner of
individuals and staff wash their hands.
hand washing. Hand sanitizer may be
Frequent and careful hand washing is the
used in certain situations. Ifbar soap is
most effective way to avoid spreading
used, it should be kept on a rack that
organisms that cause disease.
allows drainage of water. If liquid soap
All staff should wash their hands is used, the dispenser should be replaced
utilizing aseptic technique upon arrival or cleaned when empty; never add
to work or after handling infectious liquids to a partially full dispenser.
materials without the use of personal Disposable single use towels should
protective equipment (gloves). In the always be used to dry hands instead of
absence of a true emergency, personnel common use towels.
should wash their hands with soap and
Universal precautions should be
water or a hand sanitizer for at least 30
taken to protect both you and the
seconds (one may recite the alphabet to
individual. Avoid direct skin contact
himself/herself while washing), utilizing
with mucous membranes, bodily fluids,
friction, from the wrists down. Hands
secretions, excretions, and wounds. Any
should be washed:
open place on your skin, even very small
• before and between caring for each ones, can become an entry site for the
individual; infection. Wearing gloves when you are
likely to have contact with blood, body
• before and after touching wounds;
fluids, or objects that could be
• after contact with mucous contaminated with blood will offer
membranes, blood, body fluids, or sufficient protection. If there is a risk of
excretions; splashing or spraying of infectious
materials, protective eye goggles and a
surgical mask should also be worn.
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