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CHCCS305A Assist clients with medication

Reading 3: Assist/support client with administration of medication

Reading 3: Assist/support client with administration of medication 1

Introduction 4

Remind and prompt client to take medication at correct time 4

Assist clients with administration of medications as required in accordance with legislation, organisation policies and the level of support needed as identified in their care/support plan 5

Supervise and observe clients when taking medication and confirm with them their ingestion or completion 6

Complete documentation/record of medication administration according to organisation procedures 7

Observe client for any changes in condition and seek assistance from a health professional, supervisor, medical officer or emergency services as indicated in the organisation’s policies 8

Discard waste products according to organisation procedures and/or manufacturer’s instructions 9

Introduction

In this topic you will be looking at your role in assisting/supporting the resident with administration of medication. More specifically, you will examine the procedures and necessary checks that must take place to ensure that assistance/support with administration of medication is conducted in a safe and effective manner.

Remind and prompt client to take medication at correct time

Doctors and pharmacists will normally prescribe medications to be taken at specific times for a reason, for example:

· before food, after food, or with food

· four times a day but no closer than four hours between each dose

· immediately before going to bed at night.

The right time to give a medication is based on a knowledge of the desired effects of the medication, the characteristics of the drug, its possible interactions with other drugs and the individuals daily schedule. Aged care or health support workers should know why a medication is ordered at a certain time of the day. Medication times should not be altered without prior consultation with the prescribing practitioner. It is the aged care or health support workers responsibility to assist with medication administration as prescribed.

Some medications require a constant level of the medication in the blood stream for it to be therapeutic. It medications are not taken at the correct time it could place the resident at unnecessary risk or cause them distress (eg an anticonvulsant may be ordered twice a day at 0800 and 2000. If it is administered too early, eg at 1800, it may result in seizure activity in the early hours of the morning).

It is essential that clients follow these instructions to ensure that they gain the most benefit from their medication and reduce problems associated with side effects, overdose and drug interactions. You need to check with the client how often a medication is taken or applied and when they last took the medication. If you know that a resident needs to take the medication at 1300 and they are out in the garden you need to remind them that their medication is due.

Assist clients with administration of medications as required in accordance with legislation, organisation policies and the level of support needed as identified in their care/support plan

When you assist a resident with medication administration it must always be done in accordance with you facility policies, procedures and guidelines and with the relevant legislation.

Relevant legislation can be:

· Aged Care Act 1997

· Poisons and Therapeutic Goods Act 1966

· Poisons and Therapeutic Goods Regulation 2008

· Disability Services Act 1993 (NSW).

Go to NSW Government’s Legislation page at: http://www.legislation.nsw.gov.au to look at the above pieces of legislation.

Facility policies in regard to administration of medications will include such things as:

· identification of resident

· staff recognition

· response by the resident to being called by their name

· confirmation of resident by other staff members, by family or friends

· what to do if a resident who is self medicating does not identify themselves

· checking with the resident the amount of medication to be taken, the route and the time for medication.

The resident’s care plan must be checked before each episode of medication giving as to what level of support the resident needs. This support may involve:

· unscrewing the cap of a bottle

· ‘popping’ the medication from the blister pack

· dissolving the medication in water

· measuring a liquid medication into a measuring cup

· crushing of dividing tablets where indicated by the pharmacist or doctor

· placing the medication into a nebuliser

· adjusting resident’s posture.

Supervise and observe clients when taking medication and confirm with them their ingestion or completion

When assisting a client with self-medication it is important to observe the complete ingestion of the medication. If the medication is not ingested completely this will result in the medication not having the desired effect and as a consequence could have serious effects for your resident.

A resident may spit out the medication. You may be able to encourage them to take it again so long as it is intact. If the resident still refuses and spits out the medication again keep the medication to show your supervisor that it has not been ingested.

If after trying three times to encourage your resident to take their medication completely and they still refuse then you must record it on the medication chart and report it to your supervisor.

Sometimes incomplete ingestion can occur because of difficulties in swallowing whole tablets. If this is the case you should discuss with your supervisor if the tablet is able to be divided or crushed. Under NO circumstances should you divide or crush a medication without authority.

Other circumstances that can be defined as incomplete ingestion are vomiting and refusal to take medications.

Vomiting may occur after taking a medication and could happen instantly, or up to two or three hours afterwards. The resident may vomit for a number of reasons; it could be because the medication itself is causing nausea and vomiting, or because of an acute condition that is unrelated to the medication, such as gastroenteritis. In these circumstances the resident should be assessed by the doctor or registered nurse.

If a resident refuses to take their medications, as an aged care or health support worker, you should remain mindful of the fact that the resident does have a right to refuse to take their medications and it may be necessary for the doctor to discuss this with the resident to help determine if there is a possible resolution that meets their needs.

There are special exceptions to the right to refuse medication for people who are deemed to be unable to make sound judgements about their own health care needs. These exceptions are included in the relevant State or Territory Acts, for example the Mental Health Acts, Guardianship Acts and Public Health Acts.

Complete documentation/record of medication administration according to organisation procedures

All facilities have requirements to document information. This enables nursing and care staff, doctors, allied health workers such as physiotherapists and any other authorised parties to have access to a record of what has occurred with a particular resident. Documentation is required by legislation on all aspects of a resident’s care.

Report and record

All care facilities are required to keep a record of the medications that clients are self-administering.

Aged care or health support workers will be required to report and record their observations during the provision of assistance with self-medication. This may mean entering information into a medication chart, initialling a medication card or writing a short report into the client’s general care record.

The facility will provide you with exact instructions on your reporting requirements.

In some facilities you may be required to report/record:

· that the medication was observed to be swallowed, taken or applied in the appropriate manner

· that you witnessed the client self-administer medications from a dose administration aid

· any change in the client’s condition, reactions to medications, complaints of side effects or adverse drug reactions

· any refusal to take medication

· any changes in the client’s ability to self-medicate

· any difficulties with the self-medication process, for example, unable to swallow whole tablets

· any inconsistencies that arise, for example, medication errors or near-miss medication errors.

When the client self-administers ‘when required’ (prn) medication, aged care or health support workers may need to record the times and dosage of the medication taken on the medication chart and record why the medication was taken, and the outcome. For example:

‘Client self-administered medication ‘X’ 500 mg at 10:30 am stating that it was for pain relief. At 12.00pm client states that the pain has decreased’

In some facilities clients may be required to sign their own medication chart stating that the self administration event had taken place.

Observe client for any changes in condition and seek assistance from a health professional, supervisor, medical officer or emergency services as indicated in the organisation’s policies

There are many possible changes that you may observe in your client’s condition that must be immediately reported to a supervisor or health professional and these changes are noted below.

As a aged care or health support worker you are required to observe, report and record any change in the client’s condition eg therapeutic effects of medication, any side effects of medication, any adverse drug reactions.

Observe, report and record any changes in the client’s condition

The aged care or health support worker should observe the client for any change in condition after taking medication. Because medications can work either quickly or slowly on the body, reactions to medications may present within minutes or over several hours in time.

Where possible you should note if the therapeutic effect of the drug has taken place. For example, the asthma medication has assisted with the return of effective breathing, the sleeping tablet has enabled the person to rest and sleep, the client reports that the analgesia has reduced or removed the feelings of pain and discomfort.

Because all medications can have different effects on different people, it is difficult to provide a comprehensive list of the types of changes in condition that can occur with medications.

In general, you should closely observe the client for any of the following changes:

· changes to airway (choking)

· changes to breathing (slowed, fast or absent breathing)

· changes to circulation (altered pulse rate, altered blood pressure, complaints of chest pain or palpitations, loss of consciousness and absence of pulse)

· changes in resident’s colour (eg pale or flushed appearance or bluish tinge)

· changes to the skin (colour, redness, rash, swelling)

· feelings of dizziness, slurred speech, unexpected drowsiness, blurred vision, confusion, disorientation, headaches, nausea or vomiting

· any unexpected change in behaviour

· any other change in condition that is uncharacteristic for the individual client

· others as advised by a doctor or health professional.

Any change in the client’s condition must be reported to a supervisor and recorded in the client’s care record.

Clients may need close observation, first aid and/or medical intervention if changes to airway, breathing or circulation are experienced.

Discard waste products according to organisation procedures and/or manufacturer’s instructions

Your facility will have a policy and procedure that you are to follow when dealing with waste.

/ When disposing of waste products you must follow standard precautions at all times.

Any waste or equipment that is labelled ‘use once only’ should be discarded in the appropriate disposal unit or waste bin. Equipment or items that you use whilst assisting a client with self-medication that will need to be disposed of includes:

· spoons

· medicine cups

· gloves

· paper towel

· tissues

· cotton wool.

/ If your client/resident vomits during the administration of medication you should inspect the vomitus before discarding to see if any medication is present. If there is any evidence of medication report it to your supervisor.
/ Be sure to wear gloves during disposal of the vomitus.

For further reading on OHS refer to OHS Policy – Resource Sheet 1 in the Victorian Government – department of Human Services – Public Health Sector’s Occupational Health and Safety Management Framework Model at: http://www.health.vic.gov.au/ohs/policy.htm

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