Assessment of Resident S Ability to Manage And/Or Self-Administer Medications

MEDICATION ADMINISTRATION BY THE RESIDENT

ASSESSMENT OF RESIDENT’S ABILITY TO MANAGE AND/OR SELF-ADMINISTER MEDICATIONS

Policy

Each resident who desires to manage and/or self-administer his/her own medications is assessed to determine if that practice is safe.

The resident’s ability to continue to safely manage and/or self-administer medications is evaluated at least annually,as required by applicable state regulations, or more often if there is significant change in the resident’s physical, cognitive, or sensory status.

Assessments are conducted by the resident’s physician in collaboration with other qualified, licensed, health professional (e.g., registered nurse, care coordinator, consultant pharmacist), or as required by applicable state regulations.

Procedures

A.Upon entry into the ALC, at least annually,and more often if there is a significant change in the resident’s physical, cognitive, or sensory status, the resident’s ability to manage and/or self-administer his/her own medications will be assessed by the resident’s physician in collaboration with other designated qualified, licensed health professionals (e.g., registered nurse, care coordinator, consultant pharmacist), or as required by applicable state regulations.

B.An assessment is conducted of the resident’s cognitive, physical, and visual ability to order, manage and/or self-administer medications.

1)Cognitive function can be assessed using the Mini Mental State Exam or equivalent.

2)Physical and visual ability assessment requires an observational technique.

C.A skills assessment should be conducted to determine the resident’s ability to manage and/or self-administer medications by observing the resident taking his/her own medications. Skills assessment should include the following or as required by applicable state laws.

1)The resident is informed of the medication’s purpose, and is given an overview on reading the label, scheduling medication doses, and how to open the prescription package or container.

2)The resident is then asked to read the label on each prescription and indicate how much of the medication should be taken, at what time the medication should be taken, and any other special instructions for use.

3)The resident is asked to remove the medication from the package or container. For liquid dosage forms, the resident should be observed pouring the prescribeddose.

4)The resident is asked to self-administer the medication.

5)The resident should be observed to ensure that oral solid and liquid dosage forms are swallowed, sublingual dosage forms are dissolved under the tongue, and orally disintegrating tablets are dissolved in the mouth.

6)For inhalers, the resident should be observed to ensure proper preparation and administration technique.

7)For topicals, including ophthalmic drops and ointment, and transdermal patches, the resident should be observed for the proper application technique.

8)For injectables such as insulin, the resident should be observed for proper technique to draw the correct amount of insulin into the syringe and inject the insulin into subcutaneous tissue.

D.The resident’s ability to continue to safely manage and/or self-administer medications is evaluated at least annually, as required by applicable state laws, and more often if there is a significant change in the resident’s physical, cognitive, or visualstatus. The resident demonstrates, to the satisfaction of the person performing the assessment:

1)Knowledge of intended medication use.

2)Ability to recognize the medication.

3)Ability to read the label on the medication container.

4)Knowledge of the correct times to take the medications.

5)Ability to produce all currently used medication containers, which reflect the current prescribed orders.

6)Proper storage of all medications.

7)Sufficient manual dexterity to accurately self-administer the medications.

8)Ability to order medications.

Related Appendices

Appendix 24: Self-Administration of Medications, Evaluation of Resident's Ability

RESIDENT MANAGEMENT AND SELF-ADMINISTRATION OF MEDICATIONS

Policy

Each resident who desires to manage and self-administer his/her own medications is permitted to do so if it is determined that the practice is safe for the resident, and the practice adheres to applicable state laws and regulations.

Procedures

A.Residents who manage and self-administer his/her own medications may be offered the services of a consultant pharmacist upon entry into the ALC and at least annually thereafter or as required by applicable state regulations.

B.Residents who are evaluated tosafely manage and self-administer their own medications will be permitted to keep their medications in a designated locked area in their own apartment/room, per the policy and procedures for medication storage in the resident apartment/room.

C.All current medications and dosage schedules are listed in the resident’s Medication Record (MR). The resident’s MR will be kept in a central location at the ALC.

Related Appendices

Appendix 20: Medication Record

Related Policies

Assessment of Resident’s Ability to Manage and/or Self-Administer Medications (Chapter 9)

Consultant Pharmacist Services (Chapter 2)

Medication Records (Chapter 8)

Medication Storage in Resident Apartment/Room (Chapter 6)

OVERVIEW OF RESIDENT SELF-ADMINISTRATION OF MEDICATIONS WITH ASSISTANCE FROM ASSISTED LIVING COMMUNITY STAFF

Residents’ needs may vary considerably in terms of the level of oversight or assistance required to self-administer medications. The nature and extent of medication assistance provided by the ALC is governed by state laws and regulations and the specific medication services provided by the ALC.

The following policy uses the term “Medication Assistance” to describe the variety of medication services provided by the ALC, including reminding the resident to take his/her medications, monitoring resident self-administration of medications, or assisting resident with self-administration of medications. The exact nature of the services provided by the ALC for different levels of medication assistance and the terminology used to describe them should be specified and defined in the final policies and procedures and be in compliance with applicable state laws and regulations.

For example:

A.“Reminding” may include telling the resident when it is time to take a medication, or reminding the resident when it is time to reorder a medication from the pharmacy.

B.“Monitoring” may include supervising self-administration; observing the resident to ensure that the medication is taken at the proper time and that all medications due are taken; checking for adequate supply of medications; and observing for signs and symptoms of common side effects and adverse effects.

C.“Assisting” may include identifying which medications are due to be taken at a specific time; bringing the medication to the resident; reading container labels; verifying the resident’s name on the label; verifying the correct medication; checking the dosage; assisting the resident with opening medication containers; opening medication containers; handing the medication to the resident; positioning the resident; preparing medications for resident self-administration at a specific time; placing containers with medications to the mouth of the resident; applying medication upon request; disposing of used supplies; and storing medications. Assisting may also include helping a resident to fill a new prescription or refill an existing one.

Refer to your state assisted living regulations, as these definitions vary from state to state.

Regardless of the level of medication assistance provided by the ALC, staff responsible for medication assistance must be adequately trained to do so. Some states have specific training requirements for ALC staff who assist with the administration of medications. In general, at a minimum, staff assisting with resident self-administration should be familiar with:

A.The names of medications commonly used by the population served and their intended uses.

B.Common side effects of specific medications.

C.Common drug interactions.

D.Signs and symptoms of adverse medication effects.

E.The five “Rs” of medication administration: Right drug, right dose, right resident, right route of administration, and right time of administration.

F.Metric and apothecary systems of measurement, and measures of equivalence.

G.Common medical and pharmacy abbreviations.

H.Proper medication administration techniques.

I.Infection control procedures, including proper hand washing techniques.

J.ALC medication policies and procedures.

RESIDENT SELF-ADMINISTRATION OF MEDICATIONS WITH ASSISTANCE FROM ASSISTED LIVING COMMUNITY STAFF

Policy

Each resident who desires to self-administer his/her own medications, with assistance by ALC staff, is permitted to do so if it is determined that the practice would be safe for the resident.

Medication assistance will be provided by ALC staff, in accordance with applicable state laws and regulations.

Personnel authorized to assist residents who self-administer medications may do so only after they are adequately trained in the techniques of medication administration, and are familiar with the medications to be administered.

Procedures

A.Residents who self-administer their own medications, with assistance from the ALC, may have their drug regimens reviewed by the consultant pharmacist at least quarterlyor as required by applicable state regulation.

B.Residents who receive medication assistance from the ALC will have their medication stored in a designated, locked area in their apartment/room, or have their medications stored in a centrally located secured medication storage area.

C.All current medications and dosage schedules are listed in the resident’s MR. The resident’s MR will be kept in a central location and updated as changes to the resident’s medication regimen occur.

STAFF PROCEDURES FOR MEDICATION ASSISTANCE

A.Hands are washed thoroughly prior to assisting any resident who self-administers medications using appropriate hand washing techniques. Hands must be washed any time that the resident or medication containers are touched.

B.Unless otherwise specified by the physician, routine medications are taken according to the established medication administration schedule for the ALC.

C.Review the resident’s MR and note the time(s) that medications are due to be taken.

D.Note any discontinued or changed orders or allergies prior to assisting the resident with self-administration of medications.

E.Medications are taken within a two (2) hour window (1 hour prior to 1 hour subsequent) of the scheduled time, except medications to be given with food, or before or after meals, which are taken precisely as ordered. If there is a question about the specific time a medication should be given, consult with the consultant pharmacist or pharmacy provider.

F.Check the label on the medication vial or container to ensure that the medication is for the resident. Medications supplied for one resident are never to be taken by another resident.

G.Before the resident takes his/her medication, the medication and dosage schedule on the resident’s MR is compared with the medication label. If the label and MR are different or if there is any other reason to question the dosage or directions, this should be reported to theDirector of Nursing or designee immediately prior to the resident taking the medication. Medications should not be taken until the situation is clarified.

H.Before the resident takes his/her medication, the medication in the medication reminder/adherence device or multi-medication package is compared to the resident’s MR. If there is a discrepancy between the MR and the number of doses in the reminder device, this should be reported to the Director of Nursing or designee immediately, prior to the resident taking the medication. Medications should not be taken until the situation is clarified.

I.Obtain and record any vital signs (e.g., pulse, blood pressure) as ordered by the physician/prescriber prior to the resident taking the medication. If a medication is “held” because the vital signs were outside the stated parameters, circle the time in the correct space on the MR, write “held” and the reason (i.e., P<60), and initial. If more than two (2) consecutive doses are held, report this to the Director of Nursing or designee for follow-up with physician/prescriber and/or family/responsible party.

J.If a resident has difficulty removing the cap from the prescription bottle, staff may assist with the removal of the cap if the resident identifies the medications to be taken. Resident may request non-child resistant caps from the pharmacy.

K.Assist with preparation of medications for resident self-administration.

1)See Appendix 37Medication Administration–Specific Procedures for correct techniques to administer different dosage forms.

L.When a resident is receiving medications in liquid form that require precise measurement, devices provided by the manufacturer or obtained from the pharmacy provider are used to allow accurate measurement of doses.

M.Staff will give the resident the medication from the medication container, either directly or by placing the medication into a medication cup; medication will not be touched by staff.

N.Staff will give the resident the medication from the correct day and time of the medication reminder device, either directly or by placing the medication into a medication cup; medication will not be touched by staff.

O.Disposable containers (i.e., medication cups) used for medication administration are never reused.

P.Observe the resident taking the medication.

Q.Medication administration is documented on the resident’s MR by the person assisting with resident self-administration at the time the medication is taken, including an explanation if the medication was not taken.

R.The resident’s MR is initialed by the person assisting the resident with self-administration in the space provided under the date and on the line for the specific medication. Initials on each MR are verified with a full signature in the space provided.

S.If a dose of a regularly scheduled medication is refused by the resident, circle the time in the correct space on the MR, write “Ref,” and initial. If more than two (2)consecutive doses are refused, report this to the Director of Nursing or designee for follow-up with physician/prescriber and/or family/responsible party. If the medication was not taken, staff should circle their initials then document the reason for the missed medication on the reverse side of the MR, or make special notation in the electronic MR.

T.Assisting with resident self-administration of PRN (i.e., as needed) medications is done only by designated, authorized ALC staff or the family/responsible party. When medications are taken “as needed,” the following documentation is provided:

1)Date, time, dose, and route of administration.

2)Complaints or symptoms for which the medication was taken.

3)Results achieved from taking the dose and the time results were noted.

4)Signature and initials of person recording administration and effects.

U.If it appears that the resident is unable to self-administer medications safely, staff will report this immediately to the Director of Nursingor designee for consultation with the physician/prescriber to assess discontinuation of self-administration order.

V.The physician/prescriber, family/responsible party, and the Director of Nursing or designee is notified of any adverse effects that occur.

Related Appendices

Appendix 20: Medication Record

Appendix 22:Medication Pass Schedule (Sample)

Appendix 22a: MedicationPass Schedule (Blank)

Appendix 23:Medications and Their Relationship to Food

Appendix 37: Medication Administration — Specific Procedures

Related Policies

Adverse Medication Reactions (Chapter 11)

Consultant Pharmacist Services (Chapter 2)

Medication Records (Chapter 8)

Medication Storage in Resident Apartment/Room (Chapter 6)

Pharmacy: ROCKHILL LTC PHARMACYEffective Date: 03/01/2016

The ASCP Pharmacy Policy and Procedure Manual for Assisted Living