Assisting With Medications

Assisting With Medications

 

OBJECTIVES:

At the end of the class you will be able to:

  1. Apply some laws relating to assisting with medicines and what a nursing assistant can or cannot do.
  2. Relate several route procedures and some age related route and form considerations.
  3. Describe how medicine indications, contraindications, interactions, side effects, adverse reactions, dosages, proper storage and disposal as well as the components of a complete label and a complete MD order impact on assisting with medicines.
  4. Recognize acceptable abbreviations and their meanings.
  5. List and apply the 7 "rights of medication administration" (right medicine, patient, time, dose, route, form, and documentation)
  6. Summarize the uses, contraindications, side effects and implications of common medication classifications.
  7. Apply infection control principles to assisting with medications.

INTRODUCTION

 

Several states across the U.S. let unlicensed assistive personnel (UAP), such as nursing assistants, to assist and help people with their medicines. Assisting is not giving medicines. Assisting is simply helping the person to take their own medicines.

 

LEGAL ISSUES

 

Florida State Statute (Chapter 465.003) states that "administration means the obtaining and giving of a single dose of medicinal drugs by a legally authorized person to a patient for her or his consumption." (Florida State Statute, 2010)

Florida State Statute (Chapter 400.488) lists what assisting with the self-administration of medicines is and the laws about it when the person is cared for in their own home.

 

Florida State Statute (Chapter 400.4256) lists what assisting with the self-administration of medications is and the laws about it when the person is cared for in an assisted living home

 

"(1) For purposes of this section, the term:

(a) "Informed consent" means advising the patient, or the patient's surrogate, guardian, or attorney in fact, that the patient may be receiving assistance with self-administration of medication from an unlicensed person.

(b) "Unlicensed person" means an individual not currently licensed to practice nursing or medicine who is employed by or under contract to a home health agency and who has received training with respect to assisting with the self-administration of medication as provided by agency rule.

(2) Patients who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription's label or the package directions of an over-the-counter medication, assist a patient whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. Assistance with self-medication by an unlicensed person may occur only upon a documented request by, and the written informed consent of, a patient or the patient's surrogate, guardian, or attorney in fact. For purposes of this section, self-administered medications include both legend and over-the-counter oral dosage forms, topical dosage forms, and topical ophthalmic, otic, and nasal dosage forms, including solutions, suspensions, sprays, and inhalers.

(3) assistance with self-administration of medication includes:

(a) Taking the medication, in its previously dispensed, properly labeled container, from where it is stored and bringing it to the patient.

(b) In the presence of the patient, reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container.

(c) Placing an oral dosage in the patient's hand or placing the dosage in another container and helping the patient by lifting the container to his or her mouth.

(d) Applying topical medications.

(e) Returning the medication container to proper storage.

(f) Keeping a record of when a patient receives assistance with self-administration under this section.

(4) assistance with self-administration does not include:

(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.

(b) The preparation of syringes for injection or the administration of medications by any injectable route.

(c) administration of medications through intermittent positive pressure breathing machines or a nebulizer.

(d) administration of medications by way of a tube inserted in a cavity of the body.

(e) administration of parenteral preparations.

(f) Irrigations or debriding agents used in the treatment of a skin condition.

(g) Rectal, urethral, or vaginal preparations.

(h) Medications ordered by the physician or health care professional with prescriptive authority to be given "as needed," unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent patient.

(i) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.

(5) assistance with the self-administration of medication by an unlicensed person as described in this section does not constitute administration as defined in s. 465.003.

(6) The agency may by rule establish procedures and interpret terms as necessary to administer this section." (Florida State Statute, 2004)

 

Florida State Statute (Chapter 400.4256) lists what assisting with the self-administration of medications is and the laws about it when the person is cared for in an assisted living home.

 

"(1) For the purposes of this section, the term:

(a) "Informed consent" means advising the resident, or the resident's surrogate, guardian, or attorney in fact, that an assisted living facility is not required to have a licensed nurse on staff, that the resident may be receiving assistance with self-administration of medication from an unlicensed person, and that such assistance, if provided by an unlicensed person, will or will not be overseen by a licensed nurse.

(b) "Unlicensed person" means an individual not currently licensed to practice nursing or medicine who is employed by or under contract to an assisted living facility and who has received training with respect to assisting with the self-administration of medication in an assisted living facility as provided under s. 400.452 prior to providing such assistance as described in this section.

(2) Residents who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription's label or the package directions of an over-the-counter medication, assist a resident whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. assistance with self-medication by an unlicensed person may occur only upon a documented request by, and the written informed consent of, a resident or the resident's surrogate, guardian, or attorney in fact. For the purposes of this section, self-administered medications include both legend and over-the-counter oral dosage forms, topical dosage forms and topical ophthalmic, otic, and nasal dosage forms including solutions, suspensions, sprays, and inhalers.

(3) assistance with self-administration of medication includes:

(a) Taking the medication, in its previously dispensed, properly labeled container, from where it is stored, and bringing it to the resident.

(b) In the presence of the resident, reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container.

(c) Placing an oral dosage in the resident's hand or placing the dosage in another container and helping the resident by lifting the container to his or her mouth.

(d) Applying topical medications.

(e) Returning the medication container to proper storage.

(f) Keeping a record of when a resident receives assistance with self-administration under this section.

(4) assistance with self-administration does not include:

(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.

(b) The preparation of syringes for injection or the administration of medications by any injectable route.

(c) administration of medications through intermittent positive pressure breathing machines or a nebulizer.

(d) administration of medications by way of a tube inserted in a cavity of the body.

(e) administration of parenteral preparations.

(f) Irrigations or debriding agents used in the treatment of a skin condition.

(g) Rectal, urethral, or vaginal preparations.

(h) Medications ordered by the physician or health care professional with prescriptive authority to be given "as needed," unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent resident.

(i) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.

(5) assistance with the self-administration of medication by an unlicensed person as described in this section shall not be considered administration as defined in s. 465.003.

(6) The department may by rule establish facility procedures and interpret terms as necessary to implement this section." (Florida State Statute, 2010)

 

Florida State UAPs can NOT assist with:

  • shots,
  • rectal routes,
  • vaginal routes,
  • urethral routes, or
  • IPPB or nebulizers.

If you work in another State, check with your own State to find out what you can and cannot do.

 

ROUTES AND FORMS OF MEDICINES

 

Medicines are made in many forms and for many routes. Some medicines come in more than one form. Some can be given with more than one route, if the correct form is used.

 

Complete medicine orders must state the route and the form that the patient must take.

 

FORMS

 


 

 

Medicines can come in these forms:

  • tablets
  • capsules (regular and sustained release)
  • elixirs
  • suppositories (vaginal and rectal)
  • oral suspensions
  • syrups
  • tinctures
  • ointments
  • pastes
  • creams
  • drops (eye)
  • IV suspensions and solutions
  • metered dose inhalers

ROUTES

 

 

 


 

 

 

 

Routes can be:

  • oral
  • buccal (inside cheek)
  • sublingual (under the tongue)
  • topical (on the skin)
  • ophthalmic (eye)
  • otic (ear)
  • vaginal
  • rectal
  • nasal
  • via a nasogastric or gastrostomy tube
  • inhalation
  • subcutaneous (under skin)
  • intramuscular (in the muscle)
  • intradermal (in the skin)
  • transdermal (through the skin)
  • intravenous (into the vein)



 

 

 

 

 

 

 

COMPLETE ORDERS

 

 

 

 

 

A doctor or another person, like a nurse practitioner, must write a complete and legible order for a medicine before it is given or taken.

 

A complete order must have the:

  • date of the order,
  • the time of the order,
  • name of the medicine,
  • dose,
  • route,
  • form,
  • time or frequency that it should be taken, and
  • signature of the MD or nurse practitioner.

LABELS

 

All labels must have the:

  • patient or resident name,
  • name of the medicine,
  • strength of the medicine,
  • how much to take,
  • route,
  • form,
  • when to take it,
  • date of the order,
  • date that the bottle or container was filled,
  • date that it expires and can no longer be used,
  • the name of the person who ordered it, and
  • any special instructions, such as keep out of light.

ROUTE AND FORM CONSIDERATIONS

 

The oral route is the best route for children. When a patient has a problem with swallowing, as many older people have, the following things may be done.


  • Crushing. Crushing the pill or opening the capsule and putting it in something like applesauce can help. Time release capsules, some coated tablets, effervescent tablets, medicines that upset the stomach, bad tasting medicines and sublingual medicines (those placed under the tongue) can NOT be opened or crushed. Check with the supervisor to find out if a medicine can be crushed.
  • Using a liquid form. Using a liquid form can also help people who have trouble with pills and capsules.

AGE SPECIFIC ROUTE AND FORM CONSIDERATIONS

 

Infants

  • Use a syringe, dropper or nipple for oral liquid medicines.


Toddler

  • Use a spoon or a cup for liquid oral medicines.

Preschool and School Age Children

  • Most children in these age groups are able to take capsules and tablets.

Adolescents

  • Adult dosages, routes and forms of medicines are usually now allowed.

WHAT A UAP CAN ASSIST WITH IN FLORIDA

 

In the State of Florida, you can assist with ordered prescription and over-the-counter medicines with the following routes:

  • oral,
  • topical,
  • topical ophthalmic,
  • otic, and
  • nasal.

HOW TO TAKE SOME MEDICINE ROUTES

 

You must be able to observe the patient or resident for the correct self-administration procedure. Below are routes that you can assist with, in the State of Florida. But, check with your employer to make sure that you are able to help with these routes before you do it.

For each of these procedures, the UAP can do only the steps NOT marked with a star (*). Steps with a star (*) can only be done by the person who is taking the medicine. As with all care, the person should do as much as they can for themselves. Assist only with the steps that the person needs help with.

 

Topical (Skin Surface)

Do not use on skin that is not intact unless, of course, the medicine is being used to treat broken skin. The procedure for using this route is:


  1. Open the tube.
  2. Place the top upside down to keep it clean.
  3. Put on gloves. (Both the UAP and the patient)
  4. Put the medicine on a tongue depressor. Use a cotton tipped applicator or sterile gauze for the face.
  5. Apply it in long strokes going with the direction of the hair growth. *

Transdermal

  1. Remove the old patch if there is one.
  2. Wash the area with soap and water.
  3. Find a place that has no hair on the person's upper arm or their chest.
  4. Dry the site.
  5. Put on gloves. (Both the UAP and the patient)
  6. Put the dose on the patch or strip. Do not let it touch your own skin.
  7. With the medicine down and against the skin the person should be told to gently move the strip over a 3 inch area to spread it out. Do NOT rub. *
  8. Cover with a plastic wrap or special dressing and tape it in place so that it does not fall off.
  9. Write the date, time and your initials on the cover.

 

Oral

  1. Give the patient the medicine.
  2. Remain with the patient until the medicine(s) is swallowed.

Buccal and Sublingual

 

Buccal medicines are placed between the teeth and the inside of the cheek. Sublingual medicines are taken under the back of the tongue.

  1. Give the patient the medicine.
  2. Tell the person to put the medicine inside their cheek (buccal) or under their tongue (sublingual) until it dissolves. *
  3. Tell the patient to leave the drug in its position so that it can be completely dissolved.

Ophthalmic (Eye)

  1. Put on gloves. (Both the UAP and the patient)
  2. Help the person to a sitting position or into a supine position.
  3. Have the patient tilt their head back.
  4. Have the patient look up and away.
  5. Have the person steady their hand against their forehead with the dropper in their other hand. *
  6. Pull down the lower lid.
  7. Put the number of drops into the space under the lower eye lid. *
  8. Pull down the lower lid for an eye ointment.
  9. Tell the person to squeeze the tube so that the medicine is placed on the inside of the lower eye lid, from the inside near the nose to the outer part of the inside of the lid. Do not touch the eye with the tip of the tube. * 10.Ask the person to now close their eyes. Blinking will spread the drops and rolling the closed eyes will spread the ointment over the eye. 11.Clean the excess off with a tissue.

Otic (Ear)

  1. Warm the ear drops to body temperature.
  2. Tell the person to lie on their side so that the ear to get the medicine is up.
  3. Straighten out the ear canal by pulling the ear lobe up and back.
  4. Tell the person to place the drops against the side of the inner ear as you continue to hold the ear lobe in place until you can no see any more drops. *
  5. Have the person keep their head to the side for at least 10 minutes.

Inhalation

 

There are two different types of inhalers that administer medicines with this route. These two types are:

  • Metered-dose inhalers and
  • Turbo inhalers.

The steps for using a metered dose inhaler are:

  1. Shake the bottle and remove the cap.
  2. Ask the person to breathe out.
  3. Have the person then place their lips around the mouthpiece.
  4. Tell the person to press the bottle against the mouthpiece while the person is inhaling in long, deep and slow way.*
  5. Have the person hold their breath for a couple of seconds and then breathe out slowly.
  6. Tell the person to rinse their mouth with water and then spit it out. This prevents an infection of the mouth.

The steps for using a turbo inhaler are:

  1. Slide the sleeve away from the mouthpiece.
  2. Turn the mouthpiece counter-clockwise in order to unscrew it.
  3. Put the medicine into the stem of the mouthpiece. *
  4. Rescrew the inhaler.
  5. Slide the sleeve all the way down to puncture the capsule.
  6. Tell the person to tilt their head backwards.
  7. Tell the person to blow out all the air in their lungs.
  8. Tell the patient to then breathe in deeply and hold it for a couple of seconds while the mouthpiece is in their mouth. *
  9. Repeat steps 7 and 8 until all of the medicine has been used. *
  10. The patient can then rinse their mouth if they like.

 

 

 

INDICATIONS FOR USE

 

 

 

 

 

 

 

All medicines have special uses. Most of these uses are related to the wanted actions of the medicine. Some uses are related to a medicine's side effects.

 

For example, diphenhydramine, an antihistamine, is used for both allergies as well as for sleep because one of its side effects is drowsiness.

 

Check a drug book or with your supervisor if you have any questions about a medicine.

 

PRECAUTIONS AND CONTRAINDICATIONS

 

Some medicines are contraindicated, or not allowed to be used, for some patients. For example, a medicine can be prohibited for patients that have severe kidney or liver disease and those that are pregnant or breast feeding.

 

Other medicines may only be used with some people when they are used with caution. For example, a medicine can sometimes be used, but only with caution, for an older person. It is very important to closely observe and report the patient's responses to the medicine when it is being used with caution.

 

The most common contraindication is an allergy or sensitivity to the medicine. The patient's allergies must be known before you assist the person. If you see NKA on the patient's chart, this means that the person has no known allergies.

 

ALLERGIES

 

A rash and even a life threatening reaction can happen if a medicine is taken by a person that has an allergy to it.

 

Anaphylaxis is a very severe allergic reaction that can happen if a person is allergic to a food, like peanuts or shellfish, a substance, like latex, or a medicine like penicillin or cephalosporin. It is a medical emergency that needs immediate attention.

 

The signs are:

  • itching
  • hives
  • swelling of the throat
  • trouble breathing (dyspnea)
  • shortness of breath
  • a drop in blood pressure
  • irregular heart rhythm
  • nausea
  • vomiting
  • abdominal cramping
  • loss of consciousness
  • death

INTERACTIONS

 

Medicines can interact with:

  • other medicines
  • some foods
  • some herbs
  • lifestyle (alcohol, etc)

Information about drug-drug, drug-food, drug-herb, drug-lifestyle interactions can be found in a drug reference book like the Physicians' Desk Reference (PDR) for every medicine.

 

SIDE EFFECTS AND ADVERSE REACTIONS

 

All medicines have side effects. Nausea and vomiting are the most common side effects. Some side effects are troublesome; others can be life threatening.

Adverse drug reactions are serious and they can also lead to death.

 

Some medicines also have toxic effects. For example, tinnitus is a sign of toxicity with aspirin.

 

You must know about the side effects, adverse drug reactions and the toxic effects of all medicines your patients are taking. You must observe for and report them.

 

 

 

 

DOSES

 

All medicines have special dosages and/or dosage ranges for adults and children patients.

 

Some adult dosages may be lowered for the old person because the normal changes of the aging process make this age group more prone to side effects, adverse drug reactions, toxicity and an over dose.

 

Children get medicine with a dose that is based on how much they weigh. Generally, adolescents can safely take adult dosages.

 

ABBREVIATIONS

 

Abbreviations save time, but, they can also lead to deadly effects. Some of the abbreviations that we have been using for many, many years are now being stopped because they have led to serious errors.

 

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has these guidelines and rules.

 

Hospitals, nursing homes, assisted living facilities, and all other healthcare settings must now standardize abbreviations, acronyms and symbols that they are using. They must also make a list of all that they will not use. (Joint Commission on the Accreditation of Healthcare Organizations, 2010).

 

Commonly used and acceptable abbreviations along with their meaning are below.

ABBREVIATION

MEANING

a.c.

Before meals

ad lib

Freely

a.m.

Morning

ASA

Aspirin

b.i.d

Twice a day

BM

Bowel movement

BP

Blood pressure

BS

Blood sugar

C (with line over it)

With

Cap

Capsule

Cc

Cubic centimeter

disc or D.C.

Discontinue

disp.

Dispense

elix.

Elixir

Ext

Extract

fl or fld

Fluid

g. or Gm. or g

Gram

Gr

Grain

gtt.

Drop

h. or hr.

Hour

MEq

Milliequivalent

Min

Minute

Mg

Milligram

ML

Milliliter

NPO

Nothing by mouth

NTG

Nitroglycerin

p.c.

After meals

p.m.

Evening

p.o.

By mouth

Prn

When needed

Q

Every

Qh

Every hour

Qid

Four times a day

s (with a line over it)

Without

SOB

Shortness of breath

Sol

Solution

ss.

One half

Stat

Immediately

susp.

Suspension

Syr.

Syrup

tab.

Tablet

Tbsp

Tablespoonful

Tid

Three times a day

Tinc

Tincture

Top

Topically

tr.

Tincture

tsp.

Teaspoon

ung.

Ointment

w/

With

w/o

Without

Prohibited abbreviations, suggested alternatives and the rationale for the prohibition are shown below.

 

ABBREVIATION

Mistaken For:

Instead, write

Q.D. (every day)

Q.O.D

"daily"

Q.O.D.(every other day)

Q.D

"every other day"

(Joint Commission on the Accreditation of Healthcare Organizations, 2004).

 

 

 

 

MEDICINE GROUPS (CLASSIFICATIONS)

 

 

 

 

Medicines can be grouped according to their use or function, or the system that they treat or their chemical makeup. For example, they can be grouped according to a body system like this:

  • respiratory medicines
  • cardiac medicines
  • nervous system medicines, etc.

 

 

 

 

 

 

They can also be grouped according to their function or use:

  • nonsteroidal anti-inflammatory medicines (NSAIDs)
  • narcotic analgesics
  • antidepressants, etc.

Lastly they can be grouped according to their chemical makeup:

  • aminoglycosides
  • estrogens
  • opioids, etc.

Most of the medicines within a group are quite alike but they are not identical. Grouping helps us to see the things that are the same and the things that are different. One of the best ways to learn about a large number of medicines is to learn about groups first. You will learn about some common groups later in this class.

 

 

THE SEVEN "RIGHTS"

 

 

 

 

 

When helping a person you must check and double check that you are assisting:

  1. with the right medicine
  2. the right patient
  3. at the right time
  4. with the right dose
  5. with the right route
  6. with the right form and
  7. with the right documentation

The Right Medicine

 

Do NOT use any medicine that has a label that you cannot read. Do NOT use any medicine unless it has a complete label.

 

Read and double check the label against the medicine record at least three times and tell the person the name of the medicine before you help them. If the person says they do not get this medicine, STOP. Do not help. Report this to your supervisor.

 

It is an error if a patient takes the wrong medicine. This must be reported.

 

The Right Patient

 

 

 

 

You must check the identity of the person before you help them with their medicines. You will learn more about preventing mistakes and patient identification later in this class.

 

It is an error when a person takes another person's medicine. This also must be reported.

 

The Right Time

 

 

 

 

 

The right time is 30 minutes before and up to 30 minutes after the time on the bottle and the order. For example, a person can take their medicine anytime between 9:30 am and 10:30 am if the medicine is to be given once a day and your job says in their procedure that once a day medicines are given at 10 am.

 

It is an error if it is taken at 9 am or at 11 am. This, too, must be reported.

PRN medicines are not taken at a special time of the day. They are taken only when they are needed but not more often than the order states. For example, the doctor may order aspirin q 4 h prn for pain. This aspirin can be given when the person has pain but there must be at least 4 hours between doses.

 

The Right Dose

 

 

 

 

Check and double check the dose. Scored tablets must be cut in half if the label says 1/2 tablet.

 

It is an error when the person takes more or less than they should. This error must also be reported.


The Right Route

 

Check the label to find out the right route. A buccal medication should not be swallowed (oral route).

 

It is an error when a person takes a medicine with the wrong route. This error must be reported.


The Right Form

 

Check the label against the order to make sure that you have the right form. A pill can not be given if the order says a liquid.

 

It is an error when a person takes the wrong form. This, too, must be reported.


The Right Documentation

 

All documentation must be complete and accurate. There is more information about documentation below.


REFUSED MEDICINES

 

A person has the right to refuse a medicine. This refusal must be reported and documented.

 

FORGOTTEN MEDICINES

Report and document if the person forgets their medicine and/or you forget to remind them that it is time to take their medicine.

 

OBSERVING & RECORD KEEPING

 

You must observe for a person's response to medicines. Again, some of these responses are wanted and others are not. For example, you must take a person's blood pressure to make sure that the medicine is making it lower when the person is taking a blood pressure medicine. This is a wanted effect. However, if that person becomes dizzy and their blood pressure is too low, this is NOT a wanted response.

You must observe for, report and record both the wanted and the unwanted responses to the person's medicine(s).

 

A medication that is taken, forgotten, held or refused by the patient must be written on the patient's medicine record. Other information like vital signs and apical pulse rate must also be recorded when it is needed. For example, the apical rate for a full minute must be taken and recorded before a person takes digoxin. If the rate is 54 or more, the person can take it. The dose must be held and the supervisor must be notified if the rate is less than 54. This must also be written in the person's record.

 

Complete medication records must include:

  • the person's full name,
  • room and bed number if there is one,
  • age,
  • name of the doctor,
  • any allergies,
  • medicine(s) to be taken,
  • the dose for each,
  • the route for each,
  • the form for each,
  • the date and perhaps even the time that the order was written,
  • date(s) and time(s) that the medicine is to be taken,
  • start and end dates of the order, and
  • the initials and signatures of all who have helped with the medicine(s).

Some of the legal rules for record keeping are:

  • Do NOT use white out if you make a mistake.
  • Write so that other people can read what you write.
  • Do NOT scribble.
  • If you make a mistake, cross it off with one thin line. Do NOT cover the mistake with scribble. Write "error", sign your name and date the cross off.
  • Use dark ink on records.

STORAGE OF MEDICATIONS

 

 

 

 

 

 

 

All medicines must be secure at all times. This gives safety to children, confused people, and those at risk for taking medications that are not theirs.

 

Some medicines must be kept out of light. Others have to be put in the refrigerator.

 

Others have to be kept at room temperature. Read the label to make sure that you return the medicine bottle to the right place.

 

DISPOSING MEDICINES

 

These medicines must be thrown out:

  • those that are old and expired
  • those that are in a bottle without a label
  • those that are in a bottle with a label that you cannot read
  • those that have been stopped, or discontinued, by the MD

Medicine should be thrown away in the sink under running water. They should not be thrown away in the trash can, especially if there are confused people or children in the area.

 

You must document all medicine(s) that are thrown away.

 

PREVENTING MISTAKES AND ERRORS

 

 

 

 

 

Patient identification is VITAL. Many mistakes happen when the person is not identified properly.

 

When you help with medicine, you must use at least two (2) ways of identifying the person. A bed or room number can not be one of these.

 

Some examples of two identifiers include the person's:

  • first, middle and last name;
  • a code number given to that person;
  • social security number;
  • birthday in terms of month, day and year;
  • photograph; and
  • a bar code containing two (2) or more unique identifiers.

(Agency for Healthcare Research and Quality, 2010)

 

Do NOT help with medicines if you can not identify the person. Tell your supervisor.

 

Special Measures to Prevent Medical Errors Among Populations at Risk

 

Other things that you should do to prevent medical errors for people at high risk for errors are below.

 

Decreased level of consciousness

 

Patients that are not fully alert, awake and oriented to time, place and person are at high risk for errors. Patient identification is, again, necessary when you are helping a person who is not fully awake and alert. At times, a family member or friend can help you with this process. They can also ask questions about the medicines the person will be taking. All of these things will help to avoid a mistake with this high-risk group.

 

Cognitive impairments

 

People that are confused or not oriented are at risk for mistakes. Again, patient identification is very important. Many elderly can be a little confused at some times of the day. For example, they may be a little confused when they wake up or when the sun goes down later in the day.

 

It is very helpful, depending on the person's level of cognition, to talk with the person in a way that they can understand. Also, listen to them, especially if they alert you to the fact that a medicine is not theirs. Pictures and drawings may help you to communicate with a person that is confused. Again, do not help with medicine if the person is not able to take them. Tell your supervisor.

 

Language barriers

 

Our best defense against mistakes is an awake, alert, oriented, mentally sound person who knows about all of their medicines. These "ideal" people are not seen very often. Our patients very often have problems, including a language barrier. We care for people that have come from all over the world. They may not know how to speak English.

 

This person is a challenge just like a person who is confused. They may not understand what you are saying or asking. You may also not understand what they are trying to tell you.

 

Interpreters, family or friends, pictures and drawings can help us with these people. Also, it is very wise to learn some basic foreign language phrases words when you work with a special group of people, like those who have come from Cuba, Bosnia, or another country.

 

Sensory disorders

 

Hearing and vision problems can also lead to errors. A patient that is blind will not be able to see if they are getting the wrong medicine. People with a hearing problem may not hear you when you tell them what medicine you are handing to them.

 

Things like eyeglasses and hearing aids must be given to the person in order to protect their safety. Also, the use of large print or Braille reading materials and magnifying glasses may be helpful to the person who is not able to see well.

 

Speaking loudly while facing the patient with a hearing problem may help to prevent a mistake.

 

Infants and children

 

Infants and children are not able to know about their medicines and their treatments. They are not able to ask questions. They cannot tell you if they have a concern about a wrong medicine. They are not even able to tell you their name or their birthday until they get to a certain age.

 

Follow your agency policy regarding helping with this age group.

 

Developmental delays

 

The same things you just learned above for infants and children should be done with these people, as specific to the degree of this delay.

 

Mental problems

 

Lastly, people with a mental problem are also at risk. They may take medicines that make them sleepy. They may not be able to tell you their name. They may not know about the medicines they take. They may not be able to take their medicines in the right way.

 

 

Do NOT help with any medicines when you can not do it safely.

Report these safety problems to your supervisor.

 

SOME COMMON MEDICINE GROUPS

 

ALPHA-ADRENERGIC BLOCKERS

 

Uses: Hypertension (high blood pressure)

Adverse Reactions and Side Effects: Hypotension (low blood pressure), a stuffed nose, tachycardia (fast heart rate over 100), diarrhea, nausea, and vomiting.

Contraindications: Myocardial infarction (MI) and coronary artery disease, including angina (chest pain).

Implications: Check daily weights, I&O, and the blood pressure (BP) standing and lying.

Examples of Medicines in This Group:

  • dihydroergotamine mesylate
  • phentolamine mesylate

ANTACIDS

 

Uses: Gastritis, peptic ulcer, hiatal hernia and reflux esophagitis.

Adverse Reactions and Side Effects: Constipation, diarrhea, flatus, abdominal distention, alkaluria (urine that is not normal and has a high base pH).

Contraindications: Allergy and sensitivity

Implications: Check for stomach pain, GI symptoms and kidney problems.

Examples of Medicines in This Group:

  • aluminum carbonate
  • calcium carbonate

ANTIANGINA MEDICINES

 

Uses: Angina, hypertension (high blood pressure) and irregular heart beats.

Adverse Reactions and Side Effects: Postural hypotension, fatigue, irregular heart

beats, headache, edema, dizziness.

Contraindications: Increased pressure in the brain and a bleed in the brain.

Implications: Observe for side effects and orthostatic hypotension. Check for angina (chest) pain.

Examples of Medicines in This Group:

  • propranolol
  • verapamil hydrochloride
  • nitroglycerine

ANTICHOLINERGICS

 

Uses: Some slow down the GI, urinary and gallbladder movement. Others lower GI secretions, decrease involuntary movement, and relieve nausea, and vomiting.

Adverse Reactions and Side Effects: Dryness of the mouth, paralytic ileus, constipation, urinary problems (retention and hesitancy) dizziness and headache.

Contraindications: GI or urinary obstruction, narrow-angle glaucoma, and myasthenia gravis.

Implications: Observe urine and bowel function as well as vital signs.

Examples of Medicines in This Group:

  • atropine sulfate
  • scopolamine

ANTICOAGULANTS

 

Uses: Heart attack (MI), pulmonary embolus (lung clots), deep vein thrombosis, disseminated intravascular clotting syndrome (DIC), and atrial fibrillation. It is also used with kidney dialysis.

Adverse Reactions and Side Effects: Hemorrhage, diarrhea, fever, rash and blood disorders depending on the drug.

Contraindications: Bleeding disorders, (hemophilia and leukemia), ulcers, blood problems, nephritis (kidney infection), and endocarditis (infection of the inner part of the heart).

Implications: Observe for bleeding (like blood in the mouth, blood when the person shaves, black stools, stool occult blood, ecchymosis (black and blue marks), etc. Check the BP. It could be too high.

Examples of Medicines in This Group:

  • warfarin sodium
  • heparin

ANTICONVULSANTS

 

Uses: They prevent seizures.

Adverse Reactions and Side Effects: Depressed bone marrow, which can be life-threatening, GI problems, confusion, lack of balance and slurring of speech.

Contraindications: Allergy

Implications: Observe liver and kidney function, blood, mental state, and for toxicity (ataxia, bone marrow depression, nausea, vomiting, cardiovascular problems, Stevens-Johnson syndrome)

Examples of Medicines in This Group:

  • phenytoin
  • diazepam

ANTIDEPRESSANTS

 

Uses: Depression. Bed wetting for children.

Adverse Reactions and Side Effects: Orthostatic hypotension, mouth dryness, dizziness, drowsiness, urine retention, high blood pressure, kidney failure and paralytic ileus.

Contraindications: Large prostate, seizures, kidney, liver and heart disease.

Implications: Take the BP both standing and lying. Check the mental state. Observe for unusual facial symptoms and urine retention.

Examples of Medicines in This Group:

  • sertraline
  • amitriptylyline
  • bupropion
  • phenelzine

ANTIDIABETIC MEDICINES

 

Uses: Diabetes and ketoacidosis

Adverse Reactions and Side Effects: Hypoglycemia (low blood pressure) and liver damage.

Contraindications: Oral agents are contraindicated for juvenile diabetes and ketoacidosis.

Implications: Check the blood glucose and check for signs of high and low blood sugar.

Examples of Medicines in This Group:

  • insulin
  • glyburide

ANTIDIARRHEALS

 

Uses: Diarrhea

Adverse Reactions and Side Effects: Constipation, paralytic ileus, and stomach pain.

Contraindications: Colitis

Implications: Used for short term therapy (48 hours or less). Check the bowel response.

Examples of Medicines in This Group:

  • bismuth subgallate
  • kaolin and pectin mixtures

ANITDYSRHYTHMICS

 

Uses: Fast heart rate, irregular heart beat, high blood pressure and angina.

Adverse Reactions and Side Effects: Low blood pressure, a pulse less than 60 (bradycardia) and irregular heart beats.

Contraindications: Various. Check each medicine.

Implications: Check the rate and rhythm of the pulse. Check the blood pressure, and I & O. Look for swelling (edema).

Examples of Medicines in This Group:

  • digoxin
  • quinidine

ANTIFUNGALS

 

Uses: Fungus infections

Adverse Reactions and Side Effects: Kidney, liver damage, GI problems, hypokalemia (low potassium), anorexia (lack of appetite), nausea and vomiting.

Contraindications: Depressed bone marrow.

Implications: Check the vital signs, I & O, blood, weight, hearing, kidney and liver function.

Examples of Medicines in This Group:

  • nystatin
  • amphoteracin B

ANTIHISTAMINES

 

Uses: Allergies.

Adverse Reactions and Side Effects: Most can cause drowsiness, headache, urinary retention, blood problems, thick bronchial secretions and GI effects

Contraindications: Asthma, peptic ulcer, narrow angle glaucoma.

Implications: Check the urinary, respiratory and cardiac status.

Examples of Medicines in This Group:

  • diphenhydramine hydrochloride
  • chlorpheniramine maleate

ANTIHYPERTENSIVES

 

Uses: Hypertension (high blood pressure), heart failure, angina and some irregular heart beats.

Adverse Reactions and Side Effects: Hypotension (high blood pressure), tachycardia (fast pulse), bradycardia (slow pulse), nausea, vomiting and headache.

Contraindications: Heart block
Implications: Check for edema of the feet and legs, check kidney function, blood pressure and breathing.

Examples of Medicines in This Group:

  • captopril
  • propranolol hydrochloride

ANITI-INFECTIVES

 

Uses: Infections

Adverse Reactions and Side Effects: Diarrhea, nausea, vomiting, bone marrow depression and anaphylaxis (life threatening)

Contraindications: Most people allergic to penicillin are also allergic to the cephalosporins.

Implications: Observe bowel pattern and urinary output. Check the kidney function, and for signs of another infection and bleeding.

Examples of Medicines in This Group:

  • penicillin
  • tetracycline

ANTINEOPLASTICS

 

Uses: Cancer

Adverse Reactions and Side Effects: Nausea, vomiting, hair loss, liver damage, and heart damage.

Contraindications: Liver and kidney damage.

Implications: Check kidney and liver function, I & O. Observe for bleeding, jaundice (yellow skin and yellow eyes), dependent edema, and breaks in the skin.

Examples of Medicines in This Group:

  • fluorouracil
  • cisplatin

ANTIPARKINSON AGENTS

 

Uses: Parkinson's disease

Adverse Reactions and Side Effects: Involuntary movement, insomnia, nausea, vomiting, orthostatic hypotension, dry mouth, numbness and headache

Contraindications: Narrow angle glaucoma

Implications: Check the respirations, blood pressure and changes in mental and behavioral states.

Examples of Medicines in This Group:

·  levodopa

·  entacapone

 

ANTIPSYCHOTIC AND NEUROLEPTIC AGENTS

Uses: Psychosis and anxiety. They are also sometimes used for unrelieved hiccups, nausea, vomiting, and pediatric behavior problems as well as relaxation before surgery.

Adverse Reactions and Side Effects: Some symptoms with antiparkinsonian medicines. Some side effects include dry mouth, photosensitivity (sensitive to light), hypotension (low blood pressure) and life threatening cardiac problems and breathing problems (laryngospasm).

Contraindications: Heart disease, high blood pressure, severe bone marrow depression, blood disorders, Parkinson's disease, narrow angle glaucoma and children less than 12 years of age. Cautious use with the elderly.

Implications: Check the I & O, blood pressure lying and standing (orthostatic hypotension), EPS (antiparkinsonian agents should be used for this). Observe for dizziness, palpations, tachycardia (fast heart rate), changes in emotion, level of consciousness, as well as for any walking and sleep problems.

Examples of Medicines in This Group:

  • haloperidol
  • chlorpromazine

TB MEDICINES

 

Uses: TB

Adverse Reactions and Side Effects: Anorexia, nausea, vomiting, rash, kidney, liver and hearing effects, which could be severe.

Contraindications: Kidney disease. Caution with liver disease, pregnancy and lactation

Implications: Check kidney and liver status and for signs of anemia.

Examples of Medicines in This Group:

  • isoniazid
  • rifabutin

COUGH MEDICINES & EXPECTORANTS

 

Uses: The expectorants are used for a cough from bronchitis, TB, pneumonia, cystic fibrosis and COPD. Antitussives are used for coughs that are not producing mucus.

Adverse Reactions and Side Effects: Dizziness, drowsiness and nausea

Contraindications: Iodine sensitivity, pregnancy, lactation and an over active thyroid. Caution with the old people and those with asthma

Implications: Check the cough and the sputum. Increase fluid intake and humidity to keep the mucus thin.

Examples of Medicines in This Group:

·  guaifenesin

·  codeine

 

ANTIVIRALS

 

Uses: Infections caused by a virus like HIV, herpes and varicella.

Adverse Reactions and Side Effects: Nausea, vomiting, diarrhea, headache, lack of appetite, blood problems, and kidney failure

Contraindications: People with an abnormal immune system, like AIDS, and those with herpes. Caution with pregnancy, lactation, kidney and liver disease and dehydration

Implications: Check for kidney and liver problems. Observe for signs of infection and allergic reactions (itching, rash).

Examples of Medicines in This Group:

  • acyclovir sodium
  • cidofovir

BARBITURATES

 

Uses: Epilepsy, sedation, insomnia, anesthesia, and gall stones

Adverse Reactions and Side Effects: Drowsiness, nausea, blood problems and Stevens-Johnson syndrome

Contraindications: Allergy, poor liver function and pregnancy. Caution with the elderly and those that have kidney or liver disease

Implications: Observe seizure control and for signs of toxicity (insomnia, hallucinations, hypotension, pulmonary constriction; cold, clammy skin; blue or gray lips, vomiting, delirium, weakness)

Examples of Medicines in This Group:

  • phenobarbital
  • secobarbital

BENZODIAZEPINES

 

Uses: Anxiety, acute alcohol withdrawal and pre-operative relaxation.

Adverse Reactions and Side Effects: Physical dependence and abuse, dizziness, drowsiness, orthostatic hypotension, and blurred vision

Contraindications: Narrow angle glaucoma, infants less than 6 months old. Caution with the elderly as well as with those that have kidney and/or liver disease

Implications: Check the lying and standing blood pressure (report it if it drops 20 mm Hg or more), pulse, liver and kidney function and signs of dependency. Give the person milk or food to prevent GI symptoms.

Examples of Medicines in This Group:

  • diazepam
  • clonazepam

BETA-ADRENERGIC BLOCKERS

 

Uses: High blood pressure, angina and irregular heart beats coming from the heart's ventricles.

Adverse Reactions and Side Effects: Orthostatic hypotension, diarrhea, nausea, vomiting, slow heart rate, blood problems, congestive heart failure (CHF) and spasms in the bronchus.

Contraindications: Heart block, shock and CHF. Cautious use with the elderly and those patients with COPD, coronary artery disease, asthma, kidney disease, thyroid disease, and pregnancy.

Implications: Check the blood pressure, I&O, daily weights, and pulse. Observe for edema and take the apical and radial pulse.

Examples of Medicines in This Group:

  • metroprolol
  • propranolol

BRONCHODILATORS

 

Uses: Asthma, spasm of the bronchi, COPD, and Cheyne-Stokes respirations

Adverse Reactions and Side Effects: Dyspnea (trouble breathing), bronchospasm, anxiety, tremors, throat irritation, nausea and vomiting.

Contraindications: Narrow angle glaucoma, severe heart disease, and a fast heart rate. Cautious use with hypertension, seizures, pregnancy and lactation, an over active thyroid and a large prostate

Implications: Check for response (absence of dyspnea and/or wheezing)

Examples of Medicines in This Group:

  • albuterol
  • aminophylline

CALCIUM CHANNEL BLOCKERS

 

Uses: Angina, high blood pressure and irregular heart beats.

Adverse Reactions and Side Effects: Irregular heart beats, edema, fatigue, headache, and drowsiness.

Contraindications: Systolic blood pressure of less than 90 mm HG, Wolff-Parkinson-White syndrome, heart block, and cardiogenic shock. CHF may get worse in the presence of edema. Cautious use with liver and kidney disease.

Implications: Check the blood pressure, pulse and respirations. Administer at bedtime and before meals.

Examples of Medicines in This Group:

  • verapamil
  • felodipine

CARDIAC GLYCOSIDES

 

Uses: CHF and rapid heart rate

Adverse Reactions and Side Effects: Cardiac changes, hypotension, GI problems, blurred vision, yellowish-green halos and headache.

Contraindications: Some irregular heart beats, current heart attack, severe respiratory problems, and a rapid heart beat. Caution with people that do NOT have the right amount of potassium, magnesium and/or calcium, kidney or liver disease, an under active thyroid and the elderly.

Implications: Check vital signs, check the apical heart rate for one full minute before giving it to the person to take (if less than 60, hold the dose and notify the MD). Check the I & O.

Examples of Medicines in This Group:

  • digitoxin
  • digoxin

CHOLINERGICS

 

Uses: Myasthenia gravis, bladder distention, and a paralytic ileus

Adverse Reactions and Side Effects: Spasms of the bronchi and larynx, slow breathing, a convulsion, paralysis, respiratory arrest, nausea, vomiting and diarrhea

Contraindications: Kidney or intestinal obstruction. Cautious use with children, lactation, slow pulse, low blood pressure, seizures, asthma and an over active thyroid

Implications: Check the vital signs, I & O. Check for urine retention, bradycardia (slow pulse), spasms of the bronchi, low blood pressure and slowing of the person's breathing.

Examples of Medicines in This Group:

  • neostigmine
  • bethanechol

CHOLINERGIC BLOCKERS

 

Uses: To control secretions during surgery, and to slow down the urinary, biliary and GI tracts. Some are used for Parkinson like symptoms that result from the use of a neuroleptic medicine

Adverse Reactions and Side Effects: Constipation and dryness of the mouth.

Contraindications: GI or urinary obstruction, angle closure glaucoma, and myasthenia gravis. Cautious use with the elderly and with patients who have an enlarged prostate or a rapid heart rate.

Implications: Check the urinary status and I & O. Check for any dysuria (pain while urinating), frequency or retention. The medicine may be discontinued with these signs. Observe mental status and for constipation. Administer oral doses with milk or food

Examples of Medicines in This Group:

  • atropine
  • scopolamine

CORTICOSTEROIDS

 

Uses: Some stop inflammation. Others are used for allergies, adrenal gland problems and brain swelling (edema)

Adverse Reactions and Side Effects: Insomnia, changes in behavior, an elevated mood (euphoria), an ulcer, GI irritation, sodium and fluid retention, hypokalemia (low potassium), hyperglycemia (high blood glucose), and a lack of tolerance for carbohydrates

Contraindications: Fungus infections, amebiasis, and lactation. Caution with the elderly, children and pregnant women, as well as those with diabetes, seizures, ulcers, glaucoma, CHF, hypertension, poor kidney function, myasthenia gravis and ulcerative colitis

Implications: Give the person milk or food with the medicine to prevent GI upset. Check the blood sugar, weight, I & O, and for any signs of infection. Observe for mood changes, like depression.

Examples of Medicines in This Group:

  • cortisone
  • hydrocortisone

DIURETICS

 

Uses: High blood pressure (hypertension) and edema

Adverse Reactions and Side Effects: Low potassium (hypokalemia), high blood glucose (hyperglycemia) blood problems, like anemia, and dehydration

Contraindications: Electrolyte imbalances, poor urine output and dehydration. Caution among the elderly as well as when the person has a kidney or liver disease

Implications: Potassium in the form of a tablet or liquid may be needed. A banana also gives the person potassium, Check the lying and standing blood pressures. This medicine should be given in the morning so that the person does not have to get up in the middle of the night to void.

Examples of Medicines in This Group:

  • furosemide
  • hydrochlorothiazide

HISTAMINE H2 ANTAGONISTS

 

Uses: Ulcers and GI reflux disease

Adverse Reactions and Side Effects: Blood problems, diarrhea and headache.

Contraindications: Cautious use with children less than 16 years of age, and with those people that have liver or kidney disease, and organic brain syndrome. Caution is also indicated during pregnancy and if the person is breast feeding a baby.

Implications: Check the I & O. Give it to the person during their meal so that it will take its full effect.

Examples of Medicines in This Group:

  • cimetidine
  • ranitidine

IMMUNOSUPPRESSANTS

 

Uses: Prevention of organ transplant rejection

Adverse Reactions and Side Effects: Protein, blood and albumin in the urine. Kidney

failure, liver damage, oral thrush, sore gums, fever and headache.

Contraindications: Caution with severe liver or kidney disease and pregnancy

Implications: Check for liver and kidney function. Signs of liver damage are itching, light colored stools, jaundice and dark urine. Give the person this medicine with a meal.

Examples of Medicines in This Group:

  • cyclosporine
  • azathioprine

LAXATIVES

 

Uses: Constipation, as a bowel prep and a stool softener

Adverse Reactions and Side Effects: Cramping, diarrhea, and nausea

Contraindications: Large colon, stomach pain, nausea, vomiting, impaction, GI obstruction, gastric retention and colitis. Caution must be used if the person has hemorrhoids and/or rectal bleeding

Implications: Check the I & O. The person must take this with water only. The person should not take it within one hour after taking milk, a meal or an antacid.

Examples of Medicines in This Group:

  • psyllium
  • docusate sodium

NONSTEROIDAL ANTI-INFLAMATORIES

 

Uses: Mild to moderate pain, arthritis and dysmenorrhea

Adverse Reactions and Side Effects: Blood problems, kidney problems, blood in the urine, painful urination, stomach pain, lack of appetite, anorexia, dizziness and drowsiness.

Contraindications: Asthma, severe liver and/or kidney disease. Cautious use with the elderly, children, lactation, pregnancy and for patients with GI, cardiac and/or bleeding problems.

Implications: Check the blood, kidney and liver function. Baseline hearing and eye exams are recommended so that changes can be seen. Toxicity can lead to tinnitus (ringing in the ears) and/or blurred vision.

Examples of Medicines in This Group:

  • ibuprofen
  • naproxen

OPIOID ANALGESICS

 

Uses: Moderate to severe pain

Adverse Reactions and Side Effects: GI problems (constipation, nausea, vomiting, anorexia, cramps), sedation, slow breathing, circulatory depression and increased pressure in the head

Contraindications: Upper airway obstruction, bronchial asthma, and addiction. Cautious use with kidney, liver, respiratory and heart disease.

Implications: Check the respiratory, urinary and mental status, including the person's level of consciousness. An antiemetic can be used for nausea and vomiting. Continue to check the level of pain

Examples of Medicines in This Group:

  • codeine

SALICYLATES

 

Uses: Mild to moderate pain, inflammation (arthritis), and for a fever

Adverse Reactions and Side Effects: Rash, GI symptoms, liver and blood problems, and hearing problems (tinnitus- a sign of possible toxicity)

Contraindications: Frequently occurring . Contraindicated with a vitamin K deficiency, GI bleeding, a bleeding disorder, children with Reye's syndrome. Caution with Hodgkin's disease, liver and kidney failure, anemia

Implications: Look for signs of a liver problem (clay colored stool, dark urine, diarrhea, yellow sclera and skin, itching, fever, abdominal pain) and ototoxicity (ringing or roaring in the ears, tinnitus)

Examples of Medicines in This Group:

  • aspirin
  • salsalate

THYROID MEDICINES

 

Uses: Under active thyroid gland

Adverse Reactions and Side Effects: Palpitations, tachycardia, insomnia, tremors, angina, weight loss, irregular heart beat, and thyroid storm.

Contraindications: Heart attack, and poor adrenal function. Cautious use with the elderly, pregnant and breast feeding women, and for patients with diabetes, high blood pressure, angina, and other heart disease

Implications: The person should take it at the same time every day. Check the blood pressure before each dose. Check the I & O, weight, and for irritability and nervousness

Examples of Medicines in This Group:

  • thyroid
  • levothyroxin

VASODILATORS

 

Uses: High blood pressure and angina.

Adverse Reactions and Side Effects: Hypotension (low blood pressure), hypertension (high blood pressure), EKG changes, nausea, headache

Contraindications: Tachycardia (rapid heart rate) and acute MI. Cautious use with ulcers and some heart disease

Implications: They should be taken with meals to prevent any GI problems.
Examples of Medicines in This Group:

  • amyl nitrate
  • hydralazine

INFECTION CONTROL

 

Standard precautions in healthcare greatly lower the risk of exposures to HIV and other blood borne pathogens.

 

Other infection control measures that help to prevent the spread of infection are:

  • handwashing;
  • engineering controls, such as "needleless" systems;
  • work practice controls;
  • the use of personal protective equipment, such as gowns, goggles, gloves and masks; and
  • the proper handling of sharps and regulated, biohazardous waste.

The following routine infection control measures must be taken when helping a person with their medicine.

  • ALWAYS wash your hands before and after each patient contact.
  • Wear gloves whenever you may have contact with blood and other bodily fluids as well as when touching skin that is not intact. Wash your hands before you put on gloves and wash your hands after you take them off. Gloves are not a substitute for handwashing.
  • Wear a waterproof gown, goggles and a surgical mask if you may come in contact with bodily fluids, splashes and spills.

Medical and Surgical Asepsis

 

The following routes are considered clean and, therefore, medical asepsis must be adhered to.

  • oral,
  • buccal,
  • sublingual,
  • topical,
  • vaginal,
  • rectal,
  • nasal,
  • inhalation
  • NG and G tube, and
  • transdermal Other medicine routes are sterile. These medicines are given by nurses. UAPs do not help with sterile routes.

THE AGING PROCESS & MEDICINES

 

The normal aging process affects medicines and how they act in the body of an older person. These things are described below.


Kidney

  • Medicine does not leave the body as fast as it did in the past.
  • The blood flow to the kidney is less.
  • Creatinine clearance is lower.
  • Kidney function is decreased.
  • Kidney size is smaller.
  • Dehydration can even further slow down the process of medicines leaving the body. They may build up in the body.

Liver

  • Liver size is smaller.
  • The blood flow to the liver is less. This can lead to a greater amount of the medicine in the body than there should be.

Absorption

  • The surface area of the small intestine is less.
  • Gastric acid pH is greater.

Distribution

  • Serum albumin is less. This can lead to a greater amount of the medicine in the body than there should be.
  • Increase in the percent of body fat as compared to total body weight. This may hold fat attaching (lipophilic) medicines longer than wanted. This can lead to side effects and an over dose.
  • Body water is lowered by as much as 15%. This can lead to holding more water soluble medicine than wanted. This can lead to side effects and an over dose.

Other Age Related Characteristic of the Elderly That Affect Medicines' Actions

  • Greater risk of adverse drug reactions
  • More sensitivity to medicines
  • Increased risk of toxicity, especially with nonsteriodal anti-inflammatory medicines (NSAIDS), heparin, long acting benzodiazepines, aminoglycosides, thiazides, warfarin, isoniazid and many antiarrhythmics
  • Some medicines, like benzodiazepines, may lead to higher than usual sedation
  • Drug-drug, drug-food, drug-lifestyle and drug-herb interactions increase in the elderly
  • Adverse reactions increase in the elderly

The Implications of Aging on Medicines

  • The starting dose may be only 50% of the usual adult dosage
  • Closely observe the elderly person in terms of side effects, adverse drug reactions, toxicity and therapeutic effect

SUMMARY

 

Nursing assistants (CNAs) can help people to take their medicine(s) in some states when they are taught how to do it and they are assigned to assist.

 

This class has given you a lot of information about medications and how to assist people who need your assistance with their medicines.

 

Safety is VERY important. If you have a question, STOP, and ask your supervisor.

 

REFERENCES

 

Agency for Healthcare Research and Quality (2010). 20 Tips to Help Prevent Medical Errors. Patient Fact Sheet”. [online]. AHRQ Publication No. 00-PO38. Rockville, MD. www.ahrq.gov/consumer/20tips.htm

 

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

 

Florida State Statutes (2010). Chapter 465.003 “Medication Administration”.  [online]. http://www.flsenate.gov/statutes/index.cfm?StatuteYear=2009&AppMode=Display_Results&Mode=Search%2520Statutes&Submenu=2&Tab=statutes&Search_String=465.003+

 

Florida State Statutes (2010). Chapter 400.488 “Assisting With the Self-Administration of Medications For Home Care”.  [online]. http://www.flsenate.gov/statutes/index.cfm?StatuteYear=2009&AppMode=Display_Results&Mode=Search%2520Statutes&Submenu=2&Tab=statutes&Search_String=400.488++

 

Florida State Statutes (2010). Chapter 400.4256. “Assisting With the Self-Administration of Medications For Assisted Living”. [online].  http://www.flsenate.gov/statutes/index.cfm?StatuteYear=2009&AppMode=Display_Results&Mode=Search%2520Statutes&Submenu=2&Tab=statutes&Search_String=400.4256+

 

Joint Commission on Accreditation of Healthcare Organizations (2010)." 2010 National Patient Safety Goals". [online]. http://www.jointcommission.org/NR/rdonlyres/0188A959-8EF0-4899-B3CF-195C39AA4D0F/0/NPSGChapterOutline_FINAL_OME_2010.pdf

 

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

 

Skidmore-Roth, Linda (2004). Mosby's Rapid Reference Library. CD-ROM

 

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

 

Copyright © 2010 Alene Burke

 

 


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