Module II Medication Basics

Transcription

1 Module II Medication Basics

2 Kinds of Medications People make different choices about medications and remedies. Today, there are more than 11,000 medications available to the consumer. There are also hundreds of prepackaged herbals and supplements. In addition, people may make homemade remedies. These may be manufactured remedies, or they may be ones that are traditional within families and cultures. In providing medication support, it is important to understand the differences and similarities among these different types of preparations. While these preparations are meant to improve health, it is not uncommon for people to make dangerous mistakes in using them. People use medications, remedies and nutritional supplements for various reasons, including: Prevention of illness or disease Cure for illness or disease Treatment or management of long-term health-related conditions Treatment of mental health conditions and neurological disorders Response to pain and inflammation Lifestyle choices Prescription Medications are ones that require a doctor s written approval to obtain. They must be bought from a licensed pharmacist. Usually drugs that are more likely to be abused or misused will need a doctor s prescription. This is also true of drugs that are likely to have serious problem reactions or in which dosage and timing is very important. Non-prescription Medications can be bought without a doctor s approval. They are very often called over-the-counter (OTC) medications because they can be purchased directly without having to go to a pharmacist. Sometimes an OTC medication has smaller amounts of the same active ingredients as prescription medications. The use and distribution of drugs that are on the list of controlled substances is tightly monitored because of their potential for abuse or consumer risk. They are rated and placed in Schedules by the Drug Enforcement Agency

3 (DEA). The drugs with the highest problem potential are placed in Schedule I. The drugs with the lowest problem potential are placed in Schedule V. Handling Controlled Substances The federal government and the laws of the State of Iowa require specific duties when it comes to handling controlled substances. The primary DEA Schedule from which medications might be prescribed for MYEP clients is Schedule II. So Schedule II is where we will focus this training information. The first and most important thing that you must remember is that completion of this course does not allow you to administer or handle Schedule II medications!! In accordance with the rules and regulations in the State of Iowa, in order to handle or administer Schedule II medications, you must complete and pass a state approved Medication Manager Course. If you are working with someone for whom a Schedule II medication has been prescribed, you will not be able to handle his/her medications until you have completed the Medication Manager Course (these are offered through area community colleges, and MYEP will assist you with registering for a course when necessary). It is very important that Schedule II medication be handled according to the following Drug Enforcement Agency (DEA) recommendations: Kept under double lock and key Separate from other medications Counted at a minimum of once daily (MYEP required twice daily) Documented accurately to reflect correct amount given Disposed of according to DEA requirements o Contact the pharmacy to notify of the need for disposal o Follow pharmacy recommendations on disposal of the medication o Complete a Medication Disposal Form in the presence of a witness o Both the disposing staff and the witness must sign the form Whether prescribed on an as needed basis (PRN) or on a routine basis, documentation of the administration of this medication must be reflected on the Medication Administration Record (MAR) and must be counted twice daily.

4 Natural Remedies are things that are done or taken to cure a condition or illness or alleviate the symptoms. If a substance is used, it is usually a natural substance. Natural remedies may require eating or drinking something. They may be inhaled, gargled, or rubbed on the skin. Examples or natural remedies include gargling with salt water to relieve a sore throat or drinking peppermint tea to soothe a stomach ache. Herbals are preparations made of natural substances that are found in herbs and plants. They can be used in place of medications. Sometimes they are taken with medications. These preparations are thought to cure or prevent health problems by those that use them. Supplements are vitamins, minerals and other substances such as protein or fiber, that people take to ensure good balance in their daily diet. Traditionally, medication support has focused only on preparations classified as medications. However, there are many shifts going on in our health care and social services systems. These shifts will make it more likely you will be responsible for understanding different alternatives to medications. Review some of the things changing medication support. Doctors are becoming more open to holistic mind/body/spirit healing. They may recommend or support alternative treatments The cost of prescription medication is very high. People are more often selecting over-the-counter or herbal substitutes Increased cultural diversity through immigration means greater numbers of people come from cultures with different approaches to health care Alternative therapies are becoming more common (for example, acupuncture or massage therapy). These alternative approaches may include recommendations for herbals, supplements, or home remedies Providing supports in a person s home is becoming more common. There is less regulation over alternative medication support in people s own homes. There may be more use of home remedies Cautions with Non-prescription Medications Many over-the-counter drugs, herbals and nutritional supplements can have serious or even fatal side effects. These consequences are more likely if the alternative medications are not taken properly.

5 You must be careful because: Taking these preparations in larger-than-recommended doses or for longer times than recommended can be very harmful. In some cases, poisoning can be slow and unnoticeable until it has reached the point where permanent damage has occurred These preparations can interact in unwanted ways with each other. For example, ginkgo biloba is an herbal that people use to improve memory. But it is also a blood thinner. People who take ginkgo need to inform their doctors before proceeding with any surgery. They must also check with doctors or a pharmacist before taking other medications known to thin blood such as aspirin or Coumadin. Too much blood thinner could cause a person to bleed to death Home remedies and over-the-counter treatments can mask important symptoms. Sometimes a serious condition may get worse. Avoiding Problems with Non-prescription Medications To minimize the risk of problems with over-the-counter medications, herbals, nutritional supplements and home remedies, follow these suggestions: Check for possible problem interactions ALWAYS read the label on and the information insert for the preparation fully and carefully BEFORE giving it Use the alternative preparations EXACTLY as recommended or ordered. If they do not give relief, contact the health care practitioner regarding other choices or dosages Monitor the preparations that you give to persons you support. Don t accidentally give more than recommended/ordered Stop immediately and call a doctor if there is a reaction to the preparation If the symptoms that you are treating persist for more than a few days, talks to the health care practitioner. It may be something serious Complete the Exercise Titled Module II Reactions to Medications Exercise

6 Lifestyle and the Need ed for Medications Making even small improvements in diet and activity level can: Lower cholesterol, lower blood pressure, level out blood sugars (diabetes), and improve heart and lung functioning Reduce obesity, flush toxins out of the body, and improve digestion Decrease stress and improve stress-sensitive conditions, such as arthritis, acne, or depression Greatly decrease the chances of getting many types of cancer These improvements can reduce the need for medications to treat these types of conditions. Daily living practices that can improve health include: Eating a diet high in fiber, low in saturated fat, and that includes 5 servings of fruits and vegetables and some lean protein each day Doing 30 minutes of activity each day and some weight resistance training 2-3 times a week Taking care of dental health by flossing and brushing daily and visiting a dentist for routine check-ups Avoiding the excessive use of alcohol and not using tobacco products Avoiding exposure to diseases by regular hand washing Avoiding high risk sexual behavior Kinds of Medications Medications come in many different forms. Some common forms of medications include: Pills Lozenges Liquids Creams or Ointments Patches Suppositories Sprays These medications may be taken through different routes. These include the mouth, eyes, ears, nose, skin, vagina, and rectum. Medications may be given to people with an injection of a needle. They may be delivered through feeding tubes that run directly into the stomach. Medications may

7 be absorbed through the skin or membranes. They may be swallowed, inhaled, or dissolved under the tongue. The most common route for medications is the mouth, but it must never be assumed that a medication must be taken orally. It is important to completely understand how each medication is meant to be administered. For example, some liquids may be swallowed. Others may be rubbed on the skin or added to a soaking bath. If a medication for the skin is swallowed, the person may experience serious problems. A person can die if medications are taken through the wrong route. There are basically three different kinds of timing you need to know about: Time-limited Medications These are short term medications. They are usually given to treat an illness (for example, strep throat) or a temporary condition (for example, a rash) On-going Medications These are medications that are taken regularly and in a routine way. Examples of these medications may include medications for seizures, diabetes, chronic mental health needs, cholesterol, blood pressure or daily nutritional supplements As Needed Medications (often called PRN medications). These are medications that can be given to bring relief to symptoms of illness. Or they may be given in response to other health indicators Time-Limited Medications Time-Limited medications are still serious medications. They can interact with ongoing and as-needed (PRN) medications. Make sure you understand all of the possible effects that can be anticipated. Some interactions are surprising. For example, many antibiotics can interfere with the effectiveness of birth control pills. These unintended effects can also make it more likely a person will get sunburn. Often time-limited medications are recommended in the smallest dose to effectively treat the problem. This means that skipping a dose, making major time mistakes, or not finishing the full amount of medication can reduce the effectiveness of the treatment. It may mean that the symptoms of the condition or illness disappear for a time, but come back a more serious form. Make sure these medications are taken as recommended. Routine Medications

8 When people take medications regularly there are some things to remember: Establish a schedule that makes it easy to remember to take the medications and that works with daily schedules (Such as at regular meal time or first thing in the morning) Don t forget to look at the label EACH time. It can be easy to select the wrong bottle, or to think you remember the dose when you don t! Develop a system for tracking medications. It s easy to forget. This could lead to taking too much medication or missed doses Even regular medications get changed. Be careful and thorough when assisting with medications, EVERY time. ALWAYS document that you administered a medication to or observed an individual taking their medication in the Medication Administration Record (MAR) As Needed or PRN Medications As needed or PRN medications are given to bring relief to symptoms of illness or in response to other health indicators. Some things to remember about using PRN medications: Don t give a PRN without fully reviewing the ingredients, recommendations and cautions. Make sure it is safe to use the PRN in the situation. Give only as directed. Make sure you are not using two or more PRNs with the same active ingredients There may be a non-medication alternative to a PRN for comfort (such as an ice pack or massage). Offering non-medication alternatives can reduce the need to medications and the likelihood of side effects Don t use PRNs for more than a few days for the same symptom without contacting a health care practitioner. The symptom may be a sign of something more serious that needs treatment Use of PRNs may require approval of a medical professional BEFORE the person takes the medication Track the use of PRNs carefully. It is easy to forget when and how long PRNs have been used. Not when the PRN was taken, and why, along with the result later The Five Rights of Medication Administration Defining Medication Errors

9 In order to avoid medication errors each of the following five rights must be correct for each medication, each time it is taken. If even ONE of these rights is missing, a medication error has occurred. You will learn more about each of these in future Modules. The Five Rights of Medication Administration: 1. Right Person 2. Right Medication 3. Right Time/Date 4. Right Dose 5. Right Route/Preparation/Technique Some agencies, and some training courses (such as Medication Manager) also consider the sixth right Right Documentation to be a medication error. While MYEP places a high priority on documenting medication administration, we do not consider this to be a medication error, but rather a documentation error. As such documentation errors are followed up on by supervisors directly with the DSP, but not recorded on a Medication Incident Report Form. Monitoring for Problem Reactions To prevent problems with drug interactions, always do the following: Ask the pharmacist about any possible problem interactions for all prescription and over-the-counter medications, including natural and herbal supplements Ask what will happen if two or more substances are combined Ask what you should do if there are side effects or adverse reactions with the combination of medications Set up the medication schedule to avoid interactions if possible Side effects and sensitivities to medications affect people. They can make it difficult for people to take medications as prescribed. They can cause people to be uncomfortable. Helping people track and communicate these side effects can help the person s health care practitioners find the best possible treatment. In order to manage side effects and sensitivities do the following: Know what side effects are likely to occur. Read the packaging or ask the health care professional or pharmacist about these effects

10 Make sure you understand how long these side effects may last Keep track of any uncomfortable or irritating effects that are experienced Tell the health care practitioner about the effects if they are uncomfortable or unexpected Serve as an advocate. If the health care practitioner does not seem to be concerned and the effects are bothering the person, continue to track the effects. Investigate alternatives and seek a second opinion if desired by the person Certain problems with medications need to be handled immediately. This may include contacting emergency services if needed. Some signs of serious problems include: Severe pain including headache, stomach ache, or muscle aches Signs of severe allergy. This can include: shortness of breath; hives; redness; rash; severe itching; swelling of the lips, tongue, face, hands or feet Unexpected seizures or convulsions Extreme lack of energy, confusion, or loss of consciousness When a person has difficulty communicating it is up to the direct support professional to carefully watch for problems. It is very important to write these observations down in detail. Include what day, time and exactly what happened in observable statements. Be highly alert whenever a person being supported starts a new medication. The following are signs that a person may be having problems with medications: Sleepiness or drowsiness at unusual times Change in appetite, thirst or sleep patterns Increase or unexpected decrease in usual challenging behaviors. These may include aggression, self-injury, yelling, crying, or repetitive behaviors Unusual behaviors for the person. A change in his/her mood Rashes, hives, signs of a cold, discomfort or illness When a person experiences problem reactions to a medication, the following steps need to be taken: Handle any health needs immediately and make sure the person is safe

11 Write down exactly what happened. Writing this down will help you keep track of all the important information a medical professional may need. Include the following: o When was the medication taken, and how much? o To the best of your knowledge, were any cautions or precautions missed? For example, taken with food when the medication was to be taken on an empty stomach? o What happened to the person; describe exactly what happened (for example, nausea, a rash, unexpected or increased challenging behaviors) and when it happened (time and date) Gather any information you can think of that may help determine the cause of the problem. Also, this information may help clarify if this problem is due to an allergy or sensitivity, a problem interaction with some other substance, or an unavoidable side effect. An example of questions to ask might be: was the person feeling ill; had the person taken other medications; was this a new medication or a new dose? Communicate these problems and information to the health care practitioner who prescribed the medication Keeping track of problems with medications is important. It can help the person avoid being prescribed a medication that has caused problems in the past. Health care professionals may choose to avoid whole groups of drugs that may have similar effects. However, to make those types of decisions they must know about the problem. Managing Medications When Away From Home Whether away from home for a week or an afternoon, individuals may have difficulty with maintaining regular medication routines. Some barriers to taking medications correctly can include: Normal reminders may not be present. Eating and sleeping routines, which are often linked to taking medications, may be different People may be excited about new places or activities and forget the time People may want to avoid side effects caused by their medications while away or traveling People may be concerned about privacy. They may not want people to know they take medications Some medications may be difficult to carry, especially those that need to be refrigerated

12 It may be difficult to find the necessary supplies or to have privacy when taking medications When traveling or visiting others: Carry medications in original containers with prescription labels and warnings. Ask the pharmacist for a second labeled container if you don t want to carry all of the medications with you. Place what you need for the trip or activity and leave the rest at home. Depending on the circumstances, taking extra doses may be a good idea as well Carry any medication tracking sheets with you if you are going to be bone for more than a day Carry a health information history. If emergency care is needed while traveling, this document will quickly ensure that professionals have the necessary information and contacts to provide effective health care Review People take a variety of medications, herbals, remedies and nutritional supplements. They take them to treat or prevent illnesses and medical conditions. People also use alternative preparations to enhance their quality of life All preparations can have serious effects on the body. Follow directions on medication, herbals and nutritional supplements. It si possible to overdose or do other harm if these preparations are misuses. Find out if you need a written doctor s order before using any over-the-counter medications or preparations in the support setting The five rights of medication administration include: 1. Right Person; 2. Right Medication; 3. Right Time/Date; 4. Right Dose; and 5. Right Route/Preparation/Technique. Having a health and medication history helps to ensure all important information needed by health care practitioners is available in one document. This will help prevent problems with medications Document any problems with medications. The more complex a person s disabilities the more carefully you will need to monitor for problems Traveling and leaving home make medication errors more likely. It s important to be organized, flexible and careful in keeping track of medications during these times

13 Complete the Post Test for Module II Medication Basics