MAP Trainer Webinar. Meeting Objectives. Agenda. Updates Trends What's New? Back to Basics D&S 11/7/2014. October 29, 2014

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1 MAP Trainer Webinar October 29, 2014 Meeting Objectives 1) Learn about pending Warfarin Sodium MAP policy requirements 2) Receive clarification on required components of MAP trainings 3) Learn of policies and procedures and clinical issues related to medication administration Agenda Updates Trends What's New? Back to Basics D&S 1

2 Update Organizational Chart Update DDS Technical Assistance Tool Revision MAP Resource 2

3 MAP Resource MAP Resource Update Student Curriculum AMRW Revisions 3

4 Update MAP Resource MAP Resource 4

5 Update Department of Public Health Fax # Update Department of Public Health Drug Control Program 99 Chauncy Street 11 th floor Boston MA

Revised DPH MOR Form Update DPH Advisory Ruling 6 18 14 The Role of

6 Revised DPH MOR Form Update DPH Advisory Ruling The Role of Nurses in the Medication Administration Program Update Medical Marijuana 6

7 Update Methadone Update Tramadol Trends Medication is Ordered Medication is Not Available Contact HCP Obtain a Later Start Time 7

8 Trends Effect of PRN Medication Documentation Trends Acceptable Codes DP day program W work LOA leave of absence S school P packaged by individual H hospital, nursing home, rehabilitation center Trends Documentation Late Entry 8

9 Count Sheet Scenario 12/20/yr 7:45p Morning dose not subtracted when removed. K. Mason notified. Lisa Long 12/21/yr 6a Late entry. On 12/20/yr 8a med was given but not subtracted at that time. Reggie Newton Trends Medication Occurrence Site Supervisor Follow Up Why What Minimize Recurrence/Risk Trends Health Care Provider Order Form Design 9

10 Trends Daily in the am Daily in the afternoon Daily in the evening Daily at bedtime Trends Telephone Orders Post/Verify Twice Trends Only MAP Certified staff can receive medication deliveries 10

11 Trends Medication &Treatment form corrections What s New? MAP Policy Revisions Warfarin Sodium (Anticoagulant) Therapy Training

12 Objectives 1. What is an anticoagulant? 2. Why is anticoagulant therapy necessary? 3. What is a PT/INR? 4. Who can give Warfarin sodium? Circulatory System Heart Pumps blood through the body Delivers oxygenated blood Returns deoxygenated blood to lungs Blood Clots 12

Good Blood Clots Prevents or stops bleeding Normal body function Cut Flossing teeth Nosebleed Accident Bad Blood Clots Stops the normal flow of

13 Good Blood Clots Prevents or stops bleeding Normal body function Cut Flossing teeth Nosebleed Accident Bad Blood Clots Stops the normal flow of blood within the body May cause Heart attack Stroke Deep Vein Thrombosis (DVT) blood clot in legs Pulmonary Embolism blood clot in lungs Stroke 13

14 Anticoagulant Blood thinner Brand Coumadin Generic Warfarin sodium PT/INR Blood Test PT Prothrombin Time Used to measure how long it takes blood to clot INR International Normalized Ratio A way of standardizing PT results no matter the testing method used PT/INR Blood Test PT Prothrombin Time INR International Normalized Ratio INR Target INR Range 14

15 PT/INR Blood Test May be obtained at Labs Clinics HCP visit Home self test kit Lab home visit PT/INR Blood Test If managed in ahome setting Must be performed by licensed staff Certified staff are NOT permitted to perform the test Warfarin Sodium Can be affected by Illness Infections Diarrhea Indwelling catheters Fever High B/P 15

16 Warfarin Sodium Can be affected by Other medications Certain foods Herbal preparations Medication Interactions Increase effects of Warfarin sodium Ibuprofen, Aleve, Aspirin Decrease effects of Warfarin sodium Certain antibiotics, B/P meds Food Interactions Decrease effects of Warfarin sodium Vitamin K Leafy green vegetables broccoli, kale, spinach Avocados Grapefruits and grapefruit juice 16

17 Vitamin K Important that the amount of Vitamin K eaten remains consistent Vitamin K Often used in the treatment of Warfarin sodium overdose Herbal Interactions Garlic Ginger St John s wort Echinacea Ginkgo biloba Red clover Chamomile 17

18 Warfarin Sodium May also be affected by Alcohol Nicotine Warfarin Sodium Supplied in different Strengths Shapes Colors Warfarin Sodium Administered at the same time each day helps To maintain a consistent blood level With accuracy of PT/INR results 18

19 Warfarin Sodium Med sheets must include Next PT/INR date Start/Stop dates 2 person check Special precautions Sample Med Sheet HCP Orders If received from an Anticoagulation Management Service (Coumadin Clinic) Must be signed by a HCP Telephone orders must be signed by the HCP within 72 hrs. 19

20 Tracking Follow agency policy Blister pack monitoring Add to count Flow Record or Event Sheet Policy Warfarin sodium agency policy to include Training of MAP Certified staff Emergency procedures Protocol Individualized Warfarin sodium protocol to include Details of how HCP orders are obtained Process for obtaining PT/INR lab draw PT/INR lab results Target INR range 20

21 Adverse Effects Increased risk for bleeding Report to the HCP Unusual easy bruising Prolonged bleeding from cuts gums Frequent nosebleeds Adverse Effects Increased risk for bleeding Report to the HCP Black tarry stools Persistent weakness/tiredness Nausea/vomiting, stomach pain Safety Decrease risk of bleeding by Using an electric razor for shaving a soft bristle toothbrush waxed dental floss Being cautious with knives or scissors Preventing falls Not missing lab appointments 21

22 Training Must be Certified and/or Licensed to administer Warfarin sodium Certified staff must receive Warfarin sodium Therapy training Remember Safety and Prevention Keep all HCP and lab appointments Give Warfarin sodium at same time each day Report changes when observed Monitor diet Remember You are key to safe anticoagulation therapy! 22

23 Questions Back to Basics Preceptor Survey Results Preceptor Training Format Class Makeup Materials Required Adjunct Pre Testing WebETest Features 23

24 Training Day Format Days per Training Hours per Day Frequency of Training Class Makeup Class Size Agency Requirement Before Hire Required Materials Administering Medications the Right Way Version Medication Administration Video CC&R Health Care Solutions 24

25 CC&R Health Care Solutions Adjunct Materials PowerPoint White Board Overhead DBQ Exercise Making the Connection video 25

SHEET COUNT SHEET, IF NEEDED LOCK WASH HANDS OBSERVE Liquid Medication Look at the area circled in red

26 Medication Administration WASH AREA & HANDS UNLOCK LOOK FOR MED BOOK #1 HCP ORDER TO PHARMACY LABEL #2 PHARMACY LABEL TO MED SHEET PREPARE GIVE SILENT LOOK AGAIN PHARMACY LABEL TO MED SHEET DOCUMENT MED SHEET COUNT SHEET, IF NEEDED LOCK WASH HANDS OBSERVE Liquid Medication Look at the area circled in red Guaifenesin Oral Solution USP 100mg/5mL That means each 5mL contains 100mg of Guaifenesin Review Game 26

27 Adjunct Materials Transcription Workbooks Medication Book Count Book

28 MAP Training Tools Pre-Test Components Knowledge (CBT) Transcription Medication Pass 28

29 Pre-Test Score Report Not Acceptable 29

30 Not Acceptable Not Acceptable 30

31 Medication Pass Demo Medication Pass Demo 31

32 Pre-Test 32

33 WebETest Features Class Roster Verification Forms Scheduling Directions

35 Roster 35

36 Verification Form Demographic Verification Scheduling Directions 36

37 Scheduling Directions

38 D&S Diversified Technologies Fall 2014 Update

39 Verification Form Why Use It? Pass Rates First Time Knowledge Transcription Med Pass Knowledge 7/1/11 6/30/12 7/1/13 6/30/14 DDS 71% 72% DMH ADULT 79% 79% DMH YOUTH 0% 77% 39

40 Transcription DDS DMH ADULT DMH YOUTH 7/1/11 6/30/12 64% 74% 75% 0% 71% 7/1/13 6/30/14 69% Med Pass DDS DMH ADULT DMH YOUTH 7/1/11 6/30/12 7/1/13 6/30/14 65% 68% 77% 71% 0% 71% Common Testing Issues Prior to Test Which Test? ID s? 40

41 Unacceptable ID Common Testing Issues Med Pass What Do I Verbalize? Remember the NAME! How Many Do I Pop? Common Testing Issues Med Pass Documentation Count Book Wrong Page 41

42 Common Testing Issues Transcription Dose and Strength Start/Stop Date Grid Incorrect Grid What Not to Wear Wrist Watch Cell Phones 42

43 TestMaster Universe Available in 2015 Next Meeting Date 43

Banner Health Center

Banner Health Center Coumadin Education Class Anticoagulation Clinic Please turn cell phones off. Thank you! The History of Coumadin 1920s: cattle deaths due to anti-clotting agent found in clover Mid-1940s: