Appendix E Trainer Manual-A Resource Guide for Medication Administration~1.pdf

TRAINER MANUAL

A RESOURCE GUIDE

FOR MEDICATION ADMINISTRATION

TO PREPARE

PERSONAL CARE ASSISTANTS

HOMEMAKER HOME HEALTH AIDES

AND NURSE AIDES

TO ADMINISTER MEDICATIONS

In

ASSISTED LIVING RESIDENCES AND

COMPREHENSIVE PERSONAL

CARE HOMES,

ASSISTED LIVING PROGRAMS

and DEMENTIA CARE HOMES

Revised May 2022

ACKNOWLEDGMENT

We would like to express our appreciation to the following individuals of the New Jersey Department of Health, who contributed their time, knowledge and talents to the development and revisions of this manual. Without their cooperation, creation of this trainer manual would not have been possible.

Barbara Goldman, R.N., J.D. (Retired) Assistant Director

Office of Certificate of Need and Licensure

(Marguerite) Anne Ward, RN, CALA (Retired) Health Care Services Evaluator /Nurse

Assisted Living Program

Bonnie G. Stevens, RPh, C.C.P.

Supervisor of Inspections

Division of Health Facility Survey & Field Operations Assisted Living Program

In grateful appreciation for their valuable contributions to the development of this Training Manual

Henry T. Kozek, RPh, MPA, CCP, CPM (Retired)

Editor Program Manager

Certification Program

Elinor Fritz, RN, MA (In Memoria) Director

Assessment and Survey

TABLE OF CONTENTS

Acknowledgement 2 Table of Contents 3-4 Introduction 5-6 Qualifications and Requirements for Trainers and Trainees 7 How to Train Personal Care Assistants for Medication Administration 8 How to Use the Resource Guide 9-10 Task-Oriented Outline of Program Content 11-16

PART 1 Preparing to Function Effectively in Administering Medications And Assisting with Self-Administration of Medications 17

Duty Area 1: Delegation of Selected Nursing Tasks 18-21

Duty Area 2: Identify Medication Terminology and Abbreviations 22-27

Duty Area 3: Identify Classes of Medications 28-42

Duty Area 4: Recognize Medication Purposes and Effects 43-50

Duty Area 5: Pharmacy Container or Package Labels 51-58

Examples of Commonly Prescriber Branded/Generic Medications 59-60

Duty Area 6: Medication Administration Records (MARs) and other forms 61-68

Duty Area 7: Demonstrate the Five Rights of Medication Administration 69-76

Duty Area 8: Organize to Administer Medications to Residents 77-80

Duty Area 9: Measure and Record Vital Signs Prior to Medication Administration 81-86

Duty Area 10: Administer Oral Medications Correctly 87-92

Duty Area 11: Report and Document a Client/Resident Refusal to Take Medication 93-97

Duty Area 12: Document Medication Errors 98-101

Institute for Safe Medication Practices 102-104

Duty Area 13: Dispose of Medications 105-107

Duty Area 14: Store and Secure All Medications 108-112

Duty Area 15: Maintain an Inventory of Medications 113-116

Examples of Schedule II Controlled Substances 117

Duty Area 16: Administer Medication via Gastrostomy Tube 118-122

Duty Area 17: Infection Control and Prevention 124-128

TABLE OF CONTENTS

PART 2 Administering and Assisting Residents with Self-Administration of prepared Instillations, Treatments and Injections 129

Introduction 130

Duty Area 2.1: Identify diabetes medications; demonstrate proper pen injection technique and identify and respond to symptoms of hypoglycemia 131-136

Duty Area 2.1(a) Demonstrate proper pen injection technique for medications other than

Insulin 137-138

Duty Area 2.2: Perform direct administration of appropriate medications through a Gastrostomy tube (g-tube) 139-142

Duty Area 2.3: Assist resident with self-administration or perform direct administration of ophthalmic (eye) preparations 143-147

Duty Area 2.4: Assist resident with self-administration or perform direct administration of otic (ear) preparations 148-151

Duty Area 2.5: Assist resident with self-administration or perform direct administration of nasal medication 152-156

Duty Area 2.6: Assist resident with self-administration or perform direct administration of topical medications 157-160

Duty Area 2.7: Assist resident with self-administration or perform direct administration of vaginal medications 161-164

Duty Area 2.8: Assist resident with self-administration or perform direct administration of rectal medications 165-170

Duty Area 2.9: Assist resident with self-administration or perform direct administration of inhalation preparations 171-174

Appendix A Regulations N.J.A.C. 8:36-9.2 Certified Medication Aides 175-176

Appendix B Regulations N.J.A.C. 8:36-11.5 Certified Medication Aide Program 177-180

Appendix C Questions and Answers About the Delegation of the Medication Administration

Task 181-190

INTRODUCTION

This Resource Guide for Medication Administration is designed to assist Facility Trainers/Instructors in preparing selected, qualified and certified Personal Care Assistants (PCAs) Nurse Aids (NA) & Homemaker Home Health Aids (HHA) for the responsibility of administering medications, under the circumstances when a RN delegates this task. For brevity, use of Personal Care Assistant (PCA) shall include NA and HHA throughout this manual.

Delegation of the medication administration task to a PCA who has earned the Certified Medication Aide (CMA) Credential may occur in Assisted Living Residences, Comprehensive Personal Care Homes and Dementia Care Homes or as part of an Assisted Living Program. The New Jersey Department of Health (Department) licenses these facilities. Problems or questions regarding the administration of medications by Certified Medication Aides in these settings should be referred to the Department at 609-633-8990.

In accordance with N.J.A.C. 13:37-6.2, only a Registered Professional Nurse may delegate the medication administration task. Licensed Practical Nurses are not authorized to delegate this task.

Assistance with Self-Administration versus Direct Administration of Medications

An essential element of assisted living is that residents should be encouraged to maintain their autonomy and to participate in self-care. To the extent that they are capable, residents in assisted living settings should self-administer their medications. Whenever possible, they should keep their supply of medications in their own apartment/room. For residents who are unable to independently self-administer medications, supervision and assistance with taking medications should be provided.

This training course will give PCAs who have earned the Certified Medication Aide credential, the knowledge they require to assist residents with self-administration. However, a heavy emphasis is placed on procedures for direct administration of medications for those residents who are not able to self-administer, due to the greater complexity of responsibility that is involved in performing this task under the RN's delegation. It remains the RN's duty to assess residents' capabilities, encourage self-administration of medications whenever possible and determine which individuals require direct administration of medications.

When residents require direct administration of medications, the regulations necessitate that medications be administered by the Certified Medication Aide (CMA) in their unit-of-use or unit dose medication distribution system. If CMAs are to administer medications, facilities must make appropriate arrangements with a provider pharmacy to ensure unit-of-use or unit dose packaging.

This training course requires that all prescription medications will be administered by the CMA in this manner. The exceptions to this rule are - Over-the–counter medications do not require unit dose and liquid medications (both over-the counter and prescription) do not require unit of use packaging.

Communication Between the Nurse, Physician, Pharmacist and CMA

In training the Personal Care Assistant (PCA) to administer medications as a CMA, this course emphasizes that the CMA and the delegating RN must maintain frequent close communication.

Numerous professional judgments and decisions must be made in relation to the medication administration task. Only the RN has the expertise and authority to make such judgments and decisions, in consultation with the resident's physician and pharmacist.

The RN maintains full responsibility for communicating with residents’ physicians and pharmacists concerning medication issues and, when delegating the medication administration task, for conveying necessary instructions to the CMA. Throughout this training course, Personal Care Assistants are advised to communicate exclusively with the delegating RN regarding all medication matters. The CMA is not trained to follow orders from, take directions from or otherwise interact with residents' physicians or pharmacists.

In those licensed facilities where medications will be administered by the CMA, it is essential that the delegating RN, including alternates and on-call RNs, be readily accessible to the CMA at all times. This course instructs the CMA to notify the facility administrator in those rare instances when the delegating RN cannot be reached for medication problems. It is the facility administrator's responsibility to assure adequate, on-call registered professional nursing coverage so that the RN may address any questions or problems experienced by the CMA administering medications.

Pharmacy questions and CMA/Nursing questions regarding the Trainer Manual may be directed to:

Shirley Gil, RN Supervising Health Care Evaluator Division of Health Facility Survey & Field Operations Department of Health PO Box 367 Trenton, NJ 08625-0367

(609) 633-8990 phone

(609) 943-4977 FAX

Shirley.Gil@doh.nj.gov mailto:Shirley.Gil@doh.nj.gov

QUALIFICATIONS AND REQUIREMENTS FOR

TRAINERS AND TRAINEES

TRAINER/INSTRUCTOR:

Refers to the individual(s) responsible for teaching the course in medication administration.

Requirements:

1. Current Licensure as a Registered Professional Nurse in good standing.

2. At least 24 months of clinical experience including medication administration responsibilities, or at least two years of experience teaching nursing courses, within the past five years.

3. Consultation/collaboration with a registered pharmacist. The pharmacist's credentials must be submitted at the time that the RN applies to the Department of Health (Department) to become a Trainer/Instructor.

4. Completion of a Department-approved, one-day orientation course or workshop regarding use of this Resource Guide.

5. The New Jersey Registered Pharmacist shall also be required to complete the one-day orientation course.

6. Individuals who are interested in becoming Trainers/Instructors and taking the orientation course or workshop must first submit to the Department or agency authorized by the Department to conduct the training all documentation of required credentials and professional experience. Only those individuals who have been approved will be eligible to take the orientation course and to become Trainers/Instructors.

PERSONAL CARE ASSISTANT MEDICATION ADMINISTRATION TRAINEE:

Refers to an individual who receives training to administer medications under the RN’s delegation in either an Assisted Living Residence or Comprehensive Personal Care Home, Dementia Care Home or as part of an Assisted Living Program.

Requirements:

1. Current certification in good standing as a Nurse Aide, Homemaker Home Health Aide or

Personal Care Assistant (having completed a Department-approved course).

2. Must be able to satisfactorily read, write and comprehend English and demonstrate arithmetic skills.

3. Successful completion of the medication administration training course, skills evaluation, and a statewide, standardized, written competency test.

4. Documentation of successful course completion with a certificate/letter from an approved

Facility Trainer/Instructor maintained on file at the facility.

HOW TO TRAIN PERSONAL CARE ASSISTANTS

FOR MEDICATION ADMINISTRATION

For the RN to delegate medication administration, Personal Care Assistants must have "received verifiable education and demonstrated the adequacy of their knowledge, skill and competency to perform the task being delegated" (N.J.A.C. 13:37-6.2(d)). This Resource Guide for Medication Administration contains a curriculum that must be mastered by the Personal Care Assistant to fulfill the educational requirement. Demonstration of "knowledge, skill and competency" by the Certified Medication Aide will occur in the following ways:

1. Successful completion of all "Evaluation" exercises contained within the Resource

Guide.

2. Successful passage of a statewide, standardized, written test (trainees will receive a picture certificate and laminated picture wallet size card to show that they have passed the examination).

3. Quarterly, direct observation and supervision of the medication administration task by the delegating RN.

It is the Trainer/Instructor’s responsibility to assure that Personal Care Assistants are qualified to take the medication administration training course. The Personal Care Assistant must have either:

1. Completed a nurse aide training course approved by the New Jersey State Department of Health and shall have passed the New Jersey Nurse Aide Certification Examination and be currently certified; or

2. Completed a Homemaker-Home Health Aide training program approved by the New

Jersey Board of Nursing and shall be so certified by the Board and be currently certified;

or

3. Completed a Department of Health approved course for the PCA that emphasizes the concepts of assisted living and be currently certified.

In addition to meeting the qualifications listed above, the candidate must be able to read and write English and demonstrate arithmetic skills. The Trainer/Instructor should verify that prospective trainees have these basic skills, which are essential to the medication administration task.

After selecting qualified trainees, the Trainer/Instructor should implement the curriculum in this Resource Guide.

HOW TO USE THE RESOURCE GUIDE AND COMPLETE

MEDICATION ADMINISTRATION TRAINING

The Resource Guide is divided into two parts. PART 1 contains duty areas aimed at preparing the Personal Care Assistant to function effectively in administering medications. PART 2 concerns the administration of injections and prepared treatments and instillations. The Resource Guide is further organized around a series of "duty areas" that are facets of medication administration.

Each duty area includes:

1. Objectives;

2. Topical Outline and Activities;

3. Evaluation exercises;

4. Instructor materials and/or

5. Trainee handouts.

NOTE: Instruction regarding insulin injection is an integral part of the medication training course. More information on diabetes and injection devices may be obtained through:

• The National Diabetes Education Program at http://ndep.nih.gov/;

• Eli Lilly & Company at 800-545-5979 or http://www.lillydiabetes.com/Pages/index.aspx;

• Novo Nordisk Pharmaceuticals, Inc. at 609-987-5800 or www.novonordisk-us.com;

• Meredith Corporation at http://www.diabeticlivingonline.com/medication/insulin/how-to-use-insulin-pen;

• Sanofi-Aventis at 1-800-981-2491 or www.sanofi-aventis.us or

• From your provider pharmacy or pharmacist consultant.

As stipulated in the requirements for Trainers/Instructors, the registered professional nurse (RN) shall collaborate/consult with the consultant or facility pharmacist in teaching the course. There are portions of the curriculum that are best taught by the pharmacist, in any case, the RN Trainer/Instructor and pharmacist should review the curriculum together and determine how, when, and where material should be presented, as well as identifying how facility-specific procedures and policies regarding medication administration should be incorporated.

The curriculum must take a minimum of 30 hours to complete. Competency training is spread over several weeks to allow additional time for practice and the recommended minimum of three directly supervised medication passes prior to determining candidate eligibility for the written examination.

A “Trainee Task Record” (see pages 14-16) should be completed for each individual. The Trainer/Instructor is responsible for keeping these records and must give a signed copy to the PCA at completion of the course. The Trainer/Instructor should inform students of the testing locations and any other pertinent information about the examination process (this can be obtained from the Department).

http://ndep.nih.gov/ http://www.lillydiabetes.com/Pages/index.aspx http://www.novonordisk-us.com/ http://www.diabeticlivingonline.com/medication/insulin/how-to-use-insulin-pen http://www.diabeticlivingonline.com/medication/insulin/how-to-use-insulin-pen http://www.sanofi-aventis.us/

It is important for the Trainer/Instructors to provide carefully supervised practice opportunities for the Personal Care Assistant to administer medications in the facility. This is a critical part of the learning process for trainees, as well as a mechanism for the Trainer to evaluate task competency.

However, it is not permissible for the Personal Care Assistant to administer medications without direct, one-on-one supervision and assistance by a RN, until after the trainee has passed the statewide examination and received her/his certification for medication administration.

After the Personal Care Assistant's certification for medication administration, the RN shall directly observe the individual administering medications. To promote and verify task competency, the Department of Health recommends that this supervision occur at least weekly during the first month after certification. This supervision shall be documented and a record maintained in the CMA’s file. In addition, all CMAs shall be observed at least quarterly on an on- going basis and the results documented and maintained in the CMA’s file. Quarterly medication administrations may be observed by either the RN or pharmacist, with the completion of the appropriate documentation of competency.

PERSONAL CARE ASSISTANT MEDICATION

ADMINISTRATION TRAINING PROGRAM

Task-Oriented Outline of Program Content

PART 1:

Preparing to function effectively in administering medications and assisting residents with self-administration of medications.

Duty Areas:

1. Understand the Certified Medication Aide’s scope and limits of responsibility in administering medications, in relation to Department of Health Licensing regulations and the New Jersey Nurse Practice Act.

2. Identify medication terminology and abbreviations.

3. Identify classes of medications.

4. Recognize medication purposes and effects.

5. Pharmacy container or package labels.

6. Use Medication Administration Records (MAR) and other medication forms.

7. Demonstrate the “five rights” of medication administration.

8. Organize to administer medications to one or more residents.

9. Measure and record vital signs prior to medication administration, if required.

10. Administer oral medications correctly.

11. Report and document a resident refusal to take medication.

12. Document medication errors.

13. Dispose of medications.

14. Store and secure all medications.

15. Maintain an inventory of medications.

16. Administration of medications via gastrostomy tube.

17. Infection Control and Prevention

PART II:

Administering and assisting the resident with self-administration of prepared instillations, treatments, and pen injections.

Duty Areas:

2.1 & 2.1(a) Assist resident or administer diabetes and other medications and pre-drawn insulin or other injections.

2.2 Administer medication via gastrostomy tube

2.3 Assist resident or administer eye medications.

2.4 Assist resident or administer ear medications.

2.5 Assist resident or administer nasal medications.

2.6 Assist resident or administer topical medications.

2.7 Assist resident or administer vaginal medications.

2.8 Assist resident or administer rectal medications.

2.9 Assist resident or administer inhalation medications.

TRAINER/INSTRUCTOR ORIENTATION REGARDING

MEDICATION ADMINISTRATION COURSE

Topical Outline of Program Content

All Trainers/Instructors shall have orientation in program content as outlined below

Purpose:

Persons designated as Trainers/Instructors will receive orientation in instructional practices to enhance the effectiveness of the training they provide to Personal Care Assistants regarding the delegation of medication administration.

Objectives:

Upon successful completion of the orientation, Trainers/Instructors will be able to:

• Manage the Personal Care Assistant medication administration training programs at her/his facility;

• Understand the role of the registered pharmacist in providing consultation/ collaboration;

• Understand her/his role as a Trainer/Instructor;

• Identify characteristics of the adult learner; and

• Implement a competency-based approach to training using the Resource Guide for

Medication Administration.

Content:

I. Getting ready to train adult learners

A. The adult learner

1. Characteristics and needs of the adult learner

2. Learning styles of the adult learner

3. Principles of teaching the adult learner

II. Overviews of the Resource Guide for Medication Administration

A. Instructor's Manual

B. Trainee's Manual

C. Evaluation of Competency and use of "Trainee Task Record"

III. Update on Medications

A. Diabetes Medications

B. New Medications

C. Current Issues Regarding Medication Administration in Assisted Living settings

TRAINEE TASK RECORD

Certified Medication Aide Training Program

Trainee Name: _______________________________________________________________

Facility: ____________________________________________________________________

Place a check beside the task to indicate that the trainee has performed the task in an acceptable manner; that is, achieving an acceptable rating on each component of a rating sheet or checklist, or achieving the accuracy standard designated for a written evaluation. The instructor's initials and the date should be placed beside the check.

Check for acceptable task performance.

TASKS

Instructor's

Initials Date

PART I: Duty Areas- Preparing to Function Effectively in

Administering Medications and Assisting with self-administration of Medications

1.1 Understand the Certified Medication Aide’s scope and

limits of responsibility in administering medications, in relation to Department of Health Licensing regulations and the New Jersey Nurse Practice Act.

1.2 Identify medication terminology and abbreviations. ______ ______

1.3 Identify classes of medications. ______ ______

1.4 Recognize medication purposes and effects. ______ ______

1.5 Pharmacy container or package labels. ______ ______

1.6 Use Medication Administration Records (MAR) and other

medication forms.

1.7 Demonstrate the “five rights” of medication

administration.

1.8 Organize to administer medications to one or more

residents.

1.9 Measure and record vital signs prior to medication

administration, if required.

TASKS

Instructor's

Initials Date

1.10 Administer oral medications correctly. _______ ______

.1.11 Report and document a resident refusal to take medication.

.1.12 Document medication errors. _______ ______

.1.13 Dispose of medications. _______ ______

.1.14 Store and secure all medications. _______ ______

.1.15 Maintain an inventory of medications. _______ ______

.1.16 Administration of Medication via gastrostomy tube

.1.17 Infection Control and Prevention

Part II: Administering and Assisting the Resident with

Self-administration of Prepared Installations, Treatments, and Insulin Injections

2.1 Identify diabetes medications, demonstrate proper

injection technique, and identify and respond to reactions symptoms of hypoglycemia.

2.1(a) Demo proper technique with non-insulin pens.

(with waiver approved injectable products)

2.2 Administer medications via gastrostomy tube. _______ ______

2.3 Assist resident to administer eye medications. _______ ______

2.4 Assist resident to administer ear medications. _______ ______

2.5 Assist resident to administer nasal drops and nasal

medications.

2.6 Assist resident to administer topical medications. _______ ______

2.7 Assist resident to administer vaginal medications. _______ ______

2.8 Assist resident to administer rectal medications. _______ ______

2.9 Assist resident with inhalation medications. _______ ______

I understand these task and procedures and feel comfortable performing them.

Student Comments:

Student:

Signature Date

Instructor comments:

Instructor:

Signature Date

PART I

Preparing to function effectively in administering medications and assisting with self-administration of medications

DUTY AREA 1

Understand the Certified Medication Aide’s scope and limits of responsibility in administering medications, in relation to Department of Health Licensing regulations and the New Jersey Nurse Practice Act.

Performance Objective:

Explain the meaning of "delegation."

Identify the circumstances under which the Certified Medication Aide may administer medications.

Identify the types/routes of medication administration that may be delegated by the RN to the

Certified Medication Aide.

TOPICAL OUTLINE

I. Reviewing Licensing and Nurse Practice regulations that govern medication administration and delegation of nursing functions

A. Board of Nursing: N.J.A.C. 13:37-6.2

<http://www.state.nj.us/lps/ca/laws/nursingregs.pdf>

B. Department of Health: N.J.A.C. 8:36-11.5 – Administration of Medications http://www.state.nj.us/health/healthfacilities/documents/ltc/regnjac836.pdf

ACTIVITIES

Provide trainees with handout of regulations. Discuss their meaning.

Explain consequences of administering medications without delegation by RN.

Describe the facility’s procedure for nursing delegation of medication administration function to the Certified Medication Aide.

1. What is a "regulation”? How does it guide what actions you can perform in administering medications?

2. What does "nursing delegation” mean? How will you know that the RN has delegated the task of medication administration to you?

3. Give an example of a situation where you should not administer medications.

4. Using a picture of a person, point to and briefly describe the following routes of medication administration that are permitted under the licensing regulations:

a. oral (including sublingual tablet and/or sprays)

b. ophthalmic

c. otic

d. inhalant

e. nasal

f. rectal

g. vaginal

h. topical

i. subcutaneous injection (only pre-drawn insulin and waiver approved injectable products)

j. gastrostomy tube

Duty Area 1 Evaluation

Board of Nursing Regulations

N.J.A.C. 13:37-6.2

Delegation of Selected Nursing Tasks

A. The RN is responsible for the nature and quality of all nursing care including the assessment of the nursing needs, the plan of nursing care, the implementation and the monitoring and evaluation of the plan. The RN may delegate selected nursing tasks in the implementation of the nursing regimen to licensed practical nurses and ancillary nursing personnel. Ancillary nursing personnel shall include but not limited to aides, assistants, attendants and technicians.

B. In delegating selected nursing tasks to licensed practical nurses or ancillary nursing personnel, the RN shall be responsible for exercising that degree of judgment and knowledge reasonably expected to assure that an appropriate delegation has been made.

A RN may not delegate the performance of a nursing task to persons who have not been adequately prepared by verifiable training and education. No task may be delegated which is within the scope of nursing practice and requires:

1. The substantial knowledge and skill derived from completion of a nursing education program and the specialized skill, judgment and knowledge of a RN and

2. An understanding of nursing principles necessary to recognize and manage complications, which may result in harm to the health and safety of the patient.

C. The RN shall be responsible for the proper supervision of licensed practical nurses and ancillary nursing personnel to whom such delegation is made. The degree of supervision exercised over licensed practical nurses and ancillary nursing personnel shall be determined by the RN based on an evaluation of all factors including:

1. The condition of the resident;

2. The education, skill and training of the licensed practical nurse and ancillary nursing personnel to whom delegation is being made;

3. The nature of the tasks and the activities being delegated;

4. Supervision may require the direct continuing presence or the intermittent observation, direction and occasional physical presence of a RN. In all cases, the RN shall be available for on-site supervision.

Trainee Handout

D. An RN shall not delegate the performance of a selected nursing task to any licensed practical nurse that does not hold a current valid license to practice nursing in the State of New Jersey. An RN shall not delegate the performance of a selected nursing task to ancillary nursing personnel who have not received verifiable education and have not demonstrated the adequacy of their knowledge, skill and competency to perform the task being delegated.

E. Nothing contained in this rule is intended to limit the current scope of nursing practice.

F. Nothing contained in this rule shall limit the authority of a duly licensed physician acting in accordance with N.J.S.A. 45:9-1 et seq.

Department of Health-Licensing Standards for Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs N.J.A.C.

8:36-Sub-chapter 11.5 Administration of Medications

Department of Health -Licensing Standards for Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs N.J.A.C.

8:36- Sub-chapter N.J.A.C. 8:36- Sub-chapter 9.2 Refer to the APPENDIX

Department of Health LICENSING STANDARDS FOR DEMENTIA CARE HOMES N.J.A.C. 8:37 Sub-chapter N.J.A.C. 6.2(a)1

DUTY AREA 2

Identify medication terminology and abbreviations.

Performance Objective:

Given a list of medication terms and abbreviations, match the term and the correct abbreviation as required. This must be done with 90% accuracy.

TOPICAL OUTLINE ACTIVITIES

I. Identify medication terminology and abbreviations.

A. Common medication terms and their abbreviations.

1. Before meals ac

2. Twice a day BID

3. With c

4. Without s* or ¢

5. Capsule cap

6. Elixir Elix

7. Gram gm or Gm

8. Grain gr

9. Drop gtt

10. Hour of sleep or bedtime HS

11. One (1) i

12. Intramuscular IM

13. Intravenous IV

14. Milligram mg or MG

15. After meals pc

16. By or through per

17. When necessary or as prn occasion requires

18. Every q

19. Once a day or every day qd*

20. Every hour q1H

21. Every 4 hours q4H

22. 4 times a day qid

23. Every other day qod*

24. Label or let it be marked Sig

25. Solution sol

26. Immediately Stat

27. Tablet tab

28. Ointment ung

29. Blood pressure BP

30. Temperature temp.

31. Subcutaneous sc or sub q*

32. Sublingual sl

Review handouts on medication terms and abbreviations included in this unit.

Explain each term and the abbreviation.

Use terms in subsequent training units to reinforce learning.

Use situations that typically occur in facilities to give trainees the opportunity to practice using the terminology and interpreting the abbreviations. Examples: Mr. Brown receives his cap Q.I.D. and steroid ointment p r n. Ms. Green needs assistance Stat.

In facility settings, use terms and abbreviations that occur most frequently.

Dram is an old term, but occasionally seen on prescriptions. If in the service setting dram is used, teach students the following equivalency:

one (1) dram = 5cc = 5ml = 1 tsp.

Allow adequate time for the trainees to review the terms and abbreviations and to practice using them on the job.

Use flash cards or gram format to review.

Provide additional explanation as necessary.

33. Respiration (breathing) resp.

34. Gastrointestinal Tract GI tract

35. Bowel movement BM

36. Pass water (urinate) Void (not an abbr.)

37. Heart beat apical pulse or radial pulse

38. Shortness of breath SOB

39. Both eyes ou

40. Right eyes od*

41. Left os*

42. Around-the-Clock RTC or ATC

43. Medication Administration Record MAR

44. Treatment Administration Record TAR

45. Milliliter ml

46. Cubic Centimeter cc (equals ml)

47. Three times a day TID

48. By mouth po

49. Physician’s Order Sheet POS

50. By gastrostomy tube GT or gt or G-tube or g-tube

51. Apical Pulse AP

52. Radial Pulse RP

53. Injection inj

* Indicates dangerous abbreviations that have been interpreted to have more than one meaning or have been mistaken for another abbreviation.

EVALUATION:

Give a test that requires trainees to identify medication terminology and abbreviations. A test is included in this unit.

Check trainees completed tests according to topical outline. Require 90% accuracy.

Provide additional instruction for those who fail to meet accuracy standard.

B. Measurement terms used in medication and their equivalents.

1. 1 quart 1000 ml or cc

2. 1 fluid ounce 30 ml or cc or 2 tablespoons

3. 1 ounce 30 gm

4. 15 grains 1 gm

5. 1 grain 60 mg

6. 1/2 fluid ounce 1 tablespoon

7. 1 teaspoon 5 ml or 5cc

Identifying Medication Terms and Abbreviations

PART A:

Match each term to its abbreviation by placing the number of each term in the blank beside its abbreviation.

TERM ABBREVIATION

1. Before meals ______________ qd*

2. After meals ______________ q1h

3. Every day ______________ ac

4. Every hour ______________ BID

5. Every 4 hours ______________ qod*

6. Four times a day ______________ pc

7. Twice a day ______________ qid

8. Every other day ______________ TID

9. Three times a day ______________ p r n

10. When necessary (as needed) ______________ q4h

*Indicates dangerous abbreviations that have been interpreted to have more than one meaning or have been mistaken for another abbreviation.

Duty Area 2

PART B:

Match each term to its abbreviation by placing the number of each term in the blank beside its abbreviation.

1. Milligram ______________ c

2. With ______________ gtt

3. Solution ______________ sol

4. Drop ______________ mg

5. Temperature ______________ Sig

6. Bowel movement ______________ Stat

7. Respiration (breathing) ______________ BP

8. Immediately ______________ resp.

9. Blood pressure ______________ temp.

10. Label ______________ BM

PART C:

Match each term to the equivalent measurement by placing the number of each term in the blank beside its equivalent measurement.

EQUIVALENT MEDICATION

TERM MEASUREMENT TERM

1. 1 fluid ounce ______________ 1 teaspoonful

2. 1000 ml ______________ 30 ml or 2 tbsp

3. 5 cc or 5 ml ______________ 1 quart

4. 15 ml ______________ 1 tablespoonful

Identifying Medical Terminology and Abbreviations

Before meals ac Twice a day BID With c Without s* or ¢ Cubic centimeter (also milliliter) cc Capsule cap Elixir (drug dissolved in syrup containing alcohol) elix By gastrostomy tube or g-tube GT or gt Gram gm or Gm Grain gr Drop gtt Hour of sleep or bedtime HS One (1) i Injection inj Intramuscular IM Intravenous IV Medication Administration Record MAR Milligram mg After meals pc By or through per When necessary or as occasion requires p r n Every q Every day qd* Every hour qh Every four hours q4h Four times a day qid Every other day qod* Label or let it be marked Sig Solution sol Immediately stat Tablet tab Three times a day TID Ointment Ung Both eyes ou Right eye od* Left eye os* By mouth po

• * Indicates dangerous abbreviations that have been interpreted to have more than one meaning or have been mistaken for another abbreviation. Refer to pages 107-109.

MEASUREMENT CHART

1000 ml = 1 quart 2 tbsp = 1 fluid ounce = 30 ml 30 ml = 2 tablespoonfuls 1 tbsp = 1/2 fluid ounce = 15 ml 30 gm = 1 ounce 1 tsp = 5 ml 1 gm = 15 grains 30 ml = 1 fluid ounce 60 or 65 mg = 1 grain 3 tsp = 1 tablespoonful=15 ml milliliters or centimeters = fluid measure grams or grains = solid measure

Grains, ounce and fluid ounce are units of the Apothecary System of measurement.

Milliliters, grams and milligrams are units of the Metric System of measurement. Current professionally acceptable practices in pharmacy only utilize the Metric System.

Apothecary is only included for comparison purposes.

PHYSICAL ASSESSMENT TERMS

Blood pressure = BP or B/P or b/p Temperature = temp Respiration (breathing) = resp Gastrointestinal (tract) = GI Bowel movement = BM or bm Urinate (pass water) = void Heartbeat felt at arteries = pulse Apical Pulse = AP Radial Pulse = RP Shortness of Breath = SOB Subcutaneous (beneath the skin into the fat) = sc or sub q*

DUTY AREA 3

Identify classes of medications

Performance Objective:

Given discussion and practice activities related to the classes of medications, complete with

90% accuracy, a test requiring identification of common classes of medications. Generic medications appear in lower case, while branded or trade name medications are capitalized.

Examples provided which are not all inclusive.

TOPICAL OUTLINE

A. Classes of medications with examples

1. Anti-Infectives

a. Fluoroquinolones : ciprofloxacin, levofloxacin, moxifloxacin

b. Cephalosporins: cefaclor, cefdinir, cefprozil, cephalexin, cefadroxil, cefepime, cefpodoxime, cefprozil, ceftriaxone, cefuroxime

c. Penicillins: ampicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin

d. Macrolides: erythromycin, azithromycin, clarithromycin

e. Tetracyclines: minocycline, doxycycline

f. Oxazolidinones: linezolid

g. Glycopeptide: vancomycin

h. Influenza: rimantadine, zanamivir, amantadine, oseltamivir

i. Rx Ophthalmics: ciprofloxacin, gentamicin, tobramycin

j. Topical: mupirocin, neomycin, bacitracin

2. Cardiovascular Agents

a. Vasodilators: isosorbide mononitrate, isosorbide dinitrate, nitroglycerin

b. Cardiac glycosides: digoxin

c. Beta Blockers: propranolol, metoprolol, atenolol, carvedilol, bisoprolol, nebivolol

d. Calcium Channel Blockers: diltiazem, amlodipine, nifedipine, verapamil

e. ACE inhibitors and Angiotensin receptor blockers (ARB’s): quinapril, captopril, lisinopril, enalapril, ramipril, candesartan, irbesartan, olmesartan, losartan, valsartan, telmisartan

f. Diuretics: spironolactone, bumetanide, torsemide, hydrochlorothiazide, furosemide, metolazone

g. Antiarrhythmics: amiodarone, disopyramide, flecainide

h. Platelet aggregation inhibitors: apixabam, rivaroxaban, prasugrel,

i. Pulmonary Arterial Hypertension: bosentan, sildenafil

3. Respiratory Agents

a. Theophylline

b. Beta 2-agonist Inhalers: metaproterenol, formoterol, pirbuterol, salmeterol, albuterol, levalbuterol

c. Steroid Inhalers: flunisolide, beclomethasone, fluticasone, budesonide

d. Leukotriene inhibitors: zafirlukast, montelukast, zileuton

e. Other: cromolyn

f. Intranasal: beclomethasone, fluticasone, triamcinolone, mometasone

g. Combination steroid and bronchodilator inhalers: fluticasone/salmeterol, budesonide/formoterol

h. Anticholinergic: ipratropium, tiotropium

4. Gastrointestinal Tract Agents (OTC name in parenthesis)

a. H2 blockers: nizatidine, cimetidine, famotidine

b. Antacids: aluminum hydroxide/magnesium hydroxide with or without simethicone

c. Proton pump inhibitors: rabeprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, dexlansoprazole

d. Anticholinergic agents: hyoscyamine, dicyclomine, scopolamine

e. Anti-inflammatory: mesalamine, sulfasalazine, balsalazide, olsalazine, budesonide, adalimumab

5. Hormonal Agents

a. Estrogens/Progestins: estradiol, conjugated estrogen, conjugated estrogen/medroxyprogesterone, medroxyprogesterone

b. Estrogen receptor modulator: raloxifene

c. Androgens: oxandrolone, testosterone

d. Androgen Inhibitor: dutasteride, finasteride

e. Corticosteroids: beclomethasone, betamethasone, budesonide, dexamethasone, fludrocortisone, fluticasone, hydrocortisone, methylprednisolone, prednisone, triamcinolone

f. Thyroid: liothyronine, levothyroxine

g. Anti-thyroid: methimazole, propylthiouracil

h. Osteoporosis: risedronate, calcitonin, etidronate, alendronate, teriparatide

6. Anticancer Agents

a. Dexamethasone, prednisone

b. Alkylating agent: cyclophosphamide, ifosfamide, bendamustine, carboplatin, dacarbazine, melphalan, oxaliplatin, temozolomide, thiotepa, cisplatin

c. Antimetabolite, antineoplastics: capecitabine, cytarabine, fludarabine, hydroxyurea, mercaptopurine, methotrexate, paclitaxel, fluorouracil

d. Antibiotic antineoplastics: bleomycin, daunorubicin, doxorubicin, epirubicin, mitomycin

7. Anticonvulsants

a. Hydantoins: fosphenytoin, phenytoin

b. Benzodiazepines: clonazepam, diazepam, lorazepam, clobazam

c. valproic acid, felbamate, tiagabine, levetiracetam, lamotrigine, gabapentin, topiramate, ethosuximide, zonisamide, asenapine, ezogabine, oxcarbazepine, primidone, phenobarbital, carbamazepine

8. Antipsychotic Agents

a. Phenothiazine: chlorpromazine, thioridazine, fluphenazine, trifluperazine

b. Thiothixene, haloperidol

c. clozapine, loxapine, olanzapine

d. quetiapine, risperidone, aripiprazole, ziprasidone

e. lithium

9. Antidepressants

a. Tricyclic antidepressants: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline,

b. Tetracyclic antidepressant: mirtazapine

c. bupropion, trazodone

d. SSNRI: venlafaxine, duloxetine

e. SSRI: citalopram, escitalopram, fluvoxamine, paroxetine, fluoxetine, sertraline

10. Antiparkinson Agents

a. Anticholinergic: trihexphenidyl, benztropine, diphenhydramine

b. amantadine

c. Dopamine agonist: bromocriptine, levodopa, carbidopa, carbidopa/levodopa

d. MAOI: rasagiline, selegiline

e. Tolcapone, entacapone

f. Non ergot dopamine agonist: pramipexole, ropinirole

11. Anticoagulants

a. Anticoagulant: heparin, warfarin

b. Low molecular weight heparins: enoxaparin, dalteparin

c. Selective factor Xa inhibitors: rivaroxaban, fondaparinux, apixaban

d. Thrombin inhibitors: bivalirudin, dabigatran

e. Platelet aggregation inhibitor: clopidogrel, prasugrel, cilostazol, dipyridamole

12. Antidiabetic Agents

a. Long-acting insulin: insulin detemir, insulin glargine

b. Rapid onset insulin: insulin glulisine, insulin aspart, insulin lispro

c. Short acting insulin: Regular insulin

d. Intermediate acting insulin: Insulin NPH

e. chlorpropamide, tolazamide, tolbutamide,

f. Sulfonylurea: glipizide, glyburide, glimepiride, repaglinide, nateglinide

g. miglitol, acarbose

h. SGLT2 inhibitors: dapagliflozin, canagliflozin, empagliflozin

i. Insulin sensitizer: metformin, pioglitazone, rosiglitazone

j. DPP4 inhibitor: sitagliptin, saxagliptin, linagliptin, alogliptin

k. GLP 1 Inhibitor: dulaglutide, exenatide, semaglutide, liraglutide

13. Analgesics - Narcotic

a. Schedule II: morphine, hydrocodone combinations (as of 10/14), oxycodone (alone and in combination), fentanyl, hydromorphone, methadone, codeine

b. Schedule III combinations acetaminophen with codeine,

c. Schedule IV: tramadol (as of 8/14)

d. Schedule V: pregabalin

14. Analgesics: Migraine

a. Selective serotonin agonists: naratriptan, almotriptan, frovatriptan, sumatriptan, rizatriptan, zolmitriptan

b. Ergot: dihydroergotamine

c. CGRP antagonists: rimegepant, ubrogepant

15. Analgesics - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

a. COX 1 inhibitor: celecoxib

b. Diclofenac/misoprostol

c. Flubipofen, oxaprozin, etodolac, ibuprofen, nabumetone, ketorolac, diclofenac, meloxicam, indomethacin, naproxen

16. Analgesics - Over-The-Counter or OTC

a. NSAIDSs (naproxen, ibuprofen)

b. Acetaminophen

c. Aspirin

17. Antihistamines

a. fexofenadine, desloratadine, loratadine, cetirizine, levocetirizine

b. diphenhydramine, chlorpheniramine

c. cyproheptadine

d. hydroxyzine, promethazine, clemastine

e. Rx ophthalmics: emedastine, olopatadine

18. Antihyperlipidemic (AntiCholesterol) Agents

a. Statins: fluvastatin, atorvastatin, lovastatin, pravastatin, simvastatin, rosuvastatin, pitavastatin

b. Bile acid sequestrants: cholestyramine, colesevelam

c. Gemfibrozil, fenofibrate

d. Niacin

e. Ezetimibe

19. Alzheimer’s Agents-Cognitive Enhancers

a. Memantine

b. Acetylcholinesterase Inhibitors: donepezil, rivastigmine, galantamine

20. Antianxiety Agents

a. Benzodiazepines: lorazepam, clorazepam, chlordiazepoxide, oxazepam, diazepam, alprazolam

b. Buspirone, doxepin, paroxetine, escitalopram

21. Hypnotic (Sleep) Agents

a. Zolpidem, eszopiclone, zaleplon

b. Benzodiazepines: flurazepam, triazolam, temazepam

c. Zaleplon

22. Medications Used in End Stage Renal Disease (ESRD)

a. Hypoparathyroidism: calcitriol

b. Hyperparathyroidism: paricalcitol, cinacalcet

c. Carnitor (l-carnitine)

d. Iron dextran, sodium ferric gluconate, iron polysaccharide

e. Hematopoietic agents: epoetin alfa, darbepoetin alfa

f. Phosphate binder: sevelamer, calcium acetate

23. Ophthalmics/Otics

a. Glaucoma: brinzolamide, levobunolol, betaxolol, bimatoprost, pilocarpine, timolol, tavoprost

b. Otic: antipyrine/benzocaine, ciprofloxacin, colistimethate, neomycin/polymyxin/hydrocortisone, carbamide peroxide

c. NSAIDs: ketorolac, flurbiprofen, diclofenac

24. Laxatives

a. Osmotic: polyethylene glycol, magnesium citrate, magnesium hydroxide, magnesium sulfate, sodium phosphate, glycerin, lactulose

b. Bulk: calcium polycarbophil, psyllium

c. Fecal softeners: docusate calcium, docusate sodium

d. Stimulants: cascara, castor oil, bisacodyl, senna

e. Prescription: linaclotide, lubiprostone, lactulose

25. Urinary Tract Agents

a. Urinary pH modifiers: sodium citrate, potassium phosphate, potassium citrate

b. Anticholinergics: solifenacin, flavoxate, tolterodine, oxybutinin

c. Impotence Agents: alprostadil, sildenafil, tadalafil, yohimbine, vardenafil

26. Nutrients and Nutritional Agents

a. Vitamins: A, D, E, K, B1, B2, B6, B12, C, Folic Acid

b. Minerals: Calcium, Phosphorus, Magnesium

c. Trace elements: Fluoride, Iron, Zinc

d. Electrolytes: Potassium, Sodium

e. Amino Acids: Glutamic Acid, L-Lysine, L-Tryptophan, Methionine

f. Enterals: Compleat, Ensure, Isocal, Pulmocare, Glucerna, Nutren, Osmolyte, Fibersource, Jevity, Nutren, TwoCal, Isosource, Nepro

27. Topicals

a. Creams, Gels, Lotions, Ointments, Soaps, Solutions, Sprays,

b. Antiseptics/Germicides: povidone iodine, glutaraldehyde, chlorhexidine, hexchlorophene

c. Shampoos (Rx and OTC)

d. Topical antifungal agents: Ciclopirox, miconazole, clotrimazole, ketoconazole, efinaconazole

***This list is NOT all inclusive***

B. Types of dispensed medications

1. Prescription medications

a. Controlled or Scheduled drugs

(1) Designated as accountable substances

(2) Considered to have a high potential for abuse and diversion

(3) May require special storage conditions and/or reporting procedures

b. Non-controlled drugs

All prescription medications that are not controlled or scheduled substances

2. Over the counter (OTC) medications

a. May be purchased without a prescription

b. May produce unwanted effects or adverse drug reactions

c. May be former prescription drugs (e.g., Pepcid, Allegra, Imodium)

d. May interact with prescription drugs and/or foods and/or herbal medicines

ACTIVITIES

Review the handout on classes of medications that is provided in this unit.

Explain each class, giving examples that the trainees are likely to encounter at their facility.

Have trainees write these examples on the handout.

Make reference books available to trainees at the facility. The recommended reference is, Advice for the Patient: Drug Information in Lay Language, Vol. ll, USPDI, published yearly by Micromedex <www.micromedex.com>. Similar publications are available from Consumer Reports as the Consumer Drug Reference <www.consumerreports.org/books> or 1-800-500-9760 or from MedlinePlus <http://www.nlm.nih.gov/medlineplus/>.

Explain the categories used to dispense these medications – prescription (controlled and non-controlled) and over the counter (OTC). Emphasize that medications in the OTC category should not be considered harmless. These medications may have unwanted or adverse effects, especially in the elderly population.

Guide trainees in determining whether each of the medication examples on the handout is:

a. prescription controlled, (b) prescription non-controlled, or (c) over the counter.

Give trainees a list of medications being used by residents at the facility and have them identify the class of each medication. Then have the trainees determine if each drug is: prescription controlled; prescription non-controlled or over the counter.

Direct trainees to practice identifying the class and category of the medications they assist residents with during the next several days. Provide additional explanation as necessary.

EVALUATION

Give a test which requires trainees to identify the common classes of medications. (A test is included in this unit.)

Check trainee’s completed tests using the unit topical outline. Require 90% accuracy. Each question counts 10 points for a total of 100 points. Provide additional instruction to those who do not achieve the accuracy standard.

http://www.consumerreports.org/books%3e%20or%201-800-500-9760 http://www.nlm.nih.gov/medlineplus/

27 COMMON CLASSES OF MEDICATIONS AND EXAMPLES OF EACH

1. Anti-Infectives

a. Fluoroquinolones : ciprofloxacin, levofloxacin, moxifloxacin

b. Cephalosporins: cefaclor, cefdinir, cefprozil, cephalexin, cefadroxil, cefepime, cefpodoxime, cefprozil, ceftriaxone, cefuroxime

c. Penicillins: ampicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin

d. Macrolides: erythromycin, azithromycin, clarithromycin

e. Tetracyclines: minocycline, doxycycline

f. Oxazolidinones: linezolid

g. Glycopeptide: vancomycin

h. Influenza: rimantadine, zanamivir, amantadine, oseltamivir

i. Rx Ophthalmics: ciprofloxacin, gentamicin, tobramycin

j. Topical: mupirocin, neomycin, bacitracin

k. Other examples:______________________________________________________

2. Cardiovascular Agents

a. Vasodilators: isosorbide mononitrate, isosorbide dinitrate, nitroglycerin

b. Cardiac glycosides: digoxin

c. Beta Blockers: propranolol, metoprolol, atenolol, carvedilol, bisoprolol, nebivolol

d. Calcium Channel Blockers: diltiazem, amlodipine, nifedipine, verapamil

e. ACE inhibitors and Angiotensin receptor blockers (ARB’s): quinapril, captopril, lisinopril, enalapril, ramipril, candesartan, irbesartan, olmesartan, losartan, valsartan, telmisartan

f. Diuretics: spironolactone, bumetanide, torsemide, hydrochlorothiazide, furosemide, metolazone

g. Antiarrhythmics: amiodarone, disopyramide, flecainide

h. Platelet aggregation inhibitors: apixabam, rivaroxaban, prasugrel,

i. Pulmonary Arterial Hypertension: bosentan, sildenafil

j. Other examples:______________________________________________________

3. Respiratory Agents

a. Theophylline

b. Beta 2-agonist Inhalers: metaproterenol, formoterol, pirbuterol, salmeterol, albuterol, levalbuterol

c. Steroid Inhalers: flunisolide, beclomethasone, fluticasone, budesonide

d. Leukotriene inhibitors: zafirlukast, montelukast, zileuton

e. Other: cromolyn

f. Intranasal: beclomethasone, fluticasone, triamcinolone, mometasone

g. Combination steroid and bronchodilator inhalers: fluticasone/salmeterol, budesonide/formoterol

h. Anticholinergic:…