MAP Manual

Administering
t
h
e
M edications
Right way
Margaret Casey-Mederios RN
CC&R Healthcare Solutions
Winthrop, Massachusetts
Administering Medications the Right Way

Author: Margaret Casey Mederios, R.N.
Writer:
Kathleen
Masucci, R.N.
Administering
Medications
the Right Way
Editors:
onnie Christiansen,
ELS R.N.
Author: LMargaret
Casey Mederios,
Sarah
Campbell
Writer: Kathleen Masucci, R.N.
Editors:
Lonnie
Christiansen,
ELS Health Care Solutions
Copyright
2005,
2012 by CC&R
Sarah
Campbell
Library of
Congress
Registration Number: TX 5-912-197
ISBN:
978-0-9857646-1-6
Copyright
2005, 2012 by CC&R Health Care Solutions
Version
Number
4.1.1Registration Number: TX 5-912-197
Library of
Congress
ISBN:
CC&R 978-0-9857646-1-6
Healthcare Solutions
Version
P.O.
Box Number
520086 4.1.1
Winthrop, MA 02152
CC&R
Solutions
Phone:Healthcare
877-539-0109
P.O.
520086
Fax: Box
617-539-3036
Winthrop,
MA 02152
Web: www.medicationadministration.com
Phone: 877-539-0109
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is available from CC&R Healthcare Solutions. For more information, please call
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please
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All rights reserved. No part of the publication may be reproduced, stored in a retrieval
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Table of Contents
2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions
To the Student . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

How the Manual Is Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
What You Will Learn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Special Learning Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
Melissa, Chip, and Freddy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
A Note on Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
SECTION 1: The Basics of Medication Administration . . . . . . . . . . . . .
Module 1: Administering Medications the Right Way . . . . . . . . . . . . .
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Proper Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Getting to Know the People You Support . . . . . . . . . . . . . .
How to Give Medications . . . . . . . . . . . . . . . . . . . . . . . .
Principles to Consider . . . . . . . . . . . . . . . . . . . . . . . . . .
Understanding the Cycle of Responsibility . . . . . . . . . . . . . .
The Cycle of Responsibility Comes Full Circle . . . . . . . . . . . .
Making the Cycle Part of Your Daily Routine . . . . . . . . . . . .
Skills You Need as a Direct Support Staff Member . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
1
2
3
3
5
6
7
10
13
15
17
17
19
Module 2: Medications and What You Need to Know . . . . . . . . . . . . .

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medication: What Is It? . . . . . . . . . . . . . . . . . . . . . . . . .
Categories of Medications . . . . . . . . . . . . . . . . . . . . . . .
Effects of Medication . . . . . . . . . . . . . . . . . . . . . . . . . .
Medication Interactions . . . . . . . . . . . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
21
21
23
23
24
26
30
34
35
SECTION 2: The Techniques of Medication Administration . . . . . . . . . .

Module 3: How to Observe and Report Information . . . . . . . . . . . . .
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Objective and Subjective Information . . . . . . . . . . . . . . . .
The Importance of Accurate Observations and Reporting . . . . .
37
37
37
38
38
39
41
iii
When to Report Information . . . . . . . . . . . . . . . . . . . . . .

Remembering Your Observation, Recalling Details, and
Forms for Reporting . . . . . . . . . . . . . . . . . . . . . . . . . .
Report Information to the Right People . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
46
47
47
48
* Module 4: How to Prevent and Control Infection . . . . . . . . . . . . . . . 49

*MASSACHUSETTS
Non-Mandatory Content
49
49
49
50
50
51
53
53
54
Module 5: How to Administer Medications . . . . . . . . . . . . . . . . . . . 55

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Key Terms to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Support Visits to the HCP . . . . . . . . . . . . . . . . . . . . . . . . 57
Communicating with the Pharmacist . . . . . . . . . . . . . . . . . 59
Record Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Store Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
The Five Rights of Giving Medications . . . . . . . . . . . . . . . 63
Special Instructions or Precautions . . . . . . . . . . . . . . . . . . 70
Crosschecking to Ensure Safe Administration . . . . . . . . . . . . 71
General Cautionary Guidelines . . . . . . . . . . . . . . . . . . . . . 74
Three Parts of Administering Medications . . . . . . . . . . . . . . 75
Prepare for Medication Administration . . . . . . . . . . . . . . . . 77
Administer Oral Medication . . . . . . . . . . . . . . . . . . . . . . 79
Complete Medication Administration . . . . . . . . . . . . . . . . 81
Liquid Oral Medications . . . . . . . . . . . . . . . . . . . . . . . . . 85
Preparing for Administration of Liquid Medication . . . . . . . . . 87
Administering Liquid Oral Medication . . . . . . . . . . . . . . . . 89
Completing Administration of
Liquid Oral Medication . . . . . . . . . . . . . . . . . . . . . . . . 92
Medication Refusals . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
PRN Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Standing Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
iv
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Standard Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hand Washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wearing Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Review Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
* Module 6: How to Handle Special Situations . . . . . . . . . . . . . . . . . . 103

*MASSACHUSETTS
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Managing Behavioral Symptoms . . . . . . . . . . . . . . . . . . . . 104
Aging and Chronic Changes . . . . . . . . . . . . . . . . . . . . . . . 105
Swallowing Difficulty (Dysphagia) . . . . . . . . . . . . . . . . . . . 106
Administering Several Different Medications . . . . . . . . . . . . 107
Maximizing Capabilities During Medication Administration . . . 108
The Goals of Self-Administration . . . . . . . . . . . . . . . . . . . 110
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
SECTION 3: The Management of Medication Administration . . . . . . . . . 113

Module 7: Obtaining Medications . . . . . . . . . . . . . . . . . . . . . . . . 113
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Key Term to Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Information to Give to the HCP . . . . . . . . . . . . . . . . . . . . 114
Encouraging Participation in the HCP Visit . . . . . . . . . . . . . . 117
Information to Get from the HCP . . . . . . . . . . . . . . . . . . . 119
Information on a Prescription . . . . . . . . . . . . . . . . . . . . . 120
Getting Prescriptions Filled . . . . . . . . . . . . . . . . . . . . . . . 121
Ensuring the Pharmacy Provided the Right Medication . . . . . . 122
The Pharmacy Label . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Telephone/Fax Orders . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Module 8: Documentation, Recording, and Storage . . . . . . . . . . . . . . 128
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
The Medication Book . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Recording Information onto the Medication Sheet . . . . . . . . . 132
Remembering the Rights . . . . . . . . . . . . . . . . . . . . . . . 136
The Importance of Accurate Documentation . . . . . . . . . . . . 136
Countable Substances . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Storing Medications at the Home . . . . . . . . . . . . . . . . . . . 147
Disposing of Medications . . . . . . . . . . . . . . . . . . . . . . . . 148
Handling and Storing Medications Outside the Home,

Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Medication Occurrences . . . . . . . . . . . . . . . . . . . . . . . . 151
Documenting Medication Occurrences . . . . . . . . . . . . . . . . 151
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
* SECTION 4: Reference Information for Medication Administration . . . . . 158

*MASSACHUSETTS
Common Diseases, Illnesses, and Conditions,

and the Medications to Treat Them . . . . . . . . . . . . . . . . 158
Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Other Routes of Medication Administration . . . . . . . . . . . . 170
Information Needed for a First-Time HCP Visit . . . . . . . . . . . 189
List of Skills
Skill 1: How to Wash Your Hands . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Skill 2: How to Take Your Gloves Off . . . . . . . . . . . . . . . . . . . . . . . 53
Skill 3: Oral Administration of Medication . . . . . . . . . . . . . . . . . . . . 76
Skill 4: How to Use an Oral Medication Cup . . . . . . . . . . . . . . . . . . . 86
Skill 5: How to Use an Oral Dosing Syringe . . . . . . . . . . . . . . . . . . . . 86
Skill 6: How to Use a Dropper . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Skill 7: Administering a Liquid Oral Medication . . . . . . . . . . . . . . . . . 87
Skill 8: Recording Information onto the Medication Sheet . . . . . . . . . . 132
Skill 9: Documenting Medication Administration . . . . . . . . . . . . . . . . 136
Skill 10: Documenting a Missed Dose . . . . . . . . . . . . . . . . . . . . . . . . 137
Skill 11: Documenting a PRN Medication . . . . . . . . . . . . . . . . . . . . . . 139
Skill 12: Documenting a Discontinued Medication . . . . . . . . . . . . . . . . 140
vi
Massachusetts Specific Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
To the Student
As a direct support staff you have the privilege of giving
medications to the people you support. How you handle
this major responsibility can make a big difference in the
quality of their lives. It is your responsibility to help create an
environment where you can give medications safely. It is also your
responsibility to watch for changes in the people you support
and to report your observations so that others know whether a
medication is working or not.
In this manual you will learn how to administer (give)
medications in a mindful, occurrence-free manner. This means
administering medications in a careful way, using a step-bystep process, and thinking about why each step is important
as you do it. If you conscientiously follow the steps each time
you administer medication, you will not make a Medication
Occurrence, which could hurt the people you support.
This manual will guide you during your training and be a good
reference for you afterwards. Referring back to the manual will
help you stay knowledgeable and refresh your memory about the
proper procedure for administering medications. So be sure to
use it as a tool. The manual is easy to read and full of examples,
exercises, stories, and questions designed to teach you how to
administer medications safely.
Think about the importance of this manual for a moment. If
every staff member followed the steps described here, Medication
Occurrences could be a problem of the past.
Introduction
vii
How the Manual Is Organized
viii
This manual focuses on the principles of safe medication

administration, using oral medications as the primary example.
The manual is divided into 4 major sections that contain
a total of 8 modules or training units that cover a single topic
at a time. Sections 13 gradually build your knowledge of safe
medication administration. These sections also describe in detail
your roles and responsibilities in administering medications safely.
Section 4 provides reference information, which you will not
be required to master without more training. But you can use
this information as a reference if you need it. The sections and
modules of this manual are outlined below.
Section 1: The Basics of Medication Administration
Module 1: Administering Medications the Right Way
Module 2: Medications and What You Need to Know
Section 2: The Techniques of Medication Administration
Module 3: How to Observe and Report Information
Module 4: How to Prevent and Control Infection
Module 5: How to Administer Medications
Module 6: How to Handle Special Situations
Section 3: The Management of Medication Administration
Module 7: Obtaining Medications
Module 8: Documentation, Recording, and Storage
Section 4: Reference Information for Medication Administration
What You Will Learn
Think for a moment about what it takes to build a safe, sturdy

house. The three most important parts are the foundation, the
walls, and the roof. If they are not well built, your house will be
unsafe. The information in the first three sections of this manual
provide for you the three most important basic concepts. If you
study these sections carefully, the information will help you
administer medications more accurately and safely. You will also
be prepared to add to your basic knowledge as you work and
learn more.
Roof
Walls
Foundation
Figure i1: The first three sections of this manual are like the three most
important parts of building a safe, sturdy house.
In Section 1, you will learn the basics of medication

administration. This section explains three important principles to
keep in mind whenever you administer a medication. It describes
the Cycle of Responsibility and your role in it. And it explains
different medications and their effects on the body. Section 1 is
your foundation.
In Section 2, you will learn how to give medications in a
safe manner. This section explains how to observe and report
information, control infection, and follow the step-by-step
procedure for administering medications. Section 2 is the core of
the process. Think of Section 2 as the walls of the house. They are
built on the foundation and are needed to support the roof.
Introduction
ix
In Section 3, you will learn how to manage medication

administration. After you give a medication, your job is not
done. You must document that you administered it and store
the medication properly. Also, you must communicate with the
health-care provider, receive medications from the pharmacy, and
order refills on time. Managing medication administration is just
as important as giving the medications, and like the roof of the
house, protecting everything under it.
Special Learning Aids
Objectives
Objectives are statements at the beginning of each module that
tell you the key ideas you must learn. They also state what you
will be able to do after completing the module. The objectives are
numbered 1, 2, 3, 4, etc.
Terms to Study
When acquiring any new skill, you must learn the special words
related to that skill or activity. Terms to Study will help you
understand the vocabulary of medication administration. These
terms appear in boldface type and are defined at the beginning
of each module.
Apply What Youve Learned

Throughout each module you will find problems called Apply
What Youve Learned. These are real-life situations that challenge
you to apply your new knowledge. These problems also teach
you what can happen if you do not follow a particular procedure.
There may be several right answers. The key is to think about the
situation, jot down your solutions, and discuss them with your
co-workers and trainer.
Each module in this manual has special aids to help you master
the information you need to administer medications safely. These
aids will guide you, test your knowledge and skills, and reinforce
what you have learned. Below is a description of these aids:
Exercises
Exercises throughout the modules help you make sure that you
understand the information you just read about. Review Exercises
at the end demonstrate whether you have learned the important
ideas from the module. These exercises include fill-in-the-blank
questions, matching terms to definitions, word searches, and
crossword puzzles. Review Exercises also help reinforce the
language of medication administration.
Melissa, Chip, and Freddy

In addition to the learning aids, this manual introduces three
fictional characters whose problems are typical of people you
may be helping. These fictional characters are called Melissa,
Chip, and Freddy. Getting to know them will help you apply the
knowledge and skills you need when administering medication,
and will help you through your training. Whenever you find a
problem or question that mentions Melissa, Chip, or Freddy,
review the descriptions below to help you answer the question
thoughtfully.
Meet Melissa
Melissa is a 29-year-old woman with many diagnoses: Cerebral
Palsy (a brain disease she was born with that resulted in limited
movements and spasticity), seizure disorder (episodes of
uncontrolled, involuntary movement), intellectually disabled,
Aicardis syndrome (a rare condition in which the eyes and brain
do not develop correctly), scoliosis (curve of the spine). She
needs total assistance in all activities of daily living (ADLs). She
cannot speak. She uses an adaptive cup holder that lets her drink
independently. However, she must be supervised at all times when
eating and swallowing medications because she has dysphagia
(difficulty swallowing).
Meet Chip
Chip is a 45-year-old man with Trisomy 21 (Down syndrome). He
has moderate to severe intellectually disabled. He speaks in single
words and short sentences. Chip can label things or point to things
Introduction
xi
Meet Freddy
Freddy is a 30 year old man with schizophrenia (severe, chronic,
disabling brain disorder often associated with symptoms such
as hearing voices, belief that people are reading their mind
and/plotting to hurt them. As a result of the symptoms the
person may withdraw and live in constant fear). Freddy lives in
a supported housing apartment with two other gentlemen. He
interacts with his roommates, works part-time two mornings a
week at the local supermarket, and likes to go to the clubhouse
two to three times a week. He is learning to self-administer
and packages his medication weekly according to his Plan.
Currently he is on six medications that he takes twice a day.
The medications he takes regularly are for high blood pressure,
high cholesterol, constipation and to control his symptoms of
schizophrenia. He also has 2 PRN medications for anxiety and
sleep. Freddy knows the names of his medications and can tell
when he needs to take them. When asked he does not know
the purpose or side effects of his medications. He takes his
medications consistently in the AM but forgets at times to take
his PM medications. Direct support staff visit three times a week
to assist with grocery shopping, meal planning, housekeeping and
other issues. Freddy uses the bus to get back and forth to work,
the clubhouse and appointments. Freddy usually manages his
xii
he wants, but he cannot explain how he feels. Chip has multiple

physical problems. He was born with heart disease and takes two
different heart medications each day. He also takes medications
for hypothyroidism (low thyroid hormone), hypertension (high
blood pressure), arthritis (red, swollen painful joints), COPD (a
chronic lung disease), and GERD (gastroesophageal reflux disease,
which often causes heartburn). Chip has an anxiety disorder
so that at times he may be afraid or uneasy and he can show
hyperactivity and self-destructive behavior (such as head slapping)
when he is anxious. This condition is treated with a medication
given 2 times a day and PRN. Chip lives in a community home with
two other people. He is picked up daily to attend a day program
where he works on various projects.
appointments, work schedule and social activities on his own. He

has a good relationship with his roommates and often includes
them in his plans. When Freddys schizophrenia symptoms
increase, he becomes less independent, he isolates in his room,
sleeps more during the day and will refuse his medication or stop
taking it altogether. His hygiene and housekeeping duties also will
decline. At this time Freddy needs more support and guidance.
A Note on Language
In this manual the author uses terms that may be different from
those used by your agency. For example, the people to whom you
administer medications are called:
*MASSACHUSETTS
Consult the individual's health
care provider for specific info
about the individual.
*MASSACHUSETTS
The MAP Consultant must be
a physician, registered nurse,
or registered pharmacist who
provides advice and technical
assistance to Certified staff
members.
For example:
* interpreting prescriptions
* providing information about
medications
* recommending how to handle a
Medication Occurrence
3 The person, or
3 People you support
The author also recognizes that there are various practitioners
and specialists who may prescribe medications. In this manual
the prescribing practitioner is called:
3 The Health Care Provider, or

* 3 HCP
This manual uses the term intellectually disabled at times
to describe the people you support. The author realizes the
sensitivity around this language and recognizes that other terms
for the same condition may be developmentally disabled,
developmentally delayed, or mental retardation.
A Note on Dates
The author recognizes the HCP may order medications in 30, 60,
or 90 day intervals as well as annually for certain medications. For
training purposes only, the year (yr) has not been designated on
the Health Care Provider order, pharmacy label, and medication
sheet.
Introduction
xiii
About the Author

Margaret (Peggy) Casey-Mederios, Founder and President of CC&R
Healthcare Solutions, is a registered nurse for more than thirty years and has
authored numerous manuals and books for nurses, nurse assistants, and home
health aides since 1983. The primary focus of the material she has developed
has always been the desire to teach caregivers how to balance the tasks of their
jobs with the ability to care. Peggy believes this balance is necessary to ensure
quality care while maintaining the resident, clients or patients quality of life.
Peggys vast experience working with frontline staff has given her a unique
ability to write material that is comprehensive as well as user-friendly.
CC&R Healthcare Solutions, based in Winthrop, MA is dedicated to developing

and implementing quality caregiving solutions for the health care industry.
These solutions include providing services that assess the caregiving functions
in various settings, and develops trainingincluding customized texts and
competency testing programs for states, and individual employers.
Acknowledgments
Kathy Masucci, RN provided invaluable assistance and is also the co-author of
Administering Medications the Right Way Trainers Manual.
Kathy and I would like to extend our sincere appreciation to the following:
Jill Morrow
Dorothea Federico
Sue Lyas
Barbara Breen
Linda Goodale
Linda McCall
Sharon Oxx
Gina Hunt
Jeanne Reed
Walter Polesky
Lisa Kaliton
Joanne Shea
John Boisseau
Betsy Kenerson
Barbara Sudano
Marie Brunelle
Ted Kirby
Adam Wilczek
Catherine Cordeiro
Rosemary Sullivan,
Bob Boyer
Amy Avakian
for her inspiration about Carolyn Whittemore
Kathy Leber
Melissa
Noreen Egan
Dedication
This book is dedicated to our families, our husbands, Frank and Rich, and our
children, Mairead, Ricky, Ryan and Matty, for giving up precious time so we
could write this training book. We believe it will make the difference in the lives
of people who need our support and protection the most. Thank you, we hope
you are proud of us.
xiv
Administering Medications the Right Way is one step in the direction of

creating assurances that the frailest population in the country, our intellectually
disabled, our mentally ill and elderly are receiving medications in a safe manner.
Her goal, hope and vision with this Manual is to make a difference in that
arenato do quality training and to assure that people are safe.
MAP CERTIFICATION
Please note that MAP Certification is not valid for
administration of medications to individuals who are:
Under the age of 18
In certain DDS day programs
Residing in nursing homes
In long-term (generally more than 30 days) respite programs
In crisis intervention, stabilization, or hospital diversion
centers and programs
In hospitals
In Intensive Residential Treatment Programs (IRTP)
In programs licensed or Certified by other departments such
as the Office for Children, Department of Youth Services, or
Department of Social Services.
In DMH and DDS sites not possessing a Massachusetts
Controlled Substance Registration (MCSR) from the
Department of Public Health.
D&S Testing Process a
CERTIFICATION
You qualify to take the MAP test after successful completion of
an approved MAP Training program.
The Massachusetts Department of Developmental Services
(DDS) and Department of Mental Health (DMH) have
contracted with D&S Diversified Technologies to provide
testing, scoring and registry services. A MAP Testing Candidate
handbook is available at www.hdmaster.com. (No PIN is
required.) For questions not answered here please contact:
It is to your advantage to spend time on your own taking

sample tests on a computer. To access the sample computer
based test (CBT) go to www.hdmaster.com.
Click on Massachusetts MAP Testing and Registry
Click on Sample Test Shortcut
Each sample test is 10 questions
To end the exam, type SUNSET in the top right box
Click on Stop Exam
You will see your results (the % answered correctly).
If questions were answered incorrectly you will also see the
topic of the question missed.
RE-CERTIFICATION
Re-certification is required every two years. Once a candidates
Certification expires, he/she may no longer administer
medications. Candidates will be eligible to re-certify if they
are in good standing per the Massachusetts MAP Registry
maintained by D&S Diversified Technologies. You can be
re-certified by taking the re-certification test through the D&S
Diversified Technologies or your provider.
It is strongly recommended that you take a review course
before testing.
It is important to update any change in your name, address,
telephone number, or email address at the following website:
www.hdmaster.com.
D&S Testing Process b
D&S Diversified Technologies

PO Box 418, Findlay, OH 45839
Toll free 1.877.851.2355 Fax 1.419.422.7395
FREQUENTLY ASKED QUESTIONS

1. What is a MAP-Certified staff person?
Direct support staff, including licensed nurses whose job
description does not require a nursing license, who have a
current MAP Certificate to administer medications in DMH/
DDS adult residential and day programs.
2. Where is my MAP Certification valid?

Certification is transferable between registered MAP programs
only.
3. How long is my Certificate valid for?
MAP Certification is effective on the date that test results
are posted on the D&S Diversified Technologies website
(www.hdmaster.com).
MAP Certification is valid for two years until the last day of the
month in which you passed the test. For example, if you passed the
test on January 6, 2012, your expiration date is January 31, 2014.
4. What happens if my MAP Certification expires?
If your MAP Certification expires, you have one year to
re-certify. If you do not get re-certified within one year, you
must complete the full MAP Certification training program
again and retake the written and skills tests. You cannot
administer medications until you complete the training and
testing.
5. What happens if I do not pass the re-certification test?
You cannot administer medications and are no longer
considered MAP Certified until you pass the re-certification
test.
6. Do I have to keep track of my expiration date?
Yes, you are responsible for ensuring that your certification
remains current and valid.
All DMH/DDS community programs are required to maintain
acceptable proof of staff MAP Certification (in other words, a
print out of the Massachusetts MAP Certification) available at
www.hdmaster.com
MAP Online Registry
Click Public Verification
D&S Testing Process c
SECTION
The Basics of Medication

Administration
efore you can give medications to the people you support,

you must understand certain critical information. The
information you learn in Section 1 is the foundation for everything
else you need to know to administer medications safely. Section 1
of this manual has two modules:
Module 1: Administering Medications the Right Way
Module 2: Medications and What You Need to Know
Administering Medications
the Right Way
Objectives
After studying this module, you will be able to:

1. Explain why you need training in medication administration.
2. Define the term standardization and explain why it is
important in medication administration.
3. Explain why you need to know the people you support.
4. Name two rights of the people you support that relate to
medication.
5. Describe the three principles to consider in administering
medication and why each is important.
6. Describe the eight parts of the Cycle of Responsibility and
your particular role in each part.
7. List the skills you need to be successful in medication
administration.
SECTION 1: Module 1
Accurate free from occurrence or mistakes; correct.

Acute illness that is sudden, brief, and severe.
Administer manage or give medications.
Chronic illness that continues for a long time or comes
back often.
Communication talking, listening, being able to tell accurately
what you have observed about the people you support.
Document a printed or handwritten paper recording information;
to write down information; to keep a record of.
Expired a medication or a HCP order that is outdated.
Maximizing capabilities making the most of what people can do;
supporting people to their highest level of independence.
Medication chemical substance used to treat illness and disease;
medicine; sometimes called meds for short.
Mindfulness the state of being attentive, careful, observant;
always paying attention to details when giving medications.
Oral a medication taken by mouth.
Pharmacist a person skilled in preparing medications and having
the license to do so; a druggist.
Health Care Provider (HCP) a person who is medically trained
to care for people who are sick. This person can be a doctor,
nurse practitioner, physicians assistant or a psychiatric nurse
who is licensed to prescribe medications and treat the people
you support.
PRN Latin abbreviation for medications that you give as needed.
Process A systematic, continuous series of actions directed
to an end.
Response an effect that occurs as the result of a medication;
what happens after a person has received medication.
Regulate keep control of a medication.
Self-Administration the act of taking and being responsible for
ones own medication or to have the medication administration
under the complete control of the person.
Side effects effects caused by the medication that are not

wanted or intended.
Standardization the process of always following the same steps
in administering medications.
Topical a kind of medication that you apply to a persons skin.
introduction
n this module you will learn why it is important to standardize

the administration of medication. Standardizing means always
following the same steps. You will learn the importance of getting
to know the people you support, and that there are principles you
must consider each time you administer a medication. You will
review the Cycle of Responsibility and the importance of each
of its parts in the administration of medications. Finally, you will
understand your role in administering medication.
Proper Training
Medication is used to treat or prevent many acute and chronic
health problems. Many of the medications taken by the people
you support are prescribed to eliminate or lessen symptoms of a
disease or behavior rather than to cure it. The goal of medication
is to improve quality of life.
Almost all adults in our society understand that health care
providers (HCPs) prescribe medications, and pharmacists fill
prescriptions. Even a person who has never taken a medication
prescribed by a HCP is familiar with medications through
advertisements on television, in newspapers, and on the radio.
Medications can be purchased in every drugstore and in many
grocery stores.
Because medications are so common and most people take
them, you may think you do not need training in medication
administration. But there is a big difference in administering
medications to people in the environment where you work. The
people you support need your help, and you have a responsibility
SECTION 1: Module 1
*MASSACHUSETTS
An error in the administration
of a medication is called a
Medication Occurrence.
Think about how you take or give medication at home. Then put a checkmark
next to the situations you think promote a home-like environment.
____ Carrying a tray full of medications for more than one person
____ Checking name badges
____ Having people line up to take medication
____ Preparing medications for one person at a time
____ Not drawing attention to the people on medications
____ Shouting names of people who are on medications
____ Hanging medication charts on the walls for everyone to see
to make sure each person receives the best care. Training in

medication administration helps ensure that support. An agency,
such as the one for which you work, assumes responsibility for
the care and protection of each person it supports. By following
the procedures outlined in this manual, you will ensure that each
person receives medication safely.
You may also be wondering why standardization of medication
administration is so important. There are many reasons why.
Serious Medication Errors*are often made even in simple family
situations. Because service agencies are much more complexwith
many different staff, many different people needing support, staff
turnover, changing shifts, and multiple medicationsthe chance
for occurrence is much greater. Therefore, standard procedures and
steps are needed to make sure that medications are administered
correctly every time. You must learn these procedures and follow
these steps each time you administer a medication. (You will learn
these steps in Section 2 of this manual.)
It is important to follow standard steps when administering
medications. It is also important to create a home-like
environment for the people you support. Your training will help
you achieve both these goals.
Getting to Know the People You Support

In addition to following standard procedures, you need to know
the people you support. A big part of your job is looking for
changes in their physical condition or behavior. The only way
you can do that is by getting acquainted with themlearning
about their personality, physical conditions, current medications,
and capabilities. Once you know the people you support, you will
become more alert to changes in them.
Some of the people you support may not be able to tell
you about themselves because they cannot speak. Others may
need some encouragement to talk. Here are some ways to get
acquainted:
**MASSACHUSETTS
Antipsychotic
medications are used
to decrease symptoms
of mental illness. These
medications cause side
effects.
In November 1983, the
Massachusetts Supreme
Judicial Court issued a
decision that is called the
Rogers Decision. This
gave individuals who take
antipsychotic medications
new rights. These rights
help protect them from
the overuse of these
medications.
DDS and DMH have
a set of guidelines to
help determine which
individuals might need
their antipsychotic
medications administered
under a Rogers Decision.
3 Ask the person questions (if the person can respond).

3 Talk to family members and friends.
3 Read the persons Individual Support Plan.
3 Read the persons Health History.
3 Talk with other staff.
3 See how the person behaves around others.
3 Pay attention to things that change the persons behavior
or condition.
Learning about the people you support will help you

recognize changes in them, and help you to report information.
Respecting the Persons Rights

As a direct support staff, you have a responsibility to treat
everyone with dignity and respect. All the people you support
have the same rights as you do, regardless of their capabilities or
where they live.**
One example is the persons right to be free from too much
medication. If you notice someone is so sleepy that they cannot
participate in activities of daily living, you must report the
situation. It could mean the person is getting more medication
than needed or is having a bad response.
SECTION 1: Module 1
Another example is the persons right to know what medications

they are taking and its risks and benefits. When you administer a
medication, you must explain what it is and answer any questions
the person may have. Another right a person has is to refuse any
medication. If someone refuses their medication, you should ask
them why and report this to the appropriate agency staff. If you
follow these guidelines, you will be respecting each persons rights.
Apply What Youve Learned Think about the people you support, and
answer the following questions.
2. What do they have the right to know about their medications?
3. Name three ways you can get to know the people you support.
How to Give Medications

When giving medications, you must pay attention not only to
following the right steps but also to the way you perform them.
To understand this concept, take the simple task of opening
a door. The steps are always the same, but how you open the
door can send different messages. You can open a door so hard
that it bangs against a wall, or so carefully that no one hears you
enter. How you do something as simple as this can show how you
feelyour anger, frustration, or distractionor it can show your
support and consideration for others. When giving medications,
it is important to pay attention to the steps and always to be
considerate of those people you support.
1. How should you treat the people you support?
Principles to Consider
Whenever you give medication, you must keep in mind three
principles:
3 mindfulness
3 maximizing capabilities
3 communication.
These principles will help ensure that you give medication the
right way. Each principle is described below.
Mindfulness
Being mindful is a special way of paying attention. When you are
mindful, you are thinking about what you are doing. You are not
distracted or preoccupied with other thoughts. The opposite
of mindfulness is performing a routine task so automatically
that you hardly think about it at all. If you let that happen
when administering medication, you risk hurting the people you
support. So in order to be successful in medication administration
you must adopt a mindful, thoughtful, open attitude. You must
pay attention to each step you are performing to ensure a safe
administration. Here are some ways to help you become mindful
when you are giving medication:
3 Say out loud what you need to do before you perform

a step.
3 Read the steps each time you do them.

3 If more than one person needs a medication at the same
time, change the order of who goes first, second, or third.

This will help you pay attention to each step so that the
process does not become routine.
Being mindful also means being observant, and reporting

your observations in detail to the appropriate staff. Being
mindful requires that you create an environment that minimizes
distractions. You must give all your attention to safe medication
administration.
SECTION 1: Module 1
Maximizing capabilities
3 Melissa is now able to hold her own cup. It would be very
important for you to encourage and support this new step

toward independence. You could place her cup in her hand
and encourage her to take a sip with her medications.
3 Chip often tries to refuse his medications. You can help
maximize Chips capabilities by explaining the importance of

each medication and reminding him how good he feels when
he takes his medications regularly.
3 With little assistance, Freddy is learning to read the calendar
hanging on the wall in his room which gives the daily times
for his medication, and his pharmacy labels; pour the
correct dose of his medications and take his medication
independently. But sometimes Freddy forgets to take his
medication in the evening. To help Freddy remember, you
could assist in setting his wristwatch alarm to go off at the
right time or staff can call to remind him to take his evening
medication.
Before you administer any medication, you should ask yourself:

Am I helping the person to function as independently as
possible? You should always encourage people to take as much
responsibility for their own medication administration as they can.
But your primary concern is always the proper administration of
medications, whether done by you or the person you support.
Over a period of time, many people can be taught to take
partial or even complete responsibility for administering their
own medication. If the people you support are capable, you
should consider teaching them how to self-administer. Take
advantage of the time you have with a person when giving
medication. Tell the person what you are doing, and say the steps
out loud. With repetition, the person may be able to participate
in their own care. You will learn more about how to help a person
self-administer in Module 6.
Below are some suggestions for creating an environment to
maximize the capabilities of Melissa, Chip, and Freddy. (For details
about their conditions, medications, and capabilities, please refer
back to page xi.)
Communication
A big part of your job involves talking with the people you support,
the HCP, the pharmacist, and other staff. But communication is
more than just words. It includes body language or non-verbal
communicationsuch as a smile of encouragement, a touch, or
simply careful listening. Communication also includes written notes.
You can communicate in many ways.
When you communicate with the people you support, other
staff, and the HCP, you must practice good communication skills.
Here are some tips to help you express yourself effectively:
3 Speak clearly and slowly.

3 Use words you are comfortable with and know the
meaning of.
3 Look directly at the person you are speaking to.

3 Write information down so you do not forget anything.
3 Use notes to keep yourself organized.
3 Listen carefully.
3 Repeat information given to you to make sure you
understand correctly.
Remembering the principles

Mindfulness, maximizing capabilities, and communication. Think
of these principles as the chorus of a song. A chorus is repeated
over and over. Although the words of the verses may change, the
chorus stays the same. The task of administering medications to
each person is like a song. The specific medication may change
for each person, but the steps and the principles to consider
always stay the same. In every medication you administer,
remember the principles of mindfulness, maximizing capabilities,
and communication. Safe medication administration means
following the step-by-step procedure and keeping these three
principles in mind.
SECTION 1: Module 1
Apply What Youve Learned Think about the principle of maximizing

capabilities. When giving Melissa her morning seizure medication, how could
you make the most of her capabilities? Put a checkmark next to the answer
you think is best. (Remember Melissa? For details about her conditions and
capabilities, refer back to page xi.)
1. Explain to Melissa what you are doing.
2. Place her cup in her hand and encourage her to take a sip.
3. Leave her medication on her table and tell her to try to pick
them up.
Understanding the Cycle of Responsibility

The task of giving medications is just one part of a larger process.
This process is known as the Cycle of Responsibility (Figure 11).
A cycle is a series of actions that come full circle. Each part of the
cycle relies on the one before and the one after it to be complete.
For safe administration of medications, none of the parts of
the cycle can be skipped, eliminated, or performed mindlessly
(without thought). In addition, in each part of the Cycle of
Responsibility, you must keep in mind the principles to consider
so that you administer medications the right way.
The parts of the Cycle of Responsibility are described in more
detail on the following page. As you read this information, ask
yourself if any part of the cycle can be left out. If one was left
out, think about what might happen.
10
4. Hold her cup up to her mouth after you place her medications
in her mouth.
A Cycle of Responsibility
Observe or watch for changes
(physical & behavioral)
Document the medication

administration
Report changes
Support visits to the HCP
Administer medication
Store medication
Communicate with the pharmacist
Record information
Figure 11: Safe medication administration involves all of these parts or responsibilities.

Because you spend more time with the person you support than
anyone else, you are the one most likely to notice a change,
which could be physical or behavioral. Being alert to any change
is important because it may signal a problem. Being conscientious
in your observations helps make sure that the people you support
get the treatment they need.
Report changes
*MASSACHUSETTS
When you report information

regarding medications, it is
important to document the MAP
Consultants instructions.
Report information based on your actual observationsnot a

hunch or a guess of what you believe to be important or what
you think is happening. You must be factual and provide all the
details of what you observe, so that important information is not
missed. It is your responsibility to know to whom you must report
information, when to report it, and what documentation you need
to keep on file.* Being conscientious in reporting the changes you
observe is an important part of your job. For many of the people
you support, you are their eyes, ears, and voices.
SECTION 1: Module 1
11
*MASSACHUSETTS
DDS ONLY

If you receive a prescription from the HCP, you must follow
your agencys policy for getting it filled by a pharmacist.
Section 3 of this manual gives general guidelines for how
to obtain medications.
Record information
*MASSACHUSETTS
In Massachusetts, a medication
sheet may be called a medication
administration record or a
medication administration sheet.
Once you have the HCP order and after the prescription is filled,
you must carefully record the information from the HCP order and
pharmacy label. Write it down (or transcribe) on the medication
sheet*so that you and others can track the administration of the
medication. Accurately writing down the HCP order and pharmacy
label information helps prevent Medication Occurrences. The
medication sheet is important because it tells you exactly what
medication to give, how much, and how often.
Store medication
In addition, all medications must be stored properly. How
medications are stored is determined by the type of medication,
the abilities of the people living in the home, and your state and
agencys policy. You will learn more about storing medications in
Section 3.
12
If you work for the MA DDS,

you must bring a completed
Health Review Checklist to all
Primary Health Care Provider visits
including the annual physical exam.
Another part of the Cycle of Responsibility is to take the person

you support to the HCP. One of your roles is communicating
accurate information to the HCP if the person cannot. If the
person is able to give information, however, you must encourage
such independence. Information must be clear and accurate. If you
(or the person you support) do not give information correctly, a
medication may or may not be prescribed correctly or at all. This
can result in time lost treating the persons problem.*
After the visit, you must communicate (give information)
about the visit to the other members of the staff. It is very
important that you share this information so that other staff
member(s) know about any new or changed medications the HCP
may have ordered. If the person goes to HCP alone, you will have
to track all information received.
After recording accurate information and storing the medication,
you are ready to administer it to the person you support. You will
learn how to administer medications safely in Section 2.
Document the medication administration

After administering the medication, you must document on the
medication sheet that you gave the medication.
The Cycle of Responsibility Comes Full Circle

You are the key to safe medication administration. When you
give a medication to a person, you have brought the cycle full
circle. You must begin the cycle again by observing the person for
any physical/behavioral changes and reporting the information.
Reporting your observations right away can help prevent problems
that could be harmful or even fatal. You will learn about responses
and side effects of medication in Module 2.
Match the part of the Cycle of Responsibility in the left column to the activity
in the right column. Select only one answer.
A Cycle of Responsibility

1. Observe for changes,

A. Help the person tell the HCP
physical and behavioral. about the reason for the visit.
2. Report changes.
B. Give a medication.
3. Support visits to
C. Tell your supervisor about your
the HCP. observations.
4. Communicate with
D. Notice that the person vomits
the pharmacist. after taking a medication.
5. Record information.
E. Write the HCP order and pharmacy label
information to the medication sheet.
6. Store medications.
F. Placing a medication in a secure area.
7. Administer medications.
G. Receiving a filled prescription.
8. Document the administration. H. Place initials on a medication sheet.

SECTION 1: Module 1
13
Now you understand the Cycle of Responsibility and the principles to consider
in administering medications. Under each part of the cycle below, put a
checkmark next to the principles you think are most important for the tasks
related to that part of the cycle. Be prepared to discuss your answers with your
co-workers and trainer. Note: There may be more than one answer.
Observe for physical and behavioral changes.
Mindfulness
Report changes.
Mindfulness
Communication
Support visits to the HCP.
Mindfulness
Communication
Communicate with the pharmacist.
Mindfulness
Communication
Record information.
Mindfulness
Communication
14
Communication
Store medications.
Mindfulness
Communication
Administer medications.
Mindfulness
Communication
Document the medication administration.
Mindfulness
Communication
Making the Cycle Part of Your Daily Routine

How you incorporate the Cycle of Responsibility into your daily
routine can make a big difference in the quality of life for the
people you support. Every day it is your responsibility to help
create a distraction-free environment in which you can give
medications safely. It is also your responsibility to observe the
people you support and to report your observations so that
others can determine whether or not a medication is working.
Here are some tips for making the Cycle of Responsibility part
of your daily routine:
3 Come to work with an open, undistracted mind.

3 Talk with the staff who are leaving to find out whats been
happening.
3 Visit and greet each person you support. Ask them how they
are doing and if there is anything new.
3 If the person cannot communicate, pay attention to their

behavior and look for any changes.
SECTION 1: Module 1
15
Remember, the Cycle of Responsibility begins with you. If you

observe and report information mindfully, the people you support
will get the best results from their medications.
Apply What Youve Learned You have been supporting Melissa for
1. Observe or watch for changes (physical and behavioral).

2. Report changes.
3. Support visits to the HCP.
4. Communicate with the pharmacist.
5. Record information.
6. Store medication.
7. Administer medication.
8. Document the medication administration.
Explanation
16
six months. Since she started her new seizure medication 3 months ago,
she has not had a seizure. You arrive at work after being off for three
days. Melissa has a seizure during your shift and has also started vomiting.
(Remember Melissa? For details about her conditions and capabilities, refer
back to page xi.)
Think about this situation with Melissa and your responsibilities in the
Cycle of Responsibility. Put a checkmark next to the part(s) of the Cycle of
Responsibility you should do immediately. Explain your answer.
Skills You Need as a Direct Support Staff Member
As a staff member, you will administer medication or help people

to learn how to take it themselves (self-administration). In doing
so, your job may involve several parts of the Cycle of Responsibility.
Studies have shown that staff members need certain
knowledge and skills to successfully implement all parts of the
Cycle of Responsibility. These skills are summarized in Figure 12.
Under each heading in the table is a list of the specific tasks you
must perform to be successful. This manual and your training
will give you the knowledge and skills you need to administer
medications safely. Be sure to review this list often in your job.
Summary
In Module 1, you learned some of the basics of medication
administration. Here are the key points:
3 Proper training gives you the skills and knowledge you

need to administer medications safely.
3 Standardization, or performing the same steps every time,

helps ensure safe medication administration.
3 Getting to know the people you support will help you

become alert to physical and behavioral changes.
3 Whenever you administer medication you must think
about the three principles of mindfulness, maximizing

capabilities, and communication.
3 You are a key player in the Cycle of Responsibility.

You now know how the Cycle of Responsibility works.
Remember, the cycle is continuous, starting with observing,
then reporting changes, assisting with visits to the HCP, and
communicating with the pharmacist, recording information,
storing medications, administering them and finally
documenting the administration. Your important role in the
Cycle of Responsibility never ends.
SECTION 1: Module 1
17
Figure 12: Skills Needed to Administer Medication Safely
Documentation
3 Gather information for the visit
to the HCP.
3 Complete required paperwork
before visiting the HCP.
3 Communicate information to
the HCP.
3 Communicate to others about the
HCP order.
3 Write information from the HCP
order and pharmacy label onto the
medication sheet.
18
3 Write a note about the visit
to a HCP.
3 Document that the medication
was given.
3 Verify counts of countable
substances.
3 Enter information into a computer
(if applicable).
Administration
3 Administer oral medications.
3 Administer PRN medications
(medications given as needed,
for specific reasons written in
HCP order).
3 Administer medications through
other routes (with additional
training).
3 Administer medications via tubes
(with additional training).
3 Encourage self-administration
of medications.
3 Support refusal of medications.
Management
3 Store medications.
3 Control or regulate access to
medications.
3 Obtain medications from the
pharmacy.
3 Dispose of unused or expired
medications.
3 Complete records for disposing
medications.
Observation and Reporting

3 Respond to medication emergencies
(such as a person not breathing).
3 Observe and report changes in
behavior.
3 Report changes in condition.
3 Report Medication Occurrences.
3 Use reference materials to look up
information about medications.
3 Identify when medications have
been tampered with.
3 Report medication losses.
3 Read medication and treatment
book.
3 Read and understand medication
information sheets.
3 Determine when not to administer
a medication as directed
by the HCP.
3 Recognize physical and behavioral
changes.
3 Report refused and missed doses.
Crossword Puzzle
Complete
this crossword puzzle using the clues below and

the Terms to Study at the beginning of the module.
1
10
11
12
13
Across
2. illness that is sudden, brief, and severe
4. a printed or written paper recording
information
5. talking, listening, telling what you have
observed
7. illness that continues for a long time or
comes back often
8. free from occurrence or mistakes; correct
9. a person skilled in preparing medications and
having the license to do so; a druggist
11. the state of being attentive, careful,
observant, and always paying attention
to details
13. an effect that occurs as the result
of a medication
Down
1. making the most of what people can
do; supporting their highest level of

independence (2 words)
3. manage or give medications
6. Latin abbreviation for medications that are
given as needed
10. chemical substance used to treat illness and
disease; medicine
12. a person licensed to prescribe medications
and treat people with diseases and illnesses
(abbreviation)
SECTION 1: Module 1
19
Review Questions
Please
write your answers to the following questions on the lines below.

1. In your own words, describe why medication administration
should be standardized.
2. Name the eight parts of a Cycle of Responsibility.
4. List ten skills you are responsible for as a direct care worker when
administering medications.
20
3. List the three principles you should consider when administering

medications.
Medications and What

You Need to Know
Objectives
1. Define what a medication is.
2. Describe different categories of medications.
3. Explain how medications affect a persons body.
4. Explain desired effect, no apparent desired effect,
and unwanted effects.
5. Understand where to get more information about medications.
*MASSACHUSETTS
Medication administrators are

called Certified Staff.
Adverse response or effect an unwanted or bad response to a

medication.
Allergic reaction an abnormal response of the bodys immune
system to a medication. In an allergic reaction the immune
system starts fighting harmless substances, like medications.
Allergic reactions cause a rash, hives, or runny nose. Allergic
reactions can range from mild to severe.
Anaphylactic reaction a very dangerous allergic reaction that can
affect the whole body, causing difficulty breathing, hives, and
changes in blood pressure. An anaphylactic reaction can
be life threatening and requires immediate medical attention.
Brand-name medication a medication made by a specific
pharmaceutical company.
Countable substances prescription medications that require
special tracking. This requires 2 staff medication administrators*
count the medications each time the staff changes or each time
the keys change hands.
Desired effect the response or result expected from a medication;
therapeutic effect.
Generic medication a medication called by its chemical name;
a generic medication has the same chemicals as a brand-name
medication. A generic medication may be manufactured by
several different companies, other than the company that
originally made it.
SECTION 1: Module 2
21
22
Holistic/herbal compounds natural substances that you can buy

without a prescription.
Indication the intended use of the medication.
Medication Information Sheet is a specific resource that
contains information about medications a person is taking.
You can obtain this information from medication books, the
pharmacy or a reputable online source.
Medication interaction a change in the effect of a medication
when it is given at about the same time as another medication.
Medication interaction can change the effects of one or both
of the medications. Interactions can also occur with certain
foods as well as with alcohol, nicotine, caffeine, and other
chemical substances.
Medication sensitivity how a person responds to a medication or
other substance. Some people react more strongly than others
to the same amount of medication.
No apparent desired effect no response to a medication; lack of
the response expected from a medication.
Nonprescription medications medicines you can buy without
a prescription; over-the-counter medications.
Over-the-counter medications (OTC) medicines you can buy
without a prescription.
Paradoxical effect a response to a medication that is the
opposite of what is expected.
Prescription medications (controlled medications) medications
for which you must present a prescription from the HCP to the
pharmacy in order to buy.
Side effect an unwanted or unintended response to a medication.
Therapeutic effect the response or result expected from a
medication; the desired or beneficial effect.
Toxicity a condition in which the body stores up more of
a medication than it can handle or does not process the
medication properly. Toxicity may indicate that the dose is
too high.
Unwanted effect an unplanned and undesired response to
a medication, including allergic reactions, side effects,
paradoxical effects, etc.
introduction
edications are used to treat, cure, prevent, or relieve

various health problems in the people you support. To
be successful administering medications, you need to understand
how medications can affect the person. Without this general
understanding of medications, you cannot effectively observe
and report information about the person. In this module you will
learn what a medication is and how medications work in the body.
You will learn about some categories of medications and how
medications can affect people. Finally, you will learn where to
find additional information about medications.
Medication: What Is It?

Everyone knows at least something about medications from either
personal experience or the media and social interactions. You
might think of medication as a pill that makes you feel better or
takes pain away. Your past experiences with medications influence
how you think about them. You probably know that medication
usually produces a response that is predictable. For example,
when you take an antibiotic, your infection goes away. You also
know that some medications can cause side effectsunexpected
and unwanted responses. As you study this module, its important
to remember that each person can react to medication in
different ways. But what exactly are medications?
Medications are chemicals that enter the body and change
one or more ways that the body works. Medications are often
used because some part of the body is not working well or needs
help. When a medication is given, the hope is that it will provide
the desired effect and improve the persons health. However,
medications may also do other things to the body. Some of these
responses may be good and desirable, but others may not.
It also is very important to understand that a medication
can affect different parts of the body at the same time. This
will help you understand what you observe and what the
SECTION 1: Module 2
23
person experiences after taking a medication. Remember,

all medications have the potential to cause side effects. It is
important that you watch for both the desired effect and side
effects when the people you support are taking medication.
For example, you may notice that if you take a cold medication,
your runny nose dries up (desired effect), but it also may make
you sleepy (side effect).
Categories of Medications
3 Prescription (controlled medication)

3 Nonprescription or over-the-counter (OTC)
3 Brand name
3 Generic (chemical) name
3 Countable substances
3 Holistic/herbal compounds, vitamins, and other substances
Prescription Medications (Controlled Medications)
Prescription medications are received through a prescription
written by a health-care provider. The HCP writes the name of
the medication, the dose (how much should be given), how often
the medication should be taken, and for how long. The written
prescription is given to a pharmacist, who fills the order from
the prescription. You need an order from a HCP to administer
prescription medications.
Nonprescription or Over-the-Counter Medications

Nonprescription or over-the-counter (OTC) medications are
medications that can be bought without a prescription at a drug
store or supermarket. OTC medications are very popular. Even
though a prescription is not required, you need an order from a
HCP to administer OTC medications to the people you support.
For all nonprescription medications, the HCP must give you an
24
There are many ways to define medications. But as a direct

support staff, you only need to understand those medications
taken by the people you support. Medications can be grouped
into the following categories and are described below.
order for you to administer the medication. You need to know the
name of the medication and the dose, as well as when, how, and
why to administer it.
Brand-Name Medications
Brand-name medications are medications made by a specific

pharmaceutical company. Sometimes the HCP writes a prescription
for a brand-name product and writes no generic substitution or
brand necessary. This means that the pharmacist must provide the
brand-name medication and cannot switch to a generic medication
from another company. Examples include Tylenol and Advil.
Generic Medications
Generic medications are medications that are labeled by their
chemical name. These medications are basically the same as
brand-name medications but are made by different companies.
They are usually less expensive than the brand-name product.
Examples include Acetaminophen and Ibuprofen.
Countable Substances
*MASSACHUSETTS
For example, countable
medications must be
double locked.
All prescription medications should be stored properly. But

certain prescription medications are also considered countable
substances. These medications have specific requirements for
storing, packaging, tracking, or counting.*Medication control
agencies consider the medications in this category to have a high
potential for abuse. Examples of countable substances include
certain medications prescribed for sleep, pain, anxiety,
or agitation.
Holistic/Herbal Compounds, Vitamins and Other

Substances
Holistic and herbal compounds can be bought at health-food
stores, grocery stores, and pharmacies. These compounds can
interact with prescription and OTC medications. Therefore, the
HCP must provide you with a HCP order for any holistic or herbal
compound before they can be used by the people you support.
In addition, substances such as alcohol, caffeine, and nicotine
can interact with medications. If a person you support is using
these substances, you should report this information to the HCP.
SECTION 1: Module 2
25
A Note on Categories of Medications

Often a medication fits into more than one category. Tylenol is a
good example. Tylenol is a brand name and an over-the-counter
medication. Another example is oxycodone. Oxycodone and
acetaminophen is the generic name for Percocet (a pain medication)
which is a prescription medication, a controlled substance, and a
countable substance.
Apply What Youve Learned Freddy has been coming home feeling
1. Tell Freddy to bring home the substance, and you will give
it to him.
2. Tell Freddy to bring home the substance so you can ask the
HCP if its okay to take it.
3. Tell Freddy not to take any more holistic/herbal compounds.
4. Say nothing since Freddy can take whatever he wants.
Effects of Medication
As you learned earlier in this module, a medication is given with
the hope that it will produce the desired effect and improve
the persons health. You learned that some responses to
medication may be good, but others may not. You also learned
that medication can affect different parts of the body at the
same time.
Medications can cause several possible effects. People usually
respond to medications in similar ways. But they may experience
different side effects. They may also have different medication
sensitivity to what they are taking; this means that people may
react differently to the same amount of medication. Each person
may have a different responsebe more or less sensitive
26
unusually tired for the last week. You find out that he recently started
taking a holistic/herbal compound that he keeps in his locker at work. You
wonder whether this compound is interacting with his other medications.
What should you do? Put a checkmark next to the answer you think is best.
(Remember Freddy? For details about his conditions and capabilities, refer
back to page xii.)
depending on their age, body weight, and general health. As a

medication administrator, you must look for any changes in the
persons physical condition or behavior. Noticing changes may be
harder if the person has trouble communicating how they feel.
The important thing to remember is that any medication a person
is taking may cause physical and behavioral changes. You are in
the best position to observe and report any and all suspected
changes. It is your responsibility to carefully observe the people
you support for three possible outcomes:
3 desired effect
3 no apparent desired effect
3 unwanted effects
Desired Effect/Therapeutic Effect
When a prescribed medication works correctly as intended, it
produces the desired effect, also called the therapeutic effect.
The desired effect is the beneficial result of the medicationwhat
the HCP wants the medication to do. Examples are reducing
seizures with a medication called Tegretol, getting rid of a
headache with Tylenol. When giving a medication to a person you
are supporting, you should know the medications desired effect
or what it should do. You must also observe the persons response
to the medication.
No Apparent Desired Effect

No apparent desired effect means that the medication is not
working as intended, and the person is still experiencing the
problem. In some cases, this happens because it may take time
before the full effect of the medication can occur. In other cases,
the person does not benefit at all from the medication because
their body is different in some way.
The term no effect means that after enough time passes for
the medication to be fully effective, there is still apparently no
desired effect. For example, suppose that the health-care provider
prescribes amoxicillin (an antibiotic) to be given three times a day
for an infection. If the persons fever does not go down after
24 hours, the amoxicillin has had no effect on the infection.
SECTION 1: Module 2
27
There is always a reason for prescribing a medication. So if it

is not working, the HCP needs to know that the fever did not go
down after taking the amoxicillin. The HCP may then prescribe a
different medication, or in other cases may increase the dose of
the first medication.
Unwanted Effects
3 Allergic reaction: the persons immune system is
overreacting. It starts fighting a harmless substance, like

medication, as if defending the body from attack. Allergic
reactions can cause problems like rash, hives, or runny nose.
3 Anaphylactic reaction: a very dangerous allergic reaction
that can involve the whole body. It can be life threatening

and requires immediate medical attention. A person having an
anaphylactic reaction may have difficulty breathing, break
out in hives, or experience changes in blood pressure.
28
Whether or not the desired effect occurs, there is always the

possibility that other, unwanted effects will occur. These are
also called side effects or adverse responses. The term unwanted
effect means that the medication is causing effects that are not
intended or wanted. Unwanted effects may show up as physical or
behavioral changes. Some changes are easy to spot, such as a rash,
diarrhea, vomiting, or fainting. Other changessuch as blurred
vision, dry mouth, confusion, anxiety, or drowsinessmay be
harder to recognize.
Side effects can range from minor to serious. For example,
an antibiotic may help cure an infection, but cause nausea. The
nausea may be annoying but not serious enough to stop the
medication. An adverse response, however, is an unusual and more
serious side effect. If an adverse response occurs, the HCP may
discontinue the medication. For example, if the antibiotic causes
vomiting that results in dehydration (loss of fluid from the body),
the HCP will stop the medication or replace it with a different
medication to treat the infection.
Other unwanted effects include:
3 Paradoxical effect: the medication does the opposite of
what it is supposed to do. A paradoxical effect sometimes

occurs with medications used to calm a person. When
this happens, the medication makes the person restless or
excited rather than calm.
3 Toxicity: occurs when the body builds up more of a certain
medication than it can handle. Toxicity can be life threatening.

Certain medications are more likely to cause toxicity than
others. In some cases, one additional dose can cause toxicity.
If a person is taking a medication known to cause toxicity,
their blood must be checked regularly in the lab.
Apply What Youve Learned Think about Melissa. Since taking

Mysoline, her new seizure medication, she had been seizure free for 3
months. In this situation, her seizure medication was achieving the desired
effectto control her seizures. However, some side effects of Mysoline are
dizziness, poor coordination, blurred or double vision, nausea, and vomiting.
On the medication information sheet located with Melissas medication
sheet, you also learned that a certain blood level of the Mysoline must be
maintained to be sure seizures are controlled. Think back to the day Melissa
had a seizure after 3 months.
Melissas vomiting may indicate a side effect of the Mysoline or that the
medication level in her blood has dropped or risen from vomiting. Or it may
be a sign of toxicity to the medication, or it could even be another physical
problem. Until you report what has happened to Melissa, the HCP does not
know about the problem and cannot evaluate what is causing it. You must
report the information accurately, so that proper treatment can be started.
Read the list below. Put a checkmark next to the best thing to report
to the HCP about what is happening to Melissa. Explain your answer .
(Remember Melissa? For details about her conditions and capabilities,
refer back to page xi.)
1. Melissa is on Mysoline and had a seizure today. She must have an
upset stomach because she is vomiting.
continued 3
SECTION 1: Module 2
29
Apply What Youve Learned (continued)

2. Melissa has been vomiting and had a seizure today. She takes
Mysoline 2 times/day.
3. Melissa has been seizure free for 3 months, she vomited today, and
had a seizure. She takes Mysoline 2 times/day.
5. Melissas blood level is low from vomiting.
Medication Interactions
Often people receive more than one medication at a time.
Whenever a person is taking two or more medications, an
unwanted effect may result from the interaction (mixing) of the
medications in the body. Every medication has the potential
to interact with another medication. In fact, interactions can
occur with any combination of medications, compounds, and/or
substances. For example, when Freddy takes the holistic/herbal
30
4. Melissa is toxic from her Mysoline.
compound with his blood pressure medication, the combination

could make him unusually tired. Medication interactions may do
any of the following:
3 Increase the effects of one or more of the medications.
For example, alcohol may initially increase the effect of

a sleeping medication and make the person difficult to
awaken.
3 Decrease the effects of one or more of the medications.
For example, antacids can change how much of another

medication is absorbed in the body, which means the person
will not receive the full effect of the medication.
Remember four important points about medication interactions:

1. The more medications a person takes at one time, the
greater the possibility of a medication interaction.
2. By knowing which medications a person is already taking,
the HCP can prescribe a new medication that has a lower
chance of interacting with current medications.
3. Staff members need to report any and all changes observed
in a person taking medication. These changes could be
caused by medication interactions.
4. You can learn about medication interactions by asking
the HCP or pharmacist or by reading the package inserts
(medication information sheets) that come with
medications, as well as a drug reference book.
SECTION 1: Module 2
31
In the blank provided, write the letter of the definition that fits the term.
Effects and Categories of Medication
1. Medication Sensitivity
2. Toxicity
3. No Apparent Desired Effect
4. Allergic Reaction
6. Paradoxical Reaction
7. Anaphylactic Reaction
8. Unwanted Effects
9. Medication Interaction
10. Generic Medication
11. Prescription Medication
B. A person who only weighs 100 pounds

gets very sleepy after taking a normal
dose of Tylenol.
C. Your mother takes a new medication
for her high blood pressure. Her blood
pressure is much lower as a result.
D. A persons hair falls out while they are on
chemo for cancer.
E. Freddy feels tired and sleepy because hes
taking an herbal compound along with his
regular medications
F. You have taken an antibiotic for a week
for an ear infection. Your ear doesnt feel
any better.
G. Lab tests show that a persons liver is
being hurt by a medication they are
taking.
H. A person becomes stressed out after they
take medication that should help to calm
them.
I. A person starts to gasp and says they
cant breathe just after receiving a new
medication.
J. A medication called by its chemical
name.
K. Medication for which you must present a
written prescription from the HCP to the
pharmacy in order to buy.
32
5. Desired/Therapeutic Effect
A. A persons skin begins to itch after they

begin taking a new medication.
Getting Information about Medications

As a staff member you are not expected to be familiar with
every medication available nor are you expected to understand
different diseases, conditions, or illnesses the people you support
may have. You are expected, though, to be familiar with the
medications you administer to the people you support and their
indication. Also knowing something about the more common
diseases, illnesses, and conditions will help you understand the
desired effect of each medication. Section 4 of this manual
contains a list of common diseases, illnesses, and conditions with
examples of brand and generic medications used to treat them.
There are many resources available to help you learn about
medications. Information is available from the prescribing HCP,
the pharmacist, package inserts, reputable online sources, and
medication reference books.
Fill in the information below using one of the resources mentioned above and
a medication you are familiar with.
Name of the medication
Indication (what it is used for)
Therapeutic effect (what you expect to occur when the medication is given)
Side effects (minor or annoying symptoms)
SECTION 1: Module 2
33
Adverse responses (serious symptoms that may occur)
Medication or food interactions (medications or other substancessuch as

alcohol or certain foodswhich should not be taken with this medication)
Storage requirements, if any

Special instructions (take with food, drink lots of water)
Summary
You may be wondering how you will ever learn all this
information about medications. Take one step at a time.
Start by getting to know the people you will be supporting.
Help with medication administration and learn about the
medications each person will be taking. Build on your
knowledge as new medications are ordered. Always be sure
you know the facts about a medication before giving it. Make
this your practice every day. Medication administration is an
ongoing learning experience. You will always find something
new to learn.
34
Fill in the Blank

Complete
the statements below. If you need help, refer to the

Terms to Study in the beginning of this module.
1. When a medication does the opposite of what it is supposed
to do, this is called a
.
2. The intended use of the medication is its
.
3. Another term for the desired effect of a medication is
.
4. If a persons immune system overreacts to a medication or
other substance (by producing a rash or hives, for example), we
call this response an
.
5. The response wanted or expected from a medication is called
the
.
6.
/
compounds are
natural substances that you can buy without a prescription.
7. A medication
is a change in the effect of a
medication when it is given at about the same time as another
medication. This response can also occur with certain foods
as well as with alcohol, nicotine, caffeine, or other chemical
substances.
8. A response caused by the medication that is not wanted or
intended is called a
.
9. How responsive a person is to a medication or other substance
is known as their
.
10. A bad response to a medication is called an
effect.
11.
medications can
be bought in a drug store without a prescription from the HCP.
12.
occurs when the body stores up more

medication than it can handle, causing an adverse response.
13. The term

(4 words) means no response to the medication. In this case,
the person continues to experience symptoms.
continued 3
SECTION 1: Module 2
35
14. An
is a very strong,
dangerous allergic reaction that can involve the entire body.
This reaction happens quickly, is often life threatening, and
requires immediate medical help.
15. An allergic reaction, side effect, or paradoxical effect that was
not planned is called an
.
True/False
In the blank provided, write T if the statement is true or F if the
statement is false.
2. All medications require an order from the HCP.

3. Holistic/herbal compounds can cause adverse
responses and interactions.
4. The more medications a person takes at one time, the
greater the chances of a medication interaction.
5. It is not important for staff to understand potential
adverse responses to the medications they administer.
36
1. Over-the-counter medications will never cause an

interaction with prescription medications.
SECTION
The Techniques of
Medication Administration
ection 1 of this manual laid the groundwork of knowledge

you need to administer medications safely. If you think
of Section 1 as the foundation of a house, Section 2 could be
compared to the framework and walls. In Section 2, you will find
the bulk of information about how to perform the specific tasks
related to administering medications. You will learn how to report
information accurately, create a clean environment, and follow the
step-by step procedure for giving medications safely. You will also
discover how to work with people who have difficulty swallowing,
are elderly, refuse their medication, or self administer. Section 2
has four modules:
Module 3: How to Observe and Report Information
Module 4: How to Prevent and Control Infection
Module 5: How to Administer Medications, Step-by-Step
Module 6: How to Handle Special Situations
How to Observe and

Report Information
Objectives

1. Explain the differences between subjective and objective
information, and give examples of each.
2. Describe your responsibilities for observing and reporting.
3. Describe situations that require immediate reporting,
certain time reporting, and routine reporting.
4. List some ways to help you remember your observations
and recall details.
5. Identify various forms for reporting, and explain when they
are used.
SECTION 2: Module 3
37
Introduction
s you learned in Module 1, your skill in observing and

reporting changes in the people you support can make a big
difference in the quality of their lives. Your observations are an
excellent source of information for the HCP and others supporting
each person. This module will help you learn what observations
to report, how to report them, and when. Remember, the Cycle
of Responsibility begins with observation and reporting. Figure
31 shows you where observing for changes fits in the Cycle of
Responsibility.
38
Certain time reporting communicating with others within a

specific time frame; for example, a HCP may require reporting a
persons pulse before giving a medication if that pulse is outside
of the parameters of the HCP order.
Confidentiality the state of keeping information private; not
sharing information about the people you support with others
who are not involved in their care.
Immediate reporting communicating with others instantly.
Dangerous situations and medical emergencies require
immediate reporting.
Objective information facts that can be observed (seen, heard,
felt, or smelled) or measured (blood pressure, temperature, etc.).
Observation paying attention to and recognizing changes in the
people you support.
Routine reporting communicating with others on everyday
matters. Routine reporting is often done at the end of your
shift and given to your supervisor or other staff.
Subjective information what a person tells you about how
they feel.
The Cycle of Responsibility

Report changes
Store medication
Record information
Figure 31: Observing or watching for changes begins the Cycle of Responsibility.
Objective and Subjective Information

You must learn to recognize and communicate changes that may
occur with the people you support by using your observation and
reporting skills. You must be able to report both objective and
subjective information.
Objective information is factual. It is based on what you can
see, hear, smell, or feel when you touch. It is something you
have first-hand knowledge of. Some examples of objective
information are:
3 a cut that is red and swollen (which you can see and
maybe feel)
3 violent shaking movements (which you can see)

3 bumps on a persons body (which you can see and feel)
3 crying, moaning, or screaming (which you can hear)
Objective information also includes things that can be
measured, such as the persons vital signstheir temperature,
pulse, respiration, and blood pressure.
SECTION 2: Module 3
39
Subjective information is different. It is not something that can

be measured or observed through your senses. It is what a person
tells you about how they feel. Some examples of subjective
information are a person saying:
3 Im more tired than usual today.

3 My stomach hurts.
3 I feel dizzy.
Label the following information as subjective (S) or objective (O).

1. Melissas temperature is 101 degrees Fahrenheit.
2. Chip has been pacing, yelling, and slapping his head more than
usual today.
3. Freddy said he had a headache.
4. Melissas tongue was bleeding when she got her morning
medications.
5. Melissa was crying today.
6. Chip says he feels sick.
7. Chips knees were very red and swollen and warm to touch.
8. Chip was not able to get his shoes on this morning.
9. Freddy says his medication makes him tired.
10. Freddy slept through breakfast and missed the bus.
40
Accurate observations and reporting include both subjective

and objective informationfacts about the person as well as how
they say they feel. Good observations and detailed reporting will
help staff make important decisions about the person. They will
also help the HCP determine the best treatments and medications.
The Importance of Accurate

Observations and Reporting
*MASSACHUSETTS
DDS ONLY
Using the Health Review

Checklist can be helpful with
reporting changes.
Remember, as the staff member who spends the most time with
the person, you are often the first one to observe a change.
Some changes may be due to illness and be serious, and others
may not. Changes include behavior that is unusual or not typical
for the person. Your responsibility is to report information.*
Without your observations and accurate reporting, small changes
and medication interactions may be missed. Never feel that
information you are reporting is not important. Always follow up
on information you report. Find out what action was taken, if any,
and what the results were.
Think about Melissa, Chip, and Freddy. They each have
different abilities to communicate how they feel. If you are the
person supporting Melissa, Chip, and Freddy, you would have
to report what you observed and what they communicated to
determine the effect of the medications they received. (For details
about their conditions, medications, and capabilities, please refer
back to the descriptions of Melissa, Chip, and Freddy, beginning on
page xi.)
Because you know Melissa, Chip, and Freddy, you are able to
observe them for changes. For example, Melissa cannot tell you
how she feels, but she may sleep more, groan, or smile to express
how she feels. Changes in her behavior or facial expressions may be
the only clues you have about how she is reacting to a medication.
If Melissa would not hold onto her cup when you were giving her
the morning dose of Mysoline, what would you do?
Or consider Chip. He normally takes his medication without
difficulty. But suppose you observe Chip pacing back and forth,
mumbling phrases over and over, and not making any sense. When
giving him his medications, he knocks the cup over and spills the
water on the floor. What would you do?
Suppose that Freddy will not get out of bed for work, and you
notice that he is not interested in working on self-administering.
What would you do?
SECTION 2: Module 3
41
Put a checkmark next to the statement(s) you would report.

1. Melissa has a smile on her face today.
2. Chip was pacing back and forth, mumbling phrases over and over,
even after his PRN medication for those behaviors was given to him.
3. Freddy took his medications without any noticeable changes
this morning.
5. Chip would not talk and refused all his medications.

6. Melissa slept most of the day.
7. Freddy told you he would not take the white pill because it gives
him a headache.
8. It was hard to wake Melissa up for her evening medications.
True/False
In the blank provided, write T if the statement is true or F if the statement

is false.
1. Guessing is based on factual information.
2. Melissa is 5' 4" tall is a subjective statement.
3. Good observations should include detailed subjective and objective
information.
4. It is important to watch for changes after administering medications.
5. You should not report medical emergencies such as anaphylactic
reactions.
6. You must observe for changes in behavior.
When to Report Information

When reporting your observations, you must communicate
information clearly, accurately, and thoroughly. You must also be
sure to maintain the persons privacy and confidentiality. Only staff
and the HCP involved in their support should know information
42
4. Melissa would not hold her cup. There was a tear on her cheek
when she got her evening dose of Mysoline.
about them. For example, you should not share information with a
neighbor about the health of a person you support.
The timing of reporting is just as important as what you
report. In certain situations, timing can make a difference in the
quality of the support you give. Also remember that it is much
better to report often than to report once in a while. When in
doubt, report it.
Reporting information is your responsibility. In Figure 32
you can see that reporting changes is an important part of the
Cycle of Responsibility. Below are some guidelines to help you
understand situations that require immediate reporting, certain
time reporting, and routine reporting.

Report changes
Store medication
Record information
Figure 32: Reporting changes is an important part of the Cycle of Responsibility.
Immediate reporting
*Massachusetts
The DPH requires that the
telephone numbers for the MAP
Consultant, poison control, and
emergency numbers be posted
clearly and near the telephone in
all residences.
You must report immediately any dangerous situation or medical

emergency. To do so, you must know where to find the emergency
numbers to call, such as the poison control center, your local
hospital, and the police and fire departments. The best thing to
do is to post these numbers next to each phone.*
SECTION 2: Module 3
43
Certain time reporting

In some circumstances, information must be reported at a certain
time. For example, the HCP may need to be called to report a
blood sugar level in a person with diabetes before their morning
diabetic medication is given. In this case, this information
is reported before it is time for the medication. Or another
example, a HCP order may tell you to call if a persons fever does
not go down in 24 hours. If the fever has not dropped in that time,
you report the information to the HCP.
Routine reporting
Routine reporting is information about what happened with
the person on a particular day, and includes everyday activities.
In routine reporting, you should describe both subjective and
objective observations. You might report that Melissa seemed
happy because she was smiling every time you went into her
44
You must also report immediately those situations or conditions

that could endanger the health or safety of people. These are
conditions that you do not have to call your local emergency
number but that nevertheless pose some threat. For example,
you should report behavior that seems to be getting worse and is
starting to affect others. You know better than anyone else the
normal behavior patterns and physical conditions of the people
you support. So if you observe physical or behavioral signs that lead
you to believe that the health or safety of anyone is at risk, you
must report the situation immediately according to your agencys
procedure. Typically there are behavioral support plans in place to
address these behaviors.
You will also encounter situations where a physical or behavioral
change is not health threatening but could become more serious
over time. For example, Melissa may have a runny nose one day
and a cough the next. These could be early symptoms of an upper
respiratory infection and lead to pneumonia. So you must report this
information to the appropriate person at the time that you notice
the changes.
Any change in the persons physical condition or general
behavior could be important.
room. You may communicate routine information to family

members, other staff, or your supervisor. Routine reporting can
be done at the end of your shift, during a daily call with a family
member, or with your supervisor. This reporting can be verbal, in
writing, or both.
Read the descriptions of situations below. Then write yes if you would report
the situation or no if you would not report it.
1. No seizure activity noted today.
2. Change in mood.
3. Refused a PRN sleeping pill when they usually take one.
4. A fever that has not gone down an hour after taking ordered
acetaminophen.
5. Repeated episodes of angry or aggressive behavior, which are
manageable but not typical for the person.
6. A rash that lasts for several days or appears to be getting worse.
7. A complaint of sore throat.
8. A change in the type of seizure the person usually experiences.
9. An increase in seizure activity.
10. Unusually withdrawn behavior from a person who is usually
very social.
11. Refusal to take prescribed medications.
12. Changes in sleeping patterns (especially sleeping too much
or too little).
13. Seemingly minor problems such as colds or mild diarrhea.
14. Unexpected minor bruises.
15. Change in coordination.
continued 3
SECTION 2: Module 3
45
16. Rash.
17. No side effects noted from a new medication.
18. Call from the HCP about a persons blood level (normal results).
Remembering Your Observation, Recalling

Details, and Forms for Reporting
3 Is there anything new or changed?

3 What did I see, hear, feel, and smell today?
3 Did I have any problems or concerns while giving
medications today?
In addition to telling others what you observe, you must

document your observations. Here are some guidelines for
documenting your observations:
3 Write clearly so it is easy to read.

3 Write using ink, not pencil.
3 Follow the proper instructions if you make an error. (See
Module 8, Rules to Follow when Recording Information.)
3 Include the date and time of the documentation entry.

3 Sign your name.
Table 31 gives examples of forms your agency may use
and why.
46
It is important that you fill out forms completely and accurately.

You may find it helpful to write down your observations during
the day so you do not forget any details. You can also ask yourself
questions like:
Table 31: Examples of Forms used for Reporting
Type of Form Used to Document

Incident report, such as Accident and Injury forms
and Medication Occurrence forms
An injury, accident, or Medication

Occurrence
Physical Reporting, Data Tracking forms, such

as Seizure Activity forms and Bowel Movement
records
Specific physical issues or concerns for an

individual person
Daily logs, such as communication and

medication books
The activities of daily living and

administration of medication
Notes, such as Medication Progress and Clinical

Progress Notes
Specific issues or concerns related to a

medication administration or an activity
that is not documented elsewhere
Special circumstance forms such as Disposal form,

Telephone Order form, Leave of Absence form,
and HCP visit forms
Different situations you may encounter
Report Information to the Right People

Being aware of who you report information to is an important
part of your responsibilities. In some situations you may report
directly to the HCP and in others it may be your supervisor or
a specified consultant. Your supervisor will let you know what
information is reported to each agency personnel.
Summary
Do not think of administering medications as just a task
that has to get done during your workday. Your role as direct
support staff is important. Your conscientious observation
and reporting of changes in a persons physical condition
and behavior will contribute to their well being. Be sure to
report both subjective and objective information, following
the guidelines for reporting immediately, at a certain time, or
routinely.
SECTION 2: Module 3
47
Fill in the Blank

Complete

1. A HCP may want you to report a persons
pulse before giving a medication if their pulse
is outside the parameters on the HCP order.
Communicating within a specific time frame is called
.
2. The state of keeping information private, not sharing
information about the people you support with others not
involved in their care is called
.
are facts that can be
observed (seen, heard, felt, or smelled) or measured (blood
pressure, temperature).
4.
is paying attention to and recognizing

changes in the people you support.
5. When you report what a person tells you about how they
feel, you are reporting
information.
6.
occurs when you

communicate with others on every day matters.
7.
occurs when you

communicate with others instantly.
True/False
statement is false.
1. You must only report subjective information.
2. You do not need to report changes in behavior.
3. Any significant changes in a persons physical condition
or general behavior could be important.
4. Use an incident report to document any injury.
48
3.
How to Prevent and

Control Infection
Objectives
*Massachusetts

1. Explain the concept of clean versus dirty.
2. Explain why standard precautions are needed in medication
administration.
3. Demonstrate the proper procedure for hand washing.

4. Demonstrate the proper procedure for putting on and
taking off gloves.
Contaminated unclean or impure. The place where you prepare

medications must be clean and free from exposure to body
fluids so that medications do not become contaminated.
Infection the invasion of disease-causing germs.
Infection control measures taken to reduce the spread of germs
when administering medications.
Mucous membrane a thin covering of tissue that lines parts of
the body. There are mucous membranes in the mouth, nose, and
other openings of the body.
Standard precautions a set of rules you must follow when
administering medications to reduce the spread of infection.
The most important are hand washing and putting on and
taking off gloves.
Introduction
efore you administer medication, you must make sure that

the environment you are working in is clean. You must take
all possible measures to reduce the spread of germs so that you
do not contaminate the medication. This module will explain the
procedures you must follow.
SECTION 2: Module 4
49
Infection Control
Clean Versus Dirty
Standard Precautions
Standard precautions are a set of rules that you must follow
whenever you administer medications. Standard precautions
help protect you and the people you support from the spread of
infection. With this approach, you use the same procedures for
administering medications to someone you think is healthy that
you would use with someone you know is not. You assume that
everyones blood, other body fluids, and mucous membranes may
be infected. The procedures you will use in standard precautions are
related to administering medications. These precautions will reduce
the chance of spreading germs by making sure that the area you
are working in, the tools and medications you use, and you yourself
are clean. Even though these actions seem simple, they are very
important. The following are important steps for you to follow:
3 Make sure the place where you will prepare the medication
is clean. Scrubbing with water and soap or detergent will
clean most surfaces.
3 Wash your hands before and after each administration of

medication.
50
To understand infection control, you must understand the concept

of clean versus dirty. If something is considered clean, it remains
clean until it is contaminated with something considered dirty.
For example, if you wash your hands properly before administering
medications, your hands are considered clean. However, if you are
interrupted to answer a phone call, open the door for someone,
or blow your nose, your hands are now considered dirty until you
wash them again. The safest approach is to assume that something
is dirty and needs to be cleaned, whether its a table, a tray, a glass,
or your hands. The concept of clean versus dirty should be on your
mind at all times. Being aware of what is clean and what is dirty will
help decrease the spread of germs that could be harmful both to
you and the people you support.
3 Put on gloves if you must touch an open wound or mucous
membrane. After administering the medication, remove the

gloves, throw them away, and wash your hands again.
3 Properly throw away all materials that have been
contaminated (such as gloves and disposable cups).

The most common procedures in standard precautions are
hand washing and wearing gloves.
Hand Washing
According to standard precautions, you should wash your hands
according to these guidelines:
3 Before and after each medication administration

3 Between caring for each person
3 If you come in contact with blood or body fluids
3 After removing gloves
3 After you use the toilet
3 Before you handle food or medications
3 After you handle food or medications
3 After you sneeze or blow your nose
3 After smoking

Skill 1
How to Wash Your Hands

Before you wash your hands, be sure you have soap, a clean paper
towel, and hand cream. You must have everything ready beforehand
so you do not contaminate your hands after you wash them. Use
soap and water to wash your hands. Dry your hands thoroughly. Use
moisturizing cream if your hands become dry or cracked.
Follow these steps to wash your hands properly:
1. Turn on the water. Adjust it to a comfortable temperature.
Wet your wrists and hands.
2. Put soap on your hands.
3. Rub your hands together for at least 10-15 seconds. Work up
a lather with the soap. Wash in between your fingers and
under your fingernails.
SECTION 2: Module 4
51
4. Rinse your hands. Allow the water to run from your wrist to
your fingers.
5. Dry your hands on a clean paper or cloth towel.
6. Turn off the faucet using the towel.
7. Throw away the paper towel.
Note: When soap and water are not available, apply an
antiseptic hand cleaner and rub your hands thoroughly until
they are dry, or use antiseptic wipes to wash your hands.
What did you forget to do the first time you washed your hands? Did you
at any point contaminate your hands? What did you do differently the
second time?
List 5 occasions when you should wash your hands. Think before or after
52
Hand washing
1: Go wash your hands.
2: Re-read the steps for washing hands properly.
3: Wash your hands again following the steps, one by one, paying attention
to every detail.
Wearing Gloves
In addition to hand washing, you may need to wear gloves at
times. For example, if you need to apply an ointment to an open
area of skin, you must wear gloves.
To put gloves on properly, wash your hands as described above
and then slip the gloves on, covering your entire hand and wrist.
Skill 2
How to Take Your Gloves Off
Taking the gloves off correctly takes more practice. To take off
gloves properly, follow these steps. (If you are left-handed, use
the opposite hand from the one described.)
1. With your gloved right hand, take hold of the glove on the
left hand at the inside of the wrist, turning the glove inside
out as you pull it down over your left hand. This will help
keep the dirty or contaminated side of the glove away from
your hands. Roll the glove in a ball in your gloved right hand.
2. With your left hand, take hold of the inside of the top of
the right glove at the wrist. Then pull the right glove over
your right hand and cover the used glove held in that hand.
At this point, the right glove is inside out, with the left
glove tucked inside.
3. Throw away the gloves in the trash.
4. Wash your hands.
Summary
Understanding and practicing standard precaution procedures
is an important part of your responsibilities. These
procedures protect both you and the people you support.
When you practice the proper way to wash your hands, you
can dramatically reduce the spread of germs. Good infection
control procedures help everyone stay healthy.
SECTION 2: Module 4
53
Matching
Match
the term in the left column with the correct definition in

the right column.
A. A procedure that reduces the spread
of germs.
2. Infection
B. Thin covering of tissue that lines part

of the body
3. Hand washing
C. Set of rules you must follow when

administrating medications to
reduce the spread of infection
4. Mucous Membrane
D. The invasion of disease-causing germs
Answer the following questions.

1. Standard precaution procedures are general rules that reduce the chance
of spreading germs. Using your own words, write down the procedures you
would use before and after administering medications.
2. In your own words, define Standard Precautions and explain why these
precautions are important.
3. Describe how to wash your hands the right way.
54
1. Standard Precautions
How to Administer Medications

Objectives
1. Describe the information you receive from the HCP.
2. Describe the information the HCP gives to the pharmacy
when ordering a medication.
3. Describe what information is recorded from the HCP and

pharmacy label onto a medication sheet.
4. List the 5 rights.
5. List the series of checks that must be done to ensure a safe
medication administration.
6. Describe the general rules to follow when administering a
medication.
7. List the three parts of administering a medication.
8. Describe other routes by which medications can be administered.
9. Demonstrate how to administer an oral medication and oral
liquid medication.
10. Describe how to help a person who refuses medications.
11. Describe when and how to give a PRN medication.
Amount the number of tablets, capsules, teaspoons, mLs, etc. you

put in a cup each time the medication is given according to the
pharmacy label directions.
Dose The dose is often written in milligrams (mg), so would be
the number of mg given or prescribed to be taken at one time.
Dosage the act of giving medication in regular doses, the amount
of medication in a single dose.
Strength the potency of a medication as supplied by the pharmacy.
Milligram (mg) a measurement of quantity or amount.
Milliliter (mL) measurement of quantity or amount. (cc) and (mL)
are equal in measurement.
SECTION 2: Module 5
55
Oral the route of getting medication into the persons mouth and
swallowed.
Parenteral intramuscular (into a muscle) or intravenous (into a
vein) administration of medications; injection.
Right proper or correct. You must give medications in a proper
manner by always checking for the right person, the right
medication, the right dose, the right route, and the right time.
Route the route is defined as how or where a medication gets
into or onto a person.
n this module you will learn the step-by-step procedure for

administering oral medication. Administering medications is
done in three parts: the steps to prepare, the steps to administer,
and the steps to complete. Thinking about administering
medications in three parts will help you be organized and ensure a
safe administration of medication. Incorporating the principles of
mindfulness, maximizing capabilities, and communication are also
important when you are administering medications. Keeping these
concepts in mind at all times will help you be successful.
Getting Started
In Module 1 you learned that the process of administering
medications occurs in a cycle known as the Cycle of
Responsibility. Each part of the cycle relies on the one before
and the one after it to be complete. For safe medication
administration, none of the parts of the cycle can be skipped,
eliminated, or performed mindlessly. Remember, the parts of the
Cycle of Responsibility are:
3 Observe for changes (physical and behavioral).

3 Report changes.
3 Support visits to the HCP.
3 Communicate with the pharmacist.
3 Record information.
56
Introduction
3 Store medication.
3 Administer medication.
3 Document the medication administration.
To administer oral medications correctly, you must understand
the information you receive from the HCP and the pharmacist.
Figure 51 shows you where the visit to the HCP fits in the
Cycle of Responsibility. What you receive from the HCP and
pharmacist is part of the cycle.

Report changes
Store medication
Record information
Figure 51: Supporting visits to the HCP is an important part of the Cycle of Responsibility.
Support Visits to the HCP

Ordering medication usually begins with the visit to the HCP.
When determining that the person needs a medication, the
HCP will write a prescription. A prescription acts as the written
information for the pharmacist. The HCP must also provide
you with a written order to bring to the home. The HCP order
helps you be sure you know what the HCP wanted the person to
receive. You will learn from your agency what procedures and
forms you need to bring when supporting the visit to the HCP.
SECTION 2: Module 5
57
Figure 52 gives you an example of a HCPs visit form which

includes what the HCP will order for the person you support. A
HCP visit form should include at least the following information:
1. The persons name
2. The reason for the visit
3. Any current medications and/or allergies
4. Staff persons signature completing the form
5. The name of the new or changed medication
6. The dose of the medication
7. How often to give the medication
9. The date, including year
*Massachusetts
Other names for the HCP visit

form are encounter form, order
sheet, and consult form.
10. HCP signature

Your agency may have a specific HCP Visit Form. The top half of
* The HCP
the HCP Visit Form is to be completed before the visit.
completes the bottom half during the visit.
HCPs Visit Form

Name: Freddy Connors
Date: 1/1/yr
Health Care Provider: Dr. T. Smith
Allergies: Bactrim
Reason for visit: complaining of severe left ear pain

Current Medication: Lipitor 10 mg by mouth every day in the morning,
Risperdal 0.5 mg by mouth 2 times a day, Atenenol 25 mg by mouth every
day in the morning, Tylenol 650mg every 4 hours by mouth PRN headaches
Staff Signature: Kathy Mason
Date: 1/1/yr
Ear Infection
Medication/Treatment Orders: Amoxicillin 250 mg 2 times a day by mouth
for 10 days
Health Care Provider Findings:
Instructions:
2 weeks
Dr. T. Smith
Follow-up visit:
Signature:
Posted
Lab Work or Tests:

Date:
1/1/yr
Verified
Figure 52: Your agency will have a specific HCP Visit Form to be taken on a visit.
58
8. The route by which to give the medication

Report changes
Store medication
Record information
Figure 53: Communicating with the pharmacist is an important part of the Cycle of
Responsibility.
Communicating with the Pharmacist

In order to communicate with the pharmacist the HCP must
provide a prescription that gives the pharmacist the details
about the new medication. Here are some ways a HCP can get a
prescription to the pharmacist:
3 The prescription can be given to the person directly who

then brings it to the pharmacy.
3 The HCP can fax or send it electronically to the pharmacist.

3 The HCP can call the prescription into the pharmacist
directly.
3 A staff member can bring the prescription to the pharmacy

to be filled.
Figure 53 shows you where the pharmacist fits in the Cycle of

Responsibility.
Once the prescription is received by the pharmacy, the
pharmacist will fill the medication and make a pharmacy label for
it, using the information from the prescription. The information
on the pharmacy label and the HCP order you receive will be used
to ensure the right medication is received.
SECTION 2: Module 5
59
16. Number of refills
Pharmacy Label
2 Rose Garden Pharmacy
20 Main Street
Any Town, MA 01969
Freddy Connors 4
6
Amoxicillin 250 mg. 8
IC: Amoxil 250 mg.
10
9
Rx# 284-9726
1
3 800-555-1111
5 1/1/yr
7 Qty-20
11
Take one tablet twice a day for ten days by mouth.

13 Dr. T. Smith
Drink lots of water when taking. 12
Lot# 323-3333 14
15 Exp. Date: 1/1/yr
16 Refills: 0
Figure 54: All medications from the pharmacy must have a clearly written pharmacy label.
60
The pharmacist puts a pharmacy label on the medication

container. Figure 54 shows an example of a pharmacy label.
In general, a pharmacy label has the following information:
1. Prescription Rx number
2. Pharmacy name
3. Pharmacy telephone number
4. Name of the person for whom the medication is prescribed
5. Date the prescription was filled
6. Name of the medication
7. Total amount of tablets or liquid dispensed
8. The strength of the medication
9. The amount of the medication
10. How often the medication should be given
11. Route to use when giving the medication
12. Any special instructions
13. HCP name
14. Lot number
15. Expiration date
Along with the HCP order, the pharmacy label is important

because it provides the instructions for you to follow. Once you
receive the medication with the proper label, you can begin the
process of recording the information. This is sometimes called
transcribing.
Note: As you learned in Module 2, some medications are brand

names and others are generic. In most cases, HCPs order and
pharmacists fill the generic version of the medication unless the
HCP specifically writes on the prescription brand necessary,
with no substitutions.
Usually the pharmacist puts only one name of the
medication on the label. You may see the letters IC, which stand
for interchange with. When IC appears on the label, the
pharmacist has listed both the brand and the generic names on
the bottle. If you do not recognize the name of the medication,
you must ask the pharmacist if it is the right medication.
Apply What Youve Learned Suppose you take one of the people
you support to the HCP for their annual check up. The HCP tells the
person to begin taking Inderal and writes a HCP order on the visit form
and a prescription for Inderal. When you receive the medication from the
pharmacy, the label lists the medication as propranolol (the generic form of
Inderal). What should you do? Is propranolol the right medication?
List three ways you can learn about medication you receive.
SECTION 2: Module 5
61

Report changes
Record information
Figure 55: You will be responsible as a medication administrator to record information

from the HCP order and pharmacy label onto the medication sheet.
Record Information
The information about the medication from the HCP order and
the pharmacy label must be written onto a medication sheet
by you or the responsible staff person in your agency. The
medication sheet is the legal record of documentation for all
medications administered. Figure 55 shows you where recording
information fits in the Cycle of Responsibility.
Note: Some pharmacies prepare medication sheets when
they fill a prescription. Each staff member administering any
medication must use the HCP order, the pharmacy label, and
the medication sheet for all the checks needed to administer
a medication safely. Section 3 will provide more details about
how to work with the HCP and pharmacist.
62
Store medication

Report changes
Store medication
Record information
Figure 56: All medications must be stored. You will learn about how medications are
stored in Section 3: Module 8.
Store Medication
After the information is recorded on the medication sheet you will
store the medication before it will need to be administered. In Section
3 you will learn more about storing medications. Figure 56 shows you
where storing medication fits in the Cycle of Responsibility.
The Five Rights of Giving Medications
*Massachusetts
To remember the 5 Rights use
the acronym I must do this
right.
I - Person
Must - Medication
Do - Dose
This - Time
Right - Route
When administering medications you must think in terms of

doing it right, in other words, in a proper or correct manner.
Medication administration is concerned with several rights. These
rights include 1) the right person, 2) the right medication, 3)
the right dose, 4) the right time, and 5) the right route.* When
you administer medication, you must think about the right way
to do it. As you read through the three parts to medication
administrationthe steps to prepare, the steps to administer, and
the steps to completekeep the word right in your mind at all
times. Figure 57 shows you where administering medications fits
in the Cycle of Responsibility.
SECTION 2: Module 5
63

Report changes
Record information
Figure 57: Administering medications the right way is part of the Cycle of Responsibility.
*Massachusetts
You must call your MAP
Consultant first.
Each time you administer a medication, ask yourself, Do I have

the right person, the right medication, the right dose, the right time,
and am I using the right route? As you read the list of rights below
think about what could happen if you replaced the word right with
the word wrong. Can you imagine what kinds of problems could
occur? Each time you administer a medication you must have all the
rights in place. If any one of the rights is not correct, or if you are
not sure about one or more of them, you must not administer the
medication and you must call your designated agency personnel.*
The key is never to give the medication if you are not confident
about each of the rights.
3 Right person
3 Right medication
3 Right dose
3 Right time
3 Right route
64
Store medication
*Massachusetts
Always Remember: Make Sure Everything is Right

consultant first.

call your designated agency personnel immediately.*
If anything is wrong,
If everything is right,
R you can administer the medication.
Select two of the rights from the previous page. In the space below, describe
what you believe could happen if the right turned out to be a wrong.
What could happen if you had the wrong
?
What could happen if you had the wrong
?
What exactly do these rights mean? Below is a description of
each one.
Right Person
To make sure you are giving medication to the right person, you
have to know the people you support. In Module 1, you learned
how important this is. If you are not certain that you have
identified the right person, you must get help. You can ask other
staff, check for a picture of the person or call your supervisor for
assistance. One thing you should not do is ask the person. The
people you support may answer to other peoples names. So do
not give any medication to anyone you are not positive is the
right person.
Right Medication
On the prescription, the HCP may write the brand name but
indicate that the generic medication may be used. In this case, the
pharmacist may put both the brand name and the generic name
on the label. Remember, if you are not sure of the name of the
medication, ask the pharmacist.
SECTION 2: Module 5
65
If you are familiar with the medication and notice that the size
or color has changed, you must not administer the medication.
Call the pharmacist and ask if the medication has changed.
Describe the medication that you have, and tell the pharmacist
the name on the container. You may also ask for a description of
the medication. Do not administer anything unless you are certain
it is the right medication.
Apply What Youve Learned Suppose you come on duty and are told
1. Give Melissa the Prozac 10mg (2 tablets in the morning).

2. Call the HCP to ask if the dose of Prozac was correct.
3. Call the pharmacy, and ask the pharmacist if Prozac is the same as
Tegretol.
Right Dose
The right dose is how much medication you must give to the person
each time the medication is due, for example, 100mg. The dose
is what the HCP orders. The dose is usually written in milligrams
(mg). The strength of the medication is what the pharmacy
supplies. The strength can be the same as the dose ordered (100
mg in the example above), or it can be a number that adds up to
equal the dose. The amount is the number of tablets, capsules,
teaspoons, mLs, etc. that you put in the cup. When pharmacists fill
prescriptions, they may not always have the exact dose on hand.
So they will direct you on the pharmacy label (how much) you
have to administer to equal the dose ordered. For example, if the
HCP orders 100mg (dose), and the pharmacy only has 50mg tablets
(strength) of the medication, you will administer two (amount)
50mg tablets to equal 100mg.
66
by the previous shift staff that the HCP has ordered another anti-seizure
medication called Tegretol for Melissa, but it has not been delivered from
the pharmacy yet. When it arrives you notice that the label says Prozac
10mg, take 2 tablets by mouth in the morning. What should you do? Circle
your answer.
You should never have to do the math to figure out the

amount yourself. The pharmacy label directions will always tell
you this. For example, suppose the HCP orders a medication with
a dose of 10mg, but the pharmacy only has 5mg tablets available.
The pharmacist will label the strength as 5mg followed by
instructions to take 2 tablets. Giving the 2 tablets will provide the
dose of 10mg, which is the dose the HCP ordered. You must pay
close attention to strength and dose. These medication terms can
be very confusing and can result in an under-dose or over-dose to
the person. Either can be life threatening.
The left column shows the HCP order for a medication. The middle column is
the strength of the medication available at the pharmacy. In the right column,
write down the number of tablets you would expect to find on the pharmacy
label.

HCP Order (dose) Strength Available Amount To Give
Imuran 100mg
50mg tablets
Armour thyroid 30mg
30mg tablets
Atenolol 25mg
25mg tablets
Lorazepam 0.5mg
0.5mg tablets
Prednisone 3mg
1mg tablets
Lipitor 20mg
10mg tablets
Right Time
The right time can mean a particular time of the day, the number
of times per day, and the time between doses of a medication.
There are many ways that the HCP may specify the time to give
a medication. For example:
3 At breakfast, after meals, or at bedtime.

3 Once a day (at a particular time like in the morning), twice a
day, or three times a day.
3 Every four hours, every six hours, or every twelve hours.

SECTION 2: Module 5
67
Frequency
Twice a day
HOUR
Three times a day

HOUR
Four times a day

HOUR
8am
8am
8am
12pm
8pm
4pm
4pm
8pm
8pm
Figure 58: How many times a day to give meds. The specific times a day to choose to give meds.
68
The pharmacy label will tell you what the HCP ordered.
You will need to write on the medication sheet the times that
the medication is to be given. The actual time of day you give
a medication (based on the directions from the HCP) can vary
from agency to agency. For example, one agency may routinely
designate 8:00 a.m. as the time to give medications, ordered
once a day, while another agency may choose 9:00 a.m. as the
time. Frequency is a term that is sometimes used for Right time.
It means how often the medication should be given in a 24-hour
period or a day.
What is important about time is to follow the HCPs order
and the pharmacy labelespecially if the time is specific, in the
morning, for example. If you are allowed to determine the time to
administer, follow your agencys rules.
Also pay attention to medication orders that instruct you
to give the medication with a certain number of hours between
administrations. For example, Tylenol given every six hours around
the clock means to space the timing by six hours. A time schedule
every six hours could mean to give the medication at 12:00 a.m.,
6:00 a.m., 12:00 p.m., 6:00 p.m. Every agency will have a certain
timing structure to follow. Figure 58 gives an example of Right
time (frequency). You should always choose a specific time for the
medication. You cannot use time frames such as breakfast, lunch,
and dinner, without a specific time on the medication sheet. The
risk with doing so is that the medication times can vary day to
day, and benefits of the medication may not be achieved.
*Massachusetts
On time is defined as 1 hour

before the scheduled time, up to
1 hour after.
You will also receive guidance about giving medications

within a certain time frame. For example, you may be required
to give all medications within an hour of the time written on the
medication sheet. If you give a medication later than that time,
you will need to know what to do. You must make every effort
to give medications on time, but you should never rush giving a
medication and risk making a Medication Occurrence. Agencies
should have a policy that defines what is considered on time.*
You may be required to give medications to more than one
person at a time. Each administration of medication deserves
your individual attention. So take your time. Most medications
can be given safely one hour before the designated time on the
medication sheet up to one hour after it was due to be given.
Write your answers in the space provided.

What time would you give a sleeping pill?
If a HCP orders a medication to be given 4 times a day, what time schedule

could you use?
Right Route
The right route refers to where and how the medication gets into
the body. You will be administering medications orally (by mouth).
To administer medications using different routessuch as the skin,
ears, eyes, nose, vagina, and rectumyou will need to speak to
your supervisor about learning to administer medication by new
routes.
The HCP prescribes a medication in a certain form (tablets,
capsules, ointments, liquid, etc.). The form of the medication
determines the appropriate route. Capsules, tablets, and liquids
SECTION 2: Module 5
69
are usually swallowed (oral route). Ointments are usually applied

externally to the skin (topical route).
In your own words, define what is meant by the right route.
The pharmacist and/or HCP will also provide any special

instructions you will need to administer the medication properly.
You will find this information on the medication container. Some
examples of special instructions are take with food or take
with plenty of water. Special instructions also may include
information about how to position the person or things to avoid,
such as direct sunlight. It also will provide instructions about
particular techniques or methods to administer medications, such
as crushing a tablet or preparing sprinkles. The HCP also writes the
reason(s) for administering a medication, for example anxiety. You
will need a HCP order if the medication is changed in any way.
Special instructions from the pharmacist and or HCP are just
as important as the rights listed above. Be sure that you write
down any special instructions and the reason for administering on
the medication sheet.
70
Special Instructions or Precautions and/or Reason(s)
Apply What Youve Learned Chip is on an antibiotic and must not be
exposed to direct sunlight. While on the medication, Chip is scheduled to

go to an afternoon baseball game. Describe how you would protect Chip
from sun exposure. (Remember Chip? For details about his conditions and
capabilities, refer back to pages xixii.)
Crosschecking to Ensure Safe Administration

In the previous section, you learned that the HCP writes a
prescription form, which the pharmacist uses to fill and make
the pharmacy label. When you receive the medication from the
pharmacy, the first thing you must do is look at the HCP order
and pharmacy label to make sure you have the right medication.
Then write the information from the HCP order and the pharmacy
label onto the medication sheet. You will learn more about
documentation of medication in Section 3 of this manual.
It is important to remember that all the information you
have about the medication must match. Each time a medication
is given, you must systematically and conscientiously (mindfully)
check the three pieces of information you have available: the
Health-Care Providers order, the pharmacy label, and the
medication sheet. These three contain the rights. By always
checking these pieces of information, you can be certain you
are administering the right medication in the right dosage to
the right individual at the right time using the right route. If
any piece does not agree, the medication should not be given.
Remember, it is your responsibility to be sure the HCP order and
the pharmacy label agree with the medication sheet.
Using the HCP order and the pharmacy label, you must write
down the right person, the right medication, the right dose,
the right time, and the right route. If you document the rights
correctly, the medication sheet will be complete and accurate.
SECTION 2: Module 5
71
Crosschecks
Each time you give the medication, you must perform the
following crosschecks. Do these three crosschecks before you give
the medication:
1. When you take the medication out of the locked container,
and place it on a clean surface, check the HCP order to the
pharmacy label.
Crosscheck 1
HCP
Orders
Pharmacy
Label
Figure 59: In Crosscheck 1, compare the HCP orders to the pharmacy label. The reason for Crosscheck 1 is to make sure
the information on the pharmacy label agrees with the HCP order.
2. Before you open the container perform Crosscheck 2,

compare the pharmacy label against the medication sheet.
Crosscheck 2
=
Pharmacy
Label
Medication
Sheet
Figure 510: In Crosscheck 2, compare the pharmacy label to the medication sheet. The reason for Crosscheck 2
is to make sure the instructions and the amount on the label agrees with what is transcribed onto the
medication sheet.
72
3. Open, remove or pour the medication from the container.

Perform Crosscheck 3. Compare the pharmacy label to the
medication sheet.
Crosscheck 3
=
Pharmacy
Label
Medication
Sheet
Figure 511: In Crosscheck 3, compare the pharmacy label to the medication sheet. The reason for
Crosscheck 3 is to verify that the amount of the medication prepared is the same as what
the medication sheet and pharmacy label instruct.
4. Administer the medication.

5. After you administer the medication look again at
the pharmacy label to the medication sheet and then
document.
Note: If you made a mistake, report it immediately so that the
right treatment can be provided quickly, if needed.
To ensure a safe administration, these crosschecks or
information checks are essential each time you administer any
medicationincluding those that a person has been taking for a
long time, for example medications to control seizures or high
blood pressure. There is always a possibility that some change has
been ordered that you are unaware of. You MUST check for all the
rights each time you administer any medication to any person.
SECTION 2: Module 5
73
Apply What Youve Learned You receive a renewal delivery from the
pharmacy for a persons blood pressure medication, Norvasc 5 mg, tablets.
When you look at the medication you notice that the tablets are blue
instead of white. What should you do?
Chips dose of digoxin 0.375mg was decreased to 0.125mg because his blood
level was too high, and he showed symptoms of toxicity. It is time for Chips
morning dose of digoxin. You take the first bottle of digoxin you see from
the storage area. You read the pharmacy label and assume the dose has not
changed. After administering the digoxin to Chip and beginning to document,
you notice that the dose of 0.375mg had been discontinued, and there is
another container labeled 0.125mg. Write down the checks that would have
prevented this Medication Occurrence.
General Cautionary Guidelines

Below are some general guidelines for administering oral
medications. You must STOP administering the medication under
the following circumstances:
3 If you are unable to read the HCPs order.

3 If you are missing any piece of information.
3 If you are unable to read the original pharmacy label or if
the label is missing.
74
Apply What Youve Learned Suppose that while you were on vacation,
3 If the medication has expired.

3 If the person has an allergy to the medication.
3 If the medication has been prepared by another staff member.
3 If you have any doubt that you have the right person, right
medication, right dose, right time, or right route.
3 If the person exhibits a physical, mental or behavioral change.

3 If the person has difficulty taking the medication.
3 If the medication seems like it has been tampered with
in any way.
3 If the person is showing signs of seizures or
unconsciousness, difficulty breathing, or any other change

that appears to be health threatening. (Follow your agencys
instructions for responding and reporting an emergency.)
3 If the person refuses the medication. Never force a person

to take a medication.
If any of these situations happen, first call your agency

designated personnel for instructions, and document the
outcome. Always follow your agencys policies.
Three Parts of Administering Medications

As mentioned in the introduction, the skill of administering
medications can be divided into three parts:
1. What you do to prepare
2. What you do to administer
3. What you do to complete the administration
*Massachusetts
It is expected that you get

additional training for any
medication administered by a
route that is unfamiliar to you.
If you work for the DMH, you
cannot administer suppositories
or enemas.
This module teaches you how to administer oral medications.

As you learn about other routes of administration, you will see
that what you do to prepare and what you do to complete the
administration will be the same. These standard steps must be
incorporated before and after each administration. However, you
will find differences in what you do to administer the medication,
depending on the route, the persons unique needs, and the
environment where you will give the medication. You will need
specific training to administer medications by a different route
(other than oral).*
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75
Below is a list of the different routes of medication

administration:
Nasogastric (a tube through the nose into the stomach)

G-tube (gastrostomy tubeinto the stomach)
J-tube (jejunostomy tubeinto the small intestine)
In Section 4 of the manual, there is information on procedures for
administering medications by other routes. Remember, never give a
medication by a route unless you have been trained in that route.
Skill 3 Oral Administration of Medication

Oral administration means giving a person a medication by mouth.
Oral medications include tablets, pills, capsules, caplets, and
liquids. The procedure for administering medications orally has
been broken down into the three parts:
1. What you do to prepare
2. What you do to administer
76
3 Oral (by mouth)

3 Sublingual (under the tongue)
3 Buccal (inside the cheek of the mouth)
3 Translingual (spray onto the tongue)
3 Pulmonary inhalant (breathed in through the nose or mouth)
3 Transdermal (through the skin)
3 Topical (on the skin)
3 On the hair
3 On or into the vagina
3 On or into the rectum
3 Into the eye (ophthalmic)
3 Into the ear (otic)
3 Into the nose (nasal)
3 Injection (parenteral)
3 Subcutaneous (under the skin)
3 Intramuscular (IM, into a muscle)
3 Intravenous (IV, into a vein)
3 Via tube
3. What you do to complete the administration
These parts will help you organize the step-by-step procedure

to ensure safe and consistent medication administration. Under the
discussion of each step, you will see a section titled Remember:
This section explains the rationale or reason why the step must be
done in a particular way. It will help you apply the steps to different
environments and with people who have different needs. As you
study the steps, think about how you might modify them to meet
the needs of Melissa, Chip, and Freddy.
Note: You will find that each place you work in is set up
differently and each person has different capabilities. Because
of these differences, you may have to change the order of
the steps under preparing, administering, and completing. For
example, in one workplace, the sink may be in the same place as
the medications. In another, the sink may be down the hall. No
matter where you work or what the capabilities of the person
you support are, you must follow all of the steps.
Prepare for Medication Administration

The following are the standard preparation steps for all
medication administrations, even though the instructions here
relate only to oral medications.
Get prepared by opening the medication book to the medication

sheet for the right person you are administering the medication
to. Read the medication sheet to identify the medications to be
administered. If the medication is a countable, open the count
book to the right count sheet.
Remember: By reading the medication sheet, you are identifying
the right medication to be administered, that is, how many
medications are to be given and any special instructions you need
to be aware of. This will help you manage your time. Read the
medication information to find out why the medication is being
given and to learn any other important information such as side
effects. If you are unsure of anything, you can look up information
or call the pharmacy.
SECTION 2: Module 5
77
Note: Be mindful of the number of medications you administer

to a person at one time. If you are giving more than one
medication, you must begin with Check 1 through Check 3 for
each additional medication.
Clear and clean the area where you will be working.

Remember: You must work in a clean environment to reduce
the spread of infection. The environment must also be free of
clutter to cut down on distractions that could lead to Medication
Occurrences.
Remember: Using the skill you learned in Module 4 for hand
washing will reduce the spread of infection. Hand washing is the
single most effective way to decrease disease-causing germs.
Gather equipment.
Remember: Getting together the things that you need for the
medication administration helps you to be organized.
Identify and if possible bring the person to the area where you
will administer the medication and provide privacy.
Remember: By identifying the person, you are making sure you
have the right person. Bringing the person to the area where you
are working allows for privacy and a distraction-free environment.
Here you will be able to focus on the person and allow time to
maximize their capabilities.
Note: If you are unable to bring the person to the area where
you are working, or bringing the person to the area may be
a distraction, be sure to follow the same procedures and also
remember to lock the storage area before you leave to go to the
person.
Unlock the medication storage area to get the medication.

Remember: Keeping medications in a locked area is a safety
measure to prevent accidents.
78
Wash your hands.
Administer Oral Medication
The following are the standard administration steps for all oral
medication administrations.
Crosscheck 1 Read the medication sheet and identify the medication you
will be administering. Remove the medication from the storage
container and place it in a clean well-lit place. Perform Crosscheck
1. Compare the HCP order to the pharmacy label. As you do
Crosscheck 1, ask yourself, Do I have the right medication, for the
right person, in the right dose, at the right time, and by the right
route on these two documents? The reason for Crosscheck 1
is to make sure the information on the pharmacy label agrees
with the HCP order.
*Massachusetts
If a medication is a countable
substance, it must be in a
tamper-resistant package such as
a blister pack.
Note: You will receive medications from the pharmacist in a *

container with a child proof cap or in a tamper resistant pack.
For medications placed in a container, you must read the cap for
directions on how to remove the cap. The pharmacy label will
be securely glued to the outside of the container. In addition,
the pharmacy will place labels to the outside of the container
indicating any special instructions if needed for you to follow
when administering the medication. If using a tamper resistant
packaging or blister packs, the medication is placed in its own
bubble on a large labeled card much like a bingo card. You must
read the directions on how to remove the medication needed
for the administration. Some blister packs require peeling the
back foil. Others are removed by pushing the bubble in so the
medication pops through a thin paper layer at the back. Every
single medication is numbered to allow for easier tracking.
For tracking purposes you must always begin with the highest
number first. If the first dose to pop is number 60, the next
dose would be number 59.
SECTION 2: Module 5
79
Crosscheck 2 Before you open the container, perform Crosscheck 2. Compare

the pharmacy label to the medication sheet. As you do
Crosscheck 2 ask yourself, Do I have the right medication, for the
route on these two documents? The reason for Crosscheck 2 is to
make sure the instructions and the amount on the label agrees
with what is transcribed onto the medication sheet.
Crosscheck 3 Open the container and remove or pour the medication from
the container into the medication cup. Perform Crosscheck 3.
Compare the pharmacy label to the medication sheet. As you do
verify that the amount of the medication prepared is the same as
what the medication sheet and pharmacy label instruct.
Note: Remember too that a combination of the strength and
amount must be equal to the dose. For example, the HCPs order
may read Amoxicillin 500mg, give two times a day, but the
pharmacy label reads Amoxicillin 250mg, give 2 tabs 2 times a
day. By giving two 250mg tablets each time, you will give the
proper dose of 500mg two times a day.
80
Note: There are times when the pharmacy will send a different
looking medication than what is usually administered. If you
are not sure, call the pharmacy. You must read the label for
any directions for giving the medication. For example, the
pharmacist may put a label on the medication with directions
to give the medication with water or food. Never alter a
medication by crushing it, dissolving it in water, mixing it with
food, or pouring the contents of a capsule into liquid unless
instructed by a pharmacist and ordered by the HCP. Never split,
cut, break, or open a tablet, pill, or capsule. Every medication
dispensed from the pharmacy must be ready for you to
administer. Never share or use another persons medication.
Note: When opening a package, follow the instructions given

on the package. If you are using a blister pack, place the pack
directly over the cup, and press down on the packaging. The
medication should fall directly into the cup. Always remember
to avoid touching the medication.
If using a pharmacy container, read the directions on the cap
to open. Some caps may require that you press down as you
turn. Others ask you to line up arrows and then remove the cap.
Be sure to tap the correct number of medication(s) into the lid
and then put them into the cup.
Tell the person what medication you are administering. Hand

the medication to the person with water. Provide assistance as
needed.
Remember: The person has the right to know what medication
the HCP has ordered and why. Water helps the person swallow
the medication. If the person is unable to take the medication
on their own, you need to help them while always maximizing
capabilities.
Note: Medications are given with water unless otherwise
ordered by the HCP or written on the pharmacy label.
Make sure the person takes the medication, drinks, and swallows
the water.
Remember: By staying with the person, you can make sure the
person takes and swallows the medication without difficulty. If
the person has trouble swallowing tablets, you should call your
agency personnel for advice. Remember you cannot change a
medication without a HCP order.
Complete Medication Administration

The following are the standard completion steps for all
medication administrations, even though instruction here relates
only to oral medications.
SECTION 2: Module 5
81
Observe the person you support.

Remember: By observing the person you support after you
administer a medication, you can prevent a potential serious
problem by reporting any change.
Look again and compare the pharmacy label and the medication
sheet to be sure you have administered the right medication to
the right person, in the right dose, at the right time, and by the
right route.
Document that you gave the medication on the medication sheet

and if a countable medication also document on the count sheet.
Remember: Documenting lets all staff know that the medication
was given. You must also document your observations. Write
clearly in ink on the medication sheet. Medication sheets are legal
documents. Section 3 provides more detail about documenting
medications.
Return the medication to the storage area and lock it.

Remember: You must return all medications to the storage
area and box and lock it for safety. Storing medications will be
discussed in Section 3 of this manual. Do not throw away the box
the medication came in because it may contain information about
the medication. Lock the storage area.
Note: The location of the storage area and box will determine
when to lock it. If you need to leave the area and go to a
different room to administer medications, lock the storage box
and area before leaving.
Wash your hands.

Remember: Hand washing is the single most effective way to
decrease the spread of infection.
82
Remember: Look again to make sure you have done everything

right. Compare the pharmacy label with the medication sheet.
Never hide an occurrence. You must report all Medication
Occurrences and follow your state and agency policies for
documenting them. Medication occurrences will be discussed in
more detail in Section 3.
Table 51: Administering Medication

Preparing for Medication Administration
Read the medication sheet to identify the medications
to be administered.
Clear and clean the area.
Wash your hands.
Gather equipment.
Identify and bring the person to the area.
Unlock the medication storage area.
Administering Medication
o Crosscheck 1. Check 5 Rights. (HCP order to
D
pharmacy label)
Do Crosscheck 2. Check 5 Rights. (Pharmacy label to
the medication sheet)
Prepare the medication correctly. Remove the
medication from the container; do Crosscheck 3. Check
5 Rights. (Pharmacy label to the medication sheet)
Tell the person what medication they are taking. Give
the person the medication.
Make sure the person takes the medication.
Completing Medication Administration

Observe the person for any adverse effects.
Look again. Check 5 Rights (Compare pharmacy label
to the medication sheet.)
Document that you gave the medication.
Wash your hands.
SECTION 2: Module 5
83
Practice the steps for administering an oral medication.

Note: A good way to learn the steps is to read them out loud
as you practice. If you work with a partner or partners, have
your partner read each step out loud as you practice, and then
you do the same for your partner.
When you are preparing for medication administration, what principles

should you consider? Why?
When you are administering medication, what principles should you consider?
Why?
84
Read the steps again for administering an oral medication. What principles should
you consider with each step? Remember the principles are mindfulness, maximizing
capabilities, and communication. Write your answer in the space below.
When you are completing medication administration, what principles should

you consider? Why?
Liquid Oral Medications

Before you administer liquid oral medications, study the tips and
how-to procedures below.
Tips for Administering Liquid Oral Medications

3 Read the storage directions on the bottle. Some liquid
medications need to be refrigerated.
3 Read the label for directions on shaking the liquid
medication. Some medications may separate into different

layers when stored for too long and need to be shaken to
combine the layers.
3 If the label has no special instructions, ask the pharmacist
whether the medication can or should be given with water

or juice.
3 Do not use regular dinnerware teaspoons or tablespoons

to measure liquid medications. Instead, use oral dosing
syringes, which are the most accurate measuring devices.
3 Do not mistake a teaspoon (tsp or t) for a tablespoon

(tbsp or T).
3 If the measuring device does not match the dose, do not
use it. Call your agency personnel for assistance.
3 Do not put any liquid medication back into the bottle that
has been poured into a cup.
3 Be very careful not to waste any medication.
SECTION 2: Module 5
85
Skill 4
How to Use an Oral Medication Cup

A medication cup can be used as a tool for all oral medications.
For oral liquid medications it is commonly used to measure and
administer a liquid medication.
1. Place the medication cup on a flat surface at eye level.
2. Identify the measurement and mark it on the medication
cup using a marker, or you can use your thumbnail at the
correct measurement.
3. Slowly pour the liquid medication to the correct dose you
have identified with a marker or using your thumbnail.
5. Throw the medication cup in the wastebasket after

administering the medication.
Skill 5
How to Use an Oral Dosing Syringe

An oral dosing syringe can be used as a tool to measure and
administer liquid medication.
1. Remove the oral dosing syringe cap.
2. Insert the tip end of the syringe into the liquid medication
bottle.
3. While holding the syringe in the liquid medication, pull the
plunger up to the level that equals the dose. The dose you
want should reach the top of the plunger (the markings
are located on the side of the syringe). Remove any large
trapped bubbles by tapping the side of the syringe.
4. Remove the syringe from the bottle.
5. If you use the syringe to administer the medication, clean
the syringe thoroughly with soap and water after each use.
Skill 6
How to Use a Dropper

A dropper can be used as a tool to measure and administer a
liquid medication.
86
4. If you over pour the medication, pour the extra medication

into another cup until you have the correct amount. Throw
away the extra medication based on your agencys policy.
1. Squeeze the bulb on the dropper.

2. Insert the dropper into the medication bottle.
3. Release the bulb. When you do so, the liquid medication
will be pulled into the dropper.
4. Hold the dropper at eye level to check for the right dose.
5. Squeeze any excess medication into a clean cup and throw
excess away according to your agency policy.
6. Clean the dropper thoroughly after each use.

Note: If the medication comes with its own dropper and is used
as the cap as well you can squeeze any excess medication back
into the medication container. You do not have to wash this
type of dropper between uses.
Skill 7 Administering a Liquid Medication

Oral liquid administration means giving a person a liquid
medication by mouth. Liquid medication must be measured
correctly to obtain the ordered dose. The devices that can be
used to measure the correct dose include an oral dosing syringe,
a dropper, or a graduated medication cup. The procedure for
administering liquid oral medications is broken down into three
parts:
1. What you do to prepare.
2. What you do to administer.
3. What you do to complete the administration.
Preparing for Administration

of Liquid Medication
The following are the standard preparation steps for liquid
oral medications.
Get prepared by opening the medication book to the medication

sheet for the right person you are administering the medication
to. Read the medication sheet carefully to identify the
medications to be administered. If the medication is a countable,
open the count book to the right count sheet.
SECTION 2: Module 5
87
Remember: By reading the medication sheet, you are

identifying the right medication to be administered, that
is, how many medications are to be given, and any special
instructions you need to be aware of. This will help you
manage your time. Read the medication information sheet to
find out why the medication is being given and to learn any
important information like side effects. If you are unsure of
anything, you can look up information or call the pharmacy.

Remember: You must work in a clean environment to reduce
the spread of infection. The environment must also be free of
clutter to cut down on distractions that could lead to Medication
Occurrences.
Wash your hands.

Remember: Using the skill you learned in Module 4 for hand
washing will reduce the spread of infection. Hand washing is the
single most effective way to decrease disease-causing germs.
Gather equipment.
Remember: Getting together the things that you need for the
medication administration helps you to be organized.
Identify the person, bring the person to the area where you will
administer the medication, and provide privacy.
Remember: By identifying the person you are making sure you
have the right person. Bringing the person to the area where you
are working allows for privacy and a distraction-free environment.
Here you will be able to focus on the person and allow time to
maximize their capabilities.
88
Note: Be mindful of the number of medications you administer

to a person at one time. If you are giving more than one
medication, you must begin with Crosscheck 1 through
Crosscheck 3 for each additional medication.
Note: If you are unable to bring the person to the area where
you are working, be sure to follow the same procedures and
also remember to lock the storage area before you leave to go
to the person.
Unlock the medication storage area to get the medication.
Remember: You must unlock the storage area, if necessary, to

get the medication you need to administer. Keeping medications
in a locked storage area is a safety measure to prevent accidents.
Administering Liquid Oral Medication

The following are the standard administration steps for a liquid
oral medication.
Crosscheck 1 Read the medication sheet and identify the medication you
will be administering. Remove the medication from the storage
container and place it in a clean well-lit place. Perform Crosscheck
1. Compare the HCP order to the pharmacy label. As you do
route on these two documents? The reason for Crosscheck 1
is to make sure the information on the pharmacy label agrees
with the HCP order.
Crosscheck 2 Before you open the container, perform Crosscheck 2. Compare
the pharmacy label to the medication sheet. As you do
Crosscheck 2 ask yourself, Do I have the right medication, for the
make sure the instructions and the amount on the label agrees
with what is transcribed onto the medication sheet.
SECTION 2: Module 5
89
Shake the bottle, if required, before giving the medication.

Remember: Some liquid medication needs to be shaken to be
effective. If so, the pharmacy label on the bottle will say shake
well before removing the cap.
Remove the cap, and place it upside down on a clean flat surface.
Remember: Placing the cap upside down prevents germs from
getting into the cap and into the liquid medication. Some caps
may require that you press down as you turn, and then remove.
Read the directions on the cap.
eye level.
Remember: In order to get an accurate measurement, you must
have the medication cup or device on a flat surface at eye level as
you pour the liquid medication.
Note: Other measuring devicessuch as calibrated medication
droppers, spoons, or oral dosing syringescan be used to
measure correct doses of liquid medications. Before you fill the
measuring device, know to what level it should be filled. If you
are unfamiliar with the measuring device, ask your supervisor or
call the pharmacist for assistance.
Identify the measurement and mark it on the medication cup or

measurement device with your thumbnail
Remember: By identifying and marking with your thumbnail the
amount needed, you can be sure of the right dose as you pour the
liquid medication.
Crosscheck 3 Open the container and remove or pour the medication from
the container into the medication cup. Perform Crosscheck 3.
Compare the pharmacy label to the medication sheet. As you do
verify that the amount of the medication prepared is the same as
what the medication sheet and pharmacy label instruct.
90
Place the medication cup or measuring device on a flat surface at
Remember: By holding the medication cup or measuring device

on a flat surface and marking the amount with your thumbnail
with one hand while pouring the liquid medication with the other,
you are making sure that you have the right dose. Pouring slowly
will help you avoid overfilling the cup and wasting the medication.
Always avoid touching the medication. Pouring away from the
label will help to prevent any damage to it.
Remember: The strength and amount must be equal to the dose.
For example, the HCP may order liquid Amoxicillin, 500mg, 4
times daily. The pharmacy label reads: Amoxicillin 500mg, give
10mL 4 times daily. You would pour 10 mL into the measuring
device to get 500mg each time you administer the medication.
Always remember to avoid touching the medication.
Wipe off any excess liquid medication from the bottle, and put
the cap back on securely.
Remember: By wiping off the excess liquid medication, you
are keeping the bottle and the label clean and free from germs.
Putting the cap back on the bottle helps prevent any spillage. It
is important not to waste any medication so that you will have
enough for each dose.
Tell the person what medication you are administering. Hand the
medication to the person. Provide assistance as needed.
Remember: The person has the right to know what medication
the HCP has ordered and why. If the person is unable to take the
medication on their own, you need to help them while always
maximizing capabilities.
Make sure the person takes the medication and swallows it.
Remember: By staying with the person, you can make sure the
person takes and swallows the medication without difficulty.
SECTION 2: Module 5
91
Completing Administration
of Liquid Oral Medication
The following are the standard completion steps for
administration of liquid oral medication.
Observe the person you support.

Remember: By observing the person after you administer a
medication, you can prevent potential problems by reporting any
change.
Look again and compare the pharmacy label and the medication
Remember: Check again to make sure you have done everything

right. Compare the pharmacy label with the medication sheet.
Never hide an occurrence. You must report all Medication
Occurrences and follow your state and agency policies for
documenting them. Medication Occurrences will be discussed in
more detail in Section 3.
Document that you gave the medication on the medication sheet

and if a countable medication also document on the count sheet.
Remember: Documenting lets the staff know that the
medication was given. You must also document your observations.
Write clearly in ink on the medication sheet. Medication sheets
are legal documents. Section 3 provides more detail about
documenting medications.
Return the medication to the storage area and box and lock it.
Remember: You must return all medications to the storage
area and box and lock it for safety. Storing medications will
be discussed in Section 3 of this manual. Do not throw away
the packaging because it may contain information about the
medication. Lock the storage area.
Note: The location of the storage box and area will determine
when to lock it. If you need to leave the area and go to a
different room to administer medications, lock the storage box
and area before leaving.
92
sheet to be sure you have administered the right medication to

the right person, in the right dose, by the right route, and at the
right time.
Wash your hands.

Remember: Hand washing is the single most effective way to
decrease the spread of infection.
Table 52: Administering a Liquid Medication

Read the medication sheet to identify the medications
to be administered.
Clear and clean the area.

Wash your hands.
Gather equipment.
Identify and bring the person to the area.
o Crosscheck 1. Check 5 Rights. (HCP order to
D
pharmacy label)
Do Crosscheck 2. Check 5 Rights. (Pharmacy label to
the medication sheet)
Shake the bottle, if required, before giving the
medication.
Remove the cap, and place it upside down on a clean
flat surface.
Place the medication cup or measuring device on a
flat surface at eye level.
Identify the measurement and mark it on the
medication cup or measurement device with your
thumbnail.
Slowly pour the liquid medication into the
medication cup or measuring device; pour only to
your thumbnail marking the right amount. Be sure to
pour away from the label. Do Crosscheck 3. Check 5
Rights. (Pharmacy label to the medication sheet)
Wipe off any excess liquid medication from the
bottle, and put the cap back on securely.
Tell the person what medication you are
administering. Hand the medication to the person.
Provide assistance as needed.
Make sure the person takes the medication and
swallows it.
SECTION 2: Module 5
93

Look again. Check 5 Rights (Compare pharmacy label
to the medication sheet.)
Wash your hands.
Note: A good way to learn the steps is to read them out loud
as you practice. If you work with a partner or partners, have
your partner read each step out loud as you practice, and then
you do the same for your partner.
Think about the steps to administering a liquid oral medication. Considering

the unique abilities of Melissa, Chip, and Freddy, how would you help them
with their medication administration? Describe what you would do. (For details
about their conditions and capabilities, refer back to page xi.)
Melissa
Chip
Freddy
94
Practice the steps for administering an oral medication.
Medication Refusals
*Massachusetts
A refusal occurs when the

person:
* Refuses to take the

medication at all - or spits it out
immediately.
* Does not swallow the
medication and spits it out later.
* Self-induced vomiting within

one half hour after taking
medications.
From time to time, you will encounter a person who refuses to

take their medication.* When a person refuses their medication,
you must make every effort to understand the reason why. Does
the medication taste bad? Does it change the way the person feels?
Is the person experiencing a side effect that you cannot see and
they cannot tell you about? Your understanding of the reason for
the refusal may be the only way you can come up with a solution.
Does the dose need to be reduced? Does the medication need to
be changed? Should it be mixed in food or liquid? Do you simply
need to explain why the medication is important? Should you try
to make the process fun for the person? Maybe changing the time
of day that you give the medication could make a difference. All
these suggestions must be discussed with your designated agency
personnel. Documenting medication refusal is covered in Module 8.
Here are some tips for managing this situation:
3 Try leaving the person alone for a few minutesbut take
the medication with youand attempt the administration

again in 1520 minutes.
3 If the person refuses again, try one more time, in another 15
or 20 minutes before considering this a final refusal. Three
attempts should be tried before considering it as a refusal.
3 If the person still refuses, report the refusal according to

your agency policy.
3 Be sure to ask why the person does not want to take the
medication. It might make them feel sleepy or bad in
some way.
3 Explain that you will call the HCP and discuss how the
medication makes the person feel. It could be that the dose

is too high, and the HCP may decide to lower it or make
another change to improve how the person feels.
If a person refuses a dose of medication, be sure to find out what

specific action you must take. You will need to call the HCP to notify
them that the person is not receiving their medication.
SECTION 2: Module 5
95
Apply What Youve Learned Over the last three months you have
been supporting Freddy. His HCP prescribed Risperdal to help him with his
schizophrenia. Today you go to give Freddy his medication and he refuses.
Freddy tells you he does not need the medication. What would you do? Put
a check next to all of the actions you would take. (Remember Freddy? For
details about his conditions and capabilities, refer back to page xii)
A
sk Freddy at least 3 times before you say he refuses his medication.
T
alk with Freddy about what he is feeling, why he is refusing the
medication and what knowledge he has about his condition.
R
eport to the HCP what Freddy feels like when taking the medication
and why he doesnt want to take it.
PRN Medications
PRN medications are medications that are given only when
needed for specific reasons as written by the HCP. The HCP
orders a PRN medication to treat a specific problem or symptom.
The PRN order specifies the start and stop time if needed and
the dose to be given. For example, the HCP might order a PRN
medication for Ibuprofen, 600mg, every six hours, as needed,
by mouth for three days for complaint of lower back pain. This
means that when the person complains of lower back pain, you
can offer them the Ibuprofen. If the pain continues after three
days, you should call the HCP.
There is always a reason for giving a medication to the people
you support. You need to know that reason so you can explain
to the person what the medication is and why they should take
it. You also need to know the right reason so you can observe for
changes that will tell you whether the medication is working or
not. This is particularly true for PRN medications, which you can
only give for the reason specified by the HCP order. For example,
some people take Tegretol for their seizure disorder, and others
96
C
all your supervisor about formulating a plan with Freddy and other
staff to help him understand the important reasons for taking this
medication.
take it to help control pain. If you do not know why someone is

taking a medication, you cannot observe for the desired effect.
To ensure you administer the right medication for the right
reason, you must:
3 Ask the HCP the reason for the medication.

3 Look up information about the medication.
3 Share the information with other staff and the person
taking the medication.
The key point to remember about a PRN medication is that

the order must be written for specific reasons. In the example
above, if the person complains of a headache, you cannot give
them the Ibuprofen because it was ordered PRN for lower back
pain. You would have to get another order to treat the headache.
When you administer a PRN medication, document the
administration in the persons progress note. Include in this
documentation the date and time of administration, the reason
you gave it, and whether it relieved the persons complaint. In
addition, put the time of the administration in the medication
sheet along with your initials. See figure 512 for an example of a
progress note.
An example of the documentation for a PRN medication on
the medication sheet can be found in Section 3 of this manual.
SECTION 2: Module 5
97
10 am
Ibuprofen 600mg

Low back pain
Reason
Medication Progress Note

12 pm & 2 pm states pain free
Kathy Masucci
Result or Response Signature
Date Time Medication & Dosage Held Refused Given

6/20/yr
Figure 512: Sample Progress Note.
98
Apply What Youve Learned Suppose that Chip has an order for Ativan
0.5mg for anxiety symptoms (such as head slapping and pacing). When you
come on duty, you notice that Chip is pacing back and forth and mumbling.
You try to calm Chip following the calming methods in his behavior
support plan. The behavior support plan is where information can be found
regarding Chips anxiety and what to try before administering Ativan. Chip
resists everything you try. You administer his PRN order for Ativan. Write a
progress note describing this situation. (Remember Chip? For details about
his conditions and capabilities, refer back to page xixii.)
Below is a list of medications that have more than one desired effect. Select
one of them. Using the resources you have available, list all the different
desired effects this one medication may have. For example, Elavil is used
to treat depression, but can also be used to treat insomnia and migraine
headaches.
Cytoxan
Prozac
Inderal
Elavil
Tegretol
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99
Documentation

Report changes
Store medication
Record information
Figure 513: Documenting the administration must be done after each administration.
100
After each time you administer a medication, immediately

document the administration in all the appropriate locations.
Where and how you document depends on the type of
medication you administered. For all medications given you
write your initials in the block next to the time and date of the
administration on the medication sheet.
You must also initial the bottom of the medication sheet and
sign your name next to your initials. By doing so, everyone can
identify who completed the medication sheet. You need to sign
and initial only once on each medication sheet.
If the medication is considered a countable substance, you
must document the administration on an additional sheet that
shows when the medication was removed from the package. It
is important that you remember to subtract the amount of the
medication you gave from the amount available and show the
number of pills or the amount of liquid remaining. Figure 513
shows you where documenting fits in the cycle of responsibility.
Your agency may require documentation on more than one

form. Check with your designated agency staff for instructions on
how you must document the administration process and where
you should file it. In Module 7 you will learn more details about
documentation.
Summary
*Massachusetts
Consultant.
Imagine what would happen if there were no clear procedures

for administering medications. Every staff member could
give medications and document administration any way they
wanted. Confusion, occurrences, injuries, and lawsuits would
result.
Studies have shown that most Medication Occurrences
are linked to not following the proper procedures that use the
rights of medication administration. If you have any doubt as
to whether you have the right person, the right medication,
the right dose, the right time, and the right route, do not give
the medication.* Call your designated agency personnel.
If you take your time, follow the proper procedure
explained in this module, perform all the checks, and
document each administration each time, you will always
administer medications safely.
Fill in the Blank

Complete

1. When administering medications, you should always
incorporate the principles to consider. These are
,
, and
2. Right means to do something
or
,
.
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101
3. What rights must you keep in mind when administering

medications?
Right
Right
Right
Right
Right
4. The amount of each medication given or ordered to be
taken at one time is called the
.
5.
is the same as the potency of a medication.
1. If you are missing any pieces of information.

2. If you are able to read the original pharmacy label.
3. If the original label on an OTC medication is missing or you cannot
read the label.
4. If the person has a change in behavior.
5. If the person is having difficulty swallowing.
6. If you do not have any doubt that you have the right person, right
medication right dose, right time, and right route.
7. If the rights are checked and are correct.
8. If you have a teaspoon to measure 2 tablespoons.
9. If a person tells you they do not want to take a medication.
10. A PRN medication order is written for a specific reason.
102
Write Stop on the blank if you think you should stop before administering
a medication under the circumstance. Write Go if you think you should
administer the medication.
How to Handle
Special Situations
Objectives
*Massachusetts
After studying this, you will be able to:

1. Describe how to handle a person who exhibits difficult
behavioral symptoms when taking medication.
2. Describe what can happen as a person ages and how this
affects the ability to take medications.
3 Describe what to do if a person takes a number of

medications.
4 Describe what to do if a person has difficulty swallowing.
5. Describe your role in self-administration.
Acute problem a problem that happens quickly and goes away

when treated.
Behavior manner of conduct; how a person acts.
Chronic problem a problem that begins gradually and lasts a
long time.
Dysphagia difficult swallowing.
Gastroesophageal reflux disease (GERD), a disease or condition
that causes stomach contents to back up into the esophagus;
often called heartburn.
Sedate to calm with medication
Self-Administration the act of taking and being responsible for
ones own medication or to have the medication administration
under the complete control of the person.
Introduction
n this module you will learn how to administer medications to

people with challenging behaviors, age-related difficulties, and
increasing chronic problems. Some of these problems and changes
may interfere with your ability to administer medications to the
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103
people you support. A person may lose the ability to swallow

medications, or need more medications to be administered.
You will also learn about which people are able to take their
medications and what you can do to promote self-administration.
Managing Behavioral Symptoms
104
You will be caring for people with intellectual disabilities,

mental illness, and/or a combination of both, as well as for
people with physical disabilities that limit their capacity to care
for themselves. You may also support people with challenging
behavior. Challenging behavior is not a symptom of intellectual
disabilities, but it can be part of a mental illness or a way that the
person communicates their needs. Some people are often unable
to tell you what they are experiencing inside or describe how
they feel. Their behavior may be their only way to convey pain,
fear, illness, anxiety, boredom, hunger, or need for attention. Their
behavior may also be the only way you will know the effect of
their medication. Think about Melissa and Chip. How would you
know if a medication was having the desired effect?
When challenging behaviors occur in a person, you will be
asked to observe and report the circumstances surrounding their
behavior. Your observations and reporting will help put a plan
in place to lessen or prevent the behavior. Your observations
and reporting also will help everyone better understand the
cause or the reason for the behavior, which is very important.
Behavioral symptoms maybe due to illness, or an unmet physical,
psychological, or social need. All strategies must be exhausted
before considering medication. Think about Chip and his anxiety
disorder. Before giving him the Ativan PRN order, other calming
strategies were attempted. In many cases, medication can help
reduce symptoms, make the person feel better, and support
independence.
Your close observation and reporting of the person is critical.
You need to report whether the medication is helping to ease the
behavioral symptom and whether it sedates the person.
Sometimes you will witness difficult behavioral symptoms
when you are administering medications. For example, Freddy
might refuse his medication, Melissa might not open her mouth,
or Chip might refuse to swallow his pills. Review the content in

Module 5 on Medication Refusals for suggestions on what to do.
Apply What Youve Learned Lately when you call Chip to administer
his medication, he starts to pace and wring his hands. Sometimes he begins
to head slap. What could you do to help this situation? (Remember Chip? For
details about his conditions and capabilities, refer back to pages xixii.)
Aging and Chronic Changes

As you learned in Module 1, getting to know the people you
support is the only way you will be able to identify changes in
them. To give quality support, you must understand changes the
person is experiencing. Some changes may be part of normal
aging, but others may be more serious. A change may result from a
disease requiring immediate treatment, sometimes called an acute
problem. Your responsibility is to report the changes you observe.
Everyone ages differently, and each body system ages in
different ways. Your responsibility is to be aware of what is
happening to the people you support. In addition to the aging
process, people may experience acute and chronic diseases that
may affect their medication administration.
Two common problems you may encounter are the persons
inability to swallow medications and an increase in the number
of medications a person needs.
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105
Swallowing Difficulty (Dysphagia)

If a person has problems swallowing medications, you will have to
work with a health-care practitioner, such as a speech therapist, to
come up with a solution. There are many reasons for dysphagia or
difficulty swallowing. The therapist can help you understand why
the person is having difficulty. Once the cause of the dysphagia
is discovered, health care practitioners can put a plan in place to
support the person. Following are some ways to support a person
who has a problem swallowing:
3 Have the person tilt their head forward, tucking the chin
3 After the administration, position and keep the person
upright for at least 15-20 minutes.
3 Decrease distractions.
3 Cue the person verbally and non verbally. (For example put
the cup to the persons lips.)
3 Have at least 8 to 12 oz of water available for the person

to drink.
3 If you have a HCP order, add the medication to food or

crush the medication and add to a liquid.
Be aware of the people you support who have dysphagia.

A person who is having a problem may cough or gag when
swallowing, spit up after swallowing, or sound as if something
is rattling in their chest.
Take your time administering medications, and follow the
therapists guidelines for helping the person to swallow. If you are
uncomfortable with the situation, discuss your concerns with your
supervisor. Never leave the person alone until you are sure they
have swallowed the medication.
Choking
If the person begins to choke, you may have to administer the
Heimlich maneuver. You can learn more about the Heimlich
Maneuver by attending a Choke Saver or First Aid course given by
106
toward the chest, when swallowing.
your agency or by a community organization such as the American

Red Cross. Be aware that choking is very frightening for the person
as well as for staff.
Take Chip as an example. Chip has a disease called GERD,
which stands for gastroesophageal reflux disease. This means
that after Chip swallows food, liquid, or medication, it may not
stay down in his stomach. GERD causes the stomach contents
to back up into Chips esophagus (the canal that connects the
stomach to the throat). Chip may experience heartburn or worse
he may inhale food, liquid, or medication into his lungs. When
administering Chips medications, you would have to consider
the following:
3 When his medications are scheduled. You would not want
to give him a large number of medications before bedtime.

Lying flat increases the reflux.
3 The type of liquid you give him to swallow his medications.

Some juices increase the heartburn.
3 Foods that could make his symptoms worse. If you are
supposed to mix his medications in food, avoid chocolate,

onions, peppermint, coffee, and high-sugar foods. These
foods may weaken or relax the muscle that connects the
esophagus to the stomach and make the GERD worse.
Administering Several Different Medications

As people age or develop various conditions or diseases, they are
often prescribed many different medications. One person may
also see a number of HCPs who specialize in particular diseases.
(For example, Chip sees a cardiologist for his heart problems and a
gastroenterologist for his GERD.)
Each HCP may prescribe medications. Therefore, it is very
important that you know the persons medical history, medications,
and what the medications are for. You must communicate to
each practitioner all the medications each person is prescribed. In
addition, you must ask the HCP and the pharmacist questions about
the interactions of the medications. You can also get information
about medication interactions using your medication resources. You
SECTION 2: Module 6
107
will have to pay close attention to the people you support to be

sure that the medications do not cause unwanted effects. As you
learned in Module 2, the more medications the person takes, the
greater the risk for medication interactions.
Maximizing Capabilities During

*Massachusetts
See MAP Policy, Section 07

Self-Administration
108
Read the MAP policy and

procedure manual for
information on
self-administration.
While administering medications, take advantage of this time

* It is important for the person to be
to help each person learn.
involved and participate, no matter how little the person may
be able to do. Encourage even those people with the most
severe disabilities to participate as much as they can. Helping
each person to take their medication on their own - to be self
administering or to have the medication administration under the
complete control of the person, should be part of the plan.
When administering medication, you need to consider
the principles of mindfulness, maximizing capabilities, and
communication (explained in Module 1). Because people have
different abilities, some may only be able to swallow a pill, while
others can take medication on their own. You must make an ongoing
effort to get each person involved in medication administration.
Remember, medication administration involves a structured stepby-step process that each person can learn. Make this your goal.
Promoting these steps means breaking down each task into smaller
parts. Throughout this process, you need to communicate verbally
by talking with the personand non verbally, using cues such as
handing the person a cup of water. Breaking down the steps one
at a time and using both verbal and nonverbal communication are
important skills for promoting the task of self-administration. For
example, Preparing for Medication Administration includes to clear
and clean the area you will be working. If you were breaking this
down you would first clear the area, then you would hand the person
a cloth to clean the surface.
Think about Chip. He speaks in single words and short sentences. Chip can label
or point to things he wants. Next, review the steps for administering an oral
medication (summarized below). How could you involve Chip in administering
his own medications? Circle the steps you think he could do independently.
(Remember Chip? For details about his conditions and capabilities, refer back
to pages xixii.)

Read the medication sheet to identify the medications to

be administered.
Wash your hands.
Gather equipment.
Identify the person. Bring the person to the area where you will
administer the medication, and provide privacy.

Check that you have the right medication for the right person,
in the right dose, at the right time, and by the right route
(Crosscheck 1), by checking the HCP order to the pharmacy label.
Check again to be sure you have the right medication for the
right person, the right dose, the right time, and the right route
(Crosscheck 2), by checking the pharmacy label to the medication
sheet.
Prepare the medication correctly. Remove or pour the medication
from the container. Check again to be sure you have the right
medication for the right person, the right dose, the right time, and
the right route (Crosscheck 3), by checking the pharmacy label to
the medication sheet.
the medication to the person with water. Provide assistance
as needed.
Make sure the person takes the medication, drinks, and swallows
the water
SECTION 2: Module 6
109


Look again and compare the pharmacy label and the medication sheet
to be sure you have administered the right medication to the right
person, in the right dose, by the right route, and at the right time.
Return the medication to the storage area and box and lock it.
Wash your hands.
The Goals of Self-Administration
Documentation of this process is

noted by placing a P (Packaged)
on an observation sheet.
110
*Massachusetts
Certified staff are not permitted
to set up medication planners
or pill dispensers, or to pre-pour
medications for individuals
learning to self-administer.
Individuals may, under the
supervision of Certified staff
and/or licensed staff, pour
their own medications into
appropriately labeled weekly
medication containers.
When you think of self-administration, what comes to mind? A

person asking you how to do it each time? A person who needs
lots of cueing, prompting, and reminding? Or someone who takes
medication without reminders and without your involvement?
Self-administration should be the goal for all people. Each time
you administer medications, you have a special opportunity to
teach the person the task of safe medication administration. But
what does it mean to be self-administrating?
Self-administration should be defined when medication
administration is under the complete control of the person.*
Think about the Cycle of Responsibility. When the person is selfadministering, they will take responsibility for each part of the cycle.
The goal in self-administration is for the person do the following:
3 Communicate issues and problems to their HCP.
3 Fill their own prescriptions.
3 Recognize if the medication has been filled accurately.
3 Take their medication as prescribed: the right medication,
at the right time, in the right dose, by the right route.
3 State what the medication is supposed to do and why they
are taking it.
3 Tell the staff whether the medication is working as intended.
3 Report problems to the appropriate designated agency
personnel.
3 Request a change in medication.
3 Demonstrate ability to store medication so that medications
are inaccessible to others.
3 Have knowledge of the common side effects of the medication.
Remember, not all the people you support will be able to

achieve self-administration. They may be able to do one or several
of the items on this list. Your agency, along with the health
care team, will put a plan in place to help achieve the persons
individual goals. The HCP will provide the health team with a
written order approving the goal of achieving self-administration.
What is defined by the team will determine what your role will
be. For example, you may be asked to help set up a reminder
calendar or supervise an individual packaging meds for a week.
Your job is to help each person participate as much as they can
in their own medication administration. Most agencies will have
specific policies for self-administration. You may find that the
agency will have policies that will:
3 define what self-administration means.*

3 establish a criteria for self-administration.
3 have specific information about the person who self-administers.
3 give specific information on how staff should support a
*Massachusetts
See Massachusetts Specific
Forms for the Observation Tool
for Self Administration.
person who self-administers.
3 outline a written teaching plan of action with time frames,

goals, and documentation that staff should follow.
Summary
Depending on the changes a person is experiencing, you will need
to adjust how you administer medication. Be open and creative.
Consider each persons needs and maximize their potential to
help them achieve the highest level of independence.
Fill in the Blank

Complete

1. The act of taking ones own medications without reminders
or staff involvement is called
.
2.
manner of conduct.
is how a person acts or their
SECTION 2: Module 6
111
3. A person who has difficulty swallowing has

.
4. When an illness begins gradually and lasts a long time, it is a
5. A disease that causes stomach contents to back up into the
esophagus is called
.
6. When an illness happens quickly and goes away when
treated, it is an
7.
means to calm, to quiet.
True/False
1. People who are intellectually disabled are often unable

to tell you what they are experiencing inside or how
they feel.
2. Changes in behavior may be the only way a person
can convey pain, fear, illness, anxiety, hunger, or
need for attention.
3. Your observations and reporting will help put a plan
in place to lessen or prevent undesirable behavior.
4. Before giving anti-anxiety medications to a person,
you should try other calming methods.
Review Exercise
Freddy is learning to self-administer. Put a check next to the facts
that should be included in his plan. (Remember Freddy? For details
about his conditions and capabilities refer back to page xii.)
Information on each of the 6 medications he is taking.
Information about targeted symptoms for his PRN
medications.
A reminder to staff to check Freddys pill organizer for
missed doses.
A weekly review with Freddy to be sure he is aware of
the medication he takes.
A schedule of reminders to call Freddy to prompt him
to take his evening medications.
112

statement is false.
SECTION
The Management of
his manual has been compared to the building of a house.

Section 1 laid the groundwork of knowledge you need to
administer medications safely. It is your foundation. Section 2
gave you the information about how to perform specific tasks in
medication administration. It can be compared to the framework
and walls. Section 3 will teach you very important management
aspects of medication administration. Think of Section 3 as the
roof of the house, protecting everything under it.
In Section 3 you will learn what to communicate to the HCP
and to other staff at the home or agency regarding prescribed
medications. You will learn how to get prescriptions filled and
receive them from the pharmacy. You will also learn how to store
the medication properly, document a medication administration,
and record a Medication Occurrence. Section 3 has two modules:
Module 7: Obtaining Medications
Module 8: Documentation, Recording, and Storage
Obtaining Medications
Objectives
1. List what information is important to take on a visit to the HCP.
2. Describe what you can do to encourage the persons
involvement during the HCP visit.
3. Describe the information you must get from the HCP when a
new medication is prescribed or an existing one is changed.
4. List the information included on a HCP order and a
pharmacy label.
5. Explain how to determine whether the pharmacy provided
the right medication.
6. Describe the information you must get from the HCP when
taking a telephone or fax order.
SECTION 3: Module 7
113
KEY TERM TO STUDY

Prescription the HCPs instructions to the pharmacist.
Introduction
Information to Give to the HCP
*MASSACHUSETTS
DDS ONLY
When visiting the HCP you
should bring the following
documents:
* Health Review Checklist
* Health Care Encounter Form
* Screening Guidelines
(for annual exam)
* Health Record
(for annual exam)
114
Ordering new medication begins with a visit to the HCP. You will
often accompany a person you support on this visit. Before the
visit you should gather information about the person and know
the reason for the visit so that the HCP can prescribe the most
appropriate treatments and medications. You should also obtain
any forms that you will need to bring back to the home. If this
is the persons first visit to the HCP, you should bring a summary
of their medical history.* (Section 4 includes a checklist of
information to take with you on a first visit.)
If the visit is routine (such as an annual check-up) or due to a
change in the persons health or behavior, your responsibility is to
present the facts about what you have observed about the person.
To prepare for the visit, ask yourself the following questions:
3 Has anything changed for the person?
3 Is the person experiencing any new symptoms?
3 If something has changed, can you describe in detail what
is going on?
3 Is the person taking all their medications?
3 Is the persons current medication doing what it is supposed
to do?
3 Is the person improving or not?
3 Are there any special instructions or monitoring (vital signs)
to be reported?
n this module, you will learn what information you must bring
to and receive from the HCP on a visit, how to encourage the
person to participate in the visit, and how to determine whether
you receive the right medication from the pharmacy. Keep in
mind that your knowledge of the medication is critical to safe
medication administration.
Gather as much information as possible including:

3 all current prescriptions
3 over the counter medications
3 herbal compounds
3 any allergies
and present it in an organized way. The visit to the HCP is a time
when your communication skills become very important. The best
thing you (or the people you support) can do during the visit is
to communicate to the HCP what has happened to the person
or what has changed since the last visit. You must communicate
your observations accurately. Present only the facts and the
information the person reports to you. You should use these same
guidelines when speaking to the HCP over the phone.
For those people you will support that will attend HCP visits
independently, your responsibilities are important and may vary
for each person. Some of your responsibilities include:
3 Making appointments.
3 Alerting the person a day or two in advance of the
upcoming appointment.
3 Making transportation arrangements.
In addition, discuss with the person what they should review
with the HCP during the visit. Supply the person with proper
documents, for example, the HCP visit form. Remind the person
that the HCP visit form needs to be filled out completely (have
the person read it to make sure the information is clear). Review
the information they must obtain from HCP. Remind the person
to make sure all prescription refills are obtained at the time of
the HCP visit. Remember, if the person does not bring back new
orders or instructions, it is your responsibility to receive them.
SECTION 3: Module 7
115
Apply What Youve Learned Remember when Melissa had a seizure

after 3 months on a new seizure medication? Write down what you would
tell the HCP about what happened to Melissa.
116
Encouraging Participation in the HCP Visit

The people you support will differ in their ability to prepare
for and participate in the HCP visit. Some will be able to
communicate and advocate for themselves, and others will
not. Some will only need your help to gather the necessary
information or records before the visit. They can get to the HCP
and pharmacist by themselves. Other people will need more
assistance, and a few will depend almost entirely on your help.
In all cases, encourage the people you support to participate as
much as possible. It is your responsibility to help maximize their
capabilities.
Here are some tips for encouraging participation:
3 Review with the person what they will say to the HCP.
Practice with them before the visit. Play the role of the
HCP so that the person can become more comfortable
communicating.
3 Do not speak for the person unless it is necessary.

3 Encourage the person to give their own description first.
Then explain the symptoms and behavior changes you have

observed.
3 Let the person answer questions first.

3 Redirect the HCPs questions to the person, if the HCP
focuses on you.
3 Encourage the person to ask questions about the

medications.
3 Let the HCP hand the prescription to the person if possible.

3 Help the person get the prescription filled (if necessary).
By encouraging the persons involvement, you model for
the HCP the way the person should be treated. Many HCPs may
assume that the person is totally dependent and has little to
offer in this process. Your behavior can reinforce a positive
image of the person.
SECTION 3: Module 7
117
Think about Melissa, Chip and Freddy. Describe how each could participate in a
visit to the HCP. (For details about their conditions and capabilities, refer back
to pages xixii.)
1. What could Melissa do?
3. What could Freddy do?
118
2. What could Chip do?
Information to Get from the HCP

During the visit or when speaking over the phone, the HCP may
prescribe treatments and/or medications for the person. You are
responsible for the following:
3 Getting the written prescription. Some HCPs may call or
*Massachusetts
If the HCP gives a sample
medication to the person you
take on a HCP visit, the HCP
must place a label with the
same information as on a
pharmacy label along with the
HCPs name.
*Massachusetts
DMH only individuals receiving
psychotropic meds shall be seen
at least every 3 months. See MAP
Policy 13-6 or p117.
electronically send information on the medications being

prescribed to the pharmacy. If they do not, you must obtain
written prescriptions for all new, changed, and reordered
medications.*
3 Returning to the home or agency with all the written
instructions and orders from the HCP for all prescribed

treatments and medications. If your agency has a form for
you to use on a HCP visit, be sure to get that filled out as
well. Make copies of all new orders for other programs the
person is involved in. Remember to always document the
visit.
Note: Be sure you have any medications needing new orders

renewed at the time of your visit. Most orders for medications
taken daily are good for one year. Although some special
medication used to treat mental illness may need to be
reordered monthly or every 90 days.*
3 Taking notes about the visit so that you can communicate

to other staff what happened.
At a minimum, you must get the following information from

the HCP and bring it back to the home:
3 Diagnosis from the visit

3 Treatment needed
3 HCP order for any new medication
3 Prescription for pharmacist
3 Desired effect of the new medication, what to expect
SECTION 3: Module 7
119
You are on the evening shift and Freddy tells you he does not feel well and
he has a headache. You check the medication book and see that he does not
have anything ordered for a headache. Your supervisor tells you to call the
HCP to see if Freddy can receive some Tylenol. When you call the HCP, what
information do you want to be sure you receive? Place a check mark next to
each piece of information you must receive from the HCP over the phone.
Name of medication
Dose to be given
How it should be given

Special instructions for the medication
How long the order is good for
Information on a Prescription and HCP Visit Form

You will receive a prescription for any new medication the HCP
orders. The prescription tells the pharmacist what medication the
HCP wants the person to take. The pharmacist uses the information
from the prescription to prepare the medication and put a label on
the container. Remember the prescription is the direction to the
pharmacist.
The HCP visit form is a written order for all prescribed
treatment and medications. Figure 71 is an example of a HCP
visit form you would bring back to your agency that includes the
following information:
3 Time and date ordered

3 Name of medication
3 Dose
3 Route
3 Frequency
3 Duration
3 Special instructions/Reason
3 Signature
Remember: You are responsible for completing the top half

of the form or you must attach a copy of the persons medication
sheet so the HCP knows the persons current medications. The
HCP will complete the bottom half of the form.
120
How often it should be given
HCPs Visit Form

Date: 1/1/yr
Allergies: Bactrim
Reason for visit: complaining of severe left ear pain

Current Medication: Lipitor 10 mg by mouth every day in the morning,
Risperdal 0.5 mg by mouth 2 times a day, Atenenol 25 mg by mouth every
day in the morning, Tylenol 650mg every 4 hours by mouth PRN headaches
Date: 1/1/yr
Ear Infection
Medication/Treatment Orders: Amoxicillin 250 mg 2 times a day by mouth
for 10 days
Instructions:
2 weeks
Dr. T. Smith
Follow-up visit:
Signature:
Posted
Lab Work or Tests:

Date:
1/1/yr
Verified
Figure 71: A sample HCP visit form with the new medication order.
Getting Prescriptions Filled

Your agency will have a specific policy for the way prescriptions
should be filled and how you will receive them from the
pharmacy. Some agencies expect you or the person to go to
the pharmacy directly. Others may fax or mail the written
prescriptions to the pharmacy. Still others may require that the
HCP send the information directly from the HCP to the pharmacy.
Always follow your agencys policy for obtaining medications.
The prescription you receive from the HCP tells the
pharmacist what medication is needed for the person. The
pharmacist uses the prescription to prepare the medication and
create the label for it. When you receive the medication from
the pharmacy, you will use the information from the HCP order
and the pharmacy label to fill out the medication sheet. (You will
learn how to complete a medication sheet in Module 8.) Before
SECTION 3: Module 7
121
you fill out the medication sheet, however, you must make sure
you received the right medication.
Ensuring the Pharmacy Provided

the Right Medication
When you receive a medication from the pharmacy, follow the
guidelines below to ensure you have the right medication:
3 Read the pharmacy label. Check the persons medication
3 If you took the person to the HCP, compare the HCP order
with the pharmacy label. Check whether the medication the

HCP ordered is the same medication you received from the
pharmacy. If not, you must ask the pharmacist about the
change.
3 If you are familiar with the medication, open the bottle or

examine the blister pack and see if it looks right.
3 If you are not familiar with the medication, look it up in
one of the resources available to you. Read the package

insert for the medication. Or call the pharmacist and ask
that information be sent to you. Remember, you cannot
administer any medication until you know what it is and
why it was ordered.
*Massachusetts
Controlled substances include
ALL prescription medications.
MAP Policy requires that
programs maintain a record of
when a prescription is filled and
the quantity of the medication
dispensed by the pharmacy.
In addition, certain controlled
medications, e.g., narcotics and
stimulants, are referred to as
countable medications. See
MAP Policy 10-3 for complete
information on managing
countable medications.
122
After making sure you have the right medication, check

whether it is a countable substance.*If it is, you must count the
pills and record the number on the appropriate form. Liquid
countables are packaged such that once used, no liquid remains in
the container.
You can prevent a Medication Occurrence if you take these
important steps before you enter the medication onto the
medication sheet and before you give the medication to the person
you support.
sheet to see if the medication is new or a refill. If it is a new

medication, read the persons HCP visit form to see why the
medication was prescribed.
The Pharmacy Label

You will receive the medication in a plastic container, a bottle, or a
blister pack with the pharmacy label on it. The label along with the
HCP order will have all the information you need to complete the
medication sheet and administer the medication. (See Figure 72
for a sample pharmacy label). Regardless of the container type, the
pharmacy label should have the following information:
1. Prescription Rx number
2. Pharmacy name
3. Pharmacy telephone number

4. Name of the person for whom the medication is prescribed
5. Date the prescription was filled
6. Name of the medication
7. Total amount of tablets or liquid dispensed
8. The strength of the medication
9. The amount of the medication
10. How often the medication should be given
11. Route to use when giving the medication
12. Any special instructions
13. HCP name
14. Lot number
15. Expiration date
16. Number of refills
SECTION 3: Module 7
123
Pharmacy Label
2 Rose Garden Pharmacy
3 800-555-1111
20 Main Street
Any Town, MA 01969
Freddy Connors 4
5 1/1/yr
6
7 Qty-20
Amoxicillin 250 mg. 8
IC: Amoxil 250 mg.
11
10
9
Take one tablet twice a day for ten days by mouth.
13 Dr. T. Smith
Drink lots of water when taking. 12
Rx# 284-9726
1
15 Exp. Date: 1/1/yr
16 Refills: 0
Figure 72: A sample pharmacy label.
This information will appear on every pharmacy label,

although the label from one pharmacy may look different from
the label of another pharmacy.
The pharmacist is an excellent resource for information
about medications. If you are picking up the medication yourself,
ask the pharmacist any questions you have about it or ask for
written information you can take with you. Remember, it is
your responsibility to learn about the medication before you
administer it.
Telephone/Fax Orders
You may find that at times you might have to receive a telephone
or fax order for a medication needed. If these are allowed by
your state and/or agency, you must understand the procedure for
accepting these types of orders. Be sure the following information
is received:
3 HCPs name
3 Date/time the order was received
3 Person who accepted the order
3 Reason for the medication or the change in the medication
124
Lot# 323-3333 14
3 Medication to be discontinued if needed

3 New medication name, dose, route, and frequency
3 Any special instructions
3 Any common side effects to watch for
3 Discontinue date if needed.
Check with your agency to see if they use any specific form
for telephone or fax orders. Figure 73 gives you an example of a
telephone/fax order that can be used.
Telephone/Fax Order Form

Date of Order:
Time:
Name of Individual:
Allergies:
Generic Name:
Dose:
Brand Name:
Frequency:
Route:
Reason for Medication/Change:
Special Instructions/Precautions (include instructions for common

side effects, include list of parameters if vital signs need to be taken):
Discontinue Date (if any):

HCPs Name:
Staff Signature/Title:
Signature of HCP:
Date:
Figure 73: A sample Telephone/Fax order form.
SECTION 3: Module 8
125
*Massachusetts
Summary
In this module you learned that you have a very important
role in helping the people you support communicate their
needs during the visit to the HCP. Good communication
ensures they receive proper treatments and medications.
You also learned about the different ways you might receive
medications from the pharmacy. You play an important
role in preventing Medication Occurrences by paying close
attention to the information you receive from the HCP and
checking it against the medications you receive from the
pharmacy. This critical check can make a huge difference in
avoiding Medication Occurrences.
Review Exercise
In
your own words, describe the purpose of a prescription.
126
All telephone HCP orders must

be signed within 72 hours.
If a telephone order is received, the person accepting the

order must document onto the medication sheet what is to be
given using the 5 Rights. In addition, a written confirmation with
the HCP signature must be received in a specified period of time.
Remind the HCP to call the pharmacy to order the medication. If
at all possible, you should encourage the use of fax order sheets
so you can be sure you know exactly what was ordered. A fax
order from a HCP is considered a legal document.
If for any reason you are not clear, be sure not to give
the medication and then call the HCP for clarification. Most
agencies will require staff to fill out a telephone or fax order
form to be sure all the information needed for safe medication
administration is received.*
Content Review
List below the information you would bring on a HCP visit
with Melissa, following her seizure. (For details about Melissas
conditions and capabilities, refer back to page xi.)
SECTION 3: Module 7
127
Documentation, Recording,
and Storage
Objectives
Grid is the section of the medication sheet where you place your
initials after a medication has been administered. It is the part
of the medication sheet where the dates and time are found.
Medication Error a mistake in the administration, dispensing,
ordering, transcribing, or preparation of a medication that has
been given to a person. Medication Occurrences can involve
the wrong person, medication, dose, route, time, as well as the
omission of a prescribed medication.*
*Massachusetts
A medication error is called
a Medication Occurrence in
Massachusetts. A Medication
Occurrence is when one of the
five rights goes wrong.
128
Medication Sheet also called the medication log or

medication administration record (MAR). The medication
sheet contains the information for the administration
and documentation of a medication. It serves as a legal
document.

1. Explain what information you must document on a
medication sheet.
2. Demonstrate how to record information on the medication
sheet using a HCP order and pharmacy label.
3. Demonstrate how to document a medication you have
administered.
4. Demonstrate how to document a missed dose.
5. Demonstrate how to document a PRN medication.
6. Demonstrate how to document a discontinued medication.
7. State the general principles for counting medications.
8. Identify the proper storage practices for medications.
9. Explain how to dispose of medications
10. Explain how to handle and store medications outside the
home and when a person goes on a leave of absence.
11. Describe what a Medication Occurrence is and how to
report it.
Record to write down information, such as the details from

the HCP order and pharmacy label onto the medication sheet.
Storage the act of storing medications or medication in a
safe place.
Introduction
n this module you will learn about the kinds of information

you need to document after receiving a medication from the
pharmacist. You will learn how to use the HCP order and the
pharmacy label to record information on a medication sheet.
Once the medication is recorded onto the medication sheet you
can begin to administer medication. You will learn about the
different ways to document relating to administering medications.
You will also learn how to store medication properly. Finally, you
will learn how to dispose of medications and what to do if you
make a Medication Occurrence.
The Medication Book

After you are sure you have the correct medication, you must
record information in the medication book onto the medication
sheet. The form used may be called a medication sheet, log, or
medication administration record. All prescription medications,
as well as OTC medications, must be recorded on this form.
A medication book typically contains the HCP orders,
medication sheets, and medication information sheets for each
person in the home. A medication sheet (as shown in Figure 81)
is the document that tracks each medication administration. The
sheet includes the persons name, allergy information, the name
of the medication prescribed, dose, strength, amount, route, time
to be given, date given, and the name of the staff member who
administered the medication.
In some cases, the pharmacist will pre-print the medication
sheet. However, you are still responsible for checking the HCP
order to the pharmacy label and the pharmacy label against the
SECTION 3: Module 8
129
Note: It is your responsibility to observe all the people you

support, whether you administer their medications or they do.
130
*Massachusetts
A medication sheet is not

kept for a person who self
administers. The Emergency
Fact Sheet, found in the persons
record, should be kept current
with all the persons medications.
pre-printed medication sheet. Remember, all three pieces of

informationthe HCP order plus the pharmacy label must equal
information on the medication sheet.
If your agency uses pre-printed medication sheets, make
sure you learn the procedure for changing the sheet when
new medications are ordered, changed, or discontinued. PRN
medications may be recorded on a separate medication sheet.
However, all daily medications should be kept together on the
same medication sheet so that no medication is missed.
You must keep a medication sheet for all the people you
support. A medication sheet for those who are self-administering
will help you in the event that the person cannot administer
the medication themselves.* On a daily basis you do not have to
document a self-administrators medication administrations. You
do need to know about self-administrators medications so that
you can observe for effects, intended or unintended.
SECTION 3: Module 8
131
Route
Amount
Route
Amount
Route
Amount
Route
Dose
Frequency
Special Instructions/Reason:
Amount
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
MEDICATION SHEET
Allergies:
CODES
DP - day program
LOA - leave of absence
P - packaged
W - work
H-Hospital
Init.
Signature
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Figure 81: A sample of a blank medication sheet.
Site:
Name:
Stop
Start
Stop
Start
Stop
Start
Stop
Start
Month and Year:
Skill 8 Recording a New Medication Order onto the
Medication Sheet
*Massachusetts
MAP Consultant
This procedure is known as

posting and verification. Follow
these steps:
1. Place a check mark in red,
green, or other conspicuous
color next to the order being
transcribed.
2. Write posted, the date, time,
and your name on the order
under the HCP signature in the
color designated by your agency.
3. Ask a second Certified or
licensed staff person to review
the orders you transcribed and
to write verified, the date, time,
and their name on the health
care providers order form in the
color designated by your agency.
Note: If a second staff person is
not scheduled when the orders
are transcribed, then the next
Certified or licensed person on
duty must review and verify the
orders, making the appropriate
notation on the order form.
The Certified or licensed staff
person who transcribes the order
initially, may, if a second staff
person is unavailable, administer
the ordered medications before
verification is completed.
However, the next Certified
or licensed staff person on
duty must verify the orders
immediately upon arrival at the
site before administering the
medications.
132
1. The persons name.

2. The medication name, brand or generic. (It is helpful to have
both, but the name in the medication sheet should match
the name on the label from the pharmacy.) If the name of
the medication on the HCP order is different you should
call your designated agency personnel.*
3. Any allergies the person may have. Write No known
allergies if the person has none.
4. Specific instructions or precautions and/or reasons for the
medication (can come from HCP and/or Pharmacy).
5. Strength of the medication (comes from the Pharmacy).
6. Dose of the medication to be given (comes from HCP).
7. Amount to be administered (number of tablets, capsules,
mLs).
8. Frequency and specific times the medication is to be given. You
must list specific times on the medication sheet. Do not use
vague time references such as breakfast, lunch, and dinner.
9. Route by which the medication is to be given.
10. Date when the medication is to start (start date).
11. Date when the medication is to be stopped, if one is given
(stop date). If the medication is to be given continuously,
write continue or cont. under the word Stop.
Following the documentation onto the medication sheet,
your agency may require that you document that you transcribed
the HCP order.* Typically, using a colored pen, you would write
*Massachusetts
As a staff member, you may be required to complete the medication

sheet. You may also have to start a count sheet if the medication is
a countable substance that must be reconciled or counted. It is very
important that you record all the information onto the medication
sheet correctly to ensure safe medication administration
The HCP order (as shown in Figure 82) and the pharmacy labels
(as shown in Figure 83) give you the information you need to
complete the medication sheet (as shown in Figure 84). To do so
accurately, you must include the following information:
your name, date, and time next to the order being transcribed. In
addition, a second staff member must review the order that has
been transcribed. This ensures that the order has been transcribed
correctly. The second person must also document their name,
the date, and time. See Figure 82 next to the Label Medication/
Treatment Order on the sample HCP visit form.
Note: If a medication dose, frequency or route changes, this is

considered a new order. If the reason to give a PRN medication
changes, this is considered a new order. All new orders must be
recorded by discontinuing the old and writing a new order.
HCPs Visit Form

Date: 1/1/yr
Allergies: Bactrim
Reason for visit: states he has headaches, feels pressure on his forehead,
states he feels down in the dumps, and dragging, tired,
feeling tired. Also has had decreased appetite.
Current Medication: none
Date: 1/1/yr
sinus infection, Freddy has agreed to restart

Risperdal after discussion about mood swings. He states he will not refuse the
medication and give it a try again.
Medication/Treatment Orders: Amoxicillin 500mg by mouth twice daily
for 10 days. Tylenol 650mg every 6 hours by mouth PRN headaches, Risperdal 0.5
mg by mouth two times a day.
Instructions: Call HCP if begins to refuse Risperdal again.
Follow-up visit: 2 weeks
Lab Work or Tests: Sinus x-ray today
Signature: Dr. T. Smith
Date: 1/1/yr
Posted 8am 1/1/yr KMason
Verified 8:15am 1/1/yr BBillings
Figure 82: A sample HCP visit form with the new medication orders.
SECTION 3: Module 8
133
Pharmacy Labels
Rx# 284-97226
Freddy Connors
Rose Garden Pharmacy

20 Main Street
Any Town, MA 01969
Amoxicillin 250mg.
IC: Amoxil 250mg.
Exp. Date: 1/1/yr

20 Main Street
Any Town, MA 01969
Acetaminophen 325mg.
IC: Tylenol 325mg.
Rx# 284-97228
Freddy Connors
Exp. Date: 1/1/yr

20 Main Street
Any Town, MA 01969
Risperdal 0.5mg.
IC: Risperidone 0.5mg.
Figure 83: Three pharmacy labels.
134
800-555-1111
1/1/yr
Dr. T. Smith
Refills: 0
800-555-1111
1/1/yr
Qty-60
Take 1 tablet by mouth

two times a day
Lot# 777-8456
Refills: 0
Qty-240
Take 2 tablets by mouth

every 6 hours PRN headaches
Lot# 622-1701
Dr. T. Smith
Exp. Date: 1/1/yr
Dr. T. Smith
Refills: 0
Lot# 323-3863
Freddy Connors
1/1/yr
Qty-40
Take 2 tablets by mouth

twice daily for 10 days
Rx# 284-97227
800-555-1111
SECTION 3: Module 8
135
9am
Generic
Dose 0.5 mg
Route
Amount
Site: Everett Street Apt. 1b
Frequency
Dose
Strength
Brand
Generic
Frequency 2 times a day 0

Amount 1 tablet Route by mouth
Strength 0.5 mg
Risperidone
Bactrim
X X X X XX X X X X X X X XXX X X X XX
W-work
H-Hospital
P-packaged
CODES
DP-day program
LOA-leave of absence
Init.
Signature
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9pm
9am
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Strength 325 mg Dose 650 mg
Amount 2 tablets Route by mouth

N
Frequency every 6 hours /
Special Instructions/Reason: PRN Headache
Brand Risperdal
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Tylenol
Generic Acetaminophen
Allergies:
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Frequency twice a day for 10 days 9pm
Stop
Start
Stop
Cont.
Strength. 250 mg Dose 500 mg
Brand Amoxil
Generic Amoxicillin
MEDICATION SHEET
Figure 84: Sample of Freddy Connors medication sheet.
((
1/1/yr
(' Start
Cont.
Stop
1/1/yr
Start
1/10/yr
Stop
1/1/yr
Start
Month and Year: January /yr

Medication or Treatment
Remembering the Rights

As you record the information from the HCP order and the
pharmacy label onto the medication sheet, think of the rights. You
must record the right person, the right medication, the right dose,
the right time, and the right route. Always remember the HCP
order, pharmacy label, and medication sheet must match.
Rules to Follow When Recording Information

As you fill out the medication sheet, you must follow some
general rules of documentation. Be sure that:
the document.
3 The information is accurate and complete.

3 You correct an error by drawing a single line through it in
ink, writing the word error. Be sure to include your initials.
3 Do not use white out, erase, or write over any mistakes.
The Importance of Accurate Documentation

Accurate documentation is a key step in the process of safe
medication administration. Pay close attention to the strength
and dose information. Remember that the pharmacy may provide
a different strength from the dose the HCP ordered. The number
of tablets and their strength must always add up to the dose the
HCP ordered.
Just imagine what could happen if the information on the
medication sheet was wrong and did not match the HCP order
and the pharmacy label or if a medication administration was not
documented. Serious errors could occur. The person receiving
the medication could get the wrong medication or the wrong
dose (too much or too little). The next staff person might think
you forgot to give the medication and give the missed dose
resulting in a double dose of the medication.
136
Skill 9
Documenting Medication Administration

To document a medication administration, you must write
your initials in the box on the medication grid that directly
3 You write clearly and in ink so that others can read
corresponds to the date and time you gave the medication. If it is

the first time you administered the medication, you also need to
write your initials at the bottom of the medication sheet and sign
your name. Signing your name next to your initials helps everyone
identify those initials as yours. Figure 85 shows the correct way
to document a medication administration.
=`^li\/$*
Documenting Medication Administration

Month and Year: January/yr
Start
1/1/yr
Stop
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic Amoxicillin
Brand Amoxil
9am
KM KM

1/10/yr
Allergies:
MEDICATION SHEET

LL

Site: Everett Street Apt 1b
CODES
DP-day program
Init.
KM
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Figure 85: The correct way to document a medication administration.
Skill 10
*Massachusetts
When documenting a missed
dose, be sure to notify the
MAP Consultant as well as
your supervisor explaining the
missed dose and what the MAP
Consultant instructed.
Documenting a Missed Dose

If a person refuses medication, spits it out, or misses a dose for
any reason, you must follow your agencys policy for reporting
and recording the situation. Typically you document a missed
dose by drawing a circle in the box on the medication grid that
directly corresponds to the time the medication was supposed to
be given. Put your initials inside the circle.* Be sure to write a note
explaining the reason for the missed dose and, if necessary, call
your supervisor or the HCP to explain what happened. Figure 86
shows the correct way to document a medication that has been
refused or missed. Figure 87 is an example of a note that would
be written for a missed dose.
You will also find other times when the person will not
receive their medications from you. Documenting that a person is
out on an overnight trip with family or at camp must be different
SECTION 3: Module 8
137
from the practice of documenting a missed dose. You must be

able to know the reason why a medication was not received
by looking at the medication sheet. Your agency should have a
standard practice for documenting these types of situations. A list
of letters with their codes should be available for you to use. For
example, you may use the letters DP for day program.* You may
also be required to write a note and circle the days the person is
away.
*Massachusetts
Acceptable codes are:
LOA = Leave of Absence
DP = Day Program
P = Packaged for self
administration training
W = Work
H = Hospital, Nursing Home,
Rehabilitation Center
Documenting a Missed Dose

Start
1/1/yr
Generic Amoxicillin
Brand Amoxil
MEDICATION SHEET
Stop
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
KM KM

1/10/yr
Allergies:

LL
CODES

DP-day program
Init.
KM
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Figure 86: The correct way to document a missed medication.
Progress Note
Progress Note: 1/2 yr Freddy missed 9am dose of amoxicillin
because he was at the HCP office visit. Beth Kerrigan RN
called: recommended to give missed dose when Freddy
comes back.
K. Mason
Figure 87: An example of a note that would be written for a missed dose.
forms.indd 6
138
9/19/05 2:01:55 PM

Skill 11 Documenting a PRN Medication
To document a PRN medication, you must write the time of the

administration on the medication sheet along with your initials.
You must also write an explanation in the persons progress note,
including the date and time of administration, why you gave it,
and whether the persons complaint was relieved. In addition,
follow your agencys requirement for reporting. Figure 88 shows
the correct way to document a PRN medication. Figure 89 is an
example of a note the would be written for the administration of
a PRN medication.
Documenting a PRN Medication

Start
1/1/yr
Generic Amoxicillin
Brand Amoxil
MEDICATION SHEET
Stop
Start
1/1/yr
Stop
cont.
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
KM KM

1/10/yr
Allergies:

LL
Generic Acetaminophen
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Tylenol
P
R
1PM
N KM
Frequency every 6 hours
Special Instructions/Reason: PRN Headache
CODES

DP-day program
Init.
KM
LL
Signature
Kathy Mason
Init.
Signature
Lisa Long
P-packaged
W-work
H-Hospital
Figure 88: The correct way to document a PRN medication.
Progress Note
Progress Note: 1/1/yr 1pm Freddy stated
that he had a headache. Tylenol, 2 tablets (650 mg) given
by mouth. At 2pm Freddy stated that he felt much better.
The headache was all gone.
K. Mason
Figure 89: An example of a note that would be written for a PRN medication.
SECTION 3: Module 8
139
Skill 12
Documenting a Discontinued Medication
3 Use a single diagonal line to cross out the medication

description.
3 Write discontinued DC, date and initial

3 Put a second diagonal line through the medication grid.
3 Write discontinued DC, date and initial
3 Mark through all boxes next to where the medication
was scheduled to have been given. Be sure the lines go

completely through each box. You can also use xs instead
of a line if you wish.
140
Whenever a medication is discontinued, you must document this

on the medication sheet. When a medication is not changed but
the dose, frequency, or route are changed, this is considered a
new order and the new order must be recorded (transcribed). For
a PRN medication, it is considered a new order if the symptoms it
was originally prescribed for changes. All changes in a medication
order must be communicated to all staff. A progress note must
be written for all discontinued or changed medication orders.
Figure 810 shows one way to document a discontinued
medication. Follow your agency rules for documenting a
discontinued medication. Following are some general principles
for documenting a discontinued medication:
Documenting a Discontinued Medication

Start
1/1/yr
MEDICATION SHEET
Stop
Brand Amoxil
9am
KM KM
BB

Start
1/1/yr
Generic Risperidone
Brand Risperdal DC
Strength 0.5 mg
Stop
Cont.
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic Amoxicillin
1/10/yr
Allergies:
/yr
1/2
KM
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9am
KM KM
Dose 0.5 mg
/yr
DC 1/2

Frequency 2 times a day

KM
9pm KM
DP-day program
CODES
Init.
KM
Signature
Kathy Mason
BB
Billy Beesley
Init.
Signature
P-packaged
W-work
H-Hospital
Figure 810: The correct way to document a discontinued medication.
Practice documenting the following medications onto the medication sheet. Use
June 20th as the date. Medication sheets are on page 142 and 143.
1. Y
ou just received a new medication from the pharmacy for Chip. The
HCP ordered Zantac 150 mg by mouth twice a day. Written on the
pharmacy label is Zantac 75 mg two tablets by mouth two times daily.
formsEDIT.indd 7
2. A
t 9:00 a.m. today you gave Chip his dose of Ativan 0.5 mg. Use the
Medication Sheet on page 142 and the Countable Sheet on page 145 to
document.
9/19/05 2:07:10 PM
3. T
oday beginning at 9:00 a.m. you administered Melissas Mysoline 50 mg by
mouth which she gets two times daily.
4. A
t 9:00 p.m. today Melissa refused to open her mouth for her dose of
Mysoline 50 mg.
5. T
he HCP ordered Colace 100 mg by mouth (liquid) twice daily for Melissa.
Written on the pharmacy label is Give Colace 100 mg (10 mL) liquid form by
mouth twice daily. Use Melissas medication sheet to record (transcribe) the
new order. At 9:00 p.m. you give Melissa her Colace 100 mg by mouth in liquid
form as ordered. Document the June 20th, 9:00 p.m. administration.
SECTION 3: Module 8
141
6. T
oday the HCP discontinued Freddys hydrochlorothiazide 50mg by mouth
one time a day and has prescribed a new medication that just arrived from
the pharmacy. The new medication the HCP ordered is Lasix 40mg by
mouth one time a day in the morning. Written on the pharmacy label is
Lasix 20mg 2 tablets by mouth once a day in the morning. Transcribe the
new order and discontinue the hydroclorothiazide.
Questions 1 and 2
Month and Year: June/yr
Start
6/1/yr
Strength 0.5mg
None known
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Brand Ativan
Allergies:
MEDICATION SHEET
P
Dose 0.5mg
Frequency every 6 hours
Route by mouth
Start
Generic
Special Instructions/Reason: PRN anxiety
Stop
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand
Strength
Dose
Amount
Route
Frequency
CODES
Name: Chip Brown

Site: Everett Street Apt. 1a
DP-day program
Init.
Signature
Init.
Signature
P-packaged
W-work
H-Hospital
Questions 3, 4, and 5
Start
4/2/yr
Stop
Cont.
None known
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Brand Mysoline
Strength 50mg
Allergies:
MEDICATION SHEET
9am LL LL LL LL KM KM KM
JF JF JF KM KM LL LL LL KM KM KM KM
Dose 50mg

Frequency 2 times a day
9pm BS BS BS BS MT MT MT MT BS BS BS BS MT MT MT BS BS MT MT
Generic
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Start
Stop
Brand
Strength
Dose
Amount
Route
Frequency
Name: Melissa Sullivan

Site: Everett Street Apt. 1c
formsEDIT.indd 9
CODES
DP-day program
P-packaged
W-work
H-Hospital
142
Init.
LL
BS
KM
JF
Signature
Lisa Long
Init.
MT
Signature
Melissa Thompson
Barry Stevens
Kathy Mason
Jeff Frank
9/19/05 2:16:19 PM
Stop
Amount 1 tablet
cont.
Question 6
Start
1/11/yr
Generic Hydroclorothiaxide
Brand Hydrodiuril
Strength 50mg
Bactrim
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
8am LL LL LL LL BB BB BB KM KM KM LL KM KM LL LL LL LL KM KM
Dose 50mg
Stop
Start
Generic
Cont.
Allergies:
MEDICATION SHEET
Frequency 1 time/day, in morning

Stop
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand
Strength
Dose
Amount
Route
Frequency

CODES
DP-day program
Init.
LL
Signature
Init.
Signature
Lisa Long
KM
Kathy Mason
P-packaged
BB
Bill Beesley
W-work
H-Hospital
Countable Substances
*Massachusetts
All prescription medications are
defined as controlled substances.
Those medications which are
most likely to be abused must
be double locked and counted.
These medications are referred
to as countable. All countable
medications must be in tamperresistant packages. See MAP
Policy 10-2, 3, and 8 for complete
information on managing
countable medications.
*Massachusetts
formsEDIT.indd 11
Medication counts are to be

conducted whenever control of
the medication key is passed (i.e.
at the start and end of each shift/
assignment). DPH recognizes that
there are some situations where
two licensed/certified staff are
not available. In those instances it
is recommended that the single
licensed/certified staff person
coming on or off shift conduct a
count and sign the count book.
At the first opportunity for a two
person count, the count must be
conducted. Under no circumstances
should a two person count be
conducted less than once every
24 hours. MAP Policy 10-3
All medications and syringes (prefilled with a countable

medication) must be monitored, but some medications have a
higher incidence of abuse than others. These substances, which
are also called countable substances, must be reconciled or
counted.*The best time for counting these medications is every
time the staff changes. The minimum should be every 24 hours.*
The count should be done by two people: one person from the
outgoing and one from the incoming shift. Figure 811 gives an
example of a Shift Count. All shift count sheets must have
spaces to record the following:
3 date and time
3 whether or not the count was correct and
3 the signatures of both people doing the count.
The general principle for counting medications is that the
number of pills, tablets, or capsules used and on hand must add
up to the number received from the pharmacy as documented
in the amount left column on each count sheet. In addition
to counting these medications every time the staff changes,
you must document on the count sheet (such as Figure 812,
the Countable Sheet) and the medication sheet every time
you administer them. This tracking protects both staff and the
9/19/05 2:18:07 PM
SECTION 3: Module 8
143
Shift Count

Date Time
1/3/yr
3pm
1/3/yr
11pm
1/4/yr
7am
1/4/yr
3pm
11pm
Staff Coming
Staff Going
On Duty
Off Duty
Karen Smith, Evening C. Staff
Lisa Long, Day C. Staff
Bill Stevens, Night C. Staff Karen Smith, Evening C. Staff
Bill Stevens, Night C. Staff
7am
Yes
Yes

3pm
Yes
Figure 811: Shift Count

*Massachusetts
Using the index as a guide, two certified staff together must count. If
you are alone, you should check the accuracy of the count. Document
a single person count by drawing a line through the box next to your
signature or writing "single person count" in unused column.
144

1/4/yr
1/5/yr
1/5/yr

Count
Correct?
Yes
Yes
Yes
Yes
Countable Sheet
Countable Sheet
Chip Brown
C0401
Rx Number:
Doctor: Smith
Date Dispensed: 6/19/yr
Pharmacy: Sams Pharmacy
Amount Dispensed: 60
Medication and Strength: Ativan 0.5 mg
Directions: Take one tablet 2 times a day
Name:

Date
Time
6/19/yr 9AM
Amount
Tablets Amount Amount
on Hand Used
Left
Route
60
Signature
Received K. Mason/L. Long
Figure 812: Document medication on the countable sheet. Use this count sheet to answer #2, p. 141 exercise.
*Massachusetts
*Massachusetts
*Massachusetts
When documenting amount used

on the count sheet, spell out the
number of tablets removed from
the package rather than using the
numeral, i.e., one instead of 1.
When countable meds are added

into the count, 2 staff signatures
are required indicating both staff
have confirmed the number of
tablets received from the pharmacy.
Eventually a count sheet becomes full. The information at the

top of the full count sheet must be copied to the next available
count sheet in the count book. When transferring a medication
count to a new page, the process requires 2 signatures at the
bottom of the old page and the same 2 signatures at the top of
the new page. Remember to update the index.
SECTION 3: Module 8
145
Sample Index Sheet

Name
Chip Brown
Ativan 0.5mg
Valium 2mg
Ambien 5mg
Percocet 5.325mg
Sonata 5mg
Page
Number
Signature of person
responsible for removing
medication from count
1
2
3
4
5
Figure 813: Sample Index Sheet

*Massachusetts
An example of when this column
would be signed would be
if a person's medication was
discontinued by the HCP and
destroyed; a supervisor's signature
indicates that there are no longer
tablets to count.
*Massachusetts
You must document prescription
medication losses using the
designated form and report
them to the Drug Control
Program at the Department of
Public Health (DPH) by the first
business day after discovery of
the medication loss. If the loss
relates to an over-the-counter
medication, you do not have to
report it to the DPH; however,
you must report all other losses.
146
people you support from potential problems if that medication is

found missing. A separate book should be kept for all countable
substances.* The count book is a bound book and it cannot have
any loose pages. Count books all have the same basic three
sections; index, count sheets and shift count pages. The index
should contain all the names of people on countable medications
with the name and strength of the medication and the page
number of the count sheet. Figure 813 gives an example of an
index sheet. Any suspicious discrepancy must be reported based
on agency policy.*
Note: A suspicious count discrepancy is when the count is
off, and there is suspicion of tampering, theft or unauthorized
use of drugs. A count discrepancy is not suspicious if it can be
easily resolved by checking the addition or subtraction of the
medication that was used. Non suspicious count discrepancies
should also be documented in the count book.
Freddy Connors
Freddy Connors
Melissa Sullivan
Melissa Sullivan
Medication
and Strength
Using the blank countable sheet below, document that you have administered
the countable medication Ativan 0.5mg to Chip at 9 p.m. on June 19. The bottle
has a total of 60 tablets, and this is the first medication administration.
Countable Sheet
Chip Brown
Rx Number: C0401
Doctor: Dr. Susan Smith
Date Dispensed: 6/19/yr
: Sams Pharmacy
Pharmacy
Amount Dispensed: 60
and Strength: Ativan 0.5mg
Medication
: Take one tablet by mouth 2 times a day
Directions
Name:

Date
Time
6/19/yr
9am
Amount
Tablets Amount Amount
on Hand Used
Left
Route
60
Signature
Received K. Mason/L. Long
Storing Medications at the Home

After you have completed all documentation, you must properly
store the medication to ensure the safety of the people in
the home. How securely the medication is stored depends on
the type of medication. Some medications, such as countable
substances, will be stored more securely than others.
Storing is also a matter of space. You need to consider
the best location for medications to minimize distractions
SECTION 3: Module 8
147
in preparation and administration. Do not store medications

administered orally with those administered by other routes.
You might give a medication orally that you should have given
topically (on the skin). Keeping medications separate will help
prevent this type of occurrence. Your goal is to create a home-like
environment as much as possible while also ensuring the safety of
the people you support.
In most cases, you should store medications based on the
following guidelines:
3 Keep prescription and OTC medications in their original

containers.
or container used only for medications.
3 Keep prescription and OTC medications that need
refrigeration in a separate locked container. If the substance

is considered countable it must be double locked in the
refrigerator.
3 Store prescription and OTC medications under conditions
of proper sanitation and away from excessive temperature,

moisture, and light. Medications can lose their effectiveness
in the warm sun or from being stored in a bathroom where
steam can affect them. Store all medications away from
food and toxic materials such as cleaning solutions.
3 Keep the keys of locked containers or areas with the person
responsible for administering the medication. A backup

set of keys should be kept in the home in a separate area
known only to the supervisor and/or other designated staff.
3 Store oral medications separately from treatments and

medications administered by other routes.
3 Double lock countable substances. This means storing them

in a locked container in a locked area.
3 Label containers with the persons name.
Disposing of Medications
Certain procedures are recommended for disposing of and
destroying unused medication. Often a prescription medication is
148
3 Keep prescriptions and OTC medications in a locked area
*Massachusetts
You should fill out the DPH
Approved Controlled Substance
Disposal Record when disposing
of medication. Two signatures
are required with an explanation
in the count book. Please note
that the "amount used" column
should indicate the number of
pills destroyed and the "amount
left" column should indicate the
number of pills remaining even if
that number is zero.
discontinued, spit out, found on the floor, expired, or left behind

when a person leaves the program. You need to follow your
state and agency policy concerning disposing of a medication.
The guidelines include who can dispose of medication and what
documentation is needed. In addition, you must be aware of
your communitys requirements for disposing of medications.
Acceptable disposal includes flushing (restricted to those
medications so labeled), dissolving in water, crushed to a fine
powder and/or mixed with soap, used coffee grounds or kitty
litter. The goal is to be sure the medication is not usable.
Medication should be disposed of in the presence of two staff
members, and one staff member should be a supervisor. Each must
sign a document stating how much of the medication was destroyed
and when.* Never return medications back to the pharmacy.
Handling and Storing Medications

Outside the Home, Leaves of Absence
*Massachusetts
MAP requires all medications
must be passed directly from
licensed/certified staff to
licensed/certified staff as
in medications provided by
residential programs to day
programs or day habs, hospitals,
nursing homes, etc.
A dated release document listing
the meds must be signed by the
staff releasing/accepting the
meds.
When a person you support leaves their residence to go to work,

visit family, or go on an outing, they must have their medications
with them. It is your responsibility to send the person with all the
tools they need to self-administer (if they are capable) or to have
someone else administer the medication. You must also send all
the information about the persons medications to the medication
administrator outside the home.
Knowing where the person is going and how often will help
you plan the best way for them to receive medications.* For
example, if Melissa goes to a day program five days a week,
you should arrange for the pharmacy to package her daytime
medications separately. The day program will then have all the
necessary information about Melissa, administer her medication,
and document itjust as you do. The day program staff also
require the HCP order. You need to work out a plan with other
staff members and your supervisor so that each administration
is done in a safe manner. If possible, try to arrange for the
medication to be administered before the person goes out
and after the person returns. This will minimize the number of
people outside the home who administer medications. If outside
administration cannot be avoided, follow the guidelines to be sure
it is handled in a safe manner.
SECTION 3: Module 8
149
3 Provide written information about the person, including
name and a brief overview of the persons health,

personality, likes, and dislikes. Include anything you think
will help others get to know the person. (This may not be
necessary if the person is well known.) The goal is for the
person to have a positive, safe experience.
*Massachusetts
Child-proof container or a coin
envelope is acceptable.
*Massachusetts
Any LOA medication that the

person brings back to the site
cannot be used; instead, it must
be destroyed and documented
correctly.
All medication that leaves the
residence (all LOA medication)
must be documented with a
note which is kept in the file at
the residence. This note should
explain that the medication was
released and accepted and that
proper instructions were given.
The staff person who releases
the medication and the person
who is accepting the medication
must both sign this note.
A Certified staff person must
provide written instructions
and medication information
to the person who will be
administering the medication
during the LOA. For home visits,
a responsible family member
should receive some training on
administration of medication
and on potential side effects.
People taking LOA medication
may not package their own
medication unless they are
learning to self-administer and
they meet all the criteria for
self-administration.
150
instructions about the medication that you have (including

the name, dose, when to administer, and what it is for). The
residence and day programs must keep medication sheets
for all medications administered.
3 Communicate any new observations or medication changes

regarding the person to everyone involved. Its important
that the outside administrator know what happens to the
person in the home, and it is important for you to know
what happens to the person while outside the home. For
example, you might create a communication sheet that the
person can bring to the program and back to the home.
Make sure all necessary documentation about medication
changes is copied and sent to the program.
For leaves of absence, whenever possible have the pharmacy

prepare the medication needed for the person. For unplanned
absences of less than seventy-two hours, medications can be
prepared by you or a licensed staff member if the pharmacy cannot.
All medications must be in separate containers marked with the
information from the original pharmacy label. All containers must
have the persons name, name of medication and strength, dose
and amount of medication, the HCP that ordered the medication,
directions for giving the medications, date the medication was
dispensed, and how much medication is in the container. Both you
as the preparer and the receiver of the medication must sign that
you agree about what is being dispensed. You should use a tamperresistant container.*Give only the number of pills, etc. that are needed.*
Each time the person leaves the home, use a checklist to be sure
the person brings all the tools and information needed for an outside
administrator to give medications safely. Upon return, follow your
agency guidelines about medications that may be returned after a
leave of absence.
In addition, you must record

the leave of absence on the
Medication Sheet by writing
LOA in the appropriate box.
This indicates the medication
was sent with the person.
You must also record in the
Countable Substance Book any
countable substances sent on
LOA.
3 Give the outside administrator the same written
Medication Occurrences
As you will recall, medication administration is a step-by-step
process that must be done in a mindful way. You must never
allow the steps to become routine or automatic. Medication
Occurrences can usually be traced to not following the step-bystep process.
As you review the list of Medication Occurrences in Figure 8
14, ask yourself at what point in the administration you could have
prevented the occurrence. Think in terms of the administration of
medication, beginning when you receive the medication from the
pharmacy and complete the medication sheet using the HCP order
and the pharmacy label. Think about the steps to administering
the medication and the guidelines for documentation. Medication
Occurrences can occur at any point in this process.
Figure 814: Types of Medication Occurrences

3 Wrong dose gave too much or too
3 Wrong medication gave a
3 Wrong time gave medication too
3 Wrong route gave medication by
little medication during a scheduled

administration.
early or too late or not at all.
3 Wrong person gave the person
discontinued medication, or gave the

wrong medication.
the wrong route (for example, orally
instead of topically).
someone elses medication.
Documenting Medication Occurrences

*Massachusetts
consultant.
You must be aware of the requirements for reporting occurrences.

* If you make a Medication Occurrence, you must immediately call
your designated agency personnel and follow-up with a written
report including instructions given. In general, to document a
Medication Occurrence, you must answer the following questions:
3 Who was the person affected by the occurrence?
SECTION 3: Module 8
151
*Massachusetts
Follow this procedure for a

Medication Occurrence:
1. Check that the person is okay
2. Call 911 if needed
3. Contact the MAP Consultant
4. Follow recommendations
5. Document what you did
6. Notify your supervisor
8. If it is a Hotline occurrence,
send a fax to DPH within 24
hours
9. Fax or mail the occurrence
form to the MAP Coordinator
within seven days.
*Massachusetts
In every case you should think of occurrences as opportunities

to improve procedures that may put people at risk. But remember
your primary concern is the persons safety. Be sure you know your
agencys emergency procedure. It is important to focus on the
cause of an occurrence rather than on who committed it because
any staff member could make the same mistake. Identifying
why the occurrence happened and setting up a procedure to
avoid such an occurrence in the future will lessen the chance the
same mistake will be made by another staff member. Handling
occurrences in this manner will make the process of medication
administration safer for everyone involved. The type of data that
could be collected on a Medication Occurrence report includes
the following:
3 Date and time

3 Name of the medication
3 Type of occurrence
3 How many times the occurrence occurred
3 Description of what happened
3 What action was taken
3 Description of medical intervention if applicable*
Medical Intervention includes

but is not limited to, Lab work,
tests and emergency room
visits. If medical intervention,
illness, injury or death follow an
occurrence, this is a hotline
occurrence.
152
7. Fill out a Medication

Occurrence Form (MOR)
3 What type of medication was involved?

3 What type of occurrence was made?
3 When did the occurrence occur?
3 What action was taken?*
Match the Medication Occurrence in the left column with the correct definition
in the right column. Select only one answer.
Medication Occurrences
1. Wrong dose
A. Gave the medication too early or

too late.
2. Wrong time
B. Gave the person someone elses

medication.
3. Wrong person
C. Gave too much or too little

medication during a scheduled
administration.
4. Wrong route
D. Medication not given the way it

was ordered.
SECTION 3: Module 8
153
Apply What Youve Learned Imagine you return to work after being
1. What type of occurrence was made?
2. How could you have prevented this occurrence?
3. After identifying the occurrence, describe what you should do next?
154
off for a week. Your supervisor asks if you can cover a shift at another
home. Although you are not familiar with the people who live in the home,
you are confident in your ability to administer medications because you
have learned the procedure. When you arrive, you introduce yourself to
the staff from the shift before and receive a report on the people living
in the home. You are quickly introduced to each person and shown where
the medications are kept. When it is time to give the 4 p.m. medications,
you walk into the living area and say, Would John Pearson please come to
the kitchen area. A man tells you to bring his medication into the TV room
instead so that he can watch his favorite show.
You begin the procedure you learned in your training. You perform
your checks and pour the medication. You return to the living area, hand
Mr. Pearson his medication, and watch him take it. You then return to the
medication area and complete the procedure. A few minutes later another
person in the home comes up to you and says he needs his medication. You
ask his name, and he says John Pearson.
Summary
In this module you learned how important it is to record

information accurately on the medication sheet, to
document with accuracy and store medications so everyone
is safe. Being mindful with each of the procedures can make
the difference in whether an occurrence is made.
Matching
Match
the term in the left column with the correct definition in

the right column.

1. Medication Administration A. Also called the medication

Record (MAR) sheet or medication log, the
document that contains all the
information from the HCP order
and the pharmacy label.
2. Record
B. A mistake that offers the

opportunity to improve
procedures to lessen the
chance of future occurrences.
3. Storage
C. To write down information,

such as the details from the
HCP order and the pharmacy
label onto the medication
sheet.
4. Medication occurrence
D. The act of storing, a place

for storing.
SECTION 3: Module 8
155
Content Review
Practice documenting information. Add the following new
medications to Chips medication sheet and discontinue his
synthroid. Use June 20 as the date. Below you will find the HCP
visit form with Chips new and changed medication orders. The
medication sheet for recording the orders is on p. 157. Written on
the pharmacy labels are:
3 Inderal 10mg 2 tablets by mouth one time daily in morning.

3 Amoxicillin 500mg give 1 tablet 3 times a day for 10 days by
mouth.
one tablet.
3 Discontinue synthroid 0.125mg one a day in the morning
and start Armour Thyroid 30mg by mouth once a day in the

morning on an empty stomach.
HCPs Visit Form

Name: Chip Brown
Date: 6/20/yr
Health Care Provider: Dr. Susan Smith
Allergies: none
Reason for visit: complaint of pressure on forehead, mild fever, dizziness,

increased head slapping
Current Medication: Synthroid 0.125mg by mouth once a day in the morning.
Date: 6/20/yr
sinus infection, elevated blood pressure, increase

in head slapping behavior, especially anxious today
Medication/Treatment Orders: Inderal 20mg by mouth once a day in the
morning. Amoxicillin 500mg by mouth three times a day for 10 days. Ativan 1mg
every 8 hours PRN by mouth for anxiety. Discontinue Synthroid 0.125mg one time
a day in the morning and begin Armour Thyroid 30mg by mouth once a day in
the morning on an empty stomach.
Instructions: Call me if increase signs of anxiety.
2 weeks
Susan Smith, MD.
Follow-up visit:
Signature:
Posted
156
Lab Work or Tests:

Date:
Verified
6/20/yr
3 Ativan 1 mg every 8 hours PRN by mouth for anxiety. Give
SECTION 3: Module 8
formsEDIT.indd 4
157
9/19/05 2:20:16 PM
MEDICATION SHEET
Allergies:
NKA
Route
Amount
Route
Amount
Route
Amount
Route
Amount
Frequency
Dose
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
Frequency
Dose
Strength
Brand
Generic
morning
Site: Everett Street Apt. 1a
W-work
H-Hospital
P-packaged
CODES
DP-day program
LL
Init.
KM
Lisa Long
Signature
Kathy Mason
Init.
Signature
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Generic
Hour 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Brand Synthroid
9am KM KM KM LL LL LL LL KM KM KMKM KM KM LL LL LL LL LL LL
Strength 0.125mg Dose 0.125mg
Frequency once a day in the
Name: Chip Brown
Stop
Start
Stop
Start
Stop
Start
Stop
Start
cont.
Stop
5/1/yr
Start

SECTION *
*MASSACHUSETTS
Reference Information for

his section of the manual provides you with reference

information, which you are not required to master without
additional training. However, you can refer to this section if you
need the information to care for the people you support. This
section covers:
the medications to treat them
3 Vital signs
3 Other routes of medication administration
Common Diseases, Illnesses, and Conditions,

and the Medications to Treat Them
Below is an overview of some of the more common diseases,
illnesses, and conditions that the people you support may have.
You will also find a list of the most common drugs used today to
treat or minimize symptoms of these conditions.
Note: New medications are introduced to the market every
day, so this list will change frequently.
Seizure Disorder
There are many different kinds of seizures, and they may be partial
or generalized. Partial seizures begin in a specific location of the
brain. Generalized seizures begin over the entire surface of the
brain. A seizure can happen when normal signals coming from the
brain are interrupted or changed. The resulting symptoms can range
from a mild shaking of a hand to violent shaking of the entire body.
There are many causes of seizures such as head trauma, epilepsy, or
a chemical imbalance. Your responsibility is to give medication to
the person who has seizures to help control them, and to keep the
person protected during a seizure by minimizing injury.
158
3 Common diseases, illnesses, and conditions and
Following are examples of seizure medications:
3 Brand name: Dilantin

Generic name: phenytoin
3 Brand name: Lamictal Generic name: lamotrigine
3 Brand name: Depakote Generic name: valproic acid
High Blood Pressure

High blood pressure is a condition in which the force of blood
against the artery walls is too strong. Having high blood pressure
can damage a persons arteries, kidneys, and heart. Because high
blood pressure can lead to a stroke and or heart attack, some
HCPs refer to this condition as the silent killer.
When you take a persons blood pressure, you are looking
for two measurements. The top or systolic measurement is the
pressure of the blood against the artery walls when the heart
contracts. The bottom or diastolic measurement is the pressure
of the blood against the artery walls when the heart is relaxing.
Normal blood pressure should be 119/79 or below.
Following are examples of medications used to lower blood
pressure:
3 Brand name: Diuril

3 Brand name: Inderal
3 Brand name: Capoten
Generic name: chlorthiazide

Generic name: propranolol
Generic name: captopril
Bipolar Disorder
Bipolar disorder, previously called manic depression, is a fairly
common disorder. It causes the person to have extreme mood
swings that alternate between episodes of mania (highs) and
depression (lows). These episodes can come on suddenly
without any warning. Between episodes, a person can return to
normal. The cause of bipolar disorder is not known, but it can
be hereditary. Some scientists believe it is caused by a chemical
imbalance in the brain.
Following are examples of medications used to treat bipolar
disorder:
3 Brand name: Eskalith Generic name: lithium carbonate

3 Brand name: Tegretol Generic name: carbemazepine
3 Brand name: Depakote Generic name: valproic acid
SECTION 4
159
Constipation
Constipation happens when stool gets hardened and is difficult
to pass. It can be caused by many things like poor diet, lack of
exercise, medications, and certain illnesses.
Following are examples of medications used to treat
constipation:
3 Brand name: Colace

Generic name: docusate
3 Brand name: Senekot
Generic name: senna
3 Brand name: Metamucil Generic name: psyllium
Pain is a bodily sensation that causes the person distress and
suffering. There are varying degrees of pain. Pain is exactly what
the person says it is or expresses through body language. People
express pain in different ways. Some people are able to describe
the pain they feel; others cannot. Those unable to describe their
pain may become quiet, cry, or just look sad. People who are
unable to describe the pain they feel because of limitations in
verbal and cognitive skills may become agitated, restless, or even
withdrawn. Careful observation is key to helping the person in
pain. There are many medications used for pain.
Following are examples of medications used to treat pain:
3 Brand name: Tylenol

Generic name: acetaminophen
3 Brand name: Oramorph SR Generic name: morphine
3 Brand name: Percocet
Generic name: o
xycodone and
acetaminophen
Depression
Depression is an illness that can be serious. Everyone has
experienced some form of depression, feeling sad or blue. It is a
normal reaction to some of lifes problems. But when the sadness
doesnt go away and prevents a person from leading a normal life,
then the condition is more serious.
Symptoms of depression include low energy, irritability,
sadness, no appetite, and lack of interest in everyday life,
insomnia, thoughts of suicide, and in some cases, attempts at
suicide. There are different types of depression. Although the
160
Pain
cause is not completely understood, depression is thought to be

caused by an imbalance of chemicals (called neurotransmitters)
in the brain. Following are some medications used to treat
depression:
3 Brand name: Prozac Generic name: fluoxetine

hydrochloride
3 Brand name: Zoloft Generic name: sertraline

hydrochloride
3 Brand name: Paxil Generic name: paroxetine

hydrochloride
3 Brand name: Wellbutrin Generic name: bupropion

3 Brand name: Tofranil
Generic name: imipramine
Vital Signs
Vital signs are literally signs of life, indicators of a persons health.
Vital signs are:
3 Temperature a measure of body heat

3 Pulse rate a measure of heart rate
3 Respiration rate a measure of breathing (inhalation
and exhalation)
3 Blood pressure a measure of the force of blood in

the arteries
A persons pulse rate and blood pressure are the two vital signs
you will measure most often. Certain medicationssuch as those
used to treat high blood pressure and heart diseaserequire that
a persons vitals signs be measured or monitored before and after
receiving a medication. You must take all vital signs carefully and
record them accurately. Decisions about a persons medication
are often made based on vital signs. For example, you may need
to measure a persons temperature because the HCP has ordered
Acetaminophen for fever of 101 degrees or above.
You must learn the important steps to perform before, during,
and after taking a persons vital signs. And you must always follow
these standard steps.
SECTION 4
161
1. Before taking a persons vital signs, you must:
3 Clean the area where you will be working.

3 Gather all the items you will need. The items will vary
depending on each situation.
3 Identify the person, and ask the person to come to a private

area.
3 Provide privacy (The situation will determine how much
privacy you should provide. For taking a rectal temperature,

you need a room with the door closed and a sheet to cover
the person for comfort, privacy, and warmth.)
possible.
3 Wash your hands. Put on gloves, if needed.

2. During the process of taking the persons vital signs, follow
the specific procedures described later in this section,
depending on how you are measuring (oral temperature,
radial pulse rate, etc.)
3. After taking a persons vital signs, you must:
3 Assist the person, as needed, with dressing and positioning.

3 Clean the area and all the items you used. Throw away any
disposable products you used.
3 Remove your gloves, if used.

3 Wash your hands.
3 Document and report your measurements.
Temperature
Temperature is a measurement of body heat. A persons
temperature can change during the day from the lowest reading
in the morning to the highest in the evening. A higher than normal
temperature usually means the person has a fever. The temperature
of some of the people you support will not increase when they
have an infection. In fact, their temperature may be below normal,
and their skin cool and clammy (moist to touch). It is important
that you know how different people respond to infection.
162
3 Explain the procedure and have the person assist as much as
Temperature can be measured in many ways: Below are the

most common ways:
3 Axillary (under the armpit)

3 Oral (in the mouth)
3 Rectal (in the rectum)
3 Tympanic (in the ear with a probe)
Thermometers
The most common type of thermometer today is electronic,
and it can take oral, rectal, and axillary temperatures. Electronic
thermometers are quick and easy to use. You insert the
thermometer into the body, wait for the beep, and then read the
digital display. One example of an electronic thermometer is the
tympanic probe thermometer. Inserted in the ear, it measures
the temperature of blood vessels in the eardrum, and produces a
reading in seconds.
Electronic thermometers have a battery and removable
probes. Since they need recharging, you have to remember to
return an electronic thermometer to the base unit for charging.
Axillary Temperature
The axillary temperature is the least reliable method but also the
least invasive. You may want to start with this method to give
you an indication whether something is wrong. To take an axillary
temperature, use an oral thermometer in the armpit.
Taking an Axillary Temperature
Gather the following items:
3 Thermometer and cover

3 Watch with second hand, if needed
3 Paper and pencil
Then follow these steps:
1. Be sure the armpit is dry.
2. Put the thermometer in the persons armpit. Help them
place their arm along their body to secure the thermometer.
SECTION 4
163
3. Wait for the beep or signal that the temperature has been
completed.
4. Remove the thermometer.
5. Read the temperature, and write it down.
Oral Temperature
An oral temperature is the most common method of taking
a persons temperature. However, you cannot take an oral
temperature when the person:
Taking an Oral Temperature

3 Electronic thermometer or digital thermometer with cover

3 Paper and pencil
3 Watch with a second hand, if needed (most thermometers
beep or signal when ready)
Before proceeding, check with the person to make sure they

have not just eaten or drunk something hot or cold, or smoked
a cigarette in the last ten minutes. (These activities change the
temperature of the mouth and give you a false reading.) If so, wait
five to ten minutes. Then follow these steps:
1. Gently put the thermometer under the persons tongue, and
ask the person to close their mouth around it. If able, have
the person hold onto the end of the thermometer to keep
it in place. Stay with the person while the thermometer is in
their mouth.
2. Wait the amount of time needed. If using an electronic
thermometer, wait until it beeps.
3. Remove the thermometer and the plastic cover. If there is
a lot of mucous on the thermometer, use a barrier (such as
164
3 Has trouble breathing

3 Is confused or combative
3 Has a mouth disorder or gum disease
3 Has had recent mouth surgery
3 Has a seizure disorder
gloves) to remove the cover.

4. Read the temperature, and write down the result.
Rectal Temperature
You should take a rectal temperature when you cannot take
the temperature by another way. You should also take a rectal
temperature when a person:
3 Is confused or very restless and may bite an oral

thermometer
3 Can breathe only through the mouth

3 Has orders from the HCP for a rectal temperature
You should not take a rectal temperature when a person:
3 Has diarrhea
3 Has had recent rectal surgery
3 Has hemorrhoids
3 Has a seizure disorder
Check with your supervisor to make sure you should take the
persons temperature rectally. Use the rectal thermometer probe
and a disposable thermometer cover that is lubricated.
Taking a Rectal Temperature
3 Thermometer and lubricated cover

3 Watch with second hand (if needed)
3 Paper and pencil
3 Gloves
3 Tissue paper
3 Protective pad
3 Sheet for privacy
1. Position the person on their side.
2. Help the person bend their upper leg to expose the rectal area.
3. Put a plastic cover over the thermometer and lubricate it.
SECTION 4
165
4. Separate the persons buttocks with one hand while you

insert the thermometer one inch into the rectum with the
other hand.
5. Hold the thermometer in place until it beeps or signals that
it is ready.
6. Remove the thermometer.
7. Wipe the lubricant from the
rectum with toilet paper.
8. Remove the cover, read the thermometer, and write down
the temperature.
Note: Always cover the person while taking a rectal

temperature. And never leave the person alone during this time.
Tympanic Thermometer
If you are using a tympanic thermometer, insert the small cone
shaped end of the thermometer into the ear canal, wait until it
beeps, and then read the temperature on the screen.
Pulse Rate
The pulse rate is the number of times the heart beats in a minute.
You can feel the pulse in several body areasthe neck, temple,
groin, wrist, bend in the arm, behind the knee, and top of the foot.
The most common area for taking a pulse is at the wrist. This is
called the radial pulse. You can feel the pulse as a throbbing in an
artery each time the heart pumps blood through the body.
When taking a pulse, be sure that you:
3 Count the pulse rate, the number of beats you feel for
60 seconds.
3 Do not use your thumb for taking a pulse because it has a

pulse that could be confused with the persons pulse.
3 Do not press down too hard because you may temporarily

stop the blood flow and will not be able to feel the pulse.
166
9. Assist the person with dressing or positioning if needed.
The HCP will tell you what to watch for when taking the pulse
if it relates to the medication the person is taking. For example,
the HCP may write an order for Digoxin 0.25mg by mouth every
day. Please hold if the pulse is less than 60 beats per minute.
Taking a Radial Pulse
3 Watch with second hand

3 Paper and pencil

1. Place your index and middle fingers over the radial artery
(this artery is located on the thumb side of the wrist).
2. Start counting the pulse when the second hand on your
watch is on the 12.
3. Count each beat for 60 seconds. A normal pulse should
have a steady rhythm of 70-90 beats/minute. Check for
abnormalities in the rhythm.
You must report any rhythm that is uneven, unsteady, or
irregular. For example, is the pulse weak (difficult to feel) or is it
pounding, very strong, and easy to feel? Is it very fastover 90
beats/minuteor unusually slowbelow 60 beats/minutes. Is
the pulse regular, with each beat following the last? Or are there
occasional pauses between beats? Check to be sure the pulse
rate is within the limits the HCP defines before you give any
medication.
Respiratory Rate
Counting respirations is another part of taking a persons vital
signs. Respiration is the process of breathing air into the lungs
(inhaling) and breathing air out of the lungs (exhaling). Count the
respiratory rate by watching a person breathe in and out. One
respiration is equal to one inspiration (one breath in) and one
expiration (one breath out). Some medications can increase or
decrease a persons respirations. Some diseases, such as congestive
heart failure or chronic obstructive pulmonary disease (COPD),
SECTION 4
167
can change a persons respiratory rate. These diseases can cause

shortness of breath or heavy breathing.
Taking a Respiratory Rate
3 Watch with second hand

3 Paper and pencil
1. Watch the persons chest rise and fall with each breath. You
may want to rest your hand on the persons stomach or
chest to feel the rise and fall.
Blood Pressure
Blood pressure (BP) is the force of blood in the arteries. It is a vital
sign that may be monitored with certain medications. Very high
or low blood pressure can lead to medical conditions. With high
blood pressure, a person may experience a stroke, heart attack,
or other problems. With very low blood pressure, a person may
experience dizziness, tiredness, or weakness.
Two numbers are recorded for a blood pressure (for example,
120/70). The top number is called the systolic pressure, which
is the pressure in the artery when the heart is pumping. The
diastolic pressure is the pressure in the artery when the heart is
resting between beats. This is recorded as the bottom number.
Before administering any blood pressure medication, check to
make sure that the persons blood pressure is within the limits set
by the HCP.
Taking a Blood Pressure
3 Blood pressure cuff of correct size. BP cuffs come in
different sizes: pediatric, for children, and small, medium,

and large for adults. You must use the correct size to get a
correct reading.
3 Sphygmomanometer, an instrument for measuring blood

pressure
168
2. Count the respiratory rate for one full minute.
3 Stethoscope, an instrument for listening to body sounds

3 Paper and pencil
A sphygmomanometer has two pieces: a cuff, which you wrap
around the persons arm, and a manometer, a gauge that measures
systolic and diastolic pressure. Inside the cuff is a rubber bladder
connected to tubing that leads to a rubber bulb at the end. The
bulb has a valve (a little metal knob), which opens and closes
to control the flow of air going into the bladder as you take a
persons blood pressure. The valve has a screw. Turning the screw
counterclockwise opens the valve and allows air to come out of
the bladder. Turning the screw clockwise closes the valve and
allows air to be pumped into the bladder. There is also tubing that
leads to the manometer.
A stethoscope has two pieces of tubing that are connected at
one end to a round flat disk called the diaphragm. The other ends
of the tubing have ear pieces that you put into your ears to hear
sounds.
1. Have the person sit down.
2. Place either arm on the arm of a chair palm up with the
elbow at the same level as the heart. (If the arm is higher
than the heart, the blood pressure could register too high. If
the arm is lower than the heart, it could register too low.)
3. Roll the persons sleeve up toward the shoulder making sure
that it is not too tight around the arm.
4. Place the blood pressure cuff on by wrapping it around
the upper arm, one inch above the elbow (make sure
the tubing leading to the bulb and tubing leading to the
sphygmomanometer gauge are free from knots or kinks.)
5. To pump the cuff with air you must first turn the valve
located on the bulb clockwise.
6. Put the stethoscope ear pieces in your ears and locate the
brachial artery by putting your index and middle finger over
the area. (The brachial artery can be felt above the inside of
the elbow.)
SECTION 4
169
7. Once you feel the pulse, place the diaphragm of the

stethoscope over the area, and hold it in place with one
hand as you take the blood pressure.
8. With your other hand, pump air into the cuff by squeezing
the bulb until the gauge measures 180-200 mm Hg.
9. As you slowly open the valve on the bulb, watch the cuff
pressure decrease on the gauge.
10. Listen for the first thumping sound, and read the gauge.
Remember the numberthis is the top number or the
systolic pressure.
12. Write the results like this: B/P=120/80
Other Routes of Medication Administration

Sublingual Medication Sublingual means under the tongue. A
sublingual medication is a tablet you place under the persons
tongue and which dissolves slowly. Sublingual medications are
used to treat problems like heart disease.
Buccal Medication Buccal means inside the cheek of the mouth.
A buccal medication is a tablet you place inside the cheek of
the person and which dissolves slowly.
Translingual Medication Translingual refers to spraying the
tongue.
Notes about Sublingual Medications
You may be giving the medication to relieve symptoms a person is
currently experiencing (chest pain, for example). Therefore, make
careful observations and report these findings immediately. The
outcome of the administration may determine the next steps.
For example, the HCP may order a PRN medication called
Nitroglycerin tablets to be administered sublingually to a
person experiencing chest pain (angina). The order reads give
Nitroglycerin 1 tablet sublingually for chest pain, if no relief within
5 minutes administer another tablet sublingually. A third tablet
170
11. Continue to listen for a distinct change in sound (muffled)

or the last sound, and read the gauge. Remember the
numberthis is the bottom number or the diastolic
pressure.
may be administered again if the person still has chest pain after
5 minutes. If after the 3 doses 5 minutes apart, the person is still
experiencing chest pain, call for emergency medical help.
Administering Sublingual, Buccal, and Translingual Medication
Begin by following the standard preparation steps for
administering medications. Then follow these steps:
Perform Crosscheck 1 and 2.

Open container and remove or pour the medication from the
container. Perform Crosscheck 3.

Tell the person what medication you are administering. Provide
assistance as needed.
3 To administer a sublingual medication, place the tablet under

the tongue.
3 To administer a buccal medication, place the tablet on the

cheek inside the mouth along the teeth.
3 To administer a translingual spray medication, ask the person
to open their mouth, and spray the medication directly on the

tongue. You must hold the canister vertically so the spray will
go directly into the mouth.
Make sure the medication stays in place until it dissolves

completely. Tell the person not to chew the tablet. Tell the person
not to drink or smoke for one hour.
Complete the administration, remembering the standard
completion steps.
Pulmonary Inhalant Medications

Pulmonary inhalant medications are inhaled into the air
passagewaysthe nose and mouth. These medications are used
SECTION 4
171
often for people with respiratory problems, such as asthma. You

will need instructions from your supervisor for administering a
pulmonary inhalant.
Administering Pulmonary Inhalants

Begin by following the standard preparation steps for administering
medications. Then follow these steps:

172
Notes about Pulmonary Inhalants

Most pulmonary medications come in a sealed container under
pressure. If no puff or mist comes out, you can unclear the spray
nozzle by soaking the mouthpiece in water for a few minutes.
Some inhalers come with a spacer, a chamber used to help the
medication get into the air passageway better.
It is difficult to know if there is any medication in the canister.
To check how much is left, put the canister (not the mouthpiece)
into a cup of water. If the canister floats sideways on the surface,
it is empty. If the canister sinks to the bottom, it is full.
Some pulmonary inhalant medications can cause side effects
to the mucus membrane in the mouth. If the medication you
administer has this side effect, ask the person to do good mouth
care after each dose. Document this on the medication sheet to
alert other staff to remind the person to do mouth care after
each dose.
Some pulmonary inhalant medications come in a liquid
form. To administer this liquid, you need a special machine and
instructions on how to use it correctly before you can administer
such a medication.
Read and follow the directions that come with the medication.
3 If you are assisting the person, you may have to read the
directions to them several times, or you may have to hold

the canister and administer the medication yourself.
3 If the person is capable, hand the canister to them and follow

the instructions below.
Step 5: Tell the person what medication you are administering. Hand the
medication to the person with water. Provide assistance as needed.

Instructing a Person to Use an Inhaler
Following are the directions for most inhalers. These directions
will help you instruct the person on how to use an inhaler. Ask
the person to:
1. Hold the canister so that the writing and mouthpiece
are facing them and remove the protective cap over the
mouthpiece.
2. Shake the canister, breathe out, and place the canister in
the air passageway.
3. Breathe in and press down on the container to release
a puff or spray of fine mist into the air passageway.
4. Hold their breath for at least ten seconds to allow the
medications to be absorbed in the air passageway. Wait at
least one minute between puffs for adequate absorption.
(The HCP order indicates the number of puffs the person
should inhale at one time. For example, the order may say
take Albuterol inhaler 2 puffs every 6 hours.)
It takes time and practice to use a pulmonary inhalant. You
may have to assist the person with each step. Always stay with
the person while they are using the inhaler.
completion steps.
Administering Topical Medications to the Skin

Topical medications are applied directly to the skin. They include
creams, ointments, lotions, solutions, suspensions, powders, and
sprays. You administer topical medications to the specific part of
the body required by the HCP.
SECTION 4
173
Notes about Topical Medications for the Skin

Keep in mind the following when dealing with topical medications
for the skin:
3 Before and after applying a topical medication, inspect
the persons skin frequently. If there are any new signs of

redness, swelling, drainage (pus), or blistering, or if the
condition of the skin appears to get worse, call the HCP.
3 Never touch the persons skin directly with a tube of
medication. If the person has an infection, it can travel

into the tube and contaminate the medication.
avoid the persons eyes, nose, and mouth (areas with mucous
membrane).



the medication to the person if they are able to apply it. Provide
assistance as needed:
3 Put on gloves to prevent infection and to keep the medication

from absorbing into your own skin.
3 Clean any medication left from the previous application by

wiping the area with a clean gauze or cloth.
3 Read and follow the instructions carefully.

3 Do not touch the tube or bottle after touching the persons
body. This will prevent the transfer of germs to the medication.
3 Cover the area after the application, if there is an HCP order.
174
3 When applying any form of topical medication to the face,
Applying Creams and Ointments

Follow these guidelines when applying creams and ointments:
3 Apply ointments and creams with your gloved hand.

3 Apply a thin layer of the cream or ointment using light,
smooth strokes.
3 Do not massage the medication into the skin, unless
directed by the HCP. Avoid putting pressure on the skin.
3 To apply cream or ointment to a females labia (outside the
vaginal area), use your gloved hand always remembering to

maintain privacy.
3 Do not bandage the area unless directed by the HCP.

Applying Lotions
Follow these steps when applying lotions:
1. Shake the medication container if needed.
2. Pat the medication onto the specified area of the persons
body with your gloved hand.
3. Do not massage or rub the area unless directed by the HCP.
4. Allow medication to dry if covering the area.
5. Cover the area if ordered by the HCP.
Applying Powder
Follow these steps when applying powder:
1. Apply small amounts of powder to clean, dry skin.
2. Do not shake powder into the air (the person might inhale it).
Applying Topical Sprays
Follow these steps when applying topical spray:
1. Read the instructions for applying the topical spray.
2. Clean the area to be sprayed.
3. Spray the topical medication onto the skin.
4. Observe for any changes.
SECTION 4
175

completion steps.
Applying Topical Medications to the Scalp and Hair
Medications are used for a variety of problems to the scalp
and hair. Some scalp and hair problems are dry skin (dandruff),
psoriasis, and head lice (pediculosis). Begin by following the
standard preparation steps for administering medications. Then
follow these steps:

: Tell the person what medication you are administering. Hand
3 Take the medication out of the box (if there is one). Read the
instructions, especially those for treating head lice. The HCP

may have given instructions you must follow after shampooing.
Some medications and shampoos may need to stay in the hair
for a period of time before rinsing.
3 Put on gloves. Then shampoo, rinse, and dry the persons hair.
3 Comb out any tangles.
3 Change your gloves before applying the medication.
3 Using your fingertips, begin by applying the medication to the
persons natural hairline part. Spread the medication evenly.
Continue to apply the medication every inch or so. Some
medication will need to be massaged into the scalp. Always
massage gently.
3 Continue applying the medication to the entire scalp.
176
Notes about Applying Medicated Shampoo

Follow these steps when applying medicated shampoo:
1. Help the person to the sink and make them comfortable.
2. Shake the shampoo.
3. Put on gloves.
4. Wet the persons hair.
5. Apply the shampoo evenly and massage it gently into

a lather.
Note: Be careful not to get medicated shampoo in the persons
eyes nose, or mouth. If you accidentally do, see your first aid
material for flushing eyes in an emergency.
6. Rinse and dry the hair. Help the person style it.
7. Remove your gloves and throw them away.
completion steps.
Applying Rectal Medications

The HCP may order medications to be inserted into or around the
anal/rectal area. This may cause the person to feel uncomfortable
or embarrassed. Be mindful of how this affects the person and make
them feel comfortable and always provide privacy. The most common
medications used in this area are suppositories, creams, and ointments.
You may need assistance with administering a rectal medication.

SECTION 4
177
: Tell the person what medication you are administering. Hand

3 Take the suppository, ointment, or cream out of the box (if

there is one).
3 Ask the person to lower their clothing from the waist down,
and assist as needed.
3 Ask the person to lie down on the bed on their left side, and
assist as needed.
3 Place a protective pad under the buttocks and a sheet over the
3 Put on gloves.
3 Clean the rectal area. Always use strokes from the front to the
back of the perineum (the area of skin between the opening
of the penis or vagina and the rectum). It is very important to
clean in a front-to-back direction, using different sections of
the washcloth for each stroke. These measures help prevent
infection.
Inserting a Rectal Suppository

Follow these steps when inserting a rectal suppository:
1. Remove the suppository from the wrapper.
2. Apply a water-soluble lubricant.
3. With one hand, lift up the persons buttock to expose
the anal/rectal area.
4. Ask the person to take a few deep breaths and relax.
5. Insert the suppository into the rectum with the tapered or
pointed end first. Using your index finger, gently push the
suppository upward about 1 to 3 inches.
6. Wipe off any leftover lubricant from the area.
7. Assist the person to a comfortable position.
8. If the rectal suppository is administered to relieve
constipation, encourage the person to hold the suppository
in the rectum for at least 20 minutes to make sure it is
effective.
178
person for privacy.
Note: If the rectal suppository gets too soft to insert, keep it in

the wrapper and run it under cool water. Rectal suppositories
should be kept in the refrigerator.
Applying Ointment or Cream to the Anal/Rectal Area
Follow these steps when applying ointment or cream to the anal/
rectal area:
1. Ask the person to lower their clothing from the waist down
and assist as needed.
2. Ask the person to lie down on their side and assist as
needed.
3. Put on gloves.
4. Place a disposable pad under the persons buttock and a
sheet over the person for privacy.
5. Clean the anal/rectal area to remove any cream or
ointment left over from previous applications. Clean the
area by always washing in a downward motion toward the
anal/rectal area. Use different corners of the washcloth for
each stroke. These measures will help prevent infection.
6. Place the cream or ointment on a disposable gauze pad or
on the tip of one of your gloved fingers.
7. Apply the cream or ointment to the anal/rectal area.
completion steps.
Applying Medication on and into the Vagina

Vaginal medications are usually ordered to treat vaginal infection
or inflammation. The application can be uncomfortable and
embarrassing to the person. Be mindful of this and make the
person feel as comfortable as possible. You may need assistance
administering vaginal medications.
Step 1: Perform Crosscheck 1 and 2.
SECTION 4
179

3 Take the vaginal medication out of the box (if there is one).
Read all the directions and follow all the HCPs orders. Vaginal
medications are inserted into the vagina using an applicator
that comes in the box with the medication. Vaginal medications
come in different forms such as creams, suppositories, gels,
foams, and ointments.
clothing from the waist down. Assist as needed.
3 Ask her to lie on her back on the bed; assist as needed.

3 Place a protective pad under the buttocks and cover her with
a sheet.
3 Put on gloves.
3 Ask the person to bend her knees and spread her legs apart.
Assist as needed.
3 Clean the perineal area by always washing in a downward
motion from the vagina toward the anal/rectal area. Use

different corners of the washcloth for each stroke. This will
reduce the chance of spreading infection.
3 Administer the medication.

3 To apply cream or ointment to the outside of the vagina, place
a small amount on disposable gauze and apply it to the area. Or

use your gloved fingertip to apply the cream or ointment.
3 To insert medication into the vagina, carefully and gently insert

the lubricated applicator into the vagina and press on the
plunger to release the medication. Withdraw the applicator
from the vagina.
180
3 Ask the person to void (urinate) first, and then to lower her
Note: Lubricating the applicator will allow for an easier,

painless insertion of the medication.
3 Clean any leftover medication from the vaginal area.

3 Assist the person with dressing.
Most vaginal medications are administered at bedtime
because they must remain in the vagina for a period of time to be
effective. If the person has to change position, provide a sanitary
pad and clean underwear.
completion steps.
Applying Transdermal Medication (Patch)

Many transdermal medications are available today. These patches,
applied to a specific area of the body, deliver medication through
the skin. The benefit of transdermal medications is that the
person receives a constant, controlled amount of medication.

3 Remove the medicated patch from the box (if there is one). Do
not peel off the back of the patch.
SECTION 4
181
3 Put on gloves.
3 Clean with soap and water the area of the body the HCP has
specified for application of the patch. Dry the skin gently.
Inspect the skin carefully for any changes.
3 Apply the patch to the area. If the HCP has not specified an
area, place the patch where the person will not be able to
remove it and where it will not rub against clothing.
3 Document the site on the medication sheet.
Notes about Transdermal Patches
Follow these guidelines when applying transdermal patches:
3 Avoid placing patches on hairy skin. The patch will not

adhere well, and the medication will absorb poorly.
3 Rotate patch sites with each application.
3 Keep the patched area dry at all times.
3 Always wear gloves so that you will not absorb the
medication through your skin if you touch the patch.
3 Always report any skin abnormalities such as redness,
swelling, or blistering.
*3 If the patch falls off, do not replace it with a new one.

*Massachusetts
Call your MAP Consultant
Call your designated agency personnel or the HCP for

instructions on how to proceed.

completion steps.
Applying Medications in the Eyes

Medications are inserted into the eyes for many reasons. For
example, a person may need medication for dry eyes, eye
infections, or for glaucoma.
182
3 Always put the patch on the person at the same time each
day or as ordered. This allows for constant and controlled
dosage of the medication.

3 Remove the medication from the box (if there is one).
3 Ask the person to sit (a recliner chair is best) or lie down
comfortably.
3 Ask the person to tilt their head slightly back.

3 Put on gloves.
3 Remove the cap from the medication and place it on
a clean surface.
Note: The instructions may say to shake the bottle before using.
To Administer Eye Drops
Follow these steps when administering eye drops:
1. Ask the person to look away from you. (It may help them
blink less.)
2. If the person cannot look the other way, then tip the
persons head back gently and to the side of the eye you are
treating. You may need assistance.
3. Hold the eye medication bottle in one hand and the
persons forehead with the other hand. Gently apply the
right number of drops into the eye.
4. Ask the person to blink the eyes gently (to spread the
medication over the entire eye), and then to close their eyes
for one or two minutes (to let the medication absorb).
SECTION 4
183
To Administer Eye Gel or Ointments

Follow these steps when administering eye gel or ointments:
1. Hold the medication tube in one hand. With the other
hand, lower the bottom eyelid to form a pocket for the
medication.
2. Gently put in the correct dose of eye medication (gel or
ointment) by forming a ribbon of gel along the edge of the
eye from the inside to the outside of the eyelid pocket.
3. Twist the tube to break the stream of ointment or gel.
Notes about Eye Drops, Gels, and Ointments

Follow these guidelines for eye drops, gels or ointments:
3 Try not to contaminate the tube or the bottle tip by
allowing it to touch the eye or any surface.
3 Wipe any excess eye ointment, gel, or drops from the
eyelid, lashes, or face.
3 Clean off any excess medication from the tip of the
medication container using a clean gauze pad.
3 Replace the cap of the tube or bottle.
completion steps.
Applying Medications into the Ears

Ear medications are commonly used to soften earwax or to treat
problems such as inflammation and infection. Begin by following
the standard preparation steps for administering medications.
Step 1: Perform Crosscheck 1 and 2.
184
4. Ask the person to blink the eyes gently (to spread the
medication over the entire eye), and then to close their eyes
for one or two minutes (to let the medication absorb).

3 Ask the person to lie down comfortably on their side.
3 Put on gloves.
3 Remove the cap from the medication and place it on a clean

surface.
3 Hold the medication bottle in one hand. With the other hand,
gently pull on the outside of the ear up and toward the back of
the head to straighten the ear canal (for adults only).
3 Put the correct dose of medication into the ear canal. Hold this
position of the ear until you see the medication disappear into
the canal. Then release the ear.
3 Instruct the person to stay on that side for 5-10 minutes to
allow for absorption of the medication.
3 Wipe any excess ear medication from the outside of the ear.
3 Repeat the steps for the other ear (if directed by the HCP).
Note: To prevent adverse affects from cold ear drops, warm the
medication first by rolling the container in your hands, storing
the medication in a warmer place, or placing the container in a
cup of warm water.
completion steps.
Applying Medication into the Nose

The most common nasal medications are used to coat and shrink
the nasal mucous membrane (the lining of the nose). For example,
nasal medications are helpful when a person is having difficulty
breathing through the nose due to an allergy.
SECTION 4
185
To apply medication into the nose, begin by following the

standard preparation steps for administering medications. Then
follow these steps:

the medication to the person if they are able to apply. Provide
assistance as needed by:
3 Remove the cap from the medication container.
3 Ask the person to get into a comfortable position, either sitting
or lying down. (Use a reclining chair if you have one.)
3 If sitting, ask the person to tilt their head back.
3 If lying down, place a pillow under the persons shoulder so the
head is tilted back.
3 Gently place the correct dose ordered into each nostril. Try not
to contaminate the tip of the nasal medication by allowing it to
touch the nose.
3 Ask the person to keep their head back for about 5 minutes.
This will allow time for the medication to be absorbed.
Note: The correct dose means the number of drops or sprays
into each nostril. For example, a dose might read: Rhinocort
Aqua spray use one spray in each nostril once a day, or sterile
saline use two drops in each nostril three times a day.
completion steps.
186
3 Put on gloves.
Giving Medications via G-Tube and J-Tube

A gastrostomy or G-tube is a tube that is surgically placed in a
persons stomach for a medical reason. A jejunostomy or J-tube
is a tube that is surgically placed in the small intestine. The tube
is usually 12 to 15 inches long and made of flexible material. It is
held in place by a balloon (called a bumper) on the inside of the
body and by a disk on the skin outside the body. A G-tube or
J-tube is most often used for artificial feeding, when the person
is unable to eat on their own.
All medications given through a G-tube or J-tube must be in
liquid form at room temperature or crushed and or/dissolved
in liquid. You will need an order written by a HCP to crush
medications or change the form of the medication. You must
know beforehand whether the medication has to be given on an
empty stomach. If so, the person cannot eat for a period of time
before and after the administration.
Below is the procedure for giving medications via a G-tube or
J-tube. This procedure can be modified based on a persons unique
situation or the HCPs order. Begin by following the standard
preparation steps for administering medications. Then gather the
following equipment:
3 Medication
3 60 mL syringe
3 Warm water
3 Rubber band (in case the plug is misplaced)
3 Gloves
Administering the Medication
Follow these steps for administering the medication:

SECTION 4
187
Step 4: Elevate the persons head and upper body. The person must stay
in this upright position for 45 to 60 minutes after receiving the
medication to prevent fluid from getting into the lungs.
Step 5: Wash your hands.

Step 6 Put on gloves.
Step 7: Check to be sure the tube has not shifted by looking for the
permanent mark on the tube or by measuring the tube length and
comparing it to the original measurement.
Note: If it is a button type tube, you do not have to measure it.
Step 9: Remove the plug/cap and place on a clean surface nearby.

Step 10: Remove the plunger from the 60 mL syringe and insert the syringe
into the tube.
Step 11: Un-pinch the tube.

Step 12: Gently flush with 50 mLs of warm water. Do not force the water
or liquid into the tube. When the tube is almost empty, pinch it
off. Do not allow the syringe to empty completely.
Step 13: Un-pinch the tube, instill the medication, and re-pinch the tube.
Step 14: If you need to give another medication through the tube, pour
5 to 10 mLs of warm water into the tube to clean it. Then secure
the tube.
Step 15: Do not allow the tube to empty. Pinch it off.

Step 16: Repeat this procedure until you have given all the medications.
Step 17: After the last medication, flush the tube with 50 mLs of warm
water. Allow the syringe to empty completely.
Step 18: Pinch the tube, and reinsert the plug or close the cap.
Complete the administration remembering the standard
completion steps.
188
Step 8: Pinch off the tube.
Information Needed for a First-Time HCP Visit
Policies protecting a persons health information are established by

law. As a result, many agencies keep the persons complete medical
record and agency-specific forms in a special place or file to protect
privacy. You must find out where that information is located.
On the first visit to the HCP, bring either the persons medical
record (if your agency permits), or fill out a separate form with
the following information:
3 The persons past medical history. This gives the HCP
baseline data about the person. Since you do not know
which information the HCP needs, it is best to provide all
medical records.
3 History of any allergies. The HCP must know whether the
person has any known allergies because allergic reactions
can be fatal and/or may affect the treatment plan.
3 A list of current medications (including nonprescription
and OTC) and the purpose of each. Remember that the
more medications a person is taking, the greater the risk for
unwanted medication interactions.
3 Current medical and dental conditions not being treated
by medications. It is important for the HCP to know about
untreated conditions because this information may affect
the overall treatment plan.
3 Written observations of recent changes in physical or
behavioral symptoms. The HCP will need this information
for diagnosis and treatment.
3 Insurance information.
Use this checklist as you prepare for the HCP visit.
SECTION 4
189
Massachusetts Specific Forms
Table of Contents
191
Controlled Substance Disposal Record
192
DPH Medication Occurrence Report (MOR)
193-194
DPH/DMH/DDS MAP Organizational Chart
195
DDS Health Review Checklist
196-197
DDS Annual Health Screening Recommedation 198
190
DDS Health Screening Recommendations

Wallchart
199-200
DDS Health Care Record
201-206
DPH Drug Incident Report
207
DDS HCSIS MOR Form
208-210
HCP Encounter Form
211
Annual Physical Examination Form
212
Observation Tool for Self-Administration
213-215
DDS Procedure for a Medical Appointment
216
Leave of Absence Form
217
DDS Health Care Providers Order Form
Massachusetts Department of Developmental Services

HEALTH CARE PRACTITIONER (HCP) ENCOUNTER FORM
To Be Completed by DDS Provider:
Name:
Date and Time of Appointment:

Name of Health Care Practitioner:
Allergies:
Reason for Visit/Symptoms:
The following section to be completed by health care practitioner.
Results/Diagnosis:
Tests/Treatment Ordered:
New Medications Ordered/Medication Order Change*:

Name
Dose
Frequency Route Reason Prescribed
Special Instructions
Follow-up for this problem:
Date/Time:
Follow-up for other problem(s) identified at this visit:

Explain:
Date/Time:
If vital signs are indicated, please give parameters and when to call the health care practitioner.
Health Care Practitioner signature*:________________________ Print name:

To be completed by DDS Provider:
Staff Follow-up:
Yes
No
N/A
Posted
Date
Provider Staff Signature
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Transcribed orders to med log

Time
Verified Date
Time
Communicated results of visit to co-workers/supervisor

Picked-up pharmacy/medication/treatment forms
Notified Day Program of any medication changes
Guardian/health care agent/family notified
Consultation arranged
Completed lab/X-ray
Date
Scheduled lab/X-ray
Date
Staff Signature (Person accompanying patient):___________________________________________

*DDS MAP regulations require physicians order in addition to prescription.
Encounter Form, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
FORM HC-3 v2
191
Agency:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Page Number:
Program Site:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Reason:
Date:
Date Last
Filled:
Strength:
DPH Registration #:
Controlled Substance Disposal Record Form

Date:
Date Last
Filled:
Strength:
Reason:
Reason:
Date:
Date Last
Filled:
Strength:
Rx Number:
Pharmacy:
Page Number:
Countable
Controlled
Substance
Book Number:
Supervisor:
Rx Number:
Pharmacy:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Supervisor:
Date:
Date Last
Filled:
Strength:
Reason:
Supervisor:
Pharmacy:
Rx Number:
Reason:
Date:
Date Last
Filled:
Strength:
Rx Number:
Pharmacy:
Page Number:
Countable
Controlled
Substance
Book Number:
Rx Number:
Pharmacy:
Supervisor:
Page Number:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Date:
Date Last
Filled:
Strength:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Reason:
Pharmacy:
Signatures:
Staff:
Rx Number:
Supervisor:
Page Number:
Supervisor:
Page Number:
Signatures:
Staff:
Item #:
Individuals
Name:
Medication:
Amount
Disposed:
Countable
Controlled
Substance
Book Number:
Signatures:
Staff:
Page #
Destruction of all prescription medications in Schedules II -VI that are either out-dated, spoiled or have not been administered due to a change in the prescription or a stop order shall be documented on the DPH
approved disposal record. According to regulations at 105CMR 700.003(f)(3)(c): Disposal occurs in the presence of at least two witnesses and in accordance with any policies at the Department of Public Health.
DPH policy requires disposal to occur in the presence of two Certified or licensed staff of which one of the two is supervisory staff. Failure to maintain complete and accurate records of drug destruction could result in
revocation of your Controlled Substance Registration. Disposal must render the medication unusable and must be in accordance with acceptable DPH disposal practices. Unless prohibited by local ordinance,
acceptable practices include, but are not limited to, flushing (flushing should be restricted to those medications so labeled), crushing the medication and/or dissolving in water put into a sealable bag and mixing with an
unpalatable substance (such as liquid soap, used coffee grounds, kitty litter). Mixture should then be put into an impermeable, non-descript container, (e.g., detergent bottle) and placed in trash. Medications are not
permitted to be returned to the pharmacy for destruction. Medications returned to the program site (e.g., LOAs) must be destroyed as per DPH regulation. They cannot be reused by the program.
9/01/10
192
!!
Department of Public Health

Medication Administration Program
MEDICATION OCCURRENCE REPORT (side one)
Agency Name
Date of Occurrence
Individuals Name
Time of Occurrence
Site Address (street)
Site Telephone No.
City/Town
DPH Registration No.
A)
1
2
3
Zip Code
Type Of Occurrence (As per regulation, contact MAP Consultant)

Wrong Individual
Wrong Medication (includes medication given without an order)
Wrong Time (includes a forgotten dose)
Medications(s) Involved
Medication Name
As Ordered:
4
5
Wrong Dose
Wrong Route
B)
Dosage
Frequency/Time
Route
As Given:
As Ordered:
As Given:
As Ordered:
As Given:
C)
MAP Consultant Contacted (Check all that apply)
Type
Name
Registered Nurse
Registered Pharmacist
Licensed Practitioner
Date Contacted
Time Contacted
D)
Hotline Events
Did any of the events below follow the occurrence?
Yes
No
If yes, check all that apply below, and within 24 hours of discovery fax this form to DPH (617) 524-8062 or call to notify DPH at
(617) 983-6782 and notify your DDS/DMH MAP Coordinator.
For All Occurrences, forward reports to your DMH/DDS MAP Coordinator within 7 days.
Medical Intervention (see Section E below)
Illness
Injury
Death
E)
MAP Consultants Recommended Action
Medical Intervention
Yes
No If Yes, Check all that apply.
Health Care Provider Visit
Lab Work or Other Tests
Emergency Room Visit
Hospitalization
Other: Please describe
F)
Supervisory Review/Follow-up
Contributing Factors: Check all that apply. If none apply, check none (7)
1
Failure to Properly Document Administration
4
2
Medication not Available (Explain Below)
5
3
Medication Administered by Non-Certified Staff
6
(includes instances of expired or revoked Certification)
7
Narrative: (If additional space is required, continue in box F-1)
Print Name
Print Title
Contact phone
number
E-mail
address
Clinic Visit
Medication Had Been Discontinued

Improperly Labeled by Pharmacy
Failure to Accurately Record and/or
Transcribe an Order
None
Date
Occurrence Reporting is required by regulation at 105CMR 700.003(F)(1)(f).

Consultant Contact is required by regulation at 105CMR 700.003(F)(1)(g)
193
MEDICATION OCCURRENCE REPORT FORM (side two)

Agency Name
Date of Occurrence
Individuals Name
Time of Occurrence
Site Address (street)
Site Telephone No.
City/Town
DPH Registration No.
Zip Code
F-1)
Supervisory Review/Follow-up [continued from section F)]
Use this section if needed for additional narrative.
Contact Information
Western Mass Area Office

Northampton State Hospital
P.O. Box 389
Northampton, MA 01061
Telephone Number:
(413) 587-6269
Fax Number:
(413) 587-6258
Central Mass Area Office

Worcester State Hospital
305 Belmont Street
Worcester, MA 01604
Telephone Number:
(508) 368-3519
Fax Number:
(508) 363-1508
DDS-Medication Administration
411 Waverly Oaks Road
Suite 304
Southeast Area Office

Learoyd Building
P.O. Box 4007
Taunton MA 02780
Telephone Number:
(508) 977-3456
Fax Number:
(508) 977-3231
Northeast Region
DDS Northeast Region
P.O. Box A
Hathorne, MA 01937
Telephone Number:
(978) 774-5000 ext. 354
Fax Number:
(978) 739-0425
Metro Boston Area Office

85 E. Newton Street
Boston, MA 02118
Telephone Number:
(617) 626-9269
Fax Number:
( 617) 626-9216
Southeast Region
Southeast Area Office DDS
68 North Main Street
Carver, MA 02330
Telephone Number:
(508) 866-8877
Fax Number:
(617) 727-7822
Northeast/Suburban Area Office

Quincy Mental Health Center
460 Quincy Ave
Quincy, Mass 02169
Telephone Number:
(617) 984 1078
Fax Number:
(617) 984 1040
Occurrence Reporting is required by regulation at 105CMR 700.003(F)(1)(f).

Consultant Contact is required by regulation at 105CMR 700.003(F)(1)(g)
194
DDS Regional MAP

Coordinators
Central/West Region DDS
Central/West Regional Office
140State
High Avenue
Street
171
Springfield,
MA
01105
Palmer MA
01069
Metro Region
Waltham, MA 02452
Contact Information
Telephone Number:
(413) 284-5055
Fax Number:
(413) 284-1516
Telephone Number:
(781) 314-7506
Fax Number:
(781) 314-7534
Contacts
DMH Area MAP Coordinators
DPH/DMH/DDS
Medication Administration Program Organizational Chart
Mary Rota, RN, BSN, MA
Clinical Reviewer
617.983.6720
Mary.Rota@massmail.state.ma.us
Department of Mental Health

Central Office
Walter Polesky, RN
617.626.8070
Walter.Polesky@massmail.state.ma.us
Department of
Developmental Services
Sharon Oxx, RN, CDDN
Health Services Director
617.624.7792
Sharon.Oxx@massmail.state.ma.us
Melissa Touadjine
Tel. 617.626.8074
Fax 617.626.8077
Melissa.Touadjine@massmailstate.ma.us
Robert Boyer
Robert.Boyer@massmail.state.ma.us
Central-West Area
Northampton State Hospital
P.O. Box 389
Northampton, MA 01061
Tel. 413.587.6269 Fax 413.587.6258
Carolyn Whittemore
Marie Brunelle
Marie.Brunelle@massmail.state.ma.us
Central-West Area
Worcester State Hospital
305 Belmont Street
Worcester, MA 01604
Tel. 508.368.3519 Fax 508.363.1508
Gina Hunt
Gina.Hunt@massmail.state.ma.us
DDS Northeast Region
P.O. Box A
Hathorne, MA 01937
Tel. 978.774.5000 ext. 354
Fax 978.739.0425
Lisa Kaliton
Lisa.Kaliton@massmail.state.ma.us
Metro-Southeast Area
Learoyd Building
P.O. Box 4007
Taunton MA 02780
Tel. 508.977.3456 Fax 508.977.3231
Southeast Area Office DDS

68 North Main Street
Carver, MA 02330
Tel. 508.866.5000
Rene Morin
Rene.Morin@massmail.state.us.ma
Metro- Southeast Area
85 E. Newton Street
Boston, MA 02118
Tel. 617.626.9269 Fax 617.626.9216
Carolyn.Whittemore@massmail.state.ma.us
DDS Central West Regional Office

140 High Street
Springfield, MA 01105
Tel. 413.284.5055 Fax 413.284.1516
Fax 617.727.7822
Noreen Egan
Noreen.Egan@massmail.state.ma.us
DDS Metro Region
411 Waverley Oaks Road Suite 304
Waltham, MA 02452
Tel. 781.314.7506
Fax 781.314.7534
Joanne Shea
Joanne.Shea@massmail.state.ma.us
Northeast-Suburban Area Office
40 Industrial Park Road
Plymouth, MA 02360
Tel. 508.746.3224 Fax 508.746.3224
195
HEALTH REVIEW CHECKLIST
To be used by clinical or support staff to record health-related information and to help communicate recent changes to a supervisor or
health care provider (HCP). Must be completed prior to annual physical and any visit to primary care physician (PCP).
NAME:_____________________________ DATE:______________ALLERGIES__________________________
FILLED OUT BY:________________________________HCP_________________________________________
Staff Name and Title
Health Care Provider
Health Status Indicators
**Highlight or circle changes in health status.

Any Yes, Dont know or Recent Change may indicate a need for further exploration
by the HCP.
No
Yes
Dont
know
Check if
recent
change
HABITS: Does this person:

1. smoke or use tobacco products?
2. drink alcohol?
3. avoid regular exercise?
SLEEP: Does this person:
1. have problems sleeping at night?
2. get up 2 or more times during the night to go to the bathroom?
3. fall asleep during the day?
EATING/WEIGHT: Has this person:
1. gained or lost more than 10 pounds in the past year?
2. ever choked while eating?
3. had trouble chewing or swallowing?
4. cough or had a change in their breathing during or after eating or
drinking?
5. ever been reluctant to eat or drink?
6. needed to change the texture of their food or drink?
CARDIAC: Does this person:
1. ever complain of chest, jaw or left arm pain?
2. have swollen feet or ankles?
3. ever have blue lips or nails?
RESPIRATORY: Does this person:
1. frequently cough or wheeze?
2. have shortness of breath when at rest?
3. have shortness of breath while exercising?
4. have frequent colds, pneumonia, sinus infections or bronchitis?
GASTROINTESTINAL: Does this person:
1. complain of or appear to have heartburn: rub chest, or burp
frequently?
2. vomit 2 or more times per week?
3. complain of or appear to have abdominal pain?
4. have a bowel movement less than 3 times per week?
5. frequently have 3 or more bowel movements per day?
6. seem to have difficulty moving their bowels?
7. ever have blood in their bowel movements?
NEUROLOGICAL: Does this person:
1. have a seizure disorder?
2. complain of headaches, loss of consciousness, or dizziness?
3. fall a lot or have difficulty with balance?
4. walk differently lately?
5. show a change in what their seizures look like?
Health Review Checklist, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
FORM HC 2
196
Required
Health Status Indicators
No
Yes
Dont
Know
Check if
recent
change
SKIN & NAILS: Does this person have:

1. dry skin?
2. any rashes, redness or open sores on their skin?
3. any unusual lumps or bumps on or under the skin?
4. any unusual marks or moles on the skin?
5. problems with fingernails or toenails?
6. any blisters or calluses on their feet?
MOUTH: Does this person:
1. have gums that bleed while brushing their teeth?
2. have any sores in their mouth?
3. grind their teeth?
4. have bad breath?
5. have swollen gums?
VISION/ HEARING: Does this person:
1. ever have redness or drainage from their eyes?
2. rub their eyes?
3. squint?
4. ever have drainage from their ears or earwax problems?
5. respond to sound differently lately?
6. wear a hearing aid or glasses?
MOBILITY: Does this person:
1. have trouble using stairs?
2. have trouble getting around the house?
3. have difficulty standing, sitting, or bending?
MUSCULOSKELETAL: Does this person:
1. complain of or appear to have joint or muscle pain or stiffness?
2. have a history of broken bones or osteoporosis (brittle bones)?
3. have any deformities of the feet?
4. wear special shoes?
GENITOURINARY: Does this person:
1. have trouble starting to urinate?
2. complain of pain or burning during or after urinating?
3. have urine that has an unusual color or bad odor?
4. have frequent bladder or kidney infections?
5. menstruate (have a period)?
6. experience pain or other behavior changes during their period
(menstruation)?
7. report a change in their menstrual cycle?
8. ever have any unusual vaginal bleeding or discharge?
9. ever bleed or have unusual discharge from their penis?
10. have any lumps or report pain in their groin?
11. engage in sex?
BEHAVIOR: Currently, does this person ever:
1. hurt himself/herself or others?
2. damage property?
3. appear unusually sad or depressed?
4. withdraw from others?
5. display moodiness or irritability?
6. eat nonfood items?
7. complain of pain?
8. have any recent history of personal losses or major life stressors?
9. display sexually inappropriate behavior?
10. run or wander away?
11. appear anxious (nervous, agitated, restless)?
12. appear forgetful?
13. repeat words and/or actions again and again?
Notes:
Health Review Checklist, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
FORM HC 2
Required
197
Massachusetts Department of Developmental Services Annual Health Screening Recommendations
Last date
screen
performed
Ask PCP to
evaluate need
for screening
All should be under an active vision care plan and eye

examination schedule based on recommendations from an
eye specialist (ophthalmologist or optometrist). Refer to
eye specialist for changes in vision/behavior. Annual eye
exam for diabetics.
Comprehensive eye examination by age 18-22. Follow up
eye exam every 2-3 years until age 39, every 1-2 years
thereafter. More frequent eye exams for higher risk
patients per vision care plan.
Screen annually. Re-evaluate if hearing problem reported
or change in behavior noted.
Vision and Hearing

Eye
Examination
Glaucoma
Assessment
Hearing
Assessment
Mental and Behavioral Health
Screen annually for sleep, appetite disturbance, weight

Depression
loss, general agitation.
Monitor for problems performing daily activities. In persons
Dementia
with Down Syndrome, annual screen after age 40.
Immunizations (in addition to routine childhood immunizations)
Once and booster every 10 years
Annually
Once (booster at age 65)
Once. Reevaluate antibody status every
5 years.
Tetanus-diphtheria (TdaP)
Influenza vaccine
Pneumococcal vaccine
Hepatitis B vaccine
Every 3 years (sensitive TSH)

Obtain baseline as adult. Recommend
repeat if symptomatic.
Baseline, if no records of cardiac function
are available.
Down Syndrome (in addition to above recommendations)

Thyroid function test
Cervical spine x-ray to rule
out atlanto-axial instability.
Echocardiogram
Prevention Counseling
General Counseling and Guidance

Abuse or neglect
Healthy Lifestyle
Last Date
Annually counsel regarding prevention of accidents related to

falls, fire/burns, choking.
Monitor for behavioral signs of abuse and neglect.
Annually counsel regarding diet/nutrition, incorporating
physical activity into daily routines, substance abuse.
As appropriate, including genetic counseling, folic acid
supplementation, discussion of parenting capability.
FORM HC-1
Revised February 2010
include tests recommended previously or by other clinicians that have not yet been performed)
Other Screening to be considered at this appointment: (List on reverse - may
Preconception counseling.
Ask PCP
Date: _______________
Based on Massachusetts Health Quality Partnership (MHQP) Adult Preventive Care Recommendations 2007/8
Name: ___________________________Age:______
Annually
Annually
This format is to assist individuals, families, and other support providers to ensure that screening tests that are appropriate to the individual are considered at the annual physical. Review BEFORE the annual health visit.
All Adults
Height/Weight Measurement
Clinical breast/testicular exam
Every 1-2 years after age 40, at discretion of
physician/patient. Earlier if family history. Recommend
annually after age 50.
For women with prior sexual activity,
every 1-3 years after age 21. May be omitted after age
65 if previous screenings were consistently normal.
Fecal Occult Blood Testing annually after age 50
Sigmoidoscopy every 5 years after age 50
Cancer Screening
Colorectal
Cancer screen
Colonoscopy Every 10 years after age 50, per MD
recommendation or if above screen not performed.
Digital rectal exam (DRE) should be considered patients
with risk factors after age 40 and in all men after age 50
PSA test at physicians discretion after age 50
Mammography
(Women)
Prostate
cancer screen
(Men)
Total skin examination every 3 years from 20 39.
Annually age 40 and older.
Pap Smear
(Women)
Skin cancer
screen
Annually
Every 5 years or at physician discretion.
Fasting plasma glucose screen for people at high risk.
At least every 5 years until age 45. Every 3 years after
age 45.
Test annually for Hepatitis B carriers
Bone density screening per risk factors of general
population. Additional risk factors include medications,
mobility impairment, hypothyroid.
Screen for swallowing problems and symptoms of
GERD annually.
Other Recommended Screening

Hypertension
Cholesterol
Diabetes
(Type II)
Liver function
Osteoporosis
Dysphagia and
Aspiration
Annually, if at risk
Periodic testing if at risk.
Periodic testing if at risk.
Skin testing every 1-2 years for individuals at risk
Infectious Disease Screening

Chlamydia and STDs
HIV
Hepatitis B and C
Tuberculosis
Annual Health Screening Recommendations, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
198
199
19-29 Years
30-39 Years
40-49 Years
50-64 Years
Updates to 2007 revision

65 Years +
Clinical breast exam and self examination

instruction as appropriate. Mammography
annually through age 69. Age 70+ at discretion
of clinician/patient.
May be omitted after age 65 if previous
screenings were consistently normal.
First pap smear and HPV test by at 3 years after first sexual intercourse or by age 21. Every 1-3 years, at clinician/patients discretion. When speculum testing is too
traumatizing consider annual HPV testing via vaginal swab (*note: MHQP states annually if under 30)
Starting at age 50, Fecal Occult Blood testing (FOBT) and Sigmoidoscopy every 5
Not routine except for patients at high risk. Risk factors include: diagnosis of a close relative; specific genetic syndromes;
years OR annual FOBT OR Colonoscopy every 10 years. Screening after age 80 at
inflammatory bowel disease and noncancerous polyps.
clinician/patient discretion.
Testing at clinician/patients discretion considering
Discuss risks and benefits of prostate cancer screening with specific antigen (PSA)
Prostate cancer screening not routine unless at high risk. Clinical
risks/benefits of prostate cancer screening with PSA
blood test and/or digital rectal exam (DRE) with patients starting at age 50. Testing at
testicular exam at clinicians discretion.
blood test and/or digital rectal exam (DRE) for patients
clinician/patients discretion.
with risk factors (family history or African-American
ancestry).
Periodic total skin examinations every 3 years between the ages of 20 and 39 and annually at age 40 and older, regardless of skin tone and color. Frequency at clinician discretion based on risk factors.
Clinical breast exam and self examination instruction as appropriate.

Mammography not routine except for patients at high risk. Accurate and
detailed history and family history will identify risk factors.
patients
Screen annually. Re-evaluate if hearing problem is reported or a change in behavior is noted
Massachusetts DDS Health Screening Recommendations Updated February 2010
(by ophthalmologist or
optometrist)
Hearing Assessment
Hypertension
Cholesterol
a healthy diet to maintain desirable weight for height. Offer more focused evaluation and intensive counseling for adults for BMI>30kg/m2 to promote sustained weight loss.
At every medical encounter and at least annually.
At clinicians discretion.
Every five years or at clinicians discretion.
Every 3 years after age 45. (HgbA1c or fasting plasma glucose) At least every 5 years until age 45 if at high risk. (obesity, family history of diabetes, low LDL cholesterol, high triglycerides, hypertension, sedentary ; and
Diabetes (Type 2)
for African-, Hispanic-, and Native-Americans, Asian).
Annually for Hepatitis B carriers. At clinicians discretion after consideration of risk factors including long term prescription medication.
Liver Function
Dysphagia & Aspiration Chronic Dysphagia and GERD are common in individuals with DD and neuromuscular dysfunction. Screen initially and inquire about changes at annual physical.
Cardiovascular Disease Screen for cardiovascular diseases and malformations earlier and more regularly than the general population. Specific syndromes and neuroleptic medications may increase risk for cardiac disease.2
Bone density screening (BMD) starting at age 19 when risk factors are present: long term polypharmacy, mobility impairments,
Provide BMD testing. Counsel elderly patients about specific measures to prevent
hypothyroid, post- menopausal women. Periodicity of screening at clinicians discretion. Annually counsel about preventive
Osteoporosis
falls.
measures including dietary calcium and vitamin D intake, weight-bearing exercise, and not smoking
ALL, including those with legal or total blindness, should be under an active vision care plan and eye examination schedule based on recommendations from an eye specialist ( ophthalmologist or optometrist.) Refer to eye
Eye Examination
specialist if new ocular signs and/or symptoms develop, including changes in vision/behavior. Annual comprehensive eye exam for patients with diabetes.
Glaucoma Assessment Comprehensive eye exam at least once by age 18-22. Follow up eye
Comprehensive eye exam every 1-2 years, with more frequent eye exams for higher risk patients.
exam every 2-3 years, with more frequent eye exams for higher risk
Skin cancer
Additional Recommended Screening
Body Mass Index (BMI) Screen for overweight and eating disorders. Consult the CDCs growth and BMI charts (www.cdc.gov/nccdphp/dnpa/bmi/index.htm). Ask about body image and diet patterns. Counsel on benefits of physical activity and
Testicular and Prostate

Cancer
Cervical Cancer (Pelvic

Exam & Pap Smear)
Colorectal Cancer
Cancer Screening
Breast Cancer:
Mammography
Clinical breast exam and self examination instruction as Clinical breast exam and self
appropriate. Annual mammography at discretion of
examination instruction as
clinician/patient.
appropriate. Annual mammography
administration of needed immunizations.

Promote dental health through regular oral hygiene practices, assessment by a dentist at least every 6 months, and timely management of dental disease.2
Labs and Screenings
Oral Health Visit
Health Maintenance Visit Annually for all ages. Includes initial/interval history, age-appropriate physical exam; height and weight measurement; preventive screenings and counseling; screening for ocular disease or injury; assessment and
Procedure
Massachusetts Department of Developmental Services Screening Recommendations 20091
Infectious Disease
Screening
Sexually Transmitted
Infections
HIV
Hepatitis B
Hepatitis C
Tuberculosis (TB)
Immunizations
Influenza
Pneumococcal
Hepatitis B
Hepatitis A
Tetanus, Diphtheria, Pertussis
(TdaP)
Measles, Mumps, and
Rubella (MMR)
HPV Vaccine**
Varicella (Chicken Pox)
Zoster (shingles) Vaccine**
19-29 Years
40-49 Years
50-64 Years
30-39 Years
Annually
65 Years +
Annually
Once, even if vaccinated before
For chlamydia and gonorrhea: Sexually active patients under age 25: Screen annually. Patients age 25 and over: Screen annually, if at risk. Screen pregnant women at the first prenatal visit and in the third trimester,
for all STIs if at risk.
Periodic testing if at risk and testing of pregnant women at increased risk.
Periodic testing if risk factors present.
Periodic testing of all patients at high risk. Risk factors include: illicit injection use; receipt of blood product for clotting problems before 1987 and/or receipt of a blood transfusion or solid organ transplant before July,
1992 (if not previously tested); long term kidney dialysis; evidence of liver disease; a tattoo or body piercing by nonsterile needle; risky sex practices.
Tuberculin skin testing every 1-2 years when risk factors present. Risk factors include residents or employees of congregate setting, close contact with persons known or suspected to have TB.
Annually
Annually
Annually
Once and a booster after 5 years if chronic renal failure; sickle cell disease or splenectomy; immunocompromised
Once. Reevaluate antibody status every 5 years.
If at high risk and not previously immunized. (2 doses)
3 doses if not previously immunized. Booster every 10 years.
Once after age 60, not for those with weak

immune systems.
If born after 1956 and have not been immunized or have laboratory evidence of immunity. Receive a second dose of measles-containing vaccine if at risk. Ages 50+: Not routine.
Three injections given over a 6-month period to females 9-26 yrs old.
2 doses recommended for those who do not have documentation of age-appropriate immunization or a reliable history of chicken pox (varicella)
Mental and Behavioral Health

Screen annually for sleep, appetite disturbance, weight loss, general agitation.
Depression
Monitor for problems performing daily activities.
In persons with Down Syndrome, annual screen after age 40.
Dementia
For persons with Down Syndrome (in addition to the above recommendations)
Every 3 years (sensitive TSH)
Thyroid function test
Obtain baseline as adult to rule out atlanto-axial instability. Recommend repeat if symptomatic, or 30 years from baseline.
Cervical spine x-ray
Obtain baseline if no records of cardiac function are available.
Echocardiogram
General Counseling and Guidance
Annually counsel regarding prevention of accidents related to falls, fire/burns, choking and screen for at-risk sexual behavior.
Prevention counseling
Annually monitor for behavioral signs of abuse and neglect.
Abuse or neglect
As appropriate, including genetic counseling, folic acid supplementation, discussion of parenting capability.
Preconception counseling
At an appropriate age, counsel women on the changes that occur at menopause and their options for the symptom management.
Menopause management
Annually counsel regarding diet/nutrition, incorporating regular physical activity into daily routines, substance abuse.
Healthy Lifestyle
Notes: 1
Based on review of the following primary guidelines/resources.
i.
Massachusetts Health Quality Partnership (MHQP) Adult Preventive Care Recommendations 2007/81 and
ii.
Consensus Guidelines for primary health care of adults with developmental disabilities, Canadian Family Physician, Vol.52 2006
iii.
US Preventive Services Task Force Guidelines
2 Items that are indicated in Large Bold are specific recommendations that differ from the MHQP recommendations in order to reflect particular health concerns of the population with intellectual disability.
3 Vaccines are recommended, but may not be covered by MassHealth or Medicare in all cases
Massachusetts DDS Health Screening Recommendations Updated February 2010
200
HEALTH RECORD
Massachusetts Department of Developmental
Services
(13) Likes to be called:
(3) Name:
(5) Gender:
(6) SSN:
(14) Religion:
Health Insurance (type & numbers)
(15A) Ins. #1:
(15B) #:
(16A) Ins. #2:
(16B) #:
(17A) Ins. #3:
(17B) #:
(18A) Ins. #4:
(18B) #:
(7) Address Line 1:

(8) Address Line 2:
(9) City:
(10) State:
(11) Zip:
(12) Telephone:
(19) Agency Responsible for Provider Care? No Yes (19A)
Name of agency/primary contact person
(20) Consent Status: Can give own consent

Consent from guardian
(20A) If Consent from Guardian, Guardian Name:
(2) Entered By: _______________________
(To be completed or updated at the ISP and brought to all new medical contacts)
BASIC INFORMATION
(4) D.O.B:
(1) Entry Date: ____________
(21) Resuscitation Status: DNR

Full Resuscitation
(19B) Tel. #:
Unable to give own consent and no guardian

(20B) Tel. #:
(21A) If DNR is comfort care available? Yes No Unknown
(22) Health Care Proxy: Yes No Unknown (22A) Name:
(22B) Tel.#:
(23) Additional Comment regarding the individuals medical condition or state:
CONTACTS EMERGENCY AND PHARMACY (Repeat 24A 24H for additional emergency/pharmacy contacts on separate sheet)
(24A) Type
Select One
Emergency
Pharmacy
Emergency
Pharmacy
Emergency
Pharmacy
Emergency
Pharmacy
MEDICATIONS LIST
(24B)
Name
(Repeat 25A 25E for additional

medications on separate sheet)
(25A)
Medication Name
(24C)
Street Address
(24D)
City
Frequency Options:
x 4 x day
x 1 x day
x Once every other day
x 2 x day
x 1 x week
x 3 x day
(25B) Reason for Prescription

See Dictionary #1
(24E)
State
(24F)
Zip
x 2 x week
x Once every 28 days
x Every 2 Months
(25C) Frequency
Select one from above
(24G)
Telephone
x Every 3 Months
x Every 6 Months
x Annually
(25D)
Date Started
(24H)
Fax
x PRN
x Unknown
(25E)
Date Stopped
ALLERGIES (Repeat 26A 26C for additional allergies on separate sheet)

(26A)
Type
Food Medication
Environmental
Insects Other
Food Medication
Environmental
Insects Other
Food Medication
Environmental
Version: hcsis_hcr_form
(26B)
To What?
(26C)
Type of Reaction
Page 1 of 6
201
Individuals Name:
Insects Other
202
Page 2 of 6
Individuals Name:
CURRENT MEDICAL PROBLEMS AND DIAGNOSES (Select all that apply)
(27) Neurologic:
Cerebral Palsy
Epilepsy / Seizure Disorder
(28) Cardiovascular:
Coronary Artery Disease
(29) Respiratory:
Pneumonia
Congestive Heart Failure
Asthma
(30) Gastrointestinal:
GERD
Dysphagia
COPD
Osteoporosis
Renal Insufficiency / Failure
Lung Cancer
Prostate Cancer
Stomach Cancer
Urinary Retention
(34) Metabolic/Endocrine:
Diabetes
Hyperlipidemia
Autistic Disorder
Down Syndrome
Prader-Willi
Angelman syndrome
Aspiration
Recurrent Infection
Other - If Other, specify:
Anxiety disorder Generalized Anxiety

Anxiety disorder - OCD
Anxiety disorder - Panic
Disorder/agoraphobia
Anxiety disorder - PTSD
Dementia related disorders
Liver Cancer
Blood Cancer
Breast Cancer
Hyperthyroidism
Brain Cancer
Other
If Other, specify:
Hypothyroidism
Cornelia DeLange syndrome

Fetal Alcohol Syndrome
Fragile X
Phenylketonuria (PKU)
(36) Psychiatric:
Colon Cancer
Esophageal Cancer
Pancreatic Cancer
(35) Syndromes:
(32) Kidney/Urinary:
(33) Cancer/Neoplasm:
Hypertension
Recurrent Infection
Constipation
(31) Musculoskeletal:
Arthritis
Alzheimer's Disease
Rett Syndrome
Smith-Magenis syndrome
Tuberous Sclerosis
Turner's Syndrome
Impulse Control Disorder

Mental disorder due to medical problem
- related to seizure disorder
- related to medication side effects
Mood disorder - Bipolar disorder
Mood disorder - Depressive disorder
Velocardiofacial Syndrome (DiGeorge)

Williams Syndrome
Other
If Other, specify:
Personality Disorder - Antisocial

Personality Disorder - Borderline
Personality Disorder - Paranoid
Schizophrenia and thought
disorders
Psychotic Disorder not otherwise
specified
Sexual disorders
Substance use disorder
Other
If Other, specify:
(37) General Medical Problems:
FUNCTIONAL STATUS (Select all that apply)

(38) Communication:
Able to Communicate Communication Difficulties/Uses Verbalizations
Communication Difficulties/Uses Gestures Not Able to Communicate Needs
Unable to Use Call Bell
Unknown
Only speaks/understands foreign language
(39) Vision:
Normal
Low Vision
(40) Supportive Devices:

Padded side rails Splints
(41) Hearing:
Normal
(42) Toileting Ability:
Braces
Continent
Regular
Deaf
Other ____________________ Unknown
Needs Assistance
Ground
None
Unknown
Incontinent
Totally Dependent
Chopped
Unknown
Hearing Aid
Independent/Self Medicates
Needs Assistance
(45) Diet Texture:
Wears Glasses
Helmet
Hard of Hearing
(43) Medication Administration:

(44) Dining/Eating:
Independent
Blind
Catheterized
Other
Unknown
Medication Administered by Staff
Unknown
Fed Through a Tube
Unknown
Puree
Thicken Liquid
Other
Unknown
(46) Diet Type:

(47) Ambulation:
Independent-Steady Independent-Unsteady Needs Assistance-1 person Needs Assistance-2 people or more
Ambulation Aids - Walker Ambulation Aids - Cane Ambulation Aids - Crutches Ambulation Aids - Wheelchair
Non-Ambulatory Unknown Other: _______________________
(47A) If wheelchair: Owns own wheelchair? (47B) Date wheelchair acquired:
(48) Personal Hygiene:
(49) Oral Hygiene:
Independent
Independent
(50) Head of Bed Elevated:
Yes
Unknown
Unknown
No
(51) Any previous problems with anesthesia?:

(51A) If yes, explain:
Special Needs
Special Needs
Yes
No
Page 3 of 6
203
Individuals Name:
SPECIAL NEEDS (Select one)
(52) Usual response to Medical Exams: Cooperates Partially Cooperates Resistant Fearful Unknown
(53) Sedation for clinical visits: Yes No Unknown
(53B) If Yes, type of sedation used:
(53A) If Yes, what type of clinical visits:
(54) Special positioning required for examination: Yes No Unknown (54A) If Yes, Explain:
(55) Double staffing required for assistance with exams: Yes No Unknown (55A) If Yes, Explain:
(56) Requires limited waiting periods for exams: Yes No Unknown
(57) Appointment Schedule Preference: Early day
End of day Unknown
(58) Special communication device/method: Yes No Unknown

(59) Pain Response: Normal
Unique Unknown
(60) Signs of Discomfort: Yes
No
No Preference
(58A) If Yes, (Explain):
(59A) If Unique, Explain:
Unknown (60A) If Yes, Explain:
CONTACTS - HEALTHCARE PROVIDERS (Repeat 61A 61H for additional healthcare providers contacts on separate sheet)
(61B)
Name
(61C)
Street Address
(61D)
City
(61E)
State
(61F)
Zip
(61G)
Telephone
(61H)
Fax
DEMOGRAPHICS
(62) Living Status:
(Select one)
Group Home Own Family Independent

Other _________________________
(63) Marital Status (Select one):
Single
Married
Home Sharing/Shared Home
Other-Widow
Divorced
Legally Separated
(64) Work/Day Program Status: (Select all that apply)

Community Day Support Day Habilitation
Regular job
Sheltered
(65) Nursing Supports available: (Select all that apply)

In home less than 24 hr In home 24 hr
At Day Program
No Nursing Supports
Healthcare Coordination
Unknown
VNA services may be available
Unknown
IMMUNIZATIONS / TB TESTING
(66) Date of most recent TETANUS:
Administered
Unknown
Allergic
Never
(67) Date of most recent FLU SHOT:
Administered
Unknown
Allergic
Never
(68) Date of most recent PNEUMOVAX:
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
Administered
Unknown
Allergic
Never
(69) Dates of HEPATITIS B VACCINE:

(69A) Primary Series (last administered):
Series Complete
(69B) Booster:
(70) Dates most recent MEASLES/MUMPS/RUBELLA (MMR):
(71) List any other vaccinations and dates (e.g., Lyme Hepatitis A, Varicella, etc.):
Tuberculosis Skin Test (PPD):
(72) Has the individual ever had a positive skin test for tuberculosis?
(72A) If Yes, was any treatment given?
Yes
No
Yes
No
Unknown
Unknown
(72B) If Yes, please describe. If No, please explain why treatment was not given:
(73) Date of last PPD:
(73A) If unknown, explain:
204
Page 4 of 6
(61A)
Type/Specialty
Individuals Name:
PAST MEDICAL HISTORY DDS RELEASE CONTACT
(74) Medical History not released by parent/guardian
For information, contact: (Repeat 74A 74G for additional contacts on separate sheet)
(74A)
Name
(74B)
Relationship
(74C)
Street Address
(74D)
City
(74E)
State
(74F)
Zip
(74G)
Telephone
PAST MEDICAL HISTORY SURGICAL, TRAUMA AND HOSPITALIZATIONS

(Repeat 75A 75E for additional events on separate sheet)
(75B)
Type of
Hospitalization
(75A)
Type of Event
(Select one)
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
Broken Bones
Serious Trauma
Other
Medical
Surgical
Psychiatric
(75C)
Hospital Name
(75D)
Description of Event
(75E)
Date/Year
of Event
PAST MEDICAL HISTORY GYNECOLOGIC (women only)

(76) Age menstruation started (women only):
(77) Still menstruating: Yes No
Unknown
(77A) If No, age menstruation stopped:
(78) Has individual ever given birth to a child?
Yes
Unknown
No Unknown
(79) Gynecological exam status: Administered Date:

(80) PAP Smear Status: Administered Date:
Never conducted
Never conducted
Unknown
Unknown
(81) Any history of abnormal PAP smear? Yes No (81A) If Yes, please describe:
(82) Mammogram Status: Administered Date:
Never conducted
PAST MEDICAL HISTORY MEDICAL AND PSYCHIATRIC

(83) Neurologic:
Unknown
(Select all that apply)
(84) Cardiovascular:
(85) Respiratory:
Pneumonia
(86) Gastrointestinal:
GERD
Aspiration
Dysphagia

Constipation
(87) Musculoskeletal: Other - If Other, specify:

(88) Kidney/Urinary:
Renal Insufficiency / Failure
(89) Cancer/Neoplasm:
Lung Cancer
Prostate Cancer
Stomach Cancer
Colon Cancer
Esophageal Cancer
Pancreatic Cancer
(90) Metabolic/Endocrine:
Diabetes
Hyperlipidemia
(91) Psychiatric:
Anxiety disorder Generalized Anxiety

Anxiety disorder - OCD
Anxiety disorder - Panic
Disorder/agoraphobia
Anxiety disorder - PTSD
Dementia related disorders
Hyperthyroidism
Urinary Retention
Liver Cancer
Blood Cancer
Breast Cancer
Hypothyroidism
Impulse Control Disorder

- related to seizure disorder
- related to medication side effects
Mood disorder - Bipolar disorder
Mood disorder - Depressive disorder
Recurrent Infection
Brain Cancer

Personality Disorder - Antisocial
Personality Disorder - Borderline
Personality Disorder - Paranoid
Schizophrenia and thought
disorders
Psychotic Disorder not otherwise
specified
Sexual disorders
Substance use disorder
Other
If Other, specify:
Page 5 of 6
205
Individuals Name:
PAST MEDICAL HISTORY EVALUATIONS
(92) AUDIOLOGICAL EXAM Status:
Administered Date:
Never
Unknown
(93) EYE EXAM Status:
Administered Date:
Never
Unknown
(94) DENTAL EXAM Status:
Administered Date:
Never
Unknown
(95) PHYSICAL EXAM Status:
Administered Date:
Never
Unknown
(96) BONE DENSITOMETRY (bone thickness) Status: Administered Date:
Never
Unknown
(97) SIGMOIDOSCOPY or COLONSCOPY Status:
Administered Date:
Never
Unknown
(98) PSA (prostate cancer screening) Status:
Administered Date:
Never
Unknown
FAMILY HISTORY (Part 1)

(99) FATHER - Is Biological Father Known?
(100) If yes, deceased?
Yes
No
Yes
No
Unknown
(103) List all brothers and sisters with information about their
age and health:
(100B) If Deceased, cause of death:

(100C) If Not Deceased, year of birth:
(101) MOTHER - Is Biological Mother Known?
(102) If yes, deceased?
Yes
No
Yes
No
Unknown
(102A) If Deceased, age at death:

(102B) If Deceased, cause of death:
(102C) If Not Deceased, year of birth:
FAMILY HISTORY (Part 2)

Is there any family history of:
(104) DIABETES:
Yes No Unknown
(108) HIGH BLOOD PRESSURE: Yes No Unknown
(105) HIGH CHOLESTEROL: Yes No Unknown
(109) HEART DISEASE:
Yes No Unknown
(106) OSTEOPOROSIS:
Yes No Unknown
(110) COLON POLYPS:
Yes No Unknown
(107) CANCER:
Yes No Unknown
(107A) If Yes, what Type:

(111) Are there any other diseases that run in the family? Yes No Unknown
(111A) If yes, explain:
(112) Has there been any genetic counseling in the family? Yes No Unknown
(112A) If yes, what were the results?
206
Page 6 of 6
(100A) If Deceased, age at death:

Drug Control Program
Drug Incident Report
Pursuant to the Departments regulations at 105 CMR 700.005(D), registrants are required to report the loss of any controlled
substances upon discovery. When a drug loss of discovered, kindly fill out this incident report and fax it to the Drug Control Program
(617-524-8062) within twenty fours hours of discovery. Should you have questions or need to contact us, please see our website at
www.mass.gov/dph/dcp or call 617-983-6700.
Date of Report
Report Prepared By
Title
Contacts Phone Number
Contacts e-mail
Facility Information
Facility Name ______________________________________________________________________________________
Address ___________________________________________________________________________________________
City_______________________________________________
Zip Code ______________________________________
Facility Type
Hospital
Long Term Care
Clinic
MAP (DDS)
MAP (DMH)
Prison/House of Correction/Jail
School
Other (Please Specify) _______________________________________________________________
Date of Loss
Incident Type
Diversion
Ambulance
Manufacturer/Distributor
Practitioners Office
Specific location of loss (unit, floor, etc., if applicable)
Loss
Theft
Tampering
Documentation
Other (Please Specify) _________________________________________________________________________________
Drug (use additional sheets if needed)
Quantity
Strength
Dosage Form
__________________________________
_____________________
_____________________
_____________________
__________________________________
_____________________
_____________________
_____________________
__________________________________
_____________________
_____________________
_____________________
Narrative (Please explain what happened, what factors may have contributed to loss, and any other relevant information.
Please indicate if patient harm was involved. Please use additional sheets if necessary.)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
For office use only
Received by Drug Unit
Drug Incident Report
Staff initials
Intake number
Date facility contacted
R20120209-01
207
MEDICATION OCCURRENCES
Department of Developmental Services
*Individual: First Name:
Page 1 of 3
v.04212009
*Last Name:
(* = Required Field)
*(1) Reporting Provider:

*(2) Responsible Site:
*(3) Responsible Site Phone Number:
*(4) Staff Responsible for MOR Follow-up:
(4A) First Name:
(4B) Last Name:
*(5) What Happened? Choose from the following:

(Omission, Wrong individual, Wrong time, Wrong medication, Wrong route, Wrong dose)
* (7) Time:
*(8) Date of Medication Occurrence:
* (9) Time:
*(10) Did the Medication Occurrence Happen Over Multiple Consecutive Administrations?
YES
NO
*(11) If Yes in #10, over what number of doses did the medication occurrence happen?
*(12) Staff Position of Person Giving Medication: Choose from Dictionary #1
*(13) Medication Occurrence: Choose from Dictionary #2
*(14) MAP Consultants Title:
Registered Nurse
*(15) MAP Consultant Contacted:

(15A) First Name:
Yes
No
*(16) Date Consultant Contacted:
Clinic Visit
Health Care Provider (HCP)
(15B) Last Name:

*(17) Time Consultant Contacted:
*(18) Was Medical Intervention Recommended?

(19) If Yes in 18, Check All That Apply:
Lab Work
Other Tests
Registered Pharmacist
YES
NO
Health Care Provider (HCP) Visit
Emergency Room Visit
Hospitalization
*(20) Did any of the following situations or conditions result from the medication occurrence (Check All That Apply)?
Illness
Injury
Death
YES
NO
(21) Was DPH Notified?
According to MAP Policy, DPH must be notified if any medical intervention occurred as a result of the medication
occurrence. Such medication occurrences are called HOTLINES. Answering Yes to Question
# 18 and selecting
any of the choices in Question #20 requires that DPH be notified immediately. Submit HOTLINES within 24 hours of
discovery.
(22) Date DPH was Notified:
208
(23) Time:
*(6) Date of Discovery:
Individual: First Name:
Page 2 of 3
Last Name:
*(24) Was an Incident Report Filed as a Result of the Medication Occurrence?
YES
NO
(25) If Yes in 24, Fill in Incident Number, if known:

*(26) What is the agencys response to prevent this type of occurrence from happening in the future?
Choose from Dictionary #3
(27) Additional Comments (Also use if Other is selected in #26):
*(28) Name of Medication(s) as Ordered:
(29) Dosage:
(30) Frequency/Time:
(31) Route

*(32) Name of Medication(s) as Given:
(33) Dosage:
(34) Frequency/Time:
(35) Route
*(36) Number of medications supposed to be given at same time as the medication occurrence including the medication(s)
involved in the medication occurrence (check one): 0
(0, 1, 2, 3, 4, 5, 6-10, 11-15)
*(37) Was there a recent change in the medication order for the medication(s) involved in the MOR?
YES
NO
(38) If Yes in #37, date of medication order change:

*(39) Can this medication occurrence be connected to a single staff person?
YES
NO
(40) If Yes in #39, (40A) Staff Person First Name:

OPTIONAL
(40B) Staff Person Last Name:
(41) If Yes in #39, is the staff person a regular staff member? (Select one)
YES
NO, Contracted Relief Staff
NO, Agency Relief Staff
(42) If Yes in #39, does this person regularly administer medications as part of their routine responsibility?
YES
NO
(43) Was the person who caused the medication occurrence working their regular shift?
YES
NO Different Shift
NO Overtime Shift
(44) Was the person who caused the medication occurrence working at their routine site?
YES
NO
SUBMIT MOR TO MAP COORDINATOR WITHIN 7 BUSINESS DAYS OF DISCOVERY
209
Individual: First Name:
Page 3 of 3
Last Name:
MAP COORDINATOR REVIEW

*(45) Review Status:
Approved
*(46) Reason for Non-Approval:
Not Approved
Referred to Provider for follow-up
Other
(47) If Other in #46, explain:

(48) Comments/Recommendations:
210

HEALTH CARE PRACTITIONER (HCP) ENCOUNTER FORM
To Be Completed by DDS Provider:
Name:
Date and Time of Appointment:

Name of Health Care Practitioner:
Allergies:
Reason for Visit/Symptoms:
The following section to be completed by health care practitioner.
Results/Diagnosis:
Tests/Treatment Ordered:
New Medications Ordered/Medication Order Change*:

Name
Dose
Frequency Route Reason Prescribed
Follow-up for this problem:
Date/Time:
Follow-up for other problem(s) identified at this visit:

Explain:
Date/Time:
If vital signs are indicated, please give parameters and when to call the health care practitioner.
Health Care Practitioner signature*:________________________ Print name:

To be completed by DDS Provider:
Staff Follow-up:
Yes
No
N/A
Posted
Date
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Transcribed orders to med log

Time
Verified Date
Time
Communicated results of visit to co-workers/supervisor

Picked-up pharmacy/medication/treatment forms
Notified Day Program of any medication changes
Guardian/health care agent/family notified
Consultation arranged
Completed lab/X-ray
Date
Scheduled lab/X-ray
Date
Staff Signature (Person accompanying patient):___________________________________________

*DDS MAP regulations require physicians order in addition to prescription.
Encounter Form, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
FORM HC-3 v2
211
ANNUAL PHYSICAL EXAMINATION FORM

Name:
Vital Signs:
Date:
Ht
Wt
Tq
BP
General Appearance:
Skin:
HEENT:
Head
Eyes/Vision Screen
Ears/Hearing Screen
Mouth/Throat
Neck:
Chest:
Breast:
Heart:
Lungs:
Abdomen:
Genitalia:
GYN/Testicular Exam
Rectum:
Musculoskeletal:
Back/Spine
Extremities
Lymph Nodes:
Circulatory:
Neurologic:
Cranial Nerves
Reflexes
Sensory
Motor
Cognitive
Other:
HC Provider Signature:
MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
212
FORM HC-4 v2
Observation Tool For Self-Administration

Date of
Observation:
Individuals Name:
Place Number of Response on line provided.

A
Cognitive Skills
0
Unable to follow directions.
1
2
3
Follows simple directions with 1 step prompting and encouragement.

Follows complex directions with 2 step prompting and encouragement.
Independent with complex directions.
Fine Motor Coordination

0
1
2
3
No functional use of hand.

Functional use of hands but has interfering factors (e.g., tremors)
Has use of hand but no pincer grasp (i.e., hold an object between thumb and
forefinger).
Able to pick up and/or manipulate small objects.
Feeding
0
1
2
3
D
Unable to feed self.

Requires assistance at each meal.
Requires verbal prompting and encouragement.
Fully independent.
Behaviors
0
1
2
3
E
Chronically unstable or displays pica behavior (i.e., craving to ingest any

material not fit for food).
Episodes of unstable behavior.
Stable with support staff.
Reacts typically to daily life events.
Vision
0
1
2
3
F
Totally blind with no compensation from other senses.

Legally blind with residual sight or augments vision with other senses.
Slight impairment (effects on abilities is minimal).
Normal vision with/without glasses.
Communication
0
1
2
3
G
Unable to communicate basic wants and needs.

Effective communication is limited by constraints (emotional, physical, or
intellectual).
Communicates but requires clarification.
Communicates clearly.
Colors
0
1
2
3
Unable to recognize differences in color.

Able to match colors with samples.
Inconsistently identifies colors.
Consistently identifies and states colors.

213
1
2
3
Able to match colors with samples.

Inconsistently identifies colors.
Consistently identifies and states colors.

Page Two
Date of
Observation:
Individuals Name:

H
Shapes
0
1
2
3
Numbers
Has no concept of the meaning of numbers.

Inconsistent awareness of number concepts.
Understands number concepts and identifies numerals.
Understands number concepts and identifies and writes numerals.
Time
0
1
2
3
K
Has no apparent concept of time.

Inconsistent awareness of time.
Ability to tell time by major daily events.
Ability to tell time by clock or watch.
Letters/Name
0
1
2
3
L
Cannot identify any letters.

Identifies isolated letters.
Recognizes written name.
Writes name.
Medication
0
1
2
3
M
Requires special techniques/total assistance to take medications.

Refuses medications frequently.
Takes medication with encouragement.
Always takes medication well.
Medication Recognition
0
1
2
3
Unable to name or identify current medications.

Able to say names of current medications, but not able to identify specific pill
bottle or medication card.
Able to identify medication by name, pill bottle, and dosage with minimal
prompting.
Able to identify medications by name, pill bottle, dosage, and reason for taking
without prompting.
Side effects
0
1
2
3
Unable to identify/understand possible side effects of current medications.

Can identify one side effect, but not how to respond to side effect.
Identifies one or more side effects to specific medications and how to respond to
side effects after training.
Identifies side effects to specific medications and how to respond to side effects
after training.

Administering Medications the Right
WayThree
Page
0
1
2
3
214
Unable to recognize differences in shapes.

Able to match shapes with samples.
Inconsistently identifies shapes.
Consistently identifies shapes.
2
3
Identifies one or more side effects to specific medications and how to respond to
side effects after training.
Identifies side effects to specific medications and how to respond to side effects
after training.

Page Three
Date of
Observation:
Individuals Name:

O
Ability to reorder
0
1
2
Unable to identify when it is time to reorder.

Does not reorder medications or seek assistance to reorder until after medication
supply is depleted.
Seeks assistance to reorder medication before medication supply is depleted.
Can reorder by phone with staff assistance.
Calls and reorders medications independently before medication supply is
depleted.
Total score
Add up the number responses (Lines A-O) for the total Score.
Average
Score
Divide result of Total Score by 15 for the Average Score.
If Average Score is:
Less than 1.7

Greater than
1.7
Individual is not appropriate to learn to self-administer at this time.
Individual is appropriate to learn to self-administer to the full extent of

his/her ability.
Based on this Observation Evaluation Tool, I have determined that the Individual named below appears to be appropriate to
learn to self-administer medications.
Staff Persons Printed
Name
Individuals Printed
Name
Staff Persons
Signature
Date
Based on this Observation Evaluation Tool, I have determined that the individual named below does not appear to be
appropriate to learn to self-administer medications at this time because:
Staff Persons Printed

Name
Individuals Printed
Name
Staff Persons
Signature
Date
As the above named individuals Health Care Provider, I concur that this individual demonstrated the ability to self-administer.
Health Care Provider
Printed Name
HCPs Phone Number
HCPs Signature
Date
215
PROCEDURE FOR A MEDICAL APPOINTMENT

Name:
1.
PREPARE THE PERSON FOR THE APPOINTMENT

A. Discuss what is going to happen at the visit
B. Follow any instructions to medically prepare for the visit (for example, pre-medications,
fasting, wearing loose and comfortable clothing, need for accommodation for a wheelchair).
C. Bring items to keep the person occupied, money for a drink or food.
2.
BEFORE YOU LEAVE, MAKE SURE YOU HAVE THE FOLLOWING:
3.
WHEN YOU GET TO THE APPOINTMENT, DO THE FOLLOWING:

A. First, check in with the receptionist and introduce yourself and the person you are
accompanying.
B. State the reason that you are there and any problems the person is having. If the person can
speak about their health, encourage and assist him/her to do so.
C. Discuss any accommodations the person may need in the waiting room.
4.
DURING THE APPOINTMENT, HELP THE PERSON AND HEALTH CARE PROFESSIONAL
If needed, assist the individual during the appointment. Provide information to the health care professional
when asked and/or help the individual to answer questions. If you do not know the answers to the questions,
refer the health care professional to the other contact people on the Health Record
5. OBTAIN THE WRITTEN RESULTS OF THE APPOINTMENT AND THE WRITTEN

RECOMMENDATIONS:
A. Obtain completed Annual Physical form and Encounter Form and make sure that the
HCPs portion of the form is filled-out. Write down any information that is given to you
that is not on the forms.
B. Pick up any prescriptions.
C. Please remember to get signed doctors orders for all prescriptions and treatments.
D. Set-up another appointment with the receptionist if needed.
6. BRING BACK ALL FORMS, ANY PRESCRIPTIONS, DOCTORS ORDERS, AND THE
APPOINTMENT CARD TO THE APPROPRIATE PERSON.
If going to the Emergency Room (Hospital)

x Take the persons Medication Records, Insurance Card, Health Record and Encounter
x
x
form.
Be prepared to tell Emergency Room staff why you are bringing the person to the ER.
If you have any concerns about taking the person home (or to work/day program) after
the visit, tell the emergency room staff and contact your supervisor before leaving the
hospital.
Procedure for Medical Appointment v2, MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES
216
A. Persons insurance card

B. Copy of current medication sheets/medication administration record
C. The following forms depending on the purpose of the appointment:
Health Record
Health Care Practitioner Encounter Form
Annual Physical Form / Annual Health Screening Recommendations
Health Review Checklist
D. Directions to the appointment and money for parking
E. Agency on-call information (in case you need to contact someone else in the agency) and
Family/Guardian information
F. Name of the pharmacy, telephone number and directions
LEAVE OF ABSENCE
Name: ________________________Allergies: _________________________
Date of Departure: ______________ Expected Date of Return: ____________
Destination: _____________________________________________________
Medication
Strength
Amount
___________________________
Staff who prepared medications
Frequency
Route
# of
Pills
__________________________
Staff who checked medications
To whom are medications entrusted:_______________________

I understand the above information regarding medication and its administration.
My questions have been answered. I understand I may call the staff if any
further questions arise.
_______________________________
Person entrusted with medication/Date
_______________________________
Staff signature and date
Program: _______________________ Address:________________________
Phone: _________________________ Fax: ___________________________
217
Agency Scavenger Hunt

Use this tool to locate items relating to administering medications
at your agency.
Place a check next to the items found.
Medication Occurrence
Report Forms
Communication Book
Medication Progress Notes
Controlled Substance
Disposal Record
Telephone / Fax Order Forms
Leave of Absence Form
Other

Emergency Telephone Numbers
Local Poison Control Number
Supervisor Contact Information
____
MAP Consultant Contact Information
218
Medication Storage Area

Medication Book
HCP Visit Forms
Medication Sheets
Countable Substance Book
Count Sheet
Index Sheet
Shift Count
Agency, Policy & Procedure Manual
Bibliography
American Pharmacists Association. Avoiding Medication Occurrences.
http://www.pharmacyandyou.org/about medicine.med.html.
Board of Registration in Nursing. Advisory ruling.
http://www.state.ma.us/reg/boards/rn/advrul/ruldmr.htm.
Brynes G. Why does my medication give me so many side effects?
http://www.ncpamd.com/side effects.htm.
Casey-Mederios M. How to be a nurse assistant. Washington DC: AHCA; 2003.

CDC. Developmental disabilities. http://www.cdc.gov/ncbddd/dd.
Commonwealth of Massachusetts, Department of Public Health. Department of Mental
Health and Department of Mental Retardation medication administration program
policy manual. January 1, 2005. http://www.mass.gov/dph/dcp/dcp99map.pdf.
Commonwealth of Massachusetts, Department of Public Health. Department of Mental
Health and Department of Mental Retardation medication administration program
training manual. June 14, 1999, March 29, 2001.
Commonwealth of Pennsylvania. Pennsylvania code adult training facilities.
February 27, 1993.
Commonwealth of Pennsylvania. Pennsylvania code chapter 6400. Community homes
for individuals with mental retardation. Harrisburg, PA; August 15, 1998.
Direct Care Association. May 22, 2003. http://www.tusconhealthlinks.com/dca2.htm.
Easter Seals. Myths and facts about people with disabilities.
http://www.easterseals.org/pageserver?pagename=html_myths facts.
Easter Seals. Understanding medical rehabilitation.
http://www.easter-seals.org/site/pageserver.
Giving medications. 1st ed. Springhouse, PA: Springhouse Corporation; 1996.
Glazer G. Nursing World/OJIN Legislative Column. Medication administration
interventions that must be performed by a nurse. February 28, 2002.
Hardt P. What can I do about eating and swallowing difficulties? July 13, 2000.
http://www.hdfaq025.html.
Health Square. Drugs and medicines safe use.
http://www.healthsquare.com/drugmain.htm.
Huntingtons Disease Association. Eating and swallowing difficulties.
http://www.members.aol.com/hdanwlancs/fact sheet 6.html.
Illinois Nurses Association. INA testifies on proposed rules for medications.
http://www.illinoisnurses.org/testifies.html.
Bibliography
219
Institute for Safe Medication Practices. Medication occurrences.

http://www.ismp.org/pages/ismp_faq.html.
King LA. Drug toxicity index. Med Sci Law. 1993.
http://www.suicidemethods.net/tables/toxindex.htm.
Medline Plus. Aicardi syndrome.
http://www.nlm.nih.gov/medlineplus/ency/article/001664.htm.
Medline Plus Health Information. Swallowing difficulty. April 17, 2003.
http://www.nlm.nih.gov/Medline plus/ency/artcle/002115.htm.
Michigan Nurses Association. Guidelines for the administrators of medications in
Michigan assisted living facilities. May 17, 2003.
http://www.minurses.org/prac/medguidelineinALHF/whoadmins.shtml.
Region of Peel. Using medications safety. May 2003.

http://www.region.peel.on.ca/health/commonhlth/meds/medintr.htm.
Robusto L. How to administer medications. May 23, 2003.
http://www.nursingabout.com/c/ht/00/07/How_Administer_
medications0962934404.htm.
Safe Medications.com. Medications and you. May 2003.
http://www.safemedication.com/meds/medsafety.cfm.
Searle J. Eating and swallowing.
http://www.kumc.edu/hospital/huntingtons/swallowing.htnl,2003.
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation
and Treatment of Blood Pressure. 2003.
Simpson C, Hall P. Rx reading and following the directions for all kinds of medications.
1st ed. New York: The Rosen Publishing Group; 1994.
Tyme J. Hints for working with people with developmental disabilities.
http://www. ideasandtraining.com/disabilities.com/disability.tips.html.
U.S. Department of Health and Human Services. Performance standard. October 3, 2001.
http://www.acf.hhs.gov/programs/hsb/perfomance/130422PS.htm.
U.S. Food and Drug Administration. My medicines. March 30, 2000.
http://www.fda.gov/womens/takemetocare/meds.Eng.html.
U.S. Food and Drug Administration. Medication occurrences.
http://www.fda.gov/cder/drug/mederrors/default.htm.
Web MD Health. Bisacodyl. August 2, 2003.
http://www.mywebmd.com/search/search_results?query=biscodyl&filyer=myweb
md_all_filter.
Web MD Health. Dysphagia. May 13, 2003.
http://www.webmd.com/content/miller_Keane/33/miller_Keane_10619.htm.
220
Bibliography
Pharmacy in the Future. Preventing medication Occurrences.

http://www.rpsgb.orguk/nhsplan/medicerr.htm.
Web MD Health. How to get the most benefits with the fewest risks. May 16, 2003.
http://www.webmd.com/content/article/6/1680_5160.htm.
Web MD Health. Imodium. August 2, 2003.
http://www.my.webmd .com/search/searchresults?query=Imodium&filter==mywe
bmdallfilter.
Web MD Health: Medication monitoring. February 14, 2001.
http://www.webmd.com/content/healthwise/140/34842.htm.
Web MD Health. Medications used to treat mental disorders. November 2002.
http://www.webmd.com/content/article/60/671.50/htm.
Web MD Health. Mental illness basics. November 2002.

http://www.webmd.com/content/article/60/67163.htm?lastselectguid=5FE84E90BC77-405.
Web MD Health. Mysoline. August 2003.
http://www.webmd.com/content/content/article/3/4046.htm?lastselectguid=5F
E84E90-BC77.
Web MD Health. New warnings on epilepsy drug Topamax. July 11, 2003.
http://www.my.webmd.com/content/article/70/81128.htm?lastselectguide=5FE84
E90-BC77-40.
Web MD Health. Other medical concerns: swallowing problems. May 13, 2003.
http://www.webmd.com/content/article/46/1833_50747.htm.
Web MD Health. Protect yourself from prescription occurrences.
http://www.my.webmd.com/content/article/61/67577.htm.
Web MD Health. Schizophrenia. November 2002.
http://www.my.webmd.com/content/article/60/67143.htm.
Web MD Health. Taking medications correctly. December 13, 1999.
http://www.my.webmd.com/content/article/11/1689_50105.htm.
Bibliography
221

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Administering

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

To the Student . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Module 2: Medications and What You Need to Know . . . . . . . . . . . . .

SECTION 2: The Techniques of Medication Administration . . . . . . . . . .

When to Report Information . . . . . . . . . . . . . . . . . . . . . .

* Module 4: How to Prevent and Control Infection . . . . . . . . . . . . . . . 49

Module 5: How to Administer Medications . . . . . . . . . . . . . . . . . . . 55

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

* Module 6: How to Handle Special Situations . . . . . . . . . . . . . . . . . . 103

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

SECTION 3: The Management of Medication Administration . . . . . . . . . 113

Handling and Storing Medications Outside the Home,

* SECTION 4: Reference Information for Medication Administration . . . . . 158

Common Diseases, Illnesses, and Conditions,

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

Massachusetts Specific Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

How the Manual Is Organized

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

This manual focuses on the principles of safe medication

What You Will Learn

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

Think for a moment about what it takes to build a safe, sturdy

In Section 1, you will learn the basics of medication

In Section 3, you will learn how to manage medication

Special Learning Aids

Apply What Youve Learned

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

Melissa, Chip, and Freddy

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

he wants, but he cannot explain how he feels. Chip has multiple

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

appointments, work schedule and social activities on his own. He

3 The Health Care Provider, or

About the Author

CC&R Healthcare Solutions, based in Winthrop, MA is dedicated to developing

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

Administering Medications the Right Way is one step in the direction of

D&S Testing Process a

It is to your advantage to spend time on your own taking

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

D&S Diversified Technologies

FREQUENTLY ASKED QUESTIONS

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

2. Where is my MAP Certification valid?

The Basics of Medication

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

efore you can give medications to the people you support,

After studying this module, you will be able to:

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

Accurate free from occurrence or mistakes; correct.

Side effects effects caused by the medication that are not

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

n this module you will learn why it is important to standardize

Administering Medications the Right Way

2012 Margaret Casey-Mederios RN and CC&RHealthcare Solutions

2. What do they have the right to know about their medications?