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Contents
Contents
Before you begin
What is expected of a Certificate IV learner Introduction: Understanding the requirements to administer
and monitor medications
Chapter 1: Identifying potential risks to administering
medications safely
1.1 Accessing information to identify substance incompatibilities
1.2 Identifying issues that may impact on administration of medication 1.4 Confirming client identity and allergies 1.5 Identifying drugs and poisons schedules and classifications 1.6 Identifying and reporting own limitations on capability to administer Assessment activity 1: Identifying potential risks to administering medications Chapter 2: Preparing for medication administration
2.1 Establishing authority to assist with medication administration 2.2 Clarifying your role in assisting with administration of medications 2.3 Confirming dose administration aids are complete, current and ready for use 422.4 Implementing personal hygiene procedures 2.5 Fulfilling duty-of-care requirements Aspire Training & Consulting
CHCCS424A Administer and monitor medications
2.8 Identifying the purpose and function of the medications 2.9 Reporting and seeking direction about any issues that may impact on 2.10 Measuring and/or calculating dosages 2.12 Demonstrating medication administration techniques and precautions Assessment activity 2: Preparing for medication administration Chapter 3: Identifying and preparing the client
3.4 Informing the client about the procedure 3.5 Checking the client for physical or behavioural changes Assessment activity 3: Identifying and preparing the client Chapter 4: Administering required medications
4.1 Administering medications within your level of authority 4.2 Preparing and administering medications correctly 4.3 Implementing all checks to ensure medication is delivered correctly 4.4 Assisting the client to take the medication 4.5 Supervising and observing the client 4.6 Disposing of all used and unused medication and equipment 4.7 Identifying signs that p.r.n. medications are required Assessment activity 4: Administering required medications Aspire Training & Consulting
Before you begin
Chapter 5: Monitoring client response to medication
5.2 Contributing to providing medication information to clients and carers 5.3 Identifying and responding to reactions to medications 5.4 Implementing an emergency response for identified reactions 5.5 Recording and reporting responses to emergency strategies 5.6 Identifying and reporting signs of client pain 5.7 Observing, recording and reporting client response to pain relief Assessment activity 5: Monitoring client response to medication Chapter 6: Handling issues and contingencies
6.1 Reporting a client’s refusal to take or complete medication 6.2 Identifying contaminated or out-of-date medication 6.3 Implementing procedures to dispose of contaminated or out-of-date 6.4 Observing, recording and reporting changes in a client’s condition 6.5 Recording and reporting inconsistencies 6.6 Documenting and addressing inconsistencies Assessment activity 6: Handling issues and contingencies Chapter 7: Completing medication distribution and
administration
7.1 Managing medication trolleys and containers
7.2 Completing arrangements and procedures to replenish supplies 7.3 Storing medication charts appropriately 7.4 Completing medication storage procedures Aspire Training & Consulting
CHCCS424A Administer and monitor medications
Assessment activity 7: Completing medication distribution and administration Final assessment: CHCCS424A Administer and monitor
medications
Employability skills
Appendix
Glossary
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Introduction: Understanding the requirements to administer and monitor medications
Introduction
Understanding the requirements to
administer and monitor medications
Information in this workbook focuses predominantly on aged care work settings and the role of aged care workers. The information can also be used or adapted for use in other community services fields such as disability, youth, alcohol and other drugs or mental health work where appropriate and permitted by legislation and industry standards.
Registered and enrolled nurses are governed by nursing and midwifery laws in each state and territory, and nursing and midwifery regulatory authorities set up pursuant to those laws and regulations. Aged care workers, although not licensed, have a duty of
care to ensure prescribed and over-the-counter medications including complementary
therapies are safely handled by the residents themselves or by staff involved in managing
and assisting individuals with medications. All workers must comply with relevant Commonwealth and state/territory legislation and industry guidelines that include, but ƒ Aged Care Act 1997 (Cth) and regulations ƒ Disability Services Act 1986 (Cth) ƒ Drugs, Poison and Controlled Substances Act 1981 (Vic.) and other relevant legislation When administering medications, it is the responsibility of the individual care worker to ensure that they understand and comply with legislative requirements, policies and guidelines, and follow the agency’s standards for aged care so that community safety is protected.
A large number of older people, who take medications to support and improve diagnosed health conditions, are able to manage and take their medications independently, while others require some form of assistance or support. This assistance or support involves the care worker undertaking a number of set tasks; for example, using a range of equipment to administer medication via a number of medication routes in accordance with their delegated role and in line with legal and environmental guidelines, either in a person’s home or within a residential care setting.
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Chapter 1: Identifying potential risks to administering medications safely
1.2 Identifying issues that may impact on
administration of medication
Some client groups, such as older people, tend to take a large number and wide variety of medications that may often be prescribed by several physicians. This situation can result in the deliberate or unintentional misuse and/or abuse of prescription drugs. Unintentional misuse or abuse of drugs can occur because each provider usually focuses on an area of expertise that might require pharmacotherapy (the treatment of disease through the administration of drugs). If these providers do not have an effective system of relaying changes in the treatment plans to other providers, confusion and adverse polypharmacy as a result of multiple diagnoses can lead to complex medication
regimens. Obviously, the use of multiple medications increases the likelihood of adverse drug reactions or interactions.
A drug’s pharmacodynamics (what a drug does to the body) can be affected by physiological changes due to disorders such as malnutrition or Parkinson’s disease, or due to aging or other drugs. The aging process can also affect a drug’s pharmacokinetics (how our bodies deal with drugs), which in turn can affect how the drug works and the appropriate dosage. For example, when age-related bodily changes decrease absorption or distribution of the drug, a higher dosage may be needed. On the other hand, age- related changes that decrease drug metabolism and elimination may mean that a lower dosage may reach the same original effect.
Other issues that may impact on the safe administration of medication include drug interactions and side effects, cross infection and complementary therapies.
Drug interactions and side effects
The effects of drug interactions are usually unwanted and sometimes harmful.
Interactions may increase or decrease the actions of one or more drugs, resulting in unwanted side effects or failed treatment, so it is important for workers to closely monitor the client for any physical or behavioural changes. The effect a substance has on a person may be different than expected because of: Drug-to-drug interaction
Taking more than one drug might have unintended and unwanted side effects
ranging from mild to serious. Most adverse drug–drug interactions are either pharmacodynamic, meaning what a drug does to the body, or pharmacokinetic, which relates to the onset, duration and intensity of a drug’s effect in nature.
Drug–drug interactions can involve prescription or non-prescription (over-the-counter) drugs. Common drug-to-drug interactions that an aged care worker should know about can involve antidepressants, antihypertensives, digoxin, oral corticosteroids,
sedatives, warfarin and even aspirin.
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CHCCS424A Administer and monitor medications
This example illustrates the importance of requesting help if you feel that you are being asked to do something outside of your capability.
Mr Laing, who has been diagnosed with multiple forms of dementia, has recently been admitted to the facility. He is restless and becomes very agitated every time Sally approaches him to put him on the nebuliser. She feels uncomfortable and unsafe around Mr Laing, and indicates to the registered nurse that she would like to be closely supervised the next time she administers Practice task 6
Refer to your state or territory’s legislation and guidelines (and other relevant guidelines for medication administration in aged care services), to identify who has the authority to undertake specific medication tasks (ACW refers to aged care worker and RN refers to registered nurse).
Medication Task
Schedule 8 medications in a medication aid Drugs that are nebulised that have not been dispensed and prepared Drugs that are nebulised that have been dispensed and prepared by a Metered dose inhalers that have been dispensed by a pharmacist Medicines given via feeding tubes (for example, gastrostomy, Medications that are administered by the nasogastric route Apply Schedule 8 medicated patches (Buprenorphine) prescribed by a medical practitioner and dispensed by a pharmacist Administer intravenous medication
Give intravenous therapy and intravenous medications Check, change and titrate intravenous therapy solutions Give sub-cuticular or intra-muscular medications (for example, insulin or Aspire Training & Consulting
CHCCS424A Administer and monitor medications
2.10 Measuring and/or calculating dosages
While it is the responsibility of a registered nurse to calculate and measure doses
accurately, aged care workers have a duty of care to check the dose before administering the medication. All calculations and measurements must be 100 per cent accurate and in strict accordance with the written delegation and/or prescription. Aged care workers should also have the skills and knowledge to identify any errors or discrepancies in medication doses and therefore reduce the risk of over or under dosage to their clients. Commonly used units of measure within aged care settings include: ƒ mass in kilograms (kg) grams (g) and milligrams (mg) ƒ volume in litres (L) and millilitres (ml).
Formulae to calculate number/fraction of tablets
Standard formulae to calculate the number or fraction of tablets to be administered to
Required dose (RD) = Number of tablets to be administered For example, the resident’s doctor has prescribed 500 mg of Keflex® every six hours. The Keflex® in stock contains 250 mg capsules; therefore: Please note that the formula requires that both the required dose and the stock dose are expressed in the same units. Therefore, if the required dose was stated in grams and the stock dose was in milligrams, you would need to convert the required dose to milligrams first.
For example, the resident’s doctor has prescribed one gram of paracetamol every four hours. The paracetamol in stock contains 500 mg tablets.
The first step is to perform conversion calculations to ensure that the required dose and stock dose are both in the same units.
1 gram = 1000 milligrams; therefore: 1000 mg (1 gm) = 2 tablets to be administered every 4 hours Aspire Training & Consulting
CHCCS424A Administer and monitor medications
ƒ Certain environmental and practice issues may impact or contraindicate administration of medications in specific situations, so aged care workers must effectively identify and deal with these situations.
ƒ Personal care workers may be required to manage behaviours of concern, assist clients with a disability or assist clients with difficulties swallowing.
Checklist for Chapter 2
Tick the box when you can do the following.
‰ Establish authority to assist with medication administration ‰ Clarify your role in assisting with administration of medications ‰ Confirm dose administration aids are complete, current and ready for use ‰ Identify the purpose and function of the medications ‰ Report and seek direction about any issues that may impact on the medication ‰ Demonstrate medication administration techniques and precautions Aspire Training & Consulting
Chapter 4: Administering required medications
Safe disposal of insulin syringes and pen needles
Sharps are objects that can easily pierce or penetrate the skin. According to the Victorian
Government’s Better Health Channel (www.betterhealth.vic.gov.au), a needlestick injury, where the skin is accidentally punctured by a used needle, places the person that is ‘stuck’ at a risk of bloodborne diseases such as HIV and Hepatitis B and C.
Safe disposal of sharps in a sharps container that complies with Australian standards is the most significant way of reducing needlestick injuries. Make sure you place used insulin syringes and pen needles in an approved sharps container.
Safe disposal of transdermal patches
When disposing of transdermal patches it is important to:
ƒ dispose of them appropriately – there is often a considerable quantity of active drug left in the patch after the duration of their use ƒ refer to your relevant state or territory government guidelines for the disposal of transdermal drug of dependence delivery system. According to the South Australian Government Health Department’s Drugs of Dependence Unit Guideline for the Disposal of Transdermal Drug of Dependence Delivery System (www.dassa.sa.gov.au), the minimum standards of practice for the appropriate disposal of these patches are that:ƒ the disposal process – including the removal of the TDS from the person – is ƒ the patches are folded onto themselves (adhesive sides facing each other)ƒ the patches are placed in a sharps medical-waste disposal containerƒ the disposal process is recorded in the drug of dependence register, and countersigned The following example illustrates the importance of safely disposing of unwanted medicines and how the Australian Government is addressing this issue.
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Chapter 5: Monitoring client response to medication
Chapter 5
Monitoring client response to
medication
The use of medication has both benefits and the potential for harm, with all medicine providing a certain level of risk of side effects and adverse reactions, which can range from inconvenient – such as a dry mouth – to fatal. Care workers need to closely monitor clients for possible (predicted) effects and/or unexpected (allergic/adverse) effects of any treatment.
The World Health Organization indicates that harmful, unintended reactions to medicines that occur at doses usually used for treatment are called adverse drug reactions (ADRs). Information-sharing about adverse effects strengthens drug safety, and can translate into timely policy decisions that safeguard patient safety when problems do occur. In this chapter you will learn about: 5.1 Recording medication administration5.2 Contributing to providing medication information to clients and carers 5.3 Identifying and responding to reactions to medications5.4 Implementing an emergency response for identified reactions5.5 Recording and reporting responses to emergency strategies 5.6 Identifying and reporting signs of client pain 5.7 Observing, recording and reporting client response to pain relief Aspire Training & Consulting
CHCCS424A Administer and monitor medications
5.4 Implementing an emergency response for
identified reactions
Each care worker must be familiar with the facility’s standard medical emergency procedures and their role in the following medical emergencies: ƒ respiratory arrest with choking, stroke or heart attack ƒ a person who has collapsed onto the floor ƒ a person experiencing seizures or convulsions.
A prompt response is invaluable in an emergency and the treatment goal is to relieve symptoms and prevent a severe reaction.
Treatment may include: ƒ antihistamines to relieve mild allergy symptoms such as such as rash, hives and ƒ using a rescue inhaler, such as Albuterol, to reduce asthma-like symptoms (moderate ƒ corticosteroids to reduce swelling and inflammation of the client’s airways ƒ an injection of epinephrine to treat severe allergic reactions (anaphylaxis); this treatment can prevent the client from going into shock and alleviates symptoms the client is experiencing; the facility may have preloaded devices for auto-injecting adult doses of adrenaline, which a registered nurse would administer.
Respiratory distress and arrest
If trained and certified to do so, immediately begin rescue breathing and
cardiopulmonary resuscitation (CPR) if someone has stopped breathing.
The supervisor, coordinator or on-call health professional must be notified if: ƒ a client is gasping for air or having difficulty breathing normally such as: − breathing faster or slower than usual − feelings of dizziness or light-headedness − a sense of tingling in their hands or feet.
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Chapter 5: Monitoring client response to medication
Discussion topics
Learners in a classroom can form a discussion group or have a debate. Those in the
workplace might like to brainstorm these ideas with their colleagues. If you are learning independently, you might like to set up a chat room with other learners or ask a friend ƒ ‘Pain is a normal part of ageing. It is better to let the person tough it out.’ ƒ ‘Failing to provide adequate pain management for chronic pain is a form of elder ƒ ‘The nurse or the doctor is the best judge of whether a client is in pain.’ Chapter summary
ƒ MAR charts formally record medication administration activities within the RAC facility. It is important that MARs are clear, accurate and up to date, and record in an accurate, concise manner all necessary information in relation to a client’s ƒ Due to a lack of information and/or understanding, clients within a residential setting may take extra medications in an effort to relieve pain, or in the belief that symptoms will disappear more quickly, or self-medicate to alleviate other symptoms. Care workers need to carefully monitor clients and contribute to providing medication ƒ Care workers need to quickly and confidently identify and respond to adverse reactions to medications that may or may not be harmful to the person.
ƒ Observations related to incidents resulting in minor health changes should be provided to a registered nurse, who should provide the relevant information to the ƒ A registered nurse should immediately contact the on-call health professional or emergency medical services by phone with observations and any other relevant information for major/serious health changes.
ƒ It is important to accurately record the adverse medication event/s in the MAR so that the client’s healthcare team knows about any drug allergies that the client has.
ƒ Formal pain assessments that evaluate pain intensity, quality, location and duration should be routine in aged care settings. However, formal pain assessments may not be sufficient for those with speech, hearing or cognitive deficits, or for those clients ƒ Care workers must record complete, concise and essential information related to a client’s pain and response to pain relief. Aspire Training & Consulting
Chapter 6: Handling issues and contingencies
The following example illustrates the importance of carefully observing a client for changes, and then reporting and recording these changes to a supervisor or health The client is refusing her medication because she feels she has felt worse since taking the nebulised treatment. Knowing that bacteria can contaminate medications and equipment, and cause severe pneumonia in immune-suppressed and vulnerable individuals such as older people, the care worker seeks the advice of her supervising nurse. The nurse then speaks to the client’s doctor, who organises for the client to be tested. The supervising nurse also holds an ‘infection control’ meeting with all care workers, emphasising the importance of fol owing infection control procedures in relation to nebulisers.
Practice task 41
1. Develop and/or source procedures for observing, recording and reporting changes in a client’s condition. Alternatively, if you are currently working, obtain a copy of your workplace’s procedures and familiarise yourself with your role in implementing an emergency response 2. Read the case study, then complete a care note for the situation.
Case study
Shel ey Lang, a support worker, helps Mrs Crabtree take her medication for her hip
pain.
Mrs Crabtree usually has no reaction to the medication, which she has been taking for four weeks now. Mrs Crabtree suddenly becomes unsteady on her feet. Shel ey helps her to a chair and reports to the registered nurse.
Care notes
Name of client:
Details:
Signature:
Print name:
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CHCCS424A Administer and monitor medications
Assessment activity 7
Completing medication distribution and
administration
The following table maps the assessment activity for this chapter against the element and
performance criteria of Element 7 in CHCCS424A Administer and monitor medications. The activity has been designed for all learners to complete.
Performance criteria
Whole activity
1. Briefly explain what a care worker should do when a delivery of medications is
2. Describe the importance of keeping the medication cart/trolley under a care worker’s 3. List the reasons why it is important for care workers to store medication charts 4. Describe the legal requirements for storing medications.
5. Describe the legal requirements for care workers administering medications in high- level residential care situations with regard to drugs of dependence or poisons.
Record your employability skills
When you have completed the assessment activity, make sure you record the
employability skills you have developed in the table after the final assessment. Keep copies of material you have prepared as further evidence of your skills.
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