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CHCCS305A Assist clients with medication

Reading 2: Prepare the client for assistance with administration of medicine

1© NSW DET 2009

2© NSW DET 2009

Contents

Reading 2: Prepare the client for assistance with administration of medicine 1Introduction 4Implement all necessary checks to ensure the client and their medications are correctly identified according to organisation procedures and care plan 4Clarify specific assistance required to address personal needs of each client in line with organisation procedures and within work role responsibilities 8Check client medications according to the procedures identified in the organisation guidelines 11Explain the administration procedure to the client in line with requirements and organisation procedures and ensure their needs are met 14Prior to giving medication, observe the client to check for any physical or behavioural changes that may indicate need to report to supervisor or health professional in accordance with organisation policies and procedures 16Recognise circumstances when appropriate action is to report observed client health status rather than proceeding with administration of medication and seek advice of supervisor or health professional 16

3© NSW DET 2009

IntroductionIn this topic you will examine the roles and responsibilities of the aged care or health support worker in preparing the client for assistance with administration of a variety of medications via different routes. More specifically, you will examine the procedures and necessary checks that must take place to ensure that assistance with self-medication is conducted in a safe and effective manner.

Revision of your role and responsibilities for procedures in the process of assisting a client

The aged care or health support worker has a responsibility to ensure that:

the client’s current condition is assessed prior to, during, and after each self-medication event

all necessary safety checks are completed

self-medication events are free from error and are in accordance with the facility’s policies and procedures

the client is observed and supported through self-medication

the client’s condition and response to medication is evaluated

relevant reports and records are completed.

Implement all necessary checks to ensure the client and their medications are correctly identified according to organisation procedures and care plan

Assess relevant documentation

Refer to client medical records, medication management charts, resident care plan and any other relevant local documents to gain information about the client’s current health condition, requirements for self-medication and any observations/instructions made by other care staff and health professionals.

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Assess client’s current condition

Before assisting a client to take their own medication it is vital that you observe any change in their current health condition or behaviour that may impact on their ability to safely administer their own medication.

Such changes may include (but are not limited to):

alterations in ability to swallow

changes in memory and mental functioning

reduced ability to perform any of the physical skills required to self-medicate.

Any changes in the client’s condition that may impact on their ability to self-medicate is reported to a supervisor and/or the client’s doctor immediately.

It is recommended that a client’s ability to self-administer medications should be informally assessed by the aged care or health support worker prior to, during, and after every self-medication event, and formally reviewed by a doctor or registered nurse at regular intervals, for example every three months, or if changes in the client’s health condition occurs.

Perform relevant checks

When assisting the client to self-medicate it is essential that a range of checks take place to ensure that self-medication is undertaken in a safe and effective manner.

As previously covered in Reading 1 these checks are commonly known in the health care system as the 5Rs. The 5Rs are—right client, right drug, right amount, right route and right time.

5© NSW DET 2009

Figure showing the 5Rs for self-medication

The 5Rs for self-medication

Right client

To identify the client you could:

recognise them by sight

ask the client their name (not always recommended if working in a dementia unit)

confirm client identification with nursing/care staff or the client’s family and friends

check the client’s photo identification on the medication chart or the Dose Administration Aid.

In the client’s home, you could check the name on the pharmacy label on the medication containers and/or the pharmacist supplied medication card.

If you are unable to identify the client seek assistance from your immediate supervisor.

6© NSW DET 2009

Right drug

All medications should be listed on the medication chart or medication card. Ask the client to identify that they have the right medication(s).

Medication labels should be checked against the medication chart or medication card.

Right amount

The amount is also known as the dose of medication prescribed to a client by their doctor or other health professional. It will be listed and prescribed on the medication chart or medication card and on the pharmacist’s label on the medication packaging. Check with the client to identify that they have the right amount.

Right route

The route refers to how the medication is taken and should be noted on the medication chart, medication card and/or the pharmacist’s medication label on the medication packaging. Ensure that the client is aware of the right route to administer the medication, for example, by mouth, under the tongue, onto the skin surface.

Right time

Medications must be taken at the specified time. You need to check with the client how often a medication is taken or applied and when they last took the medication.

Furthermore, all medication packaging, equipment and Dose Administration Aids should be checked to ensure that they are:

within expiry date

free from error, contamination, tampering, soiling, colour changes, disintegration or deterioration

7© NSW DET 2009

Clarify specific assistance required to address personal needs of each client in line with organisation procedures and within work role responsibilitiesThe medication requirements and level of assistance required by your residents are individual to each resident so you need to be able to clarify the specific needs of each resident. There current needs may include amongst other things provision of an approved PRN order according to relevant legislation, organisation guidelines and doctors orders; assistance in securing client cooperation and posture or positioning of client including physically supporting the client.

Determine client’s exact needs

Discuss the self-medication process with the client, determine if there are any potential difficulties and negotiate the exact nature of the physical assistance that is required. For example, the need to help the client:

open containers

gain a position of comfort

measure a dose of liquid medication into a measuring cup/spoon

access and ‘pop’ medications out of ‘blister’ pack Dose Administration Aid into a medicine cup

dissolving powder medicine in water

placing medicine in nebuliser/spacer

grinding or dividing tablets where there are clear, written instructions

assist with placing eye drops accurately in the eye.

Correctly identify and greet each client and prepare them for medication

When you are going to assist a client to self-medicate, it is preferable that they are in their room as this is where their medication is stored either in a locked drawer or cupboard and it also allows for privacy.

You should knock on the resident’s door and introduce yourself and announce why you are there. The resident will normally ask you to enter their room. Greet them warmly. You should always be wearing your identification name badge where it can be clearly seen.

8© NSW DET 2009



ask the client their name (not always recommended if working in a dementia unit)





Gain consent to assist the client

Ensure that you gain consent to assist the client with their self-medication. A aged care or health support worker must not force a resident in their care to take medication. Any refusal to take medication by a resident must be reported to your supervisor and the refusal documented on the medication chart and in any other documentation according to the facility policy and procedures. Undue force is regarded as assault.

Gather equipment and prepare the environment

The equipment required to assist in self-medication will depend on the type of medication being administered and may include:

medication chart, drug sheet, care plan or case record

administration aid/medication pack

cotton wool/gauze

key to medication storage cupboard/drawer

gloves

paper towels and tissues

tablet divider

water jug and cup

tea towel

tumblers

aprons

medicine or measuring cups, dishes and spoons

9© NSW DET 2009

mortar and pestle

container for dirty spoons/medicine cups/dishes

nebuliser or spacer device.

To prepare the environment you need to ensure that the immediate surroundings are clean and allow for privacy throughout the procedure.

Help prepare the client

You can help prepare the client through:

discussing the procedure and addressing any likely difficulties

confirming the time and type of medication

establishing the type and level of support required by the client to take/receive the medication

opening bottles or dose administration aids

removing tablets or capsules from dose administration aids

measuring the amount of liquid required into a medicine cup or a cream onto the affected area

crushing or dividing tablets where indicated by pharmacist or health professional

placing medicine into nebulisers or spacers

dissolving medicine in water

Ensuring that fluids are available to assist with swallowing

encouraging participation in the process

providing privacy

assisting with comfort and positioning, for example, sitting up to take oral medications

assisting to expose the treatment area if required, for example, removing clothing to apply a medicated cream or powder.

Clients may require assistance with repositioning, such as lying down, sitting or standing up, or exposure of the treatment area.

If manual handling is required, use of designated appropriate equipment such as mechanical lifters, slide sheets, wheel chairs, etc. must be used and you should also seek assistance from other staff members if required.

All aged care or health support workers are required to follow the facility’s Occupational Health and Safety (OHS) guidelines and current legislative regulations when performing any procedure that

10© NSW DET 2009

involves manual handling.

Go to the WorkCover NSW website for additional information on manual handling at: www.workcover.nsw.gov.au

Check client medications according to the procedures identified in the organisation guidelines You must follow your facility policy and procedures when checking client medications before assisting with self-medication. These will include the five R’s; medication expiry date; any obvious discrepancies in the medication; that it is free from contamination; that administration, instructions and the identity of the client correlate with documentation; dose administration aids are intact; discrepancies in administration are documented and procedures for infection control, storage and disposal are followed.

If you are assisting the client with taking their medications you need to ensure that the medications are used according to the 5Rs. To reiterate this involves:

Right drug

All medications should be listed on the medication chart or medication card. Ask the client to identify that they have the right medication(s).

Medication labels should be checked against the medication chart or medication card.

Right amount

The amount is also known as the dose of medication prescribed to a client by their doctor or other health professional. It will be listed and prescribed on the medication chart or medication card and on the pharmacist’s label on the medication packaging. Check with the client to identify that they have the right amount.

Right route

The route refers to how the medication is taken and should be noted on the medication chart, medication card and/or the pharmacist’s medication label on the medication packaging. Ensure that the client is aware of the right

11© NSW DET 2009

http://www.workcover.nsw.gov.au/

route to administer the medication, for example, by mouth, under the tongue, onto the skin surface.

Right time

Medications must be taken at the specified time. You need to check with the client how often a medication is taken or applied and when they last took the medication.

Expiry date

All medications will have an expiry date on the packaging. If the medication is out of date you must not administer the medication and return it to the pharmacy. You will need to fill out a medication error form, document in the resident’s notes and on the medication chart why the medication was not given and also report the incident to your supervisor.

Medication discrepancies

Obvious discrepancies seen in the medication such as colour changes, disintegration, deterioration or contamination also mean that you do not proceed with the administration of the medication and it should be returned to the pharmacy. You will need to fill out a medication error form, document in the resident’s notes and on the medication chart why the medication was not given and also report the incident to your supervisor.

Dose administration aids

DAAs such as blister packs must be intact. If there is any evidence of the DAA having been tampered with you must not proceed with the administration of the medication and return it to the pharmacy. You will need to fill out a medication error form, document in the resident’s notes and on the medication chart why the medication was not given and also report the incident to your supervisor.

Identity of client



ask the client their name


12© NSW DET 2009




Infection control

All aged care facilities will have policies and procedures on infection control that you need to follow particularly on hand washing, wearing of gloves, cleaning of equipment and using non-touch techniques. The following points were covered in Reading 1:

Washing hands before, during, and after assisting clients to self-medicate is essential. Washing your hands after assisting with self-medication ensures that you remove any traces or residue of the drug that has come in contact with your skin.

Gloves should be worn if you are likely to come into contact with any body fluids whilst assisting with self-medication.

Non-touch technique should always be used when assisting with self administration. This means that you do not allow the medication to come in contact with your hands.

Clean spoons and medicine cups should be used for each resident.

Equipment should be cleaned after use.

Storage

There are many requirements for the safe storage of medications. These requirements aim to ensure that the medications are kept out of reach of children and other residents, and are stored in an environment that prevents the medication from altering due to heat, light or contamination.

You should refer to the facility’s policy on storage of medications and the manufacturer’s or pharmacist’s instructions on medication labels to guide you on the requirements of storing medications safely.

Disposal

Any waste or equipment that is labelled ‘use once only’ should be discarded in the appropriate disposal unit or waste bin and any unused, expired or medication that has been tampered with or has deteriorated should be returned to the pharmacy.

13© NSW DET 2009

Explain the administration procedure to the client in line with requirements and organisation procedures and ensure their needs are metAny procedure that you are doing with a resident, including assisting with self-medication, needs to be explained to them even if it has been done several times before. This is not only courteous, but also gives you the opportunity to observe that the resident understands what is happening. Following are the requirements that you need to follow to ensure that you are acting according to the facility procedures.

When assisting the client to self-medicate it is essential that a range of checks take place to ensure that self-medication is undertaken in a safe and effective manner. As previously covered these checks are commonly known in the health care system as the 5Rs—Right client, Right drug, Right amount, Right route and Right time.

Provide clear communication

Being able to communicate effectively with your clients is important at all times, but particularly so when you are assisting with self medication. Some of your clients may have visual and hearing problems and also as they become older their memory is sometimes not as good as it used to be.

You need to be able to communicate with your clients in a way that they are able to understand. This may mean that you have to speak slowly or a little louder at times or you may have to write things down or you may have to ask the client to repeat what you have told them so that you are sure that they can follow your instructions.

Following are some points to keep in mind:

provide a clear explanation of the medication administration procedure if necessary

support the client through verbal reminders and prompts as required

use encouraging and supporting statements

give clear instructions where required, for example, ‘now place the tablet under your tongue’

avoid the use of any medical and nursing jargon and use plain English

if required, secure the assistance of a professional interpreter or access a telephone interpreting service through your workplace supervisor.

14© NSW DET 2009

Perform relevant checks

When assisting the client to self-medicate it is essential that a range of checks take place to ensure that self-medication is undertaken in a safe and effective manner.

These checks are commonly known in the health care system as the 5Rs. The 5Rs are – right client, right drug, right amount, right route and right time.

Case study

Following is a scenario involving Dawn Schmidt as a resident in Grevillea Aged Care facility who has Down’s Syndrome and self medicates – it will help you understand the importance of the 5Rs when assisting with self administration.

‘Hello Dawn. It’s Jane again, come to remind you that it is that time of the day again for you to take your medication. Hasn’t it been a hot morning?’

‘You know we have to go through the same routine each time when I help you with your medication so bear with me won’t you while I do the checks’.

‘Tell me your name?’ (answers Dawn Schmidt). ‘I just have to check that you are still as beautiful as your photo shows you to be.’ (Check photo ID on medication chart) ‘As lovely as ever.’

‘Do you know what medication you have to take now Dawn and what time it is?’ (Answers ‘yes, I have to swallow my one iron tablet, so I don’t feel so tired all the time, at 12 noon and it is now 12.10pm and I am going to unlock my medication drawer and get the blister pack out so I can take it out of the pack.’

Dawn unlocks the medication drawer, takes the blister pack out and shows me that she is pushing the correct medication out into a medicine cup and it is the correct time, date and dose on the blister pack. I check this against the medication chart that it is correct before allowing Dawn to proceed further.

‘I’ll just fill your water glass Dawn and you can then take your tablet with the water.’

Dawn takes the water glass and swallows her tablet with the full glass of water and I watch her whilst she does this to ensure that the medication has been swallowed.

‘All gone down the hatch Dawn?’ (Answers, ‘yes, all gone’ (opens mouth for me to see.)

‘That’s great Dawn, do you want to go to the lounge room where it is a little cooler?’ (Answers ‘No, I think I will stay in my room for a while.’)

‘O.K. Dawn I’ll leave you to have a rest. See you later’.

15© NSW DET 2009

Prior to giving medication, observe the client to check for any physical or behavioural changes that may indicate need to report to supervisor or health professional in accordance with organisation policies and procedures

Assess client’s current condition

Before assisting a client to take their own medication it is vital that you observe any change in their current health condition or behaviour that may impact on their ability to safely administer their own medication.


alterations in ability to swallow

changes in memory and mental functioning

changes in levels of consciousness

reduced ability to perform any of the physical skills required to self-medicate.

client’s refusal to take medications.

Any changes in the client’s condition/behaviour that may impact on their ability to self-medicate needs to be reported to a supervisor and/or the client’s doctor immediately.

Recognise circumstances when appropriate action is to report observed client health status rather than proceeding with administration of medication and seek advice of supervisor or health professionalThere may be a time when you observe some possible changes in the condition of a resident that must be reported immediately to a supervisor or health professional. If you observe any of the changes below, under NO circumstances should you proceed with assisting with self-medication.

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changes to airway (eg choking)

changes to breathing (including slowed, fast or absent breathing)

changes to person’s colour (eg pale or flushed appearance or bluish tinge), or changes to circulation (including unexpected drowsiness, loss of consciousness, and absence of pulse).

rash

inflammation or redness

swelling

headache

skin tone

feelings of dizziness

slurring of speech

nausea and vomiting

blurred Vision

confusion

changes in behaviour

anything that appears different from the resident’s usual state

others as advised by health professional.

If you have observed that your resident has any of the changes listed above they may need close observation, first aid and/or medical intervention if changes to airway, breathing or circulation are experienced.

17© NSW DET 2009

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