Med Tech Manual Final Draft

8/2/2019 Med Tech Manual Final Draft

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Legacy House ofBountiful

Med TechManual


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HIPPA Disclamer

Allofthenamesthatareusedinthismanualarecitousandinnowayreectrealpeople

andtheirmedicalhistories.Anyreferncetoarealpersonandtheirmedicalhistorywasunintental.


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ContentsHIPPA Disclamer..................................................................................................................3Preface...................................................................................................................................7Glossary.................................................................................................................................9Section One: Handling Medication...................................................................................13 MedicationCartOrination..........................................................................................15

PullingMedication.....................................................................................................16 TheNightBox............................................................................................................18 PassingMedications...................................................................................................20 MedicationErrors.......................................................................................................20Section Two: Docmentation.............................................................................................22 DocumentingMedications.........................................................................................22 MedicationAdministrationRecord(MAR).....................................................24 DocumentingNarcotics..............................................................................................24 NarcoticRecord................................................................................................24

NarcoticCard/NarcoticSheetCount...............................................................25 DocumentingResidentsCondition.............................................................................27 DailyCharting..................................................................................................27 IncidentReports...............................................................................................29 TakingandRecordingVitalSigns..............................................................................32 DailyVitals.......................................................................................................32 DalyVitalsintheMAR....................................................................................32 BloodSugars....................................................................................................33 OxygenLevel(O

2)............................................................................................33

PulsesandBloodPressures..............................................................................34 PulseinMar......................................................................................................34 UsingtheBinders.............................................................................................35Section Three: New Orders andOrdering From Pharmacies.........................................37 NewOrders.................................................................................................................37 OrderingFromThePharmacy....................................................................................38 SuperiorCarePharmacy...................................................................................38 OrderingPriorityMedications...............................................................39 OrderingAfterHours.............................................................................39

MountianWestApothacary..............................................................................39 OtherPharmacies.............................................................................................39 NewOrderChecklist..................................................................................................40 ReorderChecklist.......................................................................................................40Section For: Emergency Sitations.................................................................................41 FirstAid......................................................................................................................41 TransportingtotheHospital.......................................................................................42 EmployeeInjuryProcedure........................................................................................42HospitalProcedure43


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BuildingEvacuation...................................................................................................44 DeathProcedures........................................................................................................45Section Five: Otside Agencies..........................................................................................46 HomeHealth...............................................................................................................46 Hospice.......................................................................................................................46 FlexCare....................................................................................................................47Section Six: Caring For Residents with Diabetes and Dementia....................................48 Residentswithdiabetes..............................................................................................48 Residentswithdementia.............................................................................................49Section Seven: Addtional Information..............................................................................50 Supplies......................................................................................................................50 DoctorsApointments.................................................................................................50 HIPAA.........................................................................................................................51Appendices ..........................................................................................................................53 AppendixA:CommonNarcoticsandAntibiotics......................................................54 AppendixB:SymbolsandAbbreviations..................................................................55

AppedixC:ConversionChart....................................................................................57 AppedixD:MilitaryTime..........................................................................................57 AppendixE:ResidentsCharts....................................................................................58 AppendixF:HowtoUseaNebulizer........................................................................59 AppendixG:HowtogiveaSuppository...................................................................59


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Preface

Thismanualwaswrittentohelpbettertrainthemedicationtechnicians(medtechs)ofLegacyHouseofBountiful.Thismanualistailoredtothepoliciesandproceduresthatareusedinthisfacility.Thismanualisacomprehensivedocumentthatdescribeshowtocompletetasksthatamedtechperformsonadailybasis.Italso

providesexamplesofhowtocorrectlylloutthedocumentsthatmedtechsarerequiredtouse. Thegoalofthismanualistohaveamorehandsonapproachtothetrainingofnewmedtechs,sothattheyarebetterpreparedtoworkwhentheirtrainingiscomplete.Also,thismanualismeanttobeusedasaref-erencemanualforcurrentmedtechswhentheyhavequestions.


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GlossaryAdministrator The person that is the director o the bilding. Also reered to as the Bliding Director.

AM (Shift): The med tech shit rom 0600 to 1430.

Assistant

Administrator:The manager that is over the aides and creates the schdle or the med techs and the aides.

Changein Stats:

Any change in the residents condition, either or better or worse, which changes the assistance that the residentneeds.

Code

(Fll Code):

This means that the resident has a ll recitation order. I needed the med tech or aide wold need to perorm lie

saving measres, sch as CPR

Ekit:

A kit o medications or residents that are on hospice. The kit is provided by hospice. The medications are to be sed

or comort measres and its se needs to be approved by the hospice nrse. Any resident on hospice needs to have

an ekit.

Face Sheet:

The cover sheet o a residents chart. This contains pertinent inormation sch as birthday, emergency contact

inormation and insrance inormation. A copy o this sheet needs to accompany the resident when they are sent

to the hospital, another acility, or a doctors appointment. And i a lab specimen is taken the ace sheet needs to

accompany the specimen.

Grave: The shit rom 2200 to 0630.

MAR:Stands or the Medication Administration Record. This is the record that is signed by the med techs to docment the

time and dosage o a medication given.

Med Cart:Oten reerred to as the cart. The med cart is where the medication that the med techs administer are kept. It locks

and has three narcotic drawers that also have a lock.

Med Room or

Wellness

Center:

This is the room where the medication and charts are kept. This is also where the Assistant Administrator has her

ofce.

Med Strip: The packaging that medication comes in rom Sperior Care. Also called ato med.

Narc: Short or narcotic

O2:The vital sign that measres the amont o oxygen in the blood stream.

Order:A signed prescription rom the doctor that can be or medication, a treatment or assessment or Home Health or

Hospice.

PLOST:Sometimes is reerred to as the DNR Order or simply the DNR. This is a legal docment that states the residents

DNR stats. The POLST is kept in the back cover o a residents chart.

PM: The med tech shit rom 1400 to 2230.

POAPower o Attorney. This is a person that has legal power to make medical decisions or the resident when the resident

is no longer able to make sch decisions.

Profle Only:The term that is sed when sending an order to Sperior Care, so that the order will appear on the MAR and

Sperior will not send the medication.

RCC:Resident Care Coordinator. The nrse that is in charge o the med techs and coordinates resident care with otside

agencies and the assistant administrator.

Sharps:Any syringe or lancet with a sharp edge. These need to be pt in a sharps container either in the residents room or

in the Med Room.


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Legacy House ofBountiful

Med TechManual

By

AmberNielsenMTCNA


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Theprimaryjobofamedtechishandlingofmedications.Tohandlemedications,allmedtechsneedtohve erstig of the six rightsofmedicationadminastration.Allmedicationerrorsoccurbecauseoneormoreoftheserightswasntfollowed.Thesixrightsareasfollows:

Right

Resident

Itisveryimportantthateachresidentreceiveshisorherownmedicationsandnotanotherresi-dentsmedications.Bydoublecheckingnamesonmedicationpackagingandtheresident,youinsuretht the rightresidentisrecievingtheright ei-cation.Ifyouareunsure,asktheresidenthisorhername,itisbetterinsureaccuracythanitistolooksillybyaskingaresidenthisorhername.

Right Time

Eachdoseofamedicationhasbeenassignedaspecictimeunlessitisanasneeded(PRN)medi-cation.Itisveryimportantthatallscheduledmedi-cationbegivenonehourbeforeorafterthesched-uledtimetoinsurethataresidentisntreceivingtoomuchofamedicationtooclosetogether.Ev-enthoughPRNmedicationsdonthaveanassignedtime,dosesmustbegivenacertainamountoftimeapart.(Theorderforthemedicationtellshowlongthatamountoftimeshouldbe.)Bycheckingthe

assignedtimeontheMARandgivingmedicationatthattime,youinsurethatthemedication right is

beingrecievedattherighttime.

Right

Medication

Eachresidenthasbeenprescribedspecicmedicationsbyhisorherdoctor.Itistherespon-sibilityofthemedtechtoinsurethateachresidentreceivestherightmedicationasprescribedas

percribedbythedoctor.

Right Dose

Everyperscibedmedicationhasbeenassignedaspecicdose.Itisimportanttotriplecheck

medicationwhenpullingittoinsurethattherightdoseisgiven.Failuretoreceivetherightdoseofamedicationcanbedetrimentaltotheresidentshealth.Forexample,evenifacoumadindoseisoff

by0.5mgitcancausebloodclottingissues.

Section One: Handling Medication


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Right Route

Eachmedicationisprescribedaroute,orplaceon/inthebodythatitistobeadministered:bymouth(PO),byeye(gtts/OU),bynose,byrec-tum.Itisveryimportantthatamedicationisdeliv-eredbytherightroute.(Noonewantstoswallowasuppository!)

Right

Documentation

Whenhandlingmedicationyoumustcorrectly

documentthatthepillwasgiven,ifitwasntgivenyouneedtodocumentwhyitwasntgiven.RightdocumentationincludessigningthepilloutintheMAR;andifitisanarcsigningoutintheNar-coticRecordBinder.Ifforsomereasonapillisnotgivenit,thatneedstobedocumentedaswell.Rememberifapillisntdocumentedcorrectlyasgiventhenitwasntgivenandisamedicationer-ror.


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Medication Cart OrinationThemedicationcart,oftencalledthemedcartorcart,iswhereallofthemedicationiskept.Therearetwomedcarts,thebigcartandthesmallcart.ThebigcartiskeptintheMedRoom.ThesmallcartiskeptinthecottageofceduringAMandPMshift;anditismovedbackintotheMedRoomattheendofPMshiftandkept

thereonthegraveyardshift.BothcartsarekeptintheMedRoomatnightbecausetheyneedtobekeptinalockedroom. Bothcartsaresetupasfollows: Top of the cart:TheMARBinderiskeptontopofthemedcart,alongwithabloodsugarschedule,andanyimportantnotices.Thebloodsugarscheduleisalistofresidentsthatneedbloodsugarstakenandatwhattimethebloodsugarneedstobetaken. Top Drawer:Thetreatmentsarekeptinthetopdrawerofthemedcart.Treatmentsincludeeyedrops,inhalers,nosesprays,andcreams.Alltreatmentsaregroupedtogetheraccordingtocategory.Pens,sharpies,smallnotebooksandtheoximeterarealsokeptinthetopdrawer. Second Drawer:Beginningintheseconddrawerandcontinuingdownasfarasneedediswheresched -uledmedicationiskept.Thescheduledmedicationisputinalphabtical orderbytheresidents last name.Each

residenthasanautomedstripormedbubbles.Also,anynonnarcoticpatches,anymedicationsnotincardsorthemedpackets,andekitsforhospiceresidentsarekeptwithautomed/medbubbles.Anyremainingdrawersuntilthebottomdrawerarewhereanymedicationsthatdonttnexttothemedicationspacketsarekept. Bottom Drawer:Thebottomdraweriswheremedicationcardsarekept.ThemajorityofthesecardsarePRNmeds.However,thereareafewmedsthatarescheduledandcomeinmedicationcardsthatarekeptinthebottomdrawer.Ifspaceallowspowdermedications,suchasMiralaxarealsokeptinthisdrawer.Themedicationcardsinthebottomdrawerinalphabetical orderbytheresidents last name strtig i the frontofthedrawer.Adividerwiththeresidentsnameisplacedinfrontofhisorhermedicationcardstokeepresidentmedicationsseperateandhelppreventmedicationerrors.Thereisalsoanarcdrawerinthebottomdrawer.Thisnarcdraweriswhenthenarcsthatcomeinekits,liquidnarcs(insryniges)andpatchesarekept.(Basicallyany

narcthatisnotpackagedinamedicationcardiskeptinthebottomnarcdrawer.) Side Drawers: Offtothesideofthemaindrawersofthemedcartarefoursmallerdrawers.Thetopdrawercontainsbothbigandsmallmedcups,medbaggies,andpillcrusherbags.Thesecondandthirddrawerarenarcdrawers,theybothhavelockboxesthatlltheentirespaceofthedrawer,thesedrawersneedtobelockedatendofthePMshift.Narccardsareorganizedinalphabetical orderbyresidents last namebeginningi the backofthedrawer.Dividersarealsousedtoseperatestheresidentsnarccards.Coumadinandantibiot-icsarealsokeptinthenarcdrawer.Thefourth/bottomsidedraweriswherepowderandextrasuppliesarekept.

The top of the cartis where the MAR, blood sgar schedleand important notices are kept.

The top drawer is where the treatments, pens and markers,and the oximeter are kept.

The top side drawer is were the med cps and baggies are

kept

Begining in the second drawer all o the ato med strips or

med bbbles are kept.

The second and third side drawers are narc drawers.

The bottom side drawer is were powder meds and extra sp

plies are kept

The bottom drawer is were med cards, powder and liqid

meds, and the third narc drawer are kept.


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Pulling Medication Eachmedtechhashisorherownwayofpullingmedications.Somepullallthepillsthattheywillpassontheirshiftinonelongpullandotherspullaccordingtothetimethattheywillpassthepills.Whetheryoupullallofyourpillsatonceordivideyourpullsup,therearesomeimportantguidelinestoremember.

Medicationpackets,automedstrips(Superior)andmedbubbles(MountainWest),arelocatedinthemedcartstartingintheseconddrawerdownbeginningi alphabetical orderbytheresidents last name.Printedoneachmedpackettheresidentsname,thedateandtimethatthepacketshouldbeadministered,andthemedicationsthatareinthepacket.

Ato Med Strip Med Bbble

Whenpullingmedications,eachmedicationthatis

listedonthepacket,oronthemedicationcardsinthenarcdrawerorbottomdrawermustbetriplechecked

againsttheMARtoinsurethatitistheRIGHT MEDI-

CATION, RIGHT DOSE, RIGHT ROUTE, is

give t the RIGHT TIME tht the RIGHT MEDI-

CATIONisbeingpulledforthe RIGHT RESIDENT.

Anymedicationsthatyouputintoaplasticbaggieormedicationcupmusthavevethingswrittenonit:

TheresidentsnameScheduledtimeofthemedication

NameofthemedicationDoseofthemedicationRouteofthemediction

Marty Fenwick2000

Coumadin

7.5mgPO

Anymedicationthatisplacedinabaggieandtapedbackontoacardmusthavefourthingswrittenonit:

TheresidentsnameThenameofthemedicaiton

DoseofthemedicationRouteofthemedication

Stan WalkerBenadryl25 mgPO

Medicationsthatarepulledneedtobeputintoa

purplebox.Theseboxesareusedtocarrymedicationwhenpassing.Whenyouarepullingmedicationsyouwillputthemedicationandanytreatmentsneededintoapurplebox.Useadifferentpurpleboxforeachmedpass.Thiskeepsmedicationseperatedandhelps

preventgivingamedicationatthewrongtime.Thepurpleboxesneedtobelockedupuntilitistimetopassoutthemedicationinthem.

Prple Medication Box


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The Night Box

Duringthegraveyardshitthereisnomedtechonduty.InsteadagravemedaidepassesthemedicationongraveyardandanyrequestedPRNmedication.Thismedicationiskeptinthenightbox.AndthemedicationthatgoesinthenightboxispulledandpreparedbythePMmedtechs.WhilethePMmedtechspreparethemedicationthatgoesinthenightboxbothAMandPMshiftshaveresponsibilitieswiththenightbox.

AM Shift: Checkthenightboxwithgraveyardmedaide.Anymedicationthatis

stillinthenightboxneedstobewrittenontheNightBoxMAR.AftertheremainingmedicationischeckedanddocumentedbothAMmedtechsandthegraveyardmedaidewillsigntheNightBoxMAR.

ReceiveabriefreportfromthegraveyardmedaideaboutanyPRNme-icationgiven,anysheduledmedicationnotgiven,fallsandinjuries,andifanyresidentwassenttothehospital.Ifaresidentwassenttothehop- italduringgraveyardthatisonFlexCaretheAMmedtechwillneedtocontactFlexCareandtellthemthatoneoftheirresidentshasgonetothe hospital.

Receive48HourFollowUps,NewIncidentReports,andanyRecordsofDeathfromthegraveyardmedaide.

ResponsiblefordestroyinganyscheduledmedicationthatwasleftinthenightboxanddocumentingontheNightBoxMARthatthemedicationwasdestroyed.

UseanyleftoverPRNmedicationinthenightbox,ifpossible.Ifthe

PRNmedicationisntusedonAMshift,itcanbeleftforthePMshifttouse. ReportanyrequestedPRNmedicationtothePMmedtech.

PM Shift: Pullallofthescheduledmedicationforgraveyard(between2230and

0700.IntheMAR,graveyardmedicationsarehighlightedinpurple); commonlyusedPRNmedicationsandanynewrequestedPRNmedications.Allmedicationneedstobelabeledwiththeresidentsname,themedicationname,dose,andtime.MedicationthatisinautomedstripsfromSuperiorcanbeleftinitspackaging.Everyt-

hingelseneedstobeplacedinabaggiewithanightboxlabel. DestroyanyPRNmedicationthatwasntusedonthePMshift. CheckthenightboxwiththegraveyardmedaideandsigntheNight

BoxMAR. GiveabriefreporttothegraveyardmedaideaboutPRNmedsgiven

andanyotherpertinentinformation. Give48HourFollowUpstothegraveyardaide.

ToseeacopyoftheNightBoxMARgotopage8.


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ThisillstrationshowstheNightBoxMARandhowtoproperly

llitout.ThePMshiftmedtechswillcheckthemedicationthattheyhave

pulled

andputintothenightboxwiththe

graveyardmedaide.Once

themedicationsarecheckandEVERYm

edicationthatislistedintheScheduledandPRNcolumnsare

present,themed

techsandgraveyardmedaideneedto

signanddateundertheP

M/GraveyardShiftChangecolumn.Th

egraveyardmedaidewill

lltheouttheNightBoxMARastheygivemedicationthroughtthenight.Ifthethereare

anyrequestsforPRNmedsnotinthenightbox,theywillalsorecordthose.WhenAMShiftarrives,thegra

veyardmedaideandtheAMshiftmedtechswillchecktheboxandrecordany

remainingmedications.Oncethemedicationsarerecordedalongwiththereasonthattheywerentgiven,thegraveyardmedaid,andtheAMshiftm

edtechneedtosignanddateunderthe

Graveyard/AMShiftChangecolumn.

An

gle

a

Rod

gers

02/12/12

2230

02/12/12

2230

02/12/12

2230

02/13/12

063002/13/12

0630

02/13/12

0630

RileyJames

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachR

ichards

ZachR

ichards

ZachR

ichards

ZachR

ichards

Z

achRichards

ZachR

ichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

ZachRichards

5/500

Mg

5/500

Mg

7.5/325

mg25/100

25MG

10MG

25MG

15MG

15Mg

60Mg

75Mcg

75Mcg

50mg

75MG

7.5/500

5/500

15Mg

5Mg

10Mg

BrynnThomas

RacheFieldng

PRN

PRN

PRN

PRN

22300600

ThomasLund

MargretSimpson

NathtanMartin

JosephPeterson

LucyMarberry

AudreyThompson

Temazepam

Tylenol

Percocet

Xanax

Simvastatin

Tramadol

NotRequested

NotRequested

NotRequested

NotRequested

ResidentRefused

ResidentwasSenttotheHospital

BillRichard

Tylenol

Lortab

Lortab

JamesPerkins

MaryDavis


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Passing Medications TheMARliststhetimesthatscheduledmedicationsneedtobeadministered.Youhaveanhourbeforeorafterthattimetoadministerthatmedication.Forexample,ifamedicationisscheduledtobegivenat

1600,youmaygiveitstartingat1500andupuntil1700.However,thetwohourwindowdoesntapplytoPRNMedications,especiallynarcot-ics.PRNmedicationsneedtobespacedaccordingtothedirectionsintheMAR.Forexample,ifaPRNmedicationiseveryfourhoursanditisgivenat1200,itcannotbegivenagainuntil1600. Forscheduledmedicationstherearevemainpasstimes:0800,1200,1400,1600and2000.Ifforsomereasonamedicationcannotbegivenbetweenthetwohourblockallot-ted,itmustbeclearedbyanursetogivethemedication.Theexceptionthatdoesntneedtobecleared;isifamedicationismissedatthe2000(bedtimepass)becausearesidentisout

ofthebuilding(duringthe2000pass)themedicaitonmaybegivenupuntil2400withoutconsultingwiththenursebeforehand. Whenyouarepassingyourmedicationsitisveryimportantthatyoudoublecheckthenameonthemedicationpacketandtheactualresi-dentthatyouaregivingthemedication.Thisinsuresthateveryresidentisreceivingthecorrectmedication.(SeeTheResidentsRightsonpage3)Ifyouareunsureofaresidentsnamebecausetheyhavejustmovedin,askthemtheirname.Itisbetterthatyouasktheresidenthisorhernameandnotanotherresidentorcoworkertoinsurethatyouaregivingtherightresidenthisorherpills.

Medication Errors Amedicationerroroccursanytimethatoneofthesixrightsisnotfollowed.Examplesofmederrorsare:givingthewrongmedicationtotheresident,notgivingamedicationattherighttime,notgivingamedication,ornotproperlysigningoutamedication.WhenamedicationerroroccursaMedicationErrorReportneedsto

belledoutandtheproperpeopleneedtobeinformed.Thesepeoplearethenurse,theresidentsdoctorandtheemergencycontactperson.InadditiontollingoutamedicationErrorReport,anIncidentReportneedsto

belledoutand48HorFollowupinneedstobestarted.Givingthewrongmedicationisanincidentthatcanchangethestatusofaresidentswellbeingandtheyneedtobemonitoredtoinsurethatnocomplicationsarisefromreceivingthewrongmedication.

ToseehowtocorrectlylloutaMedicationErrorReportgotopage10.

Remember that or all schedled medication

there is a two hor passing window.


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Boyd, Fredrick 24/15/252/12/12 1600 X Thomas, Brynn

X

XX

X

Nurse okayed not calling

2/12/122/12/12

2/12/12

16301635

1640George Garcia

Katlyn Smith

One lortab 5/500 mg every 4 hours as needed for pain.

I gave two 5/500 mg lortab at 1600instead of just one. The wrong dose of lortab was given.

The residents vitals were taken at the time of the med error, andagain an hour later and then three hours later per the nurses request. The staff will continue to

X

X

98.7 97.9 98.585 87 80

The resident for any changes.

22 21 18160/8095 94 97

156/82 154/73

116 256 220

ThisillstrationshowshowtocorrectlylloutaMedicationErrorReport.Whenyoucontactthenurseaboutthemedicationerror

she will instrct yo to check the residents vital signs oten. (Based on the med error she will tell yo how oten and how many time yo will

need to check the residents vitals.) Yo need to write those vital signs on this report and start a 48 Hor follow up and write the vitals on

that orm as well.


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Section Two: Documentation

Documenting Medications WhenmedicationisgivenitmustbeproperlydocumentedintheMARandifitisanarcthenitneedsto

besignedoutinthenarcoticRecordBinder.IfforsomereasonapillwasntgivenbecausetheresidentisLOA,refuses,orisunabletotakemedicationitmustbeproperlydocumented.Thissectioncovereshowtoproperlydocumentmedication.

TheMARBinderforeachcartislocatedontopofthecart.ResidentsMARarelist-e i alphabetical orderbylast name.AlistofthePRNmedicationthataresidenthasbeen

prescribedarelistedrst.However,ifitisanewPRNorderitmaybefoundwrittenamongthescheduledpills.OnthenextMARcycleitwillbemovedtothePRNsection.AfterthePRNmedicationsthescheduledmedicationsarelisted.Theyarelistedbythedatethattheywereprescribedorwhenthemostrecentchangewasmade. WhetheramedicationisscheduledorPRNitmustbesignedoutwhenitisgiven.Ifitisscheduledtherewillbeasquare(oftencalledbubble)thatcorrespondstothedateandtimethatamedicationwillbeadministered,youmustinitialthissquare.IfthemedicationisaPRN,putyourinitials,writethetime,andhowmanypillsweregiveninthecorrectdatecolumn.Rememberthatthisisamedicalrecordandifyoudontcorrectlydocumentthata

pillwasgiven,thenitwasntgivenandthatisamedicationerror.Toseehowtochartinthe

MARseepage13. Ifapillisrefused,spitout,ornottakenforanyreason;circleyourinitialsandlloutthebackoftheMARtoexplainwhythemedicationwasntgiven.Whyitwasntgiven,thetimethatitwassupposedtobegiven,thetimethatyouarerecordingthisinformationandyoursignature.ToseehowtodocumentmedicationsonthebackoftheMAR,gotopage12.Youwillalsoneedtorecordthisinformationinthe24HorReportandCommunica-tionBook.Toseehowtocharttheinthe24hourReportandtheCommunicationBooktogo

pages16and17.

Medication Administration Record (MAR):


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Metormin 500 MGOne Tablet Twice Daily

Cymbalta 75 MGOne Tablet Daly

Ranitidine 25 MGOne Tablet Four Daly

0800

0800

16001200

0800

2000

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RF

RJ RJ RJ RJ RJ

RJRJRJ

RJRJRJRJ

RJRJRJRJ

RJ

RJAR ARAR AR

AR

AR

ARARARAR

ARAR

ARARAR

AR

BT

BT

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BTScheduledTies MedTech

Iitls

Medications

This illstration o a MAR ront shows where the medication order is printed, where the times o the medication are

listed, and the place that the med techs initial that they have given the medication.

ThisillustrationshowshowtocorrectlylloutthebackofaMAR.WhenamedicationisnotgiventhebackoftheMAR

mustbelledoutexplainingwhythemedicationwasntgiven.

02/15/12Ranitidine 25 MG 2000 2100Resident refused due to agitation A Rogers


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Narcotics(narcs)arecontrolledsubstancesandeachpillordoseofanarcmustbeaccountedfor.Whennarcarereceivedfromapharmacytheymustbecountedtoverifythatthecorrectnumberwasdelivered.Ifthenumberthatwassupposetobedeliveredandtheactualnumberdelivereddontmatchthepharmacyneedstobecontactedsothatthecorrectamountofmedicationcanbedelivered.Afterthenarcsaredeliveredandcheckedforaccuracy,theyneedtobesignedinonaNarcoticRecordSheetandaddedtothenarccountandcardcount.Thefollowingstepsshowhowtocorrectlysigninanarc: 1.Onthetopofthesheetthereisaplacefortheresidentsname,thenameofthemedication,strengthofthemedicationandthedirectionsforadministeringthemedication.UsethedirectionsthatarelistedontheMAR,nottheonelistedonthecardorbottle.IfforsomereasontheorderonthecardorbottledoesntmatchtheonelistedontheMARnotifythenurse,theordermayhavechangedandwewerentnotiedandneedtoobtainacurrentordersowecangivethecorrectdoseofamedication. 2.Whensigninginanarctherstlinemustbelledinwiththedatethatyoureceivedthemedicationin

the datecolumn;theshift(AMorPM)shouldbelledoutintheTimecolumn;countshouldbewritteninthedosagecolumn;yoursignaturein aiistere bycolumn;andthetotalnumberofpillsormillilitersthatwerereceivedinthe#Remainingcolumn. 3.Whenyougiveanarcyouneedtowritethedatethatitwasgiveninthedatecolumn;theexacttimethatyougaveitintheTimecolumn;forthedosageyouneedtowriteTforonetablet(ifyouaregivingmorethanonetabletyouneedtolloutonelineforeachtabletthatisgiven.EachlineofthenarcsheetrepresentsONEnarc.);signyourrstintialandlastnameinthe aistere bycolumnandwritehowmanyareremain-inginthe#Remainingcolumn.

NarcoticRecordResident:Martha JonesMedication:Lortab Strength:5/500 mg

Dosage:1-2 Tabs Q 4-6 hours PRN

dte Tie dosge AdminsteredBy #Remaining

2/20/2012 PM Count ARogers 302/21/2012 080 T RFln 292/21/2012 120 T RFln 282/21/2012 120 T RFln 27

2/21/2012 1600 T RJames 26

2/21/2012 1600 T RJames 25

Documenting Narcotics:

This illstration shows how narc need to be signed in when they are recieved rom the pharmacy; and how to sign them ot when they are given

Remember, every line on the narc orm rempersents ONEpill. I yo give more than one pill at a time yo need to sign each one ot individaly

Narcotic Record:


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Toinsurethatallnarcoticswerecorrectlygivenandhavebeenaccountedfor,medtechsperformanarccountduringeachshiftchange.ThemedtechcomingondutywillcountallofthenarccardsinthedrawersandthemedtechgoingoffshiftwillcountthenarcsheetsintheNarcoticRecordBinder.ThesenumbersMUSTmatcheachotherandMUSTmatchthenarcCardandNarcSheetCountafterthenumberofcardsaddedand

subtractedisguredintothecount.Thiscountmustbedonetoinsurenarccardsand/orsheetshaventbeenlostorstolen.Ifthiscountisoffthenurseneedstobenotiedimmediatelysothattheappropriateactioncanbetaken.Afterthiscount,themedtechswillthenproceedtocounttheindividualsheetsandcards.Thisisdone

bythemedtechcomingonshiftreadingthenumberofnarcsinthecardorbottleandthenameofthenarc;andtheothermedtechwillreadthenumberonthesheetandthenarcname.Ifthenumbersdonotmatch,thenarccountisoffandthemedtechsmustgureoutwhybeforeproceeding.Ifanarcismissingorwasgiventothewrongresidentoratthewrongtimethenursemustbenotiedimmediately.Ifthenarcwasgiventothewrongresidentoratthewrongtimeamedicationerrorhasoccurredandmedicationerrorproceduresmustbefol -lowed.(SeeMediccationErrorspages9and10)Inthiscasethemissingnarccanbesignedoutspecifyingthatitwasgiventothewrongresidentoratthewrongtime.Ifthenarcismissingandcaninnowaybeaccountedfor, missig narcoticFormmustbelledoutbythemedtechthatlostthenarcandthenursemustbenotiedim-

mediately.Shewilldecidewhetherthepoliceneedtobecontactedtoinvestigatethemissingnarcandifadrugtestneedstobeperformed.Shewillthengiveinstructionsonhowtoproceed.Toseehowtolloutamissig

NarcoticFormtogopage15.

NarcoticCard/NarcoticSheetCountdte Shift #ofCards #ofNarc

Sheets#Disposed

Cards#Added

CardsTotl t

shift e

MedTech/Witess

2/20/2012 PM 123 123 -5 +10 128 AR RJ2/21/2012 M 128 128 0 0 128 RF BT2/21/2012 M/M 128 128 0 0 128 RF RJ2/21/2012 PM 128 128 -3 -5 130 RJ AR

ThisillstrationshowshowtocorrectlyllouttheNarcoticCard/NarcoticSheetCount.ThisMUST belledouteverytimeashiftchange

narccounttakesplaceandmustbesignedbythemedtechsthatparticipatedinthatcount.Thissheetshouldbelledoutthreetimesaday:

OncewhentheAMmedtechscounttogether,oncewhentheAMmedtechcountswiththePMmedtech,andnallywhenthePMmedtechs

cont together at the end o their shit.

Narcotic Card/ Narcotic Sheet Count:


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Missing Narcotic

dte 02/20/12

Tie 1400

MedTechsonDuty Brynn Thomas and Rachel Fielding

NameofResidentNarcoticbelogs to Martha Jones

NameofNarcotic Morphine

DosageofNarcotic 15 MG

NumberofNarcoticsissig 1 Tablet

Comments:When I was preforming NARC count with Riley James we noticed that one morphine tabletwas missing from the card. We searched the med cart and med room, but were unable to find it.____________________________________________________________

____________________________________________________________

Signatre of RN_____________________________________ Date______________

Signatre of Administrator____________________________ Date______________

ThisillstrationshowshowtocorrectlylloutaMissing Narcotic form. Along with a description o the pill that is missing, the med tech

needstolloutadetaileddescriptionofwhathappendwhenthenarcwentmissing.Forexample:wasitdroppedandyouwereunableto

ndit;didyounoticethatitwasmissingduringanarccount?Youalsoneedtodescribewhatyoudid:Wheredidyoulookforit?whowas

therewhenthepillwentmissingorwhenitwasnoticedmissing?


25/6116

Daily Charting: Themedtechshavetwoformsofchartingthatmustbecompletedoneachshift:The24 Hor Report the Commnication Book.Bothareimportantindocumentingandcommunicatingtheoccurrencesofeachshift.

The 24 Hor Reportisacondensedversionofthedailycharting.Thissheetincludesthenameofeachresidentassignedtothecartwhetherthemedtechhandlesthatresidentsmedicationornot;andaplaceforeachofthethreeshiftstochartanythingthathashappenedduringtheirshift. Thingsthatshouldbechartedoninthe24HourReport: Anymedicationsthatwereorderedordelivered Neworchangedorderstomedications Ifamedicationwasntgiven/takenandwhy Afallorotherincidient 48HourFollowUpthatwasstarted,countinedorcompleted

PRNmedicationsadministereddurningtheshift,andwhattimetheyweregiven IftheresidentwastransportedtothehospitalorwasLOAforanyreason(iftheresident leavesonyourshiftforwhateverreasonandwillbegoneforasigncantamountoftime chartwheretheywentandifpossiblewithwhom).

Date:__________

Room Resident AMShift PMShift Graveyard

101 mrth Joes 1 L @ 0802 L @ 120

Rere L

2 Lortab @ 1600

Lortab Delivered

102 StanWalker Ha f tody,/ ba p .Gv 2 Tn @10.

Still C/O back pain, gave2 tylenol @ 1500 and1700.

103 MartyFenwick Rein Reuei 080 AmTri. H sta-e ha i me i. I e 3

e t v i.

Resident recieved thewrong dose of Lortabtonight. Vitals were takenand 48 hour follow upwas started. Please moni-tor for any changes.

This illistration shows how to chart on the 24 Hor Report.

Documenting Residents Conditions


26/6117

TheotherchartingthatmustbecompletedduringeachshiftistheCommnication Book.Inthisbookeachresidenthasasheetthatthemedtechmustchartanychangesintheresidentsstatus;iftheresidentfellyouneedtochartwhathappenedasitwrittenontheIncidentReport;anyPRNmedicationsgivenandtheresultofthemedication;andiftheresidentisLOAorwastransportedtothehospital.CommunticationSheetsarepartoftheresidentsmedicalrecords.Whenyouarechartingonlyincludeobjectiveinformationandleaveoutandsubjectiveinformation.

Whe CommunticationSheetisfulltakeitoutofthebinder,leitintotheresidentschart,andreplacetheoldsheetwithanewone.Whenyouputanewsheetinthebindermakesurethattheresidentsfullnameis

onbothsidesofthesheet.Becausethisisamedicalrecordyouneedtowritetheirfullname,dontuseashort -enedversionoftheirnameoranickname.

Mh Je 101

2/2/12

2/2/12

2/3/12

2/3/12

Rein / n , i to ry f ekfas

Resident Stated that she is feeling better. Came to lunch__________________RJ

n Ln_____________________________________________________________RF

Resident c/o back pain at breakfast, I gave 1 Lortab at 0800. C/O pain again at lunch, I gaveanother lortab at 1200. Please monitor for any more c/o pain.__________________BT

Resident had a fall when she was walking down to dinner, aides were

able to help her up and she came to dinner. No apparent injuries, butshe did c/o back pain and pain in her upper left leg. Please monitorfor changes._______________________________________________________AR

2/4/12

2/4/12

Resident is still complaining of back and left leg pain. I gave 2 lortab at breakfast and lunch.I reordered lortab from the pharmacy,_______________________________BTResident is still c/o pain in back and left leg, I gave her 2 lortab at 1600 and 2000. If

pain continues family will take her to the doctor. Lortab was delivered tonight____RJ

This illistration shows how to chart in the commnication book


27/6118

Incident Reports: Anincidentreportislledouttodocumentfalls,injuries,changesinaresidentsstatus,oraltercationswithotherresidents.Afallisdenedasanycontactwiththegroundthatisntintentional.Ifaresidentislowedtotheoorbyastaffmemberthisstillcountsasafall,andneedstobewrittenupinanIncidentReport.Inju-riesinclude:bruises,skintears,scrapes,burns,etc.Thesealsoneedtobedocumentedwithan IncidentReport.Changesinaresidentsstatusinclude:changeinvitalsigns,orbehaviorthatisntnormalforthatresident.Allofthesethingscansignifyprogressionofadiseaseprocess,ormedicalproblemsthatneedtobeaddressed.Thatiswhyitisimperativethattheseincidentsareproperlydocumented.

The other tie tht IncidentReportistobelledoutiswhenthereisaphysicalaltercationbetweentworesidents.Ifaphysicalaltercationoccursbetweentworesidents,thenthenurseneedstobenotiedimme -diately.Thenursewillassessthesituationandnotifytheappropriatepeople:thedoctor,family,AdultProtectiveServices(APS),ect. The48HourFollowUpaccompainstheIncidentReport.ThepersonthatllsouttheIncidentReportwillalsoneedtolloutthedescriptionofwhathappenedandtherstlineofvitalsandresidentcondtiononthe48HourFollowUp.ThesetwoareasneedtoMATCHtheinformationontheIncidentReport.BoththeIncidentReportandthe48HourFollowUpneedtobelledoutinBLACKpen.Itistheresponsiblityofthemedtech

thatrecievestheIncidentReportandthe48HourFollowUp,tocheckthattheyarelledoutproperlyandtheinformationthatgivenisclear,conciseandusesobjectivedetail.IfyoureceiveanIncidentReportor48HourFollowUpthatisntlledoutcorrectly,orisunclear,youwillneedtondthepersonthatlleditoutandhavethemxanyproblems. ToseehowtocorrectlylloutanIncidentReportand48HourFollowUpgotopages19and20.


28/6119

Bu Knd1/6/12 10 Rein BaroNm , A n ne

I we t ein ro t v i 10ed, n wa n o i baro. H stae ha e t t ml t baro n losi bln n . H stae ha i ba , u ha n clnt p, n ha n pn je. I e n ba nt ih n ne t pag ed .

Ye

Ye

D. Sld 1030

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N

N/AN/A

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N/AN/A

C/O L Ba P

A n One

97.5 65 18 145/75

1/6/12 Ra Fln

I e ein n t i h. An ne t pag f .

ThisillistrationshowshowtolloutanIncidentReport.Rememberthatitneedstobelledoutcompletelyinblackpen,withclearand

concisedetails.IfyoureceiveanIncidentReportthatisnotlledoutproperlyitisyouresponsibilitytondthepersonthatlleditoutand

havethemxtheproblems.


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1/6/12Bu Knd

I we t ein ro t v i 10ed, n wa n o

1/6/12

1/6/12

1/7/12

1/7/12

1/7/12

10

1800

0600

1030

2030

145/75

140/75

137/68

158/80

148/81

97.5

98.5

98.2

99.0

98.9

65

63

70

79

79

18

18

20

20

20

N pn je, C/O l bap .

R . FlnMT

Resident still C/O Lower back pain

R. James MT

No C/O PainS. Jenkins

CNA

Resident C/O of some back pain

B. Thomas MTNo C/O Pain

A. Rogers MT

Thisillistrationshowshowtollouta48HourReport.Rememberthatitneedstobelledoutcompletelyinblackpen,withclearand

concisedetails.Ifyoureceivea48HourReportthatisnotlledoutproperlyitisyouresponsibilitytondthepersonthatlleditoutand

havethemxtheproblems.

i baro. H stae ha e t t ml t baro n los i bln n .H stae ha i ba

, u ha n clnt p , n ha n pn je. I e

n ba nt i h n ne t pag ed .


30/6121

Taking and Recording Vital Signs: Vitalsaretakenoneachshiftandmustberecordedintheappropriateplace.Thefourmainvitalsthatarecollectedoneachshiftarethedailyvitalstheaidestake,bloodsugars,pulsesorbloodpressuresthatmedtechsmusttakebeforeadministeringmedication,andoxygenlevels(O2).

Daily Vitals: Theaidesareresponsibleforgettingthedailyvitals.Whenthemedtechreceivesthem,theyneedtoberecordedinMAR.Itistheaidessresponsibilitytocollectthedailyvitalsthatareonthedailyvitalsheet,anditisthemedtechsresponsibilitytomakesurethatvitalsgetdone.Eachshifthasanassignedtimethatvitalsmustbecompletedby:AMvitalsaretobedoneby1000,PMvitalsby1600andgraveyardvitalsby0630.Iftheaideshaventtakenthevitalsbythesetimes,itistheresponsibilityofthemedtechtoremindtheaidestogetthevitalsdone.Ifthemedtechshaveaproblemwithgettingthedailyvitalsfromtheaides,thentheyneedtonotifytheRCCsothatshecancorrecttheproblem.

Take BP Once a Day 0800 12085

136

7212779

1596

15390

14990

Daly Vitals in the MAR

Med techs need to record the daily vitals that the aides collect every shit in the MARs. There are also vitals that the med techs are responsibleto collect (it will speciy in the MAR that the med tech need to take a vital sign), these vitals also need to be recorded in the MARs.


31/6122

Blood Sugars:

Oxygen Level (O2):

BloodsugarsaretakenbythemedtechsontheAMandPMshift,onthegraveyardshiftoneoftheaidesisassignedtotakethebloodsugars.Bloodsugarsthataretakenneedtoberecordedinthe bloo Sgr bierfoundintheMedRoom.Bloodsugarsaretakenusingeitherhousesuppliesortheresidentsownsupplies;itistheresponsibilityofthemedtechtoknowwhichsuppliestousewhentakingaresidentsbloodsugar.Whenthehousebloodsugarstripsarerunninglowthemedtechneedstonotifytheassistt administratorsoshecan

ordermore.Becausebloodsugarsvaryaccordingtothetimeofday,whethertheresidenthasrecentlyeaten,ortakenabloodsugarmedication(insulinoranoralagent);itisveryimportantthatbloodsugarsaretakenattheassignedtimes.Doctorsmakechangestomedicationbasedonthebloodsugarsthatarerecorded.Thereisabigdifferencebetweenabloodsugarof97beforelunchanda197afterlunch.

BloodSugarLogResident:_Joan Murdock_____________ Month/Year:Dec. 2011______

DATE PRE-BREAKFAST PRE-LUNCH PRE-DINNER BEDTIME

2/21/2012 60 250 200 3012/22/2012 70 179 128 2532/23/2012 103 315 249 151

2/24/2012 83 104 300 365

Oxygenlevel(O2)measuresthepercentofoxygenthattheredbloodcellsarecarryinginthebodyand

ismeasuredwithanoximeter.Generally,residentsthatneedtheiroxygenlevelscheckedhaveitcheckedtwiceaday,onceonAMandonceonPMshift.MedtechstakethisvitalandthenrecorditintheMAR.(MostmedtechstaketheoximeterwiththemononeoftheirpillpassesandtaketheO

2duringthatpass.)

Take Oxygen Level Every Shif 0800

2000

RF RF RF

93 98

98 94 9495

95 9595

95 93 98BT BT BT

RJ RJ RJAR AR AR

Thisillstrationshowshowtolloutabloodsugarform.AMandPMmedtechsneedtorecordthebloodsugarsthatarescheduledontheir

shits in the Blood Sgar Log. Graveyard blood sgars are collected by an aide on that shit and given to the AM med tech, it is the AM med

techs responsiblity to record the graveyard blood sgars.

Some residents need their O2taken, this is sally done twice a day (once a shit). Ater yo have taken an O

2yo need to record it in the

MAR along with yor intails.


32/6123

Pulses and Blood Pressures:

Therearesomemedicationsthatrequirethatapulseorbloodpressurebetakenbeforethemedicationisadministered.Thisisbecausethemedicationbeingadministeredcausesachangeinthisvitalsign.Forexample,digoxincontrolstheheartratebyloweringit,sobeforeadministeringitanapicalpulsemustbetaken.Ifthe

pulseislowerthan60beatsperminutethedigoxenneedstobeheld.Givingitwhentheheartrateislowerthan60beatsperminutecancauseanunsafedropinheartrate.Reverselygivingamedicationthathelpscontrollow

pulseorbloodpressurewhenthevitalsareabovetheapprovedlevelcancauseanunsaferiseinthevital.MAkesurethatyoutaketherequiredvitalsbeforegivingamedication.

Pulse in Mar:

Digoxin 25 MCG1 Tablet Every Day

0800Pluse

RF RF RF 103 97 89

BT BT BT 88 84 75

Some medication reqire that a plse or blood pressre be taken beore they are given. The MAR will speciy which medications. These vitals are

the med techs responsiblity to collect. Ater the vital is taken and the medication given the vital needs to be recorded in the MAR along with

the med techs initals. I the vital is to low or high then the med tech needs to circle their initals and pt an H nder the vital to show that the

medication was held becase the vital was too low/high.


33/6124

Using the Binders: Therearedifferentbindersthatareusedtoleandstoreinformationonresidents,newmedicationorders,medicationsthataredeliveredandreorderedfromthepharamacy.Eachbinderhasdifferentinforma-tionstoredinitandhasacertainwaythatitisled.Thissectionoffersabriefdescriptionofthebindersthatareusedtostoredifferentmedicalinformation.

Communication Book:

New Orders Book:

Reorder Book:

ThisbinderiswherethecurrentCommunicationSheetsforeachresidentarekept.InadditiontotheCommunicatonSheets,acopyofanynewordersandinstructionsaboutaresidentscare.Thesecopiesare

placedinfrontofthecommunictionsheet.MedtechsneedtoreadtheCommunicationSheetseveryshiftsothattheyareawareofhoweachresidentisdoing.Copiesofneworderesareputinthisbookforthesamereason.AsyoureadtheCommunicationSheets,youshouldalsoreadtheneworders,soyouareawareofmedicationchanges.BothcartshavetheirownCommunicationBookandresidentsaredividedintoeachbookaccordingiftheyliveonthebigcartsideorsmallcartsideofthebuilding.Withineachbindertheresidentsareputinalpha-

beticalorderbylastname.TheCommunicationBooksarekeptwiththecorresponingmedcartatalltimes.

TheNewOrdersBookiskeptintheMedRoom.Acopyofeachneworderthatisreceivedisplacedintothisbinderforquickrefernce.Thereisatabdividerforeachletterofthealphabetandthenewordersareledunderthesetabsaccordingtolastname.Whenyouleaneworderinthebook,gotothecorrectlettertaband

placetheorderonthetopoftheotherinthatsection.Thiswaythemostrecentorderisontop. Ifthereisaquestionofaneworderthisbookcanbeusedasquickrefernceinsteadoftryingtondtheorderthatmaynotyetbeledintheresidentschart.

TheReorderBookiskeptintheMedRoom.ThisbookiswherethereordersheetsthataresentSuperiorareledoncetheyhavebeenfaxedtoSuperior.IfthereisaquestionaboutwhensomethingwasorderedfromSuperioryoucanrefertothesheetsthatareinthebookforaspecicdate.AlsopackagingslipsthataresentfromALLpharmaciesareledinthisbook.Thiswaywehaverecordofthemedicationthatisdeliveredfromthepharmacies.Thesheetsinthisbookareledinchronologicalorderwiththemostrecentsheetsontop.Afteryouhavefaxedareordersheetorreceivedapackingslipfromthepharmacyputthatsheetonthetopofalloftheothersinthebook.Thatwaythesheetsstayinorder.

Narc Hard Copy Book:

Whenahardcopyorderforanarcisreceivedfromadocotor,youwilneedcallthepharmacyandletthemknowthatwehaveahardcopyforanarcthatneedstobepickedup.TheNarcHardCopyBookiswherethoseordersarestoreduntilthepharmacysendssomeonetopickthemup.Afteryouhavecalledthepharmacyyouwillneedtomakeanextracopyoftheorderandputitalongwiththehardcopyintothebook.Whenthedriverfromthepharmacydoescometopickupthehardcopy,youneedtohavethemsignanddatethecopy.Thiswaywehavearecordofwhotooktheorderandwhenitistake,incaseitislost.


34/6125

Blood Sugar Log:

BloodsugarsaretheonlyscheduledvitalsthatarenotrecordedintheMAR.TheyarerecordedintheBloodSugarLog.Thisbinderislocatedintheme Room.Eachresident,whosebloodsugarwetake,hasatabdividerwiththeirnameonit.TheBloodSugarLoghasenoughspaceforonemonthofbloodsugars.Onceyouhavetakenabloodsugaryouneedtorecorditintheappropriatepalce.Toseehowtorecordabloodsugarseepage22.OnceaBloodSugarLogisfullitneedstobeplacedintheRCCsboxsothatshecanreviewit.

Aftershehasdonethis,thelogneedstobeledintheresidentschartundertheBloodSugartab.

Medication Disposal Book: TheStaterequiresthatarecordiskeptforallofthedestroyedmedication.TheMedicationDisposalBookiswherewekeepourrecords.Todestroymedicationyouwillneedawitnesstoverifythatyouhavedestroyedthemedication.Thisisusuallytheothermedtechorthenurse.Ifthemedicationisanarc,thenthenursemustdestroythenarcandyoucanactasthewitness.Whenyoudestroyanymedicationyouneedtore -cordthatyoudidsointhisbook.OntheDisposalSheetinthebookyouneedtowritethedate,thenameoftheresidentthatthemedicationbelongsto,themedicationname,thestrength,thequanityofmedicationdestroyed,

thereasonfordestroyingthemedication(expired,theresidenthaspassedaway,ect.),andyouandthewitnesswillneedtosignthethesheet.

The Supply Book: TheSupplyBookiswereallofthesuppliesgiventotheresidentsarerecorded.Thebookhasasheetwitheveryresidentsnameandroomnumberonit.Thesesheetsare organized by room number.Whenyouuserstaidsupplies,labspecimensupplies,orgiveresidentssuppliesfromthecagesdownstairsyouneedtorecordthesuppliesthatyougavethemthedatethatyougavethemandsignthatyougavethem.ThisbookislocatedbythephoneintheMedRoom.


35/6126

Section Three: New Orders and

Ordering From Pharmacies

New Orders: Newordersorchangestocurrentordersarereceivedalmostdaily.Whenaneworderorachangetoanexistingorderisreceivedtherearecertainstepsthatmustbefollowedtoinsurethattheneworderisdocument -edproperly,themedicationisreceivedfromthepharmacyandisstartedinatimelymanner.

Step One Whenaneworderisreceiveditneedstobefaxedtotheappropriatepharmacies.IftheresidentreceivesmedicationfromSuperiorthenacopyoftheorderonlyneedstobesenttoSuperior.Iftheresidentrecevies

medsfromMountainWest,thenacopymustbesenttoMountainWest,andacopythatismarkedasproleonlyneedstobesenttoSuperior.IfacopyisntsenttoSuperiorthenitwontappearonthenextMAR.Aftertheorderhasbeensenttothepharmacyitneedstobestampedwiththefaxedstampthatislocatedbythefaxmachineinthemedroom.Andthenthedateneedsto

bewrittennexttothestamp.

Step Two Aftertheneworderisfaxedtothepharmacy,youneedtomakethreecopiesoftheorder.Onecopygoesi the newOrer bier i the me Room,onecopy

goes i the Communicationbook i frot of the resi-dentsCommunicationSheet,andthethirdcopygoesinAssistantRCCsboxintheme Roo so tht shecanchecktheorderonthenextMAR.

Step Three ThelaststepistogivetheoriginalordertothenursesothatshecanwriteitintheMAR.IfthenurseisntavailablethentheassistantRCCwillwriteitintheMAR.IfsheisntavailablethenthemedtechcanwritetheorderintheMAR.Todothis,calltheon-callnursethatisoncallandshewillokayyoutowriteinthe

orderandtellyouhowitshouldappearontheMAR.OncetheorderhasbeenwrittenontheMAR,theorderneedstobeputinthenursesboxinthemeRoososhecannote(sign)it.Oncethenursehasnotedtheorderitcanbeledintheresidentschart.


36/6127

Ordering From The Pharmacy: CurrentlytherearetwomainpharmaciesthatsupplythemedicationforLegacyHouse.TheyareSupe-riorCarePharmacy,whichistheprimarypharmacy,andMountainWestApothecary,thesecondarypharmacy.Onoccasionduetoinsuranceissuesaresidentmayneedtogothroughanotherpharmacy,butthisisrare,and

onsuchoccasionsthepharmacymustbeapprovedbythenursebecausestateregulationsrequirethatallmedi -cationsbepackageinbubblepacks.Medicationsneedtobereorderedwhenthereisaboutsevendaysworthofmedicationleft.Thiswayifthereisanyproblemwithllingtheprescriptionitcanberesolvedbeforethemedicationrunsout. Foreverypharmacy,whenyoureorderanarc,youneedtoplaceacoloredstickernexttothenumberonthenarccardwhenyoureorderedit.Youneedtosignanddatethesticker.Thisshowsthatthenarchasbeenreordered.Whenthenarccomes,placeanXonthesticker.Thisshowsthatmorenarcshavearrived. Reorderingneedstobedoneearlyintheday.IfaPMmedtechnoticesthatamedicaionneedstobere-orderedafterthepharmacyisclosed,thenthatmedicationneedstobechartedinthe24HourReport,sothattheAMmedtechcanreorderitthenextday. Whenamedicationisdeliveredfromapharmacyonlythemedtechsondutycansignforthatdelivery.

Beforeyoucansignformedicationsyouneedtocheckthelistthatissentwiththedeliveryandmakesurethateverythingthatisinthebagandonthelistmatch.Iftheydontyouneedtotellthedriverandcallthepharmacyimmediately.Alsoifapharmacytriestosendanymedicationinabottle(liquidorpillform)thenyouneedtorefusethatmedicationandcallthepharmacyimmmediatelyandtellthemthatyoucanonlyacceptmedicationinamedcardorsingledosesyringes. TheRCCneedstonotiedimmedatelywithanyproblemswhenorderingmedications;orifapharmacychangesitsorderingproceedures.

Superior Care Pharmacy:

SuperiorCarePharmacyisthepharmacythatsuppliesthemedicationstothemajorityoftheresidents.TheyalsoprintMARforalloftheresidentsregardlessofthepharmacythatsuppliesaresidentsmedication.Superiordeliversscheduledmedicationsinweeklyincrements;thepackagingisreferredtoasautomedstrips.EveryweekSuperiorfaxesoveracensusformoftheresidentsthattheyprovidemedicationsfor,anyresidentsthatareLOAforanyreasonneedtobemarkedoffthecensusformsothatSuperiorwillnotsendanautomedthatweekforthatresident.AutomedstripsaredeliveredeveryThursdayeveningandareputawayonThursdaynightsbytheassistantRCCormedtechonduty.ThenewautomedbeginsonFridaywiththe1700dose.Whenthesestripsaredeliveredtheyneedtobecheckedforaccuracy.Anyproblemsneedtobereportedtothephar-macyimmediatelysothattheerrorcanbecorrected.Errorsinclude:wrongmedicationormissingmedication.ErrorsneedtobereportedtotheRCCaswellsothatproblemscanbereportedandcorrected. SuperioralsodeliversPRNmedication,narcs,andvariousothermedicationssuchasCoumadin,an-

tibiotics,andmedicationsinmedicationcards.Thesemedicationshavenosetdeliveryschedule.Whenthereisaboutaweekleftofthemedication,itneedstobereordered.Themedcardshaveastripthatcanbepulledoffandstucktoareordersheetthatisfaxedtothepharmacy.Anymedicationsthatdonthaveastripthatcan

beplacedonthereordersheetneedtobephonedintothepharmacy.Everyshiftshouldcheckthecartforanymedicationsthatarerunninglowandneedtobedelivered.ThereordersheetforSuperiorneedstobesentinev -eryweekdaybefore1000.Anymedicationsornewordersthatareneededassoonaspossibleneedtobecalled-intothepharmacy,sothattheyknowtosenditoutthesameday.Forexample,whenyoureceiveaneworderfaxittothepharmacy,andthencallthepharmacyverifythattheyreceivedtheorder,andtellthemthatitneedstobesentoutsameday.


37/6128

Ordering Priority Medications:

Ordering After Hours:

WhenorderingamedicationfromSuperiorthatarehighpriority,suchasanantibioticorCoumadin,thepharmacyneedstobenotiedthatthemedicationneedstobesentpriority.Thiscanbedonebyfaxingtheorderasnormal,thencallingSuperiorandtellingthemthatthemedicationneedstocomepriority.Thepharmacythenhasfourhourstodeliverthemedication.IfyouhaveanyproblemswiththepharmacywhenorderingprioritymedicationsnotifytheRCCsoshecancommunicatetheseproblemstothepharmacy.

IfamedicationneedstobeorderedafterhoursorduringtheweekendcallSuperiorsweekendnumber.Anoncallpharmacistwillbepagedandcallthemedtechbackandthenitwillbedecidedhowtobestllthe

prescriptionandhaveitdeliveredtoLegacyHouse.

Mountian West Apothacary:

Other Pharmacies:

MountainWestApothecaryisthesecondarypharmacythatisused.Thispharmacyisgenerallyusedbyresidentsthatgetthemedicationsfromanotherpharmacy,usuallymailorderorVApharmacy.Thesemedica-tionsneedtoberepackagedaccordingtostateregulations.MountainWestpackagestheirmedicationsintomed

bubbles,anddeliversmedicationbubblesinaweeklyincrement.AlsolikeSuperior,MountainWestsendsmedi-cationcardsforPRN,narcs.TheassistantRCCorPMmedtechalsochangesoutthemedbubblesatnight.Andliketheautomedstrips,thebubblesneedtobecheckedforaccuracy.IfthereisanerrorthenMountainWestneedstobecontactedsotheerrorcanbecorrected.AlsoifanorderchangesduringtheweekMountainWestneedstobenotiedsothattheycanpickupthebubblesandcorrectlypackagethem. AnymedicationthatneedstobereorderedfromMountainWestneedstobephonedinby1300.Iftheorderisphonedinanylaterthan1300,itmaynotbedelivereduntilthenextday.TheAMmedtechneedstobeawareofanymedicationsneededandorderthempromptlysothattheywillbedeliveredwhentheyareneeded. MountainWestrepackagesmedicationsthatcomefromotherpharmacies,suchastheVAandmailorder

pharmacies.ThesemedicationsareoftendeliveredtoLegacyHouse.Whentheyaredelivered,themedtechneedstocallMountainWestandletthemknowwhatmedicationsneedtobepickedupandrepackaged.Whenthepharmacycomesandpicksupmedicationtheyneedtosignforthemedicationthattheyarepickingup,sothatthereisarecordofwheremedicationhasgoneandwhohastakenit.

Hospiceagenciesprovideanymedicationsfortheirpatientsthatrelatetotheadmittingdiagnosisandcomfortmedications.Thesemedicationsareprovidedbyapharmacythatthehospiceusesbecausehospicepaysforthem.Rememberthathospicepharmacieswillonlysend14daysworthofmedicationsandgenerallywontrellmedicationsuntilafewdaysbeforetheyrunout.Toreordermedicationsthatareprovidedbyahospiceagency,calltheagencyortheresidentshospicenurseandgivealistofthemedicationsthatareneeded.Theywillordertheneededmedicationfromthepharmacy,andthepharmacywilldeliver.Someresidentsuseotherpharmaciesforinsurancereasons.Whenthishappensandmedicationsneedtobereor-dered,callthepharmacyandgivealistofthemedicationsthatareneeded.Thepharmacywillllthemedica-tionanddeliverit.


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New Order Checklist

Reorder Checklist

1. Afterreceivingtheorder,faxittoSuperiorandanyotherpharmacy2. Make3copiesoftheorder:

OnecopygoestheCommunicationBook OnecopygoestheNewOrderBook

OnecopygoesintheAssitantRCCsbox3.Callthepharmacyandverifythattheyreceivedtheorder,andaskthemtosendoutthenewmedication.4.AsktheRCCorAssitantRCCtowritetheneworderintheMAR.5.PuttheorginalorderintheresidentchartorRCCsbox(ifnotsigned).

Sperior Care Pharmacy Montian West Apothacary Hospice Pharmacies

Whenpossiblepulloffthereorderstickersandplaceonthereorder

sheetsthatarefaxeddailytoSupe-riorby1000.

Callinallreorders Callthehospicenurseforallreor-ers

Callinordersthatdonthaveastickerornewordersthatneedto

besentout.

Reorderallmedicationsdailybe-fore1300

Rememberthathospicepharmaciesonlysend14daysofmedications.

Whenamedicationisneedrightawaycallitinandtellthephar-

macyitisneededpriority.


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Section Four: Emergency Situations

First Aid: AllaidesthatworkforLegacyHousearerequiredtoberstaidandCPRcertied.However,whenrstaidneedstobeadministered,itistheresponsibilityofthemedtechondutytoproviderstaid.Partofprovid -ingrstaidistodeterminewhetherornottheinjurycanbeattendedtowithinthefacilityoriftheresidentneedstobesenttothehospital.Generally,medtechsproviderstaidforskintears,cuts,lessseriouswounds,andsmallburns.FirstaidsuppliesarekeptinthecupboardsoftheMedRoom.Anysuppliesthatareusedneedtobesignedoutinthebinderthatiskeptinwiththerstaidsupplies.Tosignoutsuppliesfollowthesesteps:Inthesupply

bindereachresidentsnameisonapieceofpaper.Theseareorganizedaccordingtoroomnumber.Whenasup-plyisusedit,alongwiththedateneedtobewrittenonthepaperwiththeappropriateresidentsnameandthen

themedtechneedstosign.Somesupplieshavestickersonthemthatsaywhattheyare.Ifthesupplieshaveastickerthenplacethestickeronthepaperandinitialanddatenexttothesticker.ToreadmoreaboutusingtheSupplyBookgotopage25. ThesuppliesthatLegacyHousestocksare: b ies Bacatracin no aheret Ps TegadermPatches GauzeSquares Iftheinjurythatisbeingdressedissmallenoughthatthetegadermandpadcanbecutdownandstill

coverthewoundthanthiscanbedone.Afterward,theextrasuppliesneedtobelabeledwiththeresidentsnameandplacedintheirspotinthemedcartforfutureuse. AnyinjuriesandrstaidethatisadministeredneedstobechartedintheCommunicationBookandthe24HourReport,andanIncidentReportand48HourFollowUpneedtobelledout.Alsoremindthenextmedtechtocheckanybandagesthatyouputonaresidentforexcessbleeding/dischargeandcleaniness.

The pictre to the let shows the spply cpboard in the med room

wheretherstaidsuppliesarekept.

Thepictureaboveshowssomeoftherstaidesuppiesthatwekeepa

Legacy Hose and the spply stickers that are sed to sign ot these

spplies.


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Transporting to the Hospital:

Employee Injury Procedure:

Whenthereisasignicantchangeintheresidentsstatus,seriousillnessorinjurythatcannotbehandledwithinthefacilitythenitisnecessarytotransporttheresidenttothehospital.Ifthesituationisanemergencythentheambulanceneedstobecalled.Ifthechange,illnessorinjuryisnonemergentthenfamily

needstobecontactedandaskedwhetherornottheywanttheresidenttakentothehospitalvianonemergentambulanceoriftheyprefertotaketheresidenttothehospitalthemselves.WhensendingaresidenttothehospitaltwocopiesoftheMAR,FaceSheet,PLOSTform,andanyotherformsthatarenecessary(suchasH&P)needtoaccompanytheresident.OnecopyisfortheEMTsandtheotherisforthehospitalstaff. Whenaresidentissenttothehospitaltheon-callnurse,administrator,andemergencycontactmust

benotiedthataresidenthasleftthebuilding.Also,ifsomeonethatwassenttothehospitalreturns,thentheon-callnurse,administrator,andemergencycontactneedtobenotiedaswell.However,ifaresidenthasbeeninthehospitalformorethanthreeormoredays,theymaynotreturntothefacilityuntiltheRCCorRNassessestheresidentandclearsthemtocomeback.Ifforsomereasonthehospitaltriestosendaresi -dentbackthathasbeengoneforthreedaysandtheyhavenotbeenassessed;thenthemedtechneedstotellthehospitalthattheresidentcannotreturnuntilassessed.Andthenthemedtechneedstocontacttheon-call

nursesothatappropriateactioncanbetakentoreadmittheresident.Oncearesidentreturnsfromthehospi -tala48hourfollowupneedstobestarted.Seepage32forachecklisttosendaresidenttothehospital.

IfanemployeeisinjuredonthejobandtheRCCorassistantadministratorisnotpresentthenitisthemedtechsjobtoassisttheemployeeinfollowingthecorrectprocedures. Procedureforanonthejobinjuryare:1. Callandreporttoassistantadministrator/supervisor2. FilloutaWorkmansCompensationFormlocatedintheWellnessCenterinthegreenbinder3. FilloutanIncidentReportthatincludes: Whathappened Whenithappened Howithappened Whatyoudidaboutit Vitalsignsoftheemployee TheemployeemustgotoFirstMed(MondaythroughFridayduringregularbusinesshours)locatedat214West1500SouthBountiful,Utah.801-295-6483.IftheinjuryoccursonaSaturday,Sunday,Holiday,oraf-terregularbusinesshourstheemployeeneedstogotoInstaCare,locatedonMainStreet.Iftheinjuryisserious

anditisdeemedappropriatetodosotheemployeeshouldgotoLakeviewHospital. ForWorkersComptopayforanymedicalservicesprovidedforanonthejobinjurytheemployeeMuST: Beseenwithin24hoursoftheinjury Receivefollowupinstructions Gotoanyfollowupappointments.Iftheyfaildoso,theWorkers

Compclaimwillbedeniedandtheemployeewillberesponsibleforthebill. Keepallofthepaperworktheyreceiveandturnitintohisorher

supervisor. Themedtechthatisassistingtheemployeeneedstoinformtheemployeeabouttheserules.


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Hospital Procedure

1. Assess the situation

What is happening (Injury, Illness, Strange Behavior)? Can you idenfy any specicsymptoms?Can this wait to be addressed by a doctor or by the nurse?

(If youre not sure ask the nurse)2. What are the residents vitals?

Blood Pressure PulseTemperature ResperationsO

2Stat Blood Sugar

Is a vital sign contrubing to this situation? (i.e. low/high blood sugar, low O2Stat)

3. Is the situation emergent? Does the ambulance need to get here now? Or can a fam-ily member be contacted to transport to the hospital or Instacare? (If the family cannot provide transportation, call for a nonemergent ambulance.)

4. Do you have the correct paperwork? Remember you need to make two copies ofeach

Current MAR or Med ListFacesheetPLOST Form

5. Have you contacted the correct people? (The building administrator, RCC and

emergency contact person)

Calling the Ambulance:

When you call the ambulance you need to know a few things:1. The Address: 79 East Center Street Bountiful and the residents room number2. The med tech cell phone number you are calling from:

Big Cart: (801)834-4261Small Cart: (801)634-8267

3. The residents name, age and brief medical history4. The reason that you are calling. (Injury, Illness, and any symptoms)5. Vital signs that you have just taken.

Non Emergent Ambulance:

(801) 298-6000

Emergent Ambulance: 911


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Building Evacuation: Whethebuidlingneedstobeevacuated,itistheresponsibilityofthemedtechson-dutytosupervisetheevacuationandensurethateveryoneandeverythingthatisneededisevacuatedsafely. Whentherealarmsoundseveryemployeeinthebuildingneedstogotothefrontdesktoreceive

instructionsonwhattodo.Thealarmautomaticallynotiestheredepartment.Ifthemedtechsaretheonlysu-pervisorspresentthentheyneedtoreadtherealarmpaneltodeterminewherethereis.Oncetheyhavedonethistheyneedtosendsomeonetoinvestigatetheareawheretherealarmhasgoneoff.Thispersonwillreport

backifthereisareorifsomethinghastrippedthealarm.Whenthealarmgoesoffregardlessifitisarealreorafalsealarmtheaiistrtor maintenancemanagerneedtobenotied.Whentheredepartmentarrivestheremenwillneedtospeakwithoneofthesemanagers.Ifforsomereasonneitherofthesemanagerscanbereachedthentheassistt administratorcanbecontacted. Ifthereisareorsomeotherdisasterthatrequiresthebuildingtobeevacuatedthestaffwillgotoeachroomandnotifyeachresidentthatthebuildingneedstobeevacuated.Iftheresidentneedshelpbecausetheyareinawheelchair,thenthestaffneedstohelptheresidentintothewheelchairandescorttheresidenttotheevacuationsite.Iftheresidenthasapet,thepetwillneedtobeevacuatedaswell.If,duetothedisastera

residentcannotbesafelyreached,donotattempttodoso,waitfortheredepartmenttoarriveandtheywillsafelyevacuateresidentsthatthestaffcannotsafelyevacuate.Whenevacuatingthebuildingallhallwaysmust

becleared.Someofourresidentsleavejazzywheelchairsinthehallway,andthisisne.However,inanevacu-ationsituationthesechairsandanythingelsethatisinthehallwaysuchasdcorneedstobemovedinaresi -dentsroom. ThetwootherthingsthatneedtobeevacuatedaretheresidentschartslocatedintheWelless CeterandthemedicationincludingMARSandNarcRecords.Whentheevacuationofresidentsissafelyunderwaythemedtechsareresponsibletoevacuatethemedcarts.Themedcartscanbeloadedupwiththenecessarychartingbindersandanymedicationsthatarekeptinthecupboardsintheme Roo the Cottge Ofce.Ifforsomereasonthemedcartscannotbeevacuatedthentheircontentsneedtobeloadedintoboxessothatthemedicationscanbetakentotheevacuationsite. Theevacuationsiteisthechurchacrossthestreet.Ifthebuildingisopenthenthemeetingsitewillbethegym.TheCottageresidentswillbeevacuatedtoasmallerclassroomtopreventthemfromwanderingoff.Ifthebuildingisnotopenthenthemeetingplacewillbethechurchparkinglot.Cottge resiets resietsthatliveinthenewadditionneedtobeevacuatedtothebackofthebuildingintothebackparkinglot.Ifitissafetodosotheycanthenbetakenovertothechurchwiththerestoftheresidents.Thiscanbedonebywalk-ingthemaroundtheblock,iftheyareable,orusingcarsifpossible. Onceeveryoneandeverythingisevacuatedarollcallneedstobetakenofalloftheresidentsandstafftoinsurethateveryoneisaccountedfor.Also,amakeshiftmedareawillbesetupandthemedtechsandnurseswilltakeaccountofthemedicationtoinsurethatitisallaccountedfor. Ifthebuildingcannotbereinhabitedthenalloftheresidentswillneedaplacetostay.Theycangowith

family,besenttoanotherfacilityorifnecessarytheywillbeputupinahotel.Nomatterwheretheresidentgoeshisorhermedicationsneedtogowiththem.Themedtechswillpulltheappropriateamountofmedicationtobesentwitharesidentandsignoutanypillsthataresent.Ifresidentsareputupinahotel,theywillbetherewithotherresidentsandstaffwillaccompanythem.Inthiscasemedicationswillnotbesentaheadoftime.Theywillbepulledasusualwhentheyarescheduledtobegiven.Amedtechandtheappropriatenumberofaideswillremainatthehotelatalltimes.


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Death Procedures: Whenaresidentpassesawaytheappropriatepeopleneedtobenotied.Thesepeoplearetheemergencycontactoftheresident,thenurse,andtheadministrator.Iftheresidentisonhospicethenthehospicenurseneedstobenotiedaswell.Ifitisafterhours,weekend,orholidaythentheon-callhospicenurseneedstobecalled.Oncethefamilyhascomeinandasks,thenthemedtechcannotifythefuneralhome.Thefuneralhomeislistedonthefacesheetoftheresidentschart.Ifthereisntafuneralhomelistedthenthemedtechneedsto

askthefamilywhatfuneralhometheywouldliketobecontacted.Iftheresidentisonhospicethenhospicewillcallthefuneralhome,unlesstheyaskthemedtechtodoso. Medtechs,withthehelpoftheaides,willneedtoperformpostmortemcare.Thisincludescorrectly

positioningthelimbs,changingthebriefandclothes.Iftheresidentisonhospice,hospicemayelecttodothisandmayaskforthemedtechoraideshelpinperformingthiscare.Eitherwaypostmortemcareneedstobe

performedinatimelymannerbeforerigormortissetsin.YouwillalsoneedtolloutaRecordofDeathandhaveitsignedbythemorticianwhentheytakethebody.

BOUNTIFUL HOUSE ASSISTED LIVING

RECORD OF DEATH

NAMEOFRESIDENT:Marth Jones Room#:361D.O.B.:2/3/1919 AGE:91 SEX:Female RACE:White RELIGION:LDSDATEOFADMISSION:3/4/2005DATEOFDEATH:11/15/2011 HOUR: 2145ATTENDINGPHYSICANNOTIFIED: Dr. Geogre Gracia

801-555-1234 @2200FAMILYNOTIFIED:Lisa Johnson, Daughter

801-555-2288MORTICIANNOTIFIED:

Downunder Mortuary 801-555-3491 @ 2230NAMESOFTHOSEPRESENTATTHETIMEOFDEATH,ANDTHEIRRELATIONSHIPTOTHEDECEASED:Lisa Johnson, Daughter, Justin Johnson, grandson and Hailey Johnson, grand-daughterREMARKS:THEFOLLOWINGPERSONALITEMSWERETAKENBY:

*****************************************************************************

MORTICIANSREPORTRECEIVEDFROM

Brynn Thomas, Med Tech THEREMAINSOF: Martha Jones

RELEASETOSIGNATURE EMPLOYEESIGNATURE

DATEANDTIME DATEANDTIME


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Section Five: Outside Agencies

InadditiontotheassistancethattheresidentreceivesfromthestaffoftheLegacyHousetheymayreceivehelpformanoutsideagency.Therearethreeoutsideagenciesthatprovideassitancetoourresidents:FlexCareandhomehealthorhospice(neverbothatthesametime).Itisnotuncommonforaresidenttotrans -ferbetweenhomehealthandhospice.Nursesandmedtechsworkcloselywiththeseagenciestoinsurethattheresidentisreceivingappropriatecare.Forthisreason,goodcommunicationisimportant.Ifaresidenthasachangeinstatus,isLOAfromthefacilitybecausetheywenttothehospitalthentheagencyneedstobenoti-ed.Eachresidentonhomehealthandhospiceisassignedtoanurse;thisisthepersonthatneedstobenotiedaboutanychangesorconcernsabouttheresident. Theresidentandhisorherfamilytodecideonanagency.Thenursingstaffcanofferrecommendations

butcannottellthefamilywhichagenciescanorcannotbeused.

Home Health:

Hospice:

HomeHealthagenciesprovideskillednursingcaresthatthestaffofLegacyHousecannotprovide.Thesecaresincludediabeticcare(admisteringinsulin),cathetercare,physicaltherapytobuildstrengthand

balance,andwoundcarethatrequiresanursetodressandcleanwounds.Ifaresidentqualiestoreceivethesecaresfromanagency,thentheywillalsoqualifyforhomehealthaidevisitstohelpwithADLs.Eachagencyisdifferentinthecaresthattheywillprovideforresidentslivinginafacility.TheagencyalongwiththefamilyandRCCwilldecidewhatcarestheagencywillhelpwith.Itistheresponsiblityofthemedtechsandaidestoknowwhatcaresaresidentreceivesandonwhichdays.

Asamedtechyouinteractwitheachresidentonadailybasisandwillnoticeanychangesintheresi-dentsstatusthatmaysignifythattheresidentmayqualifyforhospice.WhensuchchangesarenoticedthemedtechneedstonotifytheRCCthattheresidentmayqualifyandbenetfromhospicecare.TheRCCwillcontactthefamilyanddoctortoobtainthepermissionandorderforanassessmenttoadmittohospice.Caresthathos -

piceprovidesforaresidentincludes:weeklynursingvisitstoassesstheresidentsstatus,skillednursingcares,

andaidevisitsforassistanceofADLssuchas:eating,andbathing.Aidevisitscanbeasfrequentasthefamily,hospicenurseandRCCagreearenecessary. Hospicewillalsoprovideanymedicationsthatrelatetotheresidentsadmittingdiagnosis,ekitsandanyothercomfortmedicationsnotintheekit.Anexamplewouldbe:ifaresidentwasadmittedtohospiceforthe

progressionofparkinsdisease,thehospiceagencywillprovideanyparkinsonsmedicationssuchascarvadopalevodopaandcomatin,medicationssuchaslortabforpainmanagement,andanekitforcomfortmeasures.Mostofthemedicationthatcomesinanekitwillbeinliquidform.Thesemedicationsneedtobeinsingledosesy-ringes.Whenorderingliquidmedicationoranekitfromhospicemakesurethatyouspecifythatliquidmedica-tionsneedtobeinsingledosesyringes.Itisthemedtechsresponsibilitytoknowwhatmedicationsareprovid-edbyhospiceandtoreorderthosemedicationsfromhospice.Reorderingcanbedonebycallingtheresidents


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Flex Care:

hospicenurseandtellinghimorherthemedicationsareneeded.Thenursewillthencallthepharmacyreorderthemedicationandhaveitdelivered.Hospicealsoprovidesbasicsuppliessuchaschucks,briefs,andgloves.Whenitisnecessarytheywillalsoprovidehospitalbeds,wheelchairs,andwalkers. HospiceistheretohelptheLegacystaffwiththeassistancethatweneedtogivetheresidentthebestqualityoflife.Thatiswhyitsveryimportanttocommunicatechangesinconditionandneedstothehospice.Appropriatetimestocallhospicewouldbe:signicantchangesintheresidentsstatus,falls,injuries,ifitap-

pearsthataresidentwouldbenetfromcomfortmedication,changingmedicationtohelptheresidentsstatus,reorderingmedicationsandsupplies,andwhentheresidentpassesaway.Iftheyouarentsurewhetherornottocallthehospicenurseaboutsomething,itisbetterthatyoudocall.Mostnursesareappreciativeoftheextrainformationthatyoucansharewiththem,especiallysincetheyarenotwiththeresidentonadaytodaybasis.Andyourobservationsmayhelpindeterminingabetterplanofcarethatwillbenettheresident. Inanemergencysituationorseriousinjuryofahospiceresident,thehospicenurseneedstobenoedandokaysendingthatresidenttothehospital.Anyresidentthatisonhospiceandissenttothehospitalwillau-tomaticallybedischargedfromhospicewhentheygotothehospital.Therefore,thereneedstobeagoodreasonthatisapprovedbythehospicenurse.

Flexcareisastateagencythathelpsresidentspayforthecostoflivinginourfacility.FlexCarealsoprovidesmanysuppliesfortheresidentsthatreceivetheirservices.IfaresidentisonFlexCareyoucannotgivethemLegacyHousesupplies.IftheyneedmoresuppliesthenyouneedtocontactFlexCareandtellthemwhichresidentneedssuppliesandwhatsuppliesareneeded. WhenaresidentonFlexCarehasafallorinjury,oristransportedtothehospitalFlexCareneedstobenotifed.AcurrentlistofresidentsonFlexCareislocatedinthefrontofbothMARs.


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Section Seven: Caring For Residents

with Diabetes and Dementia:

Residents with diabetes : Manyoftheresidentsthatliveinthefacilityhavediabetes.Theseresidentsgenerallyrequirediabeticcarefromthefacility,andoftenoutsideservicessuchashomehealth.Asmedtechyouareresponsibletomoni-torbloodsugarsofdiabeticresidents,givemedicationsthathelpcontroldiabetes,andwhennecessarygivearesidentaprelledsyringeofinsulinsothattheresidentcanadministertheinsulin.Itisimportantthatbloodsugarsaretakenattheappropriatetimesandrecordedinthecorrectplaces(SeeVitalsonpage13-14).Whenaresidentsbloodsugaristakenbyamedtechandthatresidentisonhomehealth,thebloodsugarneedstoberecordedinboththehomehealthfolderintheresidentsroomandthebloo SgrLog i the me Room. Partofprovidingdiabeticcareistobewareofsignsofhyperglycemia(highbloodsugar)orhypoglyce-

mia(lowbloodsugar).Ifanyresidentdisplayssignsofeitheroftheseconditions,thentheresidentsbloodsug -arshouldbetaken.Anabnormalreadingshouldbereportedtothenurseimmediately.Iftheresidentisdiabeticandonhomehealthorhospiceservicesthentheagencyshouldalsobecontactedimmediately.Thegurebelowshowsthesignsofhyperglycemiaandhypoglycemia.Manyofthesignsofhyperglycemiaandhypoglycemiaarethesame,soitimportantthatyouchecktheresidentsbloodsugarbeforetakingaction.

Hyperglycemia Hypoglycemia

Increased Thirst Nausea

Headache Extreme Hunger

Difficulty Concentrating Feeling Nervous or Jittery

Blurred Vision Cold Clammy Wet Skin

Frequent Urination Rapid Heartbeat

Fatigue Trembling

Blood Sugar over 180 Increased Confusion

Anxiety

Blurred Vision

Headache

Fatigue


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Residents with dementia : TheCottageisourDementiaunit.Theresidentsinthisunitneedspecialcare.Becauseoftheirdisease,theseresidentsoftenbecomememoryagitated,aggressive,andarenotabletoverbalizecomplaintsofpain,or

ofnotfeelingwell.Asamedtech,youneedtobeabletorecognizesignsofthesethingsandhelptheresident.Thiscanbedoneeitherbymedicationorredirection. MostoftheCottageresidentshaveanti-anxietymedicationthatcanbegivenwhenaresidentisanxious,aggressiveofagitated.Often,whenaresidentstartstoshowsignsofanyofthese,redirectionshouldbeattempt -edrst.Thiscanbedonebytakingtheresidentsattentionawayfromwhatiscausingthemtofeelthewaythattheydoandprovidingthemwithanotheractivity.Ifaredirectionapproachdoesnotwork,oriftheresidentsstateisbadenoughthataredirectionapproachwillnotwork,thenananti-anxietymedicationneedstobegiven. Iftheresidentdoesnthaveananti-anxietymedicationanditcomestothepointthataoneisneededthenyouneedtonotifythenurse.Thenursewillcontactthedoctorandgetaanti-anxietymedication.Iftheresidenthasamedicationbutitnolongerworksoritisdiffuculttogivebytheprescribedroute,youneedtonotifythenursesothatthedosagecanbechangedoranothermedicationcanbetried.Anexamplewouldbe,ifaresident

haslorazepaminpillformbutwhentheresidentisagitatedhewillnottakethemedication,thenaliquidorcreamformofthemedicationcanbeordered. OftenwhenyouattempttogiveaCottageresidentmedicationtheywillnottakeit.Whenthisoccursyouneedtowalkawayandgivetheresidentsometimetocalmdown.Attemptingredirectionalsohelpstochangetheresidentsfocus.Afterthatyouneedtotryadifferentapproachtogivingthemedication.Differentresidentsrespondbettertodifferentapproaches. Someresidentshaveahardtimetakingmedicationortakeitbetterwhenitiscrushedandinapplesauce.Todothis,wemusthavesignedorderfromthedoctor.Whenyouaregivingmedications,andnoticethataresidentishavingahardtimetakingmedicationortheresidentwouldtakemedicationbetterifitiscrushed,thennotifythenurseandshewillgetanordertocrushthemedication. ResidentsintheCottageareoftennotabletocomplainofpainorillness.Oftenwhenaresidentisin

painorilltheywillbecomeagitated.Asamedtechyouneedtobeabletoreadaresidentsbodylanguagesuchas:limping,favoringonelimpoveranother;andfacialexpressionssuchas:grimacing,tensionintheeyebrowstotelliftheyareinpain.Whenyounoticesignsthataresidentisinpain,thenyouneedtogivethemthepropermedication. ThemedtechthatisintheCottageduringtheAMandPMshiftactsasathirdaide.AsathirdaideyouneedtohelptheCottageaidescarefortheresidentswhentheyneedhelp.Asamedtech,youarealsointheCottagetoobservetheresidentsthatarebacktheretobettercareforthem.Byconsistentlyobservingtheresi -dents,youwillknowwhentheyneedmedicationorredirection.


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Supplies:

Doctors Apointments:

LegacyHousehassuppliesthatareavailableforresidentstouse.Thesesuppliesarebriefs,chucks,andgloves.Weneedtochargeforthesuppliesthatareavailable.Forthisreasonmedtechsaretheonlypeoplethathaveaccesstothesupplies.Whenaresidentneedssuppliesthentheaidewillnotifythemedtechanditisthenthemedtechsresponsibilitytogetthesupplies,signthemoutandgetthemtotheresident.NotallresidentsusethesuppliesthatareprovidedbyLegacyHouse,somearesuppliedbythefamilyhomehealth,hospiceorFlexCare.Itisthemedtechsresponsibilitytoknowwhetherornothousesuppliescanbegiventoaresident. Suppliesarelocatedinthebasementinthestorageroom.Theyarekeptincagesthatarelockedbecausetheyhavetosignedoutandchargedtoaresident.Thekeysforthecagesarelocatedintheme Room.Supplies

aresignedoutjustlikerstaidsuppliesintheSupplybinder.(Seepage25) Ifaresidentdoesnotuseoursupplies,themedtechmustnotifythecorrectpersonsothatsuppliescan

bebroughtin.

Oftenmedtechswillneedtoscheduledoctororvariousothermedicalappointments.Whenyoudothisyouneedtoknowifthefamilywill/cantransporttheresidenttotheappointmentoriftheActivitiesDepartmentneedstotransport.IfLegacyHouseistransportingtoanappointmentthentheappointmentneedstobemadeonthedaysandduringthetimesthatthebusisavailabletotransport.Thetimesthatthebusisavailabletotrans-

portislistedintheMedRoombythephone.Aftermakingtheappointment,anappointmentslipneedstobelledout.Themedtechmustrecordthefollowinginformationontheslip:theresidentsname,roomnumber,

phonenumber,thedateandtimeoftheappointment,thedoctorsnameandtheaddressoftheofce,yournameandanynotesthattheactivitiespersonwillneedtoknow.Oncetheslipislledoutitneedstobeplacedintheactivitiesmanagersboxorgiventoherdirectlysothatshecanscheduletransportationtotheappointment. Whenaresidentgoestothedoctorsappointmentthemedtechneedstocopyacurrentmedlist(MAR),the FaceSheet,anyotherpaperworkrequestedbythedoctor.Oftenthenursewillsendaletteraddressingthe

concernsthatshehasabouttheresident.Thispaperworkneedstobegiventothepersontakingtheresidenttotheappointment,eitherfamilyortheactivitiesperson.

Section Seven: Addtional Information


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HIPAA:

HIPAAstandsfortheHealthInsurancePortabilityandAccountabilityAct.Thisactinsurestheprivacyofpatientsmedicalrecordsandhealthplansprovidedbydoctors,hospitals,andcarefacilities.Itistherespon-

sibilityofalltheemployeesofthefacilitytoprovidetheprivacythatHIPAAinsurestoourresidents. Specicallyformedtechs,thismeansthatyoucannotdiscloseanymedicalinformationaboutaresidenttoanyonethattheresidentorPOAoftheresidenthasnotokayed.Partofthisincludeshavingconversationsaboutresidentinpublicplaces,orwithotherresidentsorfamilymembersofotherresidents.Asamedtechwhenyouhearotheremployeesdiscussingresidentsinthiswayyouneedtopolitelyremindthemthatthedis-cussiontheyarehavingisinappropriatebecauseofthelocationorthepersonthattheytalkingwith.Ifapersonasksaboutaresidentandyoucannotdiscussthatresidentwiththem,politelytellthemthatyoucannotdiscussthatinformationwiththem.IftheyhaveanyquestionsorpressureyoufurtheryoucanreferthemtotheRCC,or bilig administrator. Whenaresidentistransferredfromthefacility,employeesarenotallowedtodiscusswherethatresidenthasgoneandwhywithotherresidentsorfamilymembers.IftheypressureyoureferthemtotheRCCorBuild -

ingAdministrator. AspartofHIPAA,medtechsneedtodestroymedicationpacketsthathaveresidentnames,medicationnames,anddoctornamesonthem.Todothisshredbubblepackswhentheyareemptyandafterpassingmedi-cationshredthemedstrips.Aswellcopiesofnewordersthatdonotendupinthechartsneedtobeshreddedwhentheyarenolongerneeded.Agoodruletofollowisthatanythingthathaspersonalinformationanddoesnotendupintheresidentschartmustbeshredded.


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Appendices

AppendixA:CommonNarcsandAntibiotics

AppendixB:CommonMedications

AppendixC:SymbolsandAbbreviations

AppendixD:ConversionTable

AppendixE:MilitaryTime

Appendix F: Residents Charts

Appendix G: How to Give a Nebulizer Appendix H: How to Give a Suppository


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Appendix A: Common Narcotics and Antibiotics

ThisisalistofthenarcoticsthatarecommonlyusedatLegacyHouseofBountifuland

theformsthattheygenerallycomein.Medication Type Forms

Alprazolam(Xanax) Antianxiety Pill,Liquid,andCream

Ambien SleepAid Pill

Ativan(Lorazepam Antianxiety Pill,Liquid,andCream

Darvocet Pi Pill

Endocet Pi Pill

Fentanyl Pi Patch

Hydrocodone Pi PillandLiquid

Lorazepam(Ativan) Antianxiety Pill,Liquid,andCream

Lortab Pi PillandLiquid

methoe Pi Pill

Morphine Pi Pill,andLiquid

Narco Pi Pill

Oxycodone Pi Pill

Oxycotin Pi Pill

Percocet Pi Pill

Tylenol3 Pi Pill

Valium Pi Pill

Xanax Antianxiety Pill,Liquid,andCream

ThisisalistofthenarcoticsthatarecommonlyusedatLegacyHouseofBountifuland

theformsthattheygenerallycomein.Medication Type Forms

Alprazolam(Xanax) Antianxiety Pill,Liquid,andCream

Ambien SleepAid Pill

Ativan(Lorazepam Antianxiety Pill,Liquid,andCream

Darvocet Pi Pill

Endocet Pi Pill

Fentanyl Pi Patch

Hydrocodone Pi PillandLiquid

Lorazepam(Ativan) Antianxiety Pill,Liquid,andCream

Lortab Pi PillandLiquid

methoe Pi Pill

Morphine Pi Pill,andLiquid

Narco Pi Pill

Oxycodone Pi Pill

Oxycotin Pi Pill

Percocet Pi Pill

Tylenol3 Pi Pill

Valium Pi Pill

Xanax Antianxiety Pill,Liquid,andCream

ThisisalistoftheantibioticsthatarecommonlyusedatLegacyHouseofBountiful.

Antibiotic

Amoxicillin

Macrobid

Preisoe

ReexZPack


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Appendix B: Common Medications:

ThisisalistofmedicaitonthatiscommonlyusedatLegacyHouseofBountiful,andwhatthemedica-

tiontreats.

Medication Type

Aricept deeti

Carvedilol HeartFailure

Citalapram Depression

Counadin bloo Thier

Cymbalta Depression

digoxi HeartFailure(SlowsHeartRate)

Ditalizem HighBloodPressure

Flomax EnlargedProstateFurosemide WaterPillandHighBloodPressures

Glipizide Diabetes

Haldol Anxiety(NonNarcotic)

Lexapro Depression

Lisinopril HighBloodPressureandHeartFailure

m

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