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Agency Name
SUBJECT:
POLICY #:
PROCEDURE #:
OTHER#:
MEDICATION ADMINISTRATION
SECTION:
DEPARTMENT:
HOME HEALTH
PATIENT CARE
ORIGINAL EFFECTIVE DATE:
REVISED DATE:
ADMINISTRATIVE APPROVAL:
I.
POLICY: Medications may be administered by Home Health staff following guidelines set
forth in this policy. Every patient admitted to Home Health will have present in their
clinical chart a complete, concise, and updated medication flow sheet. The agency will
follow the Clinical Nursing Procedure Manual for administration of medications. A copy
of the Clinical Nursing Procedure Manual is maintained and available to staff in the Home
Health Office.
II.
PURPOSE: To define administration of medication/medication classes, route of
administration, and possible exceptions. To define treatment modalities that may include,
but are not limited to, intravenous administration of medications, fluids, parenteral feeding
and chemotherapy.
III.
PROCEDURES:
A. Staff Administration
1. All RN’s and LPN’s will administer medications in accordance with the State
Nursing Practice Act. All FDA approved and investigational medications for
labeled and off label uses will be administered per physician order
subsequent to evaluation of clinical appropriateness.
2. Routes authorized for use include: oral, intramuscular, intravenous, topical,
subcutaneous, epidural, intrathecal, intraperitoneal, intrapleural, cavity
irrigation, intrasynovial and inhalation. Blood components authorized to be
administered include: packed red cells, platelets, and plasma derived
products (e.g. Factor VIII, and IX, albumin, gamma globulin).
3. Therapists may administer drugs within the scope of their training and
practice in accordance with their respective State Practice Act.
4. Home Care Aides assessed as competent may apply medicated topical
ointments and creams under the direction of a Plan of Care and
nursing/therapy supervision.***
*** Some State Regulations do not permit this practice for Home Care Aides.
Section:
PATIENT CARE
Subject:
MEDICATION ADMINISTRATION
Page 2 of 5
5. Administration Exceptions – The Agency will not administer the following in
the home setting.
a) Initial dose of intramuscularly or intravenous antibiotics, unless the
patient has previously received the drug/drug family without side
effects.
b) Initial allergy vaccines.
c) Initial dose of injectable gold preparations.
B. Receipt of verbal/telephone medication orders: Nurses and /or other licensed
professionals shall be responsible for obtaining all physician orders and transcribing
them appropriately within the scope of their discipline-specific State Practice Act.
Receipt shall include:
1. Clearly repeating the name of the drug and requesting or providing the
correct spelling.
2. Repeating the dosage, route ordered, and frequency.
3. Utilizing only organization approved abbreviations in the transcribed order.
C. Competency:
1.
Nurses will be required to pass a written medication competency exam upon
hire.
2.
Only Registered Nurses who have attended chemotherapy in-service classes
or continuing education hours may administer IV vesicants. Each RN will be
inserviced by the pharmaceutical supplier regarding drug specific
appropriate protocol on a per-case basis.
3.
Clinicians may increase knowledge and competency through:
a. Attendance at inservices and seminars.
b. Instruction and hands on demonstration by a clinician qualified to
perform the procedure.
c.
Participation in self- learning opportunities (i.e., literature review or
self-study learning modules).
D. Verification of Orders and Medication Identification
1.
P&P/Adm P&P/Medication Administration
A physician’s order is necessary on the Plan of Care or supplemental order
sheet for any medication to be administered by Agency staff. Medication
labels on prescription bottles shall constitute a physician’s order.
Section:
PATIENT CARE
Subject:
MEDICATION ADMINISTRATION
Page 3 of 5
2.
The clinician will examine the medication label to verify the patient’s name,
ordered drug, dosage, frequency, route or administration directions and
compare it with the physician’s order.
3.
The clinician will be responsible to clarify any discrepancies in medication
orders with the physician.
4.
Medication names will be listed on the Plan of Care and Medication
Teaching guides in both trade and generic names (when available) to reduce
the risk of incorrect administration.
5.
Medications will be assess for stability by:
a. checking the expiration date
b. reviewing storage conditions
c. visually examining the drug for discoloration, cloudiness, particulate
matter, or other forms of deterioration
6.
The administration of medications will be documented in the clinical
progress notes and on the medication administration record.
E. Assessment for Contraindications – Nursing Responsibilities
1.
A Registered Nurse/Therapist will complete the initial medication record,
patient history, and assess for possible contraindications with the medication
to be administered.
2.
A Medication Record and history completed by a therapist will be reviewed
by a Registered Nurse.
3.
Assessment will include:
a. Known drug allergies and previous significant reactions, and
documenting such in the clinical record and front of the chart.
b. Possible drug interactions or drug incompatibility and reporting these
to the physician.
c. Possible physical or mental contraindications and reporting such to the
MD.
d. Reviewing available relevant laboratory results and reporting
abnormalities to the physician.
e. The patient or caregiver’s ability to self-administer medications if/when
appropriate.
P&P/Adm P&P/Medication Administration
Section:
PATIENT CARE
Subject:
MEDICATION ADMINISTRATION
Page 4 of 5
F. Patient Education – As appropriate to the services provided patients will be instructed
in the following elements with documentation on the clinical progress notes,
medication flow sheet, teaching guides or care plan.
1.
Recognition of adverse reactions.
2.
Necessary actions to take if adverse reactions occur.
3.
Proper use of medication supplies and equipment.
4.
Proper storage and handling of drugs.
5.
Purpose, dose, frequency and possible common side effects.
G. Educational Resources
1.
Computer-generated patient education sheets.
2.
A drug reference handbook is available in each licensed nurse supply bag.
3.
An edition of the American Hospital Formulary Service Drug Information
Book is available in the Home Health Office.
4.
A Physician’s Desk Reference is available in the Home Health office.
5.
Pharmaceutical suppliers under referral contract with Home Health may
supply patient education material and consultation services to the Agency.
6.
The Hospital Pharmacy is available for consultations.
H. Investigational Drugs – The Agency may administer drugs that have been approved by
the Federal Drug Administration for investigational purposes when all requirements of
the Investigational Drugs Policy have been fulfilled.
I.
Medication Errors and Near Miss Medications Errors: The Agency participates in the
organization-wide policy for non-punitive reporting of medication errors and/or a
near miss. Staff will not be disciplined for making or reporting medication errors or
near misses unless the error was a result of professional misconduct. Professional
misconduct is defined as the deliberate failure to follow Agency policies and
procedures that resulted in a medication error or a near miss.
1.
Medication Errors
a. Medication errors include, but are not limited to administration of
wrong medications, wrong dose, wrong time, wrong route, extra doses,
dosage omissions, and incorrect medication administration instructions
to patients and/or caregivers.
P&P/Adm P&P/Medication Administration
Section:
PATIENT CARE
Subject:
MEDICATION ADMINISTRATION
Page 5 of 5
b. The individual discovering a medication error will notify the Patient
Care Coordinator and complete a variance report. The employee
reporting the medication error will sign the variance report. Names of
staff involved in the error are not to be recorded on the variance report.
c.
2.
Medication errors that are the results of the dispensing pharmacy are to
be communicated to the Patient Care Coordinator. It will be the
responsibility of the Patient Care Coordinator to notify the pharmacy
and document notification on the variance report.
Near Miss Medication Errors
a. A near miss medication error is the identification of a medication error
before the medication is administered. This may occur during three of
the four processes in the drug ordering-delivery system: physician
ordering, transcription and verification, pharmacy dispensing and
delivery, or administration to the patient.
b.
3.
J.
The individual discovering a near miss will complete a near miss
postcard. This postcard does not require the signature or the names of
any staff involved. It shall be placed in the Assistant Director of Clinical
Service’s (ADCS) mailbox for trending purposes. The ADCS will
forward the postcard to the hospital’s organization-wide medication
error team.
The organization-wide interdisciplinary medication error team will review
reports of errors or near misses, for the purposes of performance/process
improvement.
Disposal of Unused Drugs
1.
The patient or caregiver will be instructed to dispose of unused controlled
substances, parenteral medications as dictated by the provider’s policy or
recommendations.
2.
The patient or caregiver may be instructed to dispose of other unused and
outdated medications by flushing them down the commode.
P&P/Adm P&P/Medication Administration