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Logo 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