Provider Manual For Medication Administration by Unlicensed

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Provider Manual
                            For
Medication Administration by
   Unlicensed Personnel


  RN Orientation Curriculum
                            BOOK 1




WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES
                      Bureau for Public Health
         Office of Health Facility Licensure and Certification
                    Capitol and Washington Street
                      1 Davis Square, Suite 101
                Charleston, West Virginia 25301-1799


                               1
                                       Acknowledgments

The West Virginia Department of Health and Human Resources through the Office of Health
Facility Licensure and Certification (OHFLAC) acknowledges and expresses sincere thanks and
appreciation for the assistance, support, and participation of the individuals and groups
contributing to the development of this training resource manual. The basic formatting for this
curriculum originated from the New Jersey Department of Health and the Senior Licensing
Agency.

A Council of Nurses, established in compliance with WV State Code 16-5O-5, Medication
Administration by Unlicensed Personnel, was convened and represented facilities and other
registered professional nurses who may be affected by this law. The registered professional
nurse, when training unlicensed staff to administer medications in a covered facility, must use
this training curriculum.

The Office of Health Facility Licensure and Certification would like to thank the following
individuals for their participation on the Council of Nurses and their input into the formation of
this curriculum:


                           Lanette Anderson, RN, Executive Director
                West Virginia Board of Examiners for Licensed Practical Nurses

          Dr. Rose Lowther-Berman, Program Manager II, Behavioral Health Program

                Jennifer Dorsey, RN, Prestera Center for Mental Health Services

             Rebecca Dunn, RN, Health Facility Surveyor, Assisted Living Program

                          Deanna Kramer, RN, Program Manager II,
                         Nursing Home and Nursing Assistant Programs

                      Angie McKinney, RN, Country View Assisted Living

            James Cooper, RN, Health Facility Surveyor, Behavioral Health Program

               Gloria Pauley, RN, Program Manager II, Assisted Living Program

                            Laura Rhodes RN, Executive Director
             West Virginia Board of Examiners for Registered Professional Nurses

                       Barbara Schramm, RN, REM Community Options

               Twonna Williams, RN, Program Manager I, Nursing Assistant and
                              AMAP- RN Orientation Program




                                                                              REPRINTED-4/17/09

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Table of Contents                                                          Book 1
                                                                                    Pages
Introduction
     Registered Professional Nurse Responsibility                                          5
     Facility Policy and Procedures                                                        6
     Communication and Accessibility                                                       7
     Monitoring and Supervision                                                            8
     Administration vs. Self Administration of Medications                                 9
     Legal Implications                                                                   10
     Resident / Proprietor Rights and Responsibilities                                    11
     RN and AMAP Eligibility Requirements                                                 11
     AMAP-RN Orientation                                                                  11
     Approved Medication Assistive Personnel (AMAP) Trainee                               12


Addenda  Forms
     Application for AMAP RN Orientation Course (AMAP-1)                              102
     Notification Change Form (AMAP-3)                                                104
     Retraining Verification Form (AMAP-4)                                            105
     Personal Verification Form (AMAP-6)                                              106



Training Resource Manual                                                  Book 1
                                                                                    Page
Medication Administration Training Curriculum
Medication Administration
Part I: Learning to Administer Medications


1.1      Scope and limitations for AMAP staff                                           17
1.2      Medication terminology and abbreviations                                       20
1.3      Medication                                                                     22
         a. Purposes and effects
         b. Medication types
         c. Prescription and OTC
1.4      The "six rights" of medication administration                                  33
1.5      Reading pharmacy labels and Medication Administration Records (MAR)            38
1.6      Medical asepsis and universal precautions                                      41
1.7      Organize to administer medications to one or more residents                    46
1.8      Documentation                                                                  48

                                                3
         a. Documenting on the MAR
         b. Resident refusal to take medication
         c. Medication errors
1.9      Disposal of medications                            55
1.10     Storing and securing medication                    56
1.11     Maintaining inventory                              58
1.12     Medication Delivery Systems                        60


PART II: Measuring and Recording Vital Signs


2.1     Using a stethoscope                                 64
2.2     Measuring and Recording Vital Signs                 65
        a. Oral
        b. Rectal
        c. Axillary
        d. Electronic thermometer
        e. Tympanic
2.3     Temperature                                         68
2.4     Pulse                                               70
2.5     Respiration                                         72
2.6     Blood Pressure                                      72


PART III: Administering Medications by Different Routes


3.1      Oral medications                                   78
3.2      Eye medications                                    82
3.3      Ear medication                                     85
3.4      Nasal medication                                   86
3.5      Topical medications                                88
3.6      Vaginal suppositories                              89
3.7      Rectal suppositories                               90
3.8      Inhalation / Nebulizer Treatments / Medications    92

Internet Resources                                          96

Trainee Forms
     Trainee Completion                                    97
     Trainee Task Record                                   98
     Medication Pass Observation Worksheet                100

                                                  4
INTRODUCTION
In 1999, the West Virginia Legislature passed a bill called the "Medication Administration by
Unlicensed Personnel." Prior to the passage of this bill, only licensed nurses were legally
permitted to administer medications.

This law allows unlicensed personnel in specific settings to administer certain types of
medication after successfully completing an approved training course. This law was enacted to
improve medication administration while maintaining affordable, homelike atmospheres in the
settings defined in the law.

These settings include: (1) intermediate care facilities for the mentally retarded (ICF/MR), (2)
assisted living residences (3) behavioral health group homes, (4) private residences in which
health care services are provided under the supervision of a registered professional nurse, and
(5) adult family care homes that are licensed and/or approved by the West Virginia Department
of Health.

The unlicensed staff members are called Approved Medication Assistive Personnel (AMAP), are
trained by OHFLAC approved registered professional nurses, and must work under the
supervision of the registered professional nurse (RN).

The delegated task of administering medications shall be performed in compliance with West
Virginia State Code 16-5O-1 et seq., and Legislative Rule Title 64, Series 60. Both of these
documents are accessible through the OHFLAC webpage. The RN, in conjunction with approval
by the resident / client's attending physician, may delegate medication administration to the
AMAP, after the AMAP has received the required training and testing and has demonstrated
competency in this task.

A licensed practical nurse (LPN) does not have authority to delegate or supervise medication
administration to AMAP staff. The RN maintains sole authority for determining when it is
appropriate to delegate to AMAP staff.

                  REGISTERED PROFESSIONAL NURSE RESPONSIBILITY

It is the responsibility of the AMAP RN to assure the safety and health of clients / residents. That
responsibility includes developing facility policies and procedures for administration of
medication. The RN is also responsible for knowing all regulatory requirements applicable to
Legislative Rule 64-60, Medication Administration by Unlicensed Personnel.

When training unlicensed personnel to give medications, the RN is responsible for assuring that
the candidate meets all eligibility requirements, is competent with medication administration, and
can successfully demonstrate the appropriate methods for medication administration, while
having some knowledge of the medication given.

The RN must monitor / observe the candidate's ability to administer medications, not only during
the training phase, but also in the facility setting, after the AMAP has been tested and approved.
Ongoing monitoring of AMAP staff must occur at least quarterly, and the AMAP candidate must
receive a program of retraining every two (2) years. These periodic reviews are essential to

                                                 5
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