KWHS MEDICATION POLICY AND PROCEDURES TEST

Revised February, 2011

Upon completing the review, please return it to your Manager if it is in hard copy. If completed on line, ensure that your Manager receives your Policy Review Test certification. Employees are expected to achieve 100% competency on this open book test.

Employee

Programme

Test Marked by

Test Results

Date (M/Y/D)

SECTION 1: MULTIPLE CHOICE QUESTIONS. Select the response that best answers the question or completes the statement. Please choose only one answer per question. 1. The staff person responsible for administering medications may assign administration duties to another team member. That team member documents acceptance of this responsibility on which form? A B C D Staff communication book Signature and Initial Record in the Medication Binder Call in Roster form Medication Disposal form

2. In the Check and Do system of administering medications, match what staff members are to do after each medication check. 1 2 3 4 Check when drugs are still in the package Check after drugs have been poured Check before administering drugs Check after administering drugs Dot the date/time slot on MAR sheet Ask the persons name Initial package Initial over the dot on the MAR sheet

3. Teaching someone to self medicate is a multi-staged process. Pick the best way to teach a person to remember to take their medications. A B C D Pair medication routines with well established routines that are not easily forgotten (e.g. meal times, bedtime). Organize medications into a weekly dosset or have medications put in weekly blister-packs so it is easier to identify when medications have to be taken. Consider using a dosset with a timer. Keep medications in a convenient and safe spot to cue a person to take their medications. (E.g. if medications are to be taken with breakfast, take them to the breakfast table, if they are to be taken at bedtime, keep them by the bed). All of the above.

4. What needs to be understood when a person is considering taking non-prescription medications? A B C D Expiry dates of the medication being considered. Whether the medication is listed on the persons Standing Medication sheet. What symptoms is the medication used for and how to use it. All of the above.

5. 4pm is the ordered time that John is to take his medication. How long can you wait after that time before a medication error occurs? A B C D 120 minutes 90 minutes 60 minutes 70 minutes

6. What do you do with the two copies of a completed Medication Error form? A B C D
7.

One copy goes in with the persons MAR sheets in the med binder and another to the Manager. One copy goes in with the persons MAR sheets and the other filed in the inactive file. One copy goes to the persons primary counsellor and the other to the Manager. One copy goes in the persons MAR sheets and the other copy goes to the night staff for filing. What are Sharps?

A B C D

Broken glass Scissors Invasive skin piercing device such as a blood glucose testing lancet, needle or syringe Kitchen knife

8. In accordance with the Drug and Pharmacy Regulation Act, each prescription container must have a pharmacy label with no alteration, indicating; A B C D Name of the person the medications were ordered for Directions for taking the medication Physicians name All of the above

9. Why are prescriptions filled at the same pharmacy? A B C D To ensure one professional understands the history and scope of the medication that person is on. Because KWHS has an account there. Because that pharmacy delivers. Because the physician will only deal with one pharmacy.

10. The premise behind KWHS Medication Policies and Procedures are to ensure that the 8 medication rights are followed. Check each of the correct 8 medication rights from the options below: A B C D E F G Right to a Doctor Right time of administration Right Order of medications given Right Medication Medications given to the right person Right to a second opinion Right dose of medication H I J K L M N Right to a glass of water Right documentation Right to attend a first aid course Right to refuse medication Right to privacy when getting meds Meds given for the right reason Right method or technique used

11. When do new MAR sheets for people receiving medications in day programmes need to be in that programme? A B C D The day they are required. Two weeks before they are required. Three working days prior to the next month. By the 3rd day of the current month.

12. Treatment Containers must include what? A B C D First Aid Kit Persons Photo Persons wallet Eye glass repair kit

13. What is stored in a Sharps container? A B C D Diabetic lancets and needles. Bloody tissues. Gloves. Alcoholic swabs.

14. Fill in the corresponding number for the following time conversions 1 2 3 4 5 6 7 am Noon 4pm 9pm 2pm Midnight 2400 2100 1400 1600 0700 1200

15. Medication Guidelines state that staff should be knowledgeable of the following information. A B C D Know how to fill out a time sheet. Know that meds are to be given to people in alphabetical order. Know each drug being administered and why it has been prescribed. Know the name of KWHS Executive Director.

16. Medication Treatments are described in the Medication Resource section of the KWHS Medication Policy and Procedures Manual. Choose one treatment procedure that is described in the Policy. A B C D How to administer an inhaler to a person. How to administer Ear drops. How to document an incident. How to cut the toenails of a person with diabetes.

17. What best describes what a Medication Error consist of? A B C D Any unsuccessful medication administration attempt concerning the first 7 rights Not documenting when a person has a BM when there is a PRN protocol in place When a pill is dropped and needs to be disposed of When a person becomes ill and regurgitates their medications

18. To prevent medication errors how many medication checks are involved in administering medications? A B C D Two Three Four One

19. What can be found on a Standing Medication form? A B C D Prescription drugs. Doctors signature and date when approval given for non-prescription drugs. Specific routes for taking medications. The name of the Pharmacy that dispenses the medication.

20. A Medication Application/Injury Site Documentation form can be used in the following ways. A B C D To document unexplained injuries, the development of rashes, etc. on a persons body. To indicate where to administer medications such as creams and lotions. To accompany an incident report to document an injury or potential injury during an incident. All of the above

21. What is NOT a Medication Right according to Policy?

A B C D

Right to receive the correct medication. Right to refuse medications or treatments. Right to take your medications at any time you wish. Right to receive the correct dose of medication.

22. What is the name of the form you need to fill out when a person, who is not responsible for their own medications, goes away overnight with their family? A B C D Medication Administration Record Sheet. Medication Memo Standing Medication Order Medication and Treatment Signing Sheet

23. Chose one reason it is important that all medications to be administered in day or respite programmes arrive in updated, pharmacy labelled containers that have not been altered. A B C D To be able to properly identify the medication. To ensure the medication that is to be administered has not expired. To ensure the medication dose to be given is the same that was ordered by that persons physician. All of the above.

24. Supporting Medication Documentation that needs to be sent to day programmes for consistency in care involves what forms? A B C D E F G Standing Medication Behaviour Support/PRN protocol Drug Information Sheets New Medication Monitoring form Applicable Health Care Procedures such as a seizure protocol Medication Memo when medications change All of the above

25. Who can give consent for medical treatments/procedures prescribed by a Doctor? A B C D E Parent, guardian or trustee Counsellor Manager Person using service Answer A and D.

26. When Sarah was preparing to administer 4pm medications she noticed that Carries second set of blister packed medications were not administered that morning. Pick one error classification that best describes this error. A B C D E F Medication Errors Incorrect Person Incorrect Medication Incorrect Dose Incorrect Time Incorrect Method Incorrect Reason G H I J K L Procedural Errors Incorrect Documentation Incorrect Disposal Meds forgotten to be given Meds found undigested PRN Protocol not followed Other M N O P Q R Medication Incidents Refusal Spilled or damaged Meds Meds regurgitated Meds not given out of program Emergency Hospitalization Other

27. Controlled Acts are defined as invasive aspects of care with potentially adverse outcomes. Indicate one example of a controlled act out of the examples below. A B C D Applying cream to a persons labia. . Insulin injections, suppositories and inserting a tampon. Blood Glucose testing. Cleaning the outer ears.

28. Under some circumstances a controlled act may be performed by an unregulated care provider such as a KWHS staff when: A B C D A persons parents train the staff and give their written consent for the procedure. Designated by a regulated Health Care Professional e.g. nurse and after training. Staff member feels confident to perform the controlled act because of previous experience. All of the above.

29. KWHS Medication Training consists of the following. A B C D E F Programme training using the Medication Orientation Checklist Shadowing a staff administering medications at least once. Having a trained staff shadow the new employee three times while administering medications. Achieving 100% competency on a Medication Administration Test. prior to administering medications unsupervised. Achieving 100% competency on an annual written medication Test (open book) All the above.

30. If a person refuses to take their medications, what do you do? A B C D Withhold supper until the person takes their medication Try another method or technique e.g. A different staff but avoid power struggles and honour the persons NO when all else fails. Tell the person you understand and that is Okay. Have the next shift take responsibility

31. What are the documentation procedures to follow when a new medication arrives for a person? A B C D Fill out the Medication/Health Alert form. Fill in that persons Cumulative Medication History form with the new medication. Fill in the MAR sheet with the new medication according to the directions on the prescription label All of the above

32. Administering medications is a serious responsibility with serious consequences for staff and the people in their care. When a serious error has occurred, what can be done to avoid future errors? A B C D Investigate the reason for the error occurring and initiate steps within the programme to ensure the error does not occur again. Educate the person who received the medications on how to identify their own medication so the error does not occur again. Communicate with team members concerning the error and ensure double checks are carried out to catch and avoid potential errors. All of the above

33. What are the procedures to follow when a pill has been found on the floor? A B C D Try to determine whose pill it was and re-administer it Leave it so you can point out to your manager just how sloppy the last person administering medications were Try to determine whose pill it was, dispose of it in the medication disposal, record it on the medication disposal form, write out a medication error and make a note of it in the communication binder Just throw it away because you dont know how long it was been there

SECTION 2 DOCUMENTATION QUESTIONS Follow the specific directions for each of the samples provided Put an X on the days this medication is NOT TO BE GIVEN according to these directions: Give 8.5 mg of Senokot every third day starting on the 2ND day of the month. Small round brown tablet. Din # 1235 Time 1 2 3 4 5 6 7 8 Senokot 8.5 mg 2100 Give one tablet by mouth at bedtime every three days beginning on the 2nd. Small round brown tablet Review the MAR sheet below and indicate what mistake was made based on the following directions. Remember Phenobarbital can only be packaged in 30mg. tablets: 35 Give 60mg of Phenobarbital at 8am and 8pm daily. Din # N1234 Time 1 2 3 4 5 6 7 8 9 Phenobarbital 30 mg. 0800 Take two tablets by mouth twice daily at 8am and 8pm 1600 Small white round A 0800 hrs. B Two Tablets C 1600hrs. D 60 mg.

34

10

10

36

Jordons last bowel movement was on the 3rd. Indicate on the MAR sheet which days Jordon is to receive her Lactulose PRN. Time PRN 2100 1 Sun 2 Mon 3 Tues 4 Wed 5 Thur 6 Fri 7 Sat 8 Sun 9 Mon 10 Tues

Din #1666 Lactulose 15ml Take 15 ml at bedtime for two nights beginning on the fourth night of not having a Bowel Movement Follow with 30 g of water White liquid

37

John attends his day programme from 9am to 4pm daily Monday to Friday. Record a P in the days and times this person is to receive their medication at their day programme. There are no holidays during this time frame. Time 200 mg. 0700 1200 1 Sun 2 Mon 3 Tues 4 Wed 5 Thur 6 Fri 7 Sat 8 Sun 9 Mon 10 Tues

Din #1456 Tegretol

Give two tablets at 7am, noon, and 9pm daily.

Orange oval tablet 2100 SECTION 3 TRUE OF FALSE QUESTIONS Check either T (True) of F (False) for the following statements

38

T F T F T F T F T F T F T F T F

If a medication direction on the MAR sheet does not match what is on the prescription label, staff should look into why the discrepancy exists prior to administering the medication (i.e. recent doctors appointment, misinterpreting directions, pharmacy error, documentation error etc.) Once a persons self medication schedule is well established, a change in routines wont impact their ability to remember to take their medications (e.g. holidays) Even if a person is not self medicating, teaching people about the drugs they are prescribed can reduce potential errors and increase that persons involvement in their medication routines.

39 40

41

The purpose for Medication Policy and Procedures is to keep staff knowledgeable concerning proper techniques and procedures concerning medication administration and to help keep people safe.

42 43

Medication Protocols explain why a person takes the medications they are prescribed.

In accordance with community health standards, staff responsible for administering medication shall arrange to dispose of it upon a persons death, discharge or when it is discontinued by a recognized heath providers order. Medications that must be refrigerated need to be stored in a locked container unless the refrigerator is in a secured section of the programme where vulnerable people do not have access to the fridge. According to medication resource information on applying creams, double dipping refers to two coats of chocolate on a Dairy Queen Ice Cream Cone.

44

45

46 47 48

T A Sharps injury is defined as an injury where a needle or other sharp object, contaminated with blood or F other body fluid, penetrates the skin. T Medication errors resulting in the need for medical attention are reported to the Ministry of Community and Social F Services as a serious occurrence within 24 hours. Family members are also to be informed of the error. T Most medication errors occur because staff do not follow policy, become distracted and/or fail to document properly. F

49 50 51 52

T The Medication and Treatment Signature and Initial Record must be filled out each month by staff administering F medications anytime for the current month. T Medications can be delivered to Day Option Services in peoples lunch pails, knapsacks or pockets. F T KWHS staff has the authority to change or alter any medications given to people in their care only once they have F successfully completed their medication orientation and testing. T It is desirable that only designated staff members order medications for consistency purposes. However, if a programme runs out of a required medication when the designated staff member is not available, any staff can F order or pick up a particular medication as needed. T KWHS staff members are authorized to treat minor ailments and provide first aid treatment. If the condition does F not get better after 48 hours, the person needs to seek medical treatment or advice. T Health Care Procedure involving a controlled act which involves sharps must have written procedures on how to F handle sharps safely to reduce the possibility of a sharps injury. T Staff members have 24 hours to correct a documentation omission before it is considered a medication error F T F T F T F T F T F A Behaviour Support Plan/PRN Protocol should always have information on preventative measures to reduce or eliminate typical triggers that may cause a person become anxious or lose control. Staff involved in more than 3 medication errors must be re-trained in Medication Procedures and must pass the medication administration test to prove they are competent to administer medications. The most common medication error involves people receiving the wrong medication. The administration of a Behavioural PRN medication needs to have an incident report filled out which requires one to monitor the effectiveness of the drug in reducing symptoms for up to 4 hours. Communication amongst staff members is imperative in successful medication administrations

53 54

55 56 57 58 59

60