Order of Contents...........=
...........................................................................=
......................................................................... <=
/span>1
8.A. Pharmacy Services.........=
...........................................................................=
................................................................. 3<=
u>
8.A. 1: Shoppers Drug Mart..= ...........................................................................= ................................................................. 3<= o:p>
8.A. 3: Duncan Pharmasave...=
...........................................................................=
................................................................ 3
8.B: Staff Education............................=
...........................................................................=
..................................................... 4
8.B. 1: Orientation.........=
...........................................................................=
...........................................................................=
4
8.B. 2: Basics of Medication Course....................................................................=
............................................................ 4
8.B. 3: Competency and Knowledge of Medications and Administration<=
span
style=3D'mso-tab-count:1 dotted'>................................. <=
span
style=3D'mso-tab-count:1 dotted'>............................... 4
8.C.: Safety Standards.........=
...........................................................................=
.................................................................... 5
8.C. 1: Doctor’s Orders..........................................................................=
...........................................................................=
.. 5
8.C. 2: Double Checking Procedure......................................................................=
............................ ............................... 5
8.C. 3: Quality Improvement Program....................................................................=
.......................................................... 5
8.C. 4: HSCL Nurse..........=
...........................................................................=
........................................................................ 6
8.C. 5: CARF Standards......=
...........................................................................=
.................................................................... 6
8.C. 6: Narcotics and other Controlled Medication..........................................=
............................................................. 6
8.C. 7: Storage and Preparation........................................................................= ................................................................. 6<= o:p>
8.C. 8: Medication Logbook..=
...........................................................................=
................................. ............................... 7
8.C. 9: Informed Consent....=
...........................................................................=
.................................................................... 7
8.D.: On Site Administration.........=
...........................................................................=
......................................................... 7
8.D. 1: Definitions.........=
...........................................................................=
...........................................................................=
7
8.D. 2: Medication Administration Procedure: Blister Packaging Syst=
em..........................................=
....................... 8
8.D. 3: Wasted and Refused Medication..................................................................=
...................................................... 8
8.D. 4: Administering PRN Medication...................................................................=
........................ ............................... 9
8.E.: Off Site Administration.........=
...........................................................................=
.......................................................... 9
8.E. 1: Medication at Day Programs.....................................................................=
............................................................ 9
8.E. 2: Administering Medication in the Community..........................................=
........................................................... 9
8.E. 3: Provision of PRN Medication in the Community..........................................= ..................... ............................... 10<= o:p>
8.E. 4: Self-Administration of Medication.................................................................=
...................................................... 10
8.F: Management of Errors and Adverse
Reactions/Interactions..........................................=
..................................... 10
8.F. 1: Medication Errors...=
...........................................................................=
...................................................................... 10
8.F. 2: Formal Reporting of Errors.....................................................................= ................................................................ 11<= o:p>
8.F. 3: Error Follow-Up.....=
...........................................................................=
....................................................................... 11
8.F. 4: Adverse Reactions and Drug Interactions.................................................................=
......................................... 11
8.F. 5: When a Bubble is Empty
8.G.: Processing Orders.........=
...........................................................................=
.................................................................. 1=
2 &=
nbsp;
8.G. 1: New Orders following Medical Appointments..........................................=
......................................................... 12
8.G. 2: Emergency New Orders=
...........................................................................=
............................................................... 12
8.G. 3: Discontinued Orders.=
...........................................................................=
.................................................................. 1=
2
8.H.: Changes in the population.........=
...........................................................................=
................................................... 12
8.H. 1: Transfers, Admissions and Discharges.................................................................=
............. ............................... 12<=
span
style=3D'mso-font-kerning:16.0pt'>
8.
8.
8.
8.
8.
8.
8.
8.J: Purchase and Transportation.........=
...........................................................................=
................................................. 13
8.J. 1: Purchase and Processing Invoices.................................................................=
...................................................... 13
8.J. 2: Transportation of Medication...................................................................=
............................. ............................... 14<=
span
style=3D'mso-font-kerning:16.0pt'>
8.K: Lab Work and Alternative Therapies.........=
...........................................................................=
.................................. 14
8.K. 1: Lab Work............=
...........................................................................=
.......................................................................... =
14
8.K. 2: Alternative Therapies..........................................................................=
.................................................................. 1=
5
8.L: Biohazard Management.........=
...........................................................................=
.......................................................... 15
8.L. 1: Expired, Discontinued and Wasted Medication..........................................=
....................................................... 15
8.L. 2: Sharp Object and Needle Disposal.................................................................=
...................................................... 15
8.A. 1: Shoppers Drug Mart: Tillicum, Dustin,=
Paskin,
Phone:
250 881-1980:
Contact
Person:
=
Hours: Mon-Fri&=
nbsp;
0800-2200 hrs
=
Emergencies Only:
Kardel Medication and Treatment Po=
licies
and Procedures have been reviewed and are approved by:
______________________________Murr=
ay
Byers, Pharmacist/Shoppers Drug Mart _________________Date
8.A. 2: Shoppers Drug Mart: Amelia,
Phone:
250 652-9119: FAX: 250-652-9944
Contact
Person: Scott Hall &=
nbsp;
=
Hours: Daily&nb=
sp;
0800-2200 hrs
=
Emergencies Only:
Kardel Medication and Treatment Po=
licies
and Procedures have been reviewed and are approved by:
______________________________Scott
Hall, Pharmacist/Shoppers Drug Mart _________________Date
8.A. 3: Duncan
Pharmasave: Lakes
&nbs= p; Phone: 250 748-5252
Kardel Medication and Treatment Po=
licies
and Procedures have been reviewed and are approved by:
&n=
bsp; =
; &n=
bsp; =
; &n=
bsp; =
; &n=
bsp; =
; &n=
bsp; =
; &n=
bsp;
______________________________
__________________Duncan Pharmasave___________Date
=
&nb=
sp; =
&nb=
sp; =
(printed name of pharmacist)
8.B. 1: Orientation
Employees are introdu=
ced to
the Kardel Medication Policy and Procedures at the Practical Orientation
Session at =
Paskin
Home. The Manager providing t=
he
training signs off the employee’s orientation checklist included in t=
he “Welcome
to Kardel” Staff Handbook.
Managers are responsi=
ble for
the orientation of staff members to the procedures used in each home/program
for the delivery of medication. Duties pertaining to medication and treatme=
nts
are outlined within the employee’s general shift duties. The home/program manager delegates
responsibility for medication administration based on the needs of the peop=
le
supported. Medication Administration Checks are done by another staff member
within one hour of scheduled medication administration time.
During orientation to
individual homes/programs, employees will be orientated, supervised and
approved for medication administration within that home/program by the mana=
ger. The manager and new employee will =
sign
the home orientation sheet, when the manager is confident that the new empl=
oyee
may safely administer medications. Orientated staff members also sign in the
Medication Logbook on the record of staff signatures. Employees are responsible for requ=
esting
additional training or orientation to ensure their own confidence and
competence.
8.B.2: Training: Basi=
cs of
Medication Course
In past years, employ=
ees were
encouraged to complete training in the Basics of Medication course offered
through
New employees are req=
uired to
view the Administration of Medications DVD prior to completing an in-home
orientation. A short quiz is =
also
given and kept on the personnel file.
As of March 2009, Kardel offered a =
Basics
of Medication course, presented by an LPN manager. The four hour course includes a sh=
ort
test to verify comprehension of the materials and to ensure the LPN can add=
ress
any gaps in understanding of the materials. Staff members who have medication e=
rrors
or new staff who have minimal experience administering medications may be
directed to attend this course. Documentation
of course completion is kept on the employees personnel file at the Kardel
Office.
8.B. 3: Competency:
Medication Administration and Knowledge of Medications
Effective
April 2010, the Annual Medication Administration Competency Checklist shall=
be
completed by the manager with each new employee prior to the end of their
probationary period as part of their probationary performance review and
annually with existing employees as an adjunct to their annual performance
review.
Identified
gaps in performance regarding administration of medication shall require the
employees to complete specific follow up as determined by the home/program
manager. i.e. review of DVD,
attendance at Basics of Medications course.
The
competency checklist will be repeated once the follow up plan is completed.=
Home/program
staff members must obtain a detailed knowledge of all medication used within
the home/program. In order to
assist staff members, a medication information sheet for each medication the
person is receiving will be found behind the MAR record sheets in the M.A.R.
book, or in a separate binder easily accessible to staff. The pharmacy prov=
ides
this information each time a new medication is ordered.
Staff
members are expected to know:
§ =
The drug na=
me,
usual dosage, its proposed action and expected effect
§ =
The major s=
ide
effects and what to do about them
§ =
Precautions=
8.C. 1: Doctor’s Orders
No medication is to be administered to an individual without a
doctor’s order. In an
emergency, the manager may take a verbal order. According to the Registered
Nurse’s Association of British Columbia, the computer printout and/or
label from the pharmacy is considered to be a legal doctor’s order.
8.C. 2: Double Checking Procedure
The home/program mana=
ger
delegates responsibility for medication administration based on the needs of
the people supported. Medication Administration Checks are done by another
staff member. The checker is to check that all medications, prns and treatm=
ents
have been administered and signed for.&nbs=
p;
This is to be done within one hour of medication delivery time. The
checker signs the Medication Check Form in the MAR book. When there is not a
second staff member available to check during medication times, a check is =
done
at the end of the shift. All staff members are responsible for ensuring err=
ors
are reported.
8.C. 3:<=
span
lang=3DEN-GB style=3D'font-size:11.0pt;mso-ansi-language:EN-GB;font-weight:=
normal'>
Quality Improvement Program
The
pharmacist and person’s physician review his/her medications every six
months. This need not be done on site.&nbs=
p;
A new Medication and Order Review form is processed at this time.
The
pharmacist completes an annual inspection of the medication room and proced=
ures
at each home.
A
record of this inspection and outcomes will be kept on site and at the phar=
macy
for a period of three years. The date of each inspection is also recorded in
the Medication Logbook. Manag=
ers
are responsible for arranging this annual inspection.
The
Medication Safety and Advisory Committee consists of the pharmacist(s) in
charge of pharmacy services, a group home manager, and Kardel’s nurse
consultant.
An
annual meeting is held by the committee to address the following:
Minutes
of the meeting are taken and kept for a period of three years at the Kardel
office.
For
significant behavioural issues, which may respond to medication, a referral
will be made to Developmental Disabilities Mental Health Support Team or an
appropriate alternate professional for assessment. Where possible, family a=
nd
advocates who wish to be involved in decisions regarding medication will be
included in the decision making with the permission of the person supported=
. A
professional will be asked to provide current information about the risks a=
nd
benefits for informed decision making, and appropriate follow-up.
8.C.
4: HSCL Nurse
Some
people supported may have access to an HSCL nurse. She/he works for the Ministry of H=
ealth
and is available for consultation and back up. The name and number of the nurse w=
ill be
recorded in the Medication Logbook and the home’s phone directory.
8.C. 5: CARF Standards=
As an accredited
organization, the manager documents or confirms informed consent for each
medication prescribed, when possible, on the Annual Information Update form,
completed at the annual Person Centred Planning Meeting. If the person
supported or the family has concerns about medications, the manager would
direct them to the Doctor for additional information.
8.C. 6: Narcotics
When narcotic medicat=
ion is
delivered or picked up, two staff members sign the Medication Logbook-Pharm=
acy
Medication and Supplies Record. Two
staff members check narcotic supplies every month at medication
changeover. They are checking=
each
card and accounting for the doses given, and then initialing in the medicat=
ion
logbook Controlled Drug and Narcotic Control. If liquid narcotic medication=
is
wasted it must be witnessed and/or reported by two staff members and record=
ed
in the medication logbook.
In addition to checki= ng monthly supplies of narcotic medications, all narcotic medications must be accounted for and checked by two staff members at every shift changeover. <= o:p>
As there are increased risks associated with narcotic
medications for people supported, extra safeguards (such as required witnes=
ses
for administration) may be implemented by Kardel’s nurse consultant,
nurse managers, HSCL nurses and/or Hospice Team. Kardel staff members are to adhere=
to
these safeguards as established.
8.C. 6.5: Controlled
Medication
Controlled medication such as Ativan.is provided by ph= armacy in the smallest supply necessary. Generally ½ blister packaged card is sufficient for PRNs for = most people supported. Managers wi= ll coordinate with pharmacy to ensure there are not excessive supplies of controlled medications on site.
8.C.
7: Storage and Preparation
All
medication will be stored in a locked cupboard. The key is kept in a secure place.=
An extra key is kept in a designat=
ed
place. In rare situations, a physician may order that a medication or
medications remain with the person.
An order to this effect must be on the MAR sheet. New shipments of
medication are kept in a locked cupboard.
Topical ointments and
medication are to be stored on separate shelves distinctly apart from inter=
nal
medications. Liquids are kept on the bottom shelf. Expired, discontinued and
where possible, wasted medication is kept in a locked cupboard until it is
picked up from or delivered to pharmacy. Medication to be given off-site is
kept in a locked cupboard until departure.
Medication must not be
pre-poured, unless it is for off-site administration.
Paper medication cups=
are to
be used for administering medications in “pill or tablet” form =
and
plastic medication cups are to be used for liquid medications. Plastic
medication cups can be re-used for the same person if they are washed air-d=
ried
thoroughly and labeled with person’s name in permanent marker.
Staff members will si=
gn for
all medication given immediately after they are given, except as noted for
off-site administration. Staff members do not make handwritten changes to
medication containers or MARs
8.C. 8: Medication Logbook
A medication logbook =
will be
kept in each medication area. This
logbook will be a communication book for staff members regarding medication=
. It
will include the following:
HSCL
nurse name and phone number
Previously
signed Medication Check forms
Record
of staff signatures and initials
Pharmacy
medication and supplies order form; for recording supplies that have been
ordered and those received
Controlled
and Narcotic Drug Monthly Checklists
Wasted
Liquid Narcotics
New
monthly/weekly meds and MAR sheet checks
Quality
Improvement Review Record
Errors
and Adverse Reactions
Expired
and D/C medication return to Pharmacy
Staff/Person
Supported/Family Observation Sheet
Managers document or =
confirm
informed consent for each medication prescribed, when possible, on the Annu=
al
Information Update form. If the person supported or the family has concerns
about medications, the manager would direct them to the Doctor for addition=
al information.
8..D.1: Definitions
Pharmacard Divider: A divider that separates =
one
person’s medication from another. The divider lists person’s na=
me.
Pharmafile: Dispensin=
g metal
racks for holding pharmacards. The pharmafiles are labeled for each medicat=
ion
time.
M.A.R.:Medication
Administration Record: A prof=
ile of
the person’s medication issued monthly by the Pharmacy. M.A.R.’s
are kept in a separate binder with dividers for each person, photos of each
person, special considerations and allergies, drug information sheets for e=
ach
medication people are receiving and Kardel Consulting Services medication
administration procedure. All medications given on-site must be signed for =
on
the M.A.R. immediately after dispensing.&n=
bsp;
Completed M.A.R. sheets must be kept on site for one year.
Dispensing times:
OD Once =
daily
BID Twice daily=
TID Three times=
daily
QID Four times daily<= o:p>
Medication Order Revi=
ew or
Medication Review: A form fou=
nd in
person’s binder under Physician’s Orders, which is a current,
ongoing record of orders. Rev=
iewed
at six months minimum by Physician and pharmacist.
<=
span
style=3D'font-size:11.0pt'>8.D. 2: Medication Administration Procedure for
Blister Packaging System
This proc=
edure
must be followed each and every time you administer medication. Giving medication is an important
responsibility and must be done in a systematic, careful way.
This
procedure can be found in the MAR book. the checker. Medications must be administered 1=
(one)
hour before or after the scheduled time.&n=
bsp;
If 1 (one) hour has elapsed, follow medication error procedure.
1. Wash hands<= o:p>
2.
Check the c=
urrent
date to establish the bubble number of the day
3. =
Locate and positively identify the person
4.
Find the
person’s MAR
5. =
Read the MAR direction for the first medication =
to be
given in the time slot you are dispensing.=
Pay careful attention to the time, medication, reason, dosage, person
and route. Check for special considerations.
6. =
Confirm that the MAR directions concur with the
pharmacard.
7.
Punch the
medication in bubble into med cup. Ensure medication isn’t attached to
the foil on the back of card.
If dispensing a liquid, place the medication on a flat surface and v=
iew
at eye level or measure in a syringe.
8.
Check the M=
AR
once again and mark appropriate square with a dot.
9.
Continue fo=
r all
medication to be given at that time.
10.
Check MAR f=
or
special directions i.e. crush, give with juice, give with milk etc.
11.
Approach the
person saying their name. Tel=
l the
person it is time for their medication.
12.
Administer =
the
medication to the person. DO =
NOT
LEAVE MEDICATION UNATTENDED. Ensure the person has swallowed the medication=
.
13.
Initial the=
MAR
sheet in the appropriate date and time space. Ensure your initials are also on t=
he
bottom of the MAR sheet with a signature.&=
nbsp;
Do not go on to the next person until this documentation has occurre=
d.
14.
Report any
discrepancies, refusals, meds withheld, absent people and observations of
anything unusual with the person’s status immediately and record on M=
AR
using the appropriate codes.
15.
A second staff member, the
“checker” must ensure that all medications, prns and treatments
have been administered and signed for.&nbs=
p;
This is to be done within one hour of medication/treatment delivery
time. The checker’s sig=
nature
is recorded in the MAR book on the “Medication Check” form. When
the form is filled, it is kept in the medication logbook.
16. When a checker has been unavailable to check med=
admin
during the shift, medications must be checked with on-coming staff member.<=
span
style=3D'mso-spacerun:yes'> This is recorded under “Shif=
t End
Check” on the Medication Check form found in the MAR book.
Remember
the 8 rights:
Right person, right
medication, right dose, right route, right time, right reason, right
documentation and the right attitude!!
8.D. 3: Wa=
sted and
Refused Medication
A
person may refuse medication: do
not force the person; discuss the situation with the manager or designate -
he/she may suggest different ways of approaching and/or presenting medicati=
on.
(i.e.: meds in peanut butter or banana.) If a dose is inadvertently wasted
(e.g. dropped on the floor, spit out etc.), repeat the medication by giving
medication from another blister package containing the exact medication for=
the
same time. Inform the manager of the wasted dose(s) in the Medication Logbo=
ok
and communication book. The m=
anager
will ask pharmacy to replenish the missing doses of medication. All wasted
medication, where possible, should be returned to pharmacy at the end of the
month. &=
nbsp;
8.D. 4: Administering PRN Me=
dication
Staff members may adm=
inister
a PRN medication without consultation with the manager or the HSCL nurse if=
an
order for the PRN has been made.
Check the medication order review sheet and the MAR sheet.
PRN medication is kep=
t in a
locked cupboard, clearly separated from regularly scheduled medication. In rare situations, a physician=
217;s
order may require that medication remain with the person. An order is found in the MAR.
After carefully follo=
wing the
medication administration procedure, staff members must record the
administration of the PRN medication on the back of the MAR sheet, noting t=
he
following:
§ =
Reason for
administration
Ensure that the medic=
ation
administration has been checked by co-worker and signed in medication logbo=
ok
under “Medication Check”.
8.=
E.: Off-Site Administration
For
people who are involved in day programs, at the request of the home manager,
the pharmacy will supply separate medication and MAR sheets for day
programs. The medication must=
be
sent to the home first to be checked against doctor’s orders accordin=
g to
policy before it is sent to the day program.
All
medication given at Kardel Day Programs must be supplied in packages and
accompanied by M.A.R. sheets. Medication will be kept in a locked area and =
will
be given out by the designated staff person according to the Medication
Administration Procedure.
8.E.
2: Administering Medication in the Community
When
a person requires medication outside of his/her home or day program, it is =
the
duty of the person taking the person out to ensure they receive the schedul=
ed
medication.
§ =
Medication =
and
dosage
The MAR will be recorded using pen with the number indicating
“absent from home with medication”.
Medication
administration is checked by a co-worker, and at the end of each shift.
For
blister-packaged medications, the pharmacy will provide packaged medication=
for
people away from home for more than three (3) days. The request for this medication mu=
st be
received by pharmacy three (3) days prior to the leave.
8.E. 3: Provision of PRN Medication in the Community
Oral,
sub-lingual and other PRN medication that may be necessary for a person whi=
le
away from the home or program must accompany the person. The following procedures must be
followed:
§ =
Labeled via=
ls or envelopes
for oral medication are provided by pharmacy to accompany the person
§ =
Other medic=
ation,
i.e.: epi-pens must be labeled with person’s name and instructions
§ =
Staff member
ensures an adequate supply is transported
8.E.
4: Self-Administration of Medication
A
person supported may self-administer medications if a plan for self-medicat=
ion
is
a)
approved by the medication safety and advisory committee where applicable a=
nd
the medication practitioner or nurse practitioner who prescribed or ordered=
the
medication and
b)
included in the individual care plan of the person
An Authorization for
Self-Administration of Medication form must be completed by the physician a=
nd
kept in the binder of the person supported.
The person who
self-administers medication must be provided with
=
§ =
The medicat=
ion as
required
8.F.: Management=
of Errors
and Adverse Reactions/Interactions
8.F.
1: Medication Errors
All medications are t=
o be
administered by staff members as per medication policies and procedures.
The most important ac=
tion to
be taken after a medication error has occurred is to ensure the health and
safety of the person(s) involved.
Errors that may adversely affect persons served and drug reactions a=
re
to be reported immediately to the manager: if unavailable contact the HSCL
nurse. Poison Control will be
contacted as needed, and emergency intervention will occur as needed.
Poison Control number: 1-800-567-8=
911
Medication errors inc=
lude,
but may not be limited to, the following:
8.F.
2: Formal Reporting of Errors
When a medication err=
or takes
place, which adversely affects a person we support, or requires emergency
intervention or transfer to a hospital, a Critical Incident Report must be
completed. Copies of the lice=
nsing
report must be sent to the licensing office for licensed homes – mail=
to:
VIHA Community Care Licensing 201
771 Vernon Avenue, Victoria, B.C. V8X 5A7 , fax to CLBC Analyst ( funding body) – fax 250-952-4205 and fax to program coordinator/Director=
/CEO
at the office – 383-283=
5. All medication errors which may af=
fect
persons supported must be recorded in the person’s progress notes.
All other medication =
errors
must be reported/recorded on the Medication Error/Adverse Drug Reaction Rep=
ort
form and submitted to the Manager of the home/ program for follow up.
Attending staff shoul=
d notify
manager if pharmacy needs to be contacted for replacement doses.
Once a medication err=
or is
discovered and a report has been initiated by staff member, the manager/PIC
must follow up and complete the Manager/PIC section of the report. The manager/PIC shall indicate fac=
tors
that may have contributed to the error, make recommendations/develop an act=
ion
plan and implement corrective measures.&nb=
sp;
Depending on the nature of the error, corrective measures may include
non disciplinary follow up with an employee. A more serious error or pattern of=
error
could result in disciplinary action up to and including termination of
employment. Consultation with=
the
Director of Human resources would take place to determine the appropriate l=
evel
of discipline.
The original Medicati=
on
Error/Drug reaction report is to be filed in the medication logbook. The pharmacist will review as part=
of
the annual pharmacy review.
A tally of medication=
errors
is recorded on the OH&S Monthly Statistics form which is forwarded to t=
he
office. This is to be complet=
ed by
the OH&S Representative or the home/program manager.
For Pharmacy based er=
rors-the
form is faxed to the pharmacy and to HR assistant in order to collect data =
for
the annual Medication Safety Advisory Committee meetings.
8.F. 4: Adverse
Reactions and Drug Interactions
If an individual is o=
bserved
to be experiencing a drug reaction or interaction as outlined in the drug
information sheet i.e. rash, vomiting, change in behavior, etc. the followi=
ng
steps must be taken:
=
§ =
Drug reacti=
ons
and interactions must be recorded in the person’s progress notes and =
the
Medication Logbook.
8.F. 5: When a Bubble is Empty
If a staff member is
administering medications and discovers that the medication due is not in t=
he
correct blister, he/she must first ensure that the medication wasn’t
given by asking all staff members on duty.=
Once it has been established that the medication has not been given,=
the
staff member must use the last bubble on the card for the correct time peri=
od
and make a notation in the person’s progress notes and the communicat=
ion
book, explaining the situation. The
manager will then inform the pharmacy and arrange for replacement of the
missing medication.
8.G.: Processin=
g Orders
8.G. 1: New Orders Following Medical Appointment=
s
8.G.
2: Emergency New Orders
Emergency new orders =
after
hours: For emergencies after regular business hours, the staff members shou=
ld
make arrangements for a person to be examined at a Medical Treatment Centre=
or
Hospital Emergency Unit. If
medication is required, the Treatment Centre will usually supply adequate d=
oses
to cover the person’s needs during period of time until the medication
may be ordered. This new
information should be clearly documented in the person’s progress not=
es,
Medication Order sheet, and in the communication book. The next morning, the manager will=
fax
the order to the pharmacy providing details of the medication order. The pharmacy staff will contact the
person’s physician, add the information to the person’s record =
and
send the balance of the medication as required.
8.G. 3: Discontinued
Orders
Physicians will phone
pharmacy to discontinue medication orders.=
When a drug is discontinued, or an order for a medication is changed
(e.g. the dosage or the administration time), the manager, or staff member
responsible for medication administration, will remove the medication from =
each
time slot and return to pharmacy.
The manager or person
responsible for medication administration will write “D/C” next=
to
the drug order on the MAR, and draw a diagonal line through the remaining d=
ays
of the month on the MAR for that order.&nb=
sp;
A “Notice of Medication Change form is put in the communication
book and the MAR book. The change is recorded on Medication Order Review sh=
eet.
Notification is made to person’s Day Program, if applicable.
Medication must be st=
ored in
a locked area until it is returned to Pharmacy.
8.H.: Changes in
Population
8.H.
1: Transfers, Admissions and Discharges
Home managers must no=
tify
pharmacy in the event of an admission, discharge, or death of a person. Pharmacy will confirm all medicati=
on
orders with the attending physician.
When a person is temp=
orarily
transferred to another facility, (e.g. VGH) the manager or designated staff
member will inform the pharmacy, and hold medication in the drug storage
cupboard until the person’s returns.
8.
8.
The pharmacy computer
automatically refills all regularly scheduled medication, which are package=
d in
pharmacards.
The pharmacy delivers,
pharmacards filled with medication at the end of each month. Any narcotic or
controlled drugs delivered or picked up, must signed by two staff members on
the Pharmacy Medication and Supplies form in the Medication Logbook. The
designated staff member transfers the new cards to the existing racks after=
the
last bubble of the cards have been administered.
The pharmacy picks up=
all
unused medications. Any narco=
tics
or controlled drugs returned to the pharmacy must signed for by two staff
members on the Expired and D/C medication sheet found in the Medication Log=
book.
The manager or person
designated by the manager will check new monthly meds.
8.
1: Check new MARs aga=
inst
Medication Order Review sheet and ensure orders are correct, and that new
orders have been processed and added correctly.
2:Check medication with the MARs, to ensure bubb=
les
contain the right medication, name, times and dosage
=
§ =
The card is
labeled correctly
3: Sign Medication Lo=
gbook
and the bottom of the MAR sheets, indicating that meds have been checked
according to above specifications: date and initials.
8.
After medication has =
been
checked, check person’s name, medication times on card, ensure no bub=
bles
have been opened. Remove old =
card
and replace with new card.
8.
The manager or design=
ated
staff member will peel the double-ply labels for medications that cannot be
packaged in pharmacards. (E.g=
. Oral
liquids) This label is located on the reminder pharmacard corresponding to =
the
first administration time, or on the actual container.
The label is then pla=
ced on a
reorder sheet.
The reorder sheet may=
also be
used to provide special instructions to pharmacy and for placing orders for
general supplies.
To maximize efficienc=
y the
pharmacy requests that supplies, PRN medication cards, cards for day progra=
ms,
and other supplies be ordered on the 23rd of each month to be
delivered with next months’ medications. When faxing orders, please follow up with a phone call to confirm the=
fax
has arrived.
8.
At the request of the=
home manager,
the pharmacy will send supplies (i.e., inventory supplies including med cup=
s,
incontinence supplies, gloves, and catheters). A packing slip is included w=
ith
delivery and each item must be checked and initialed when received. Items p=
aid
by the people supported will be noted.&nbs=
p;
The manager will check the packing slip with the monthly bill. Once approved by the manager, the =
bill
is forwarded to Accounts Payable Department. These items will be billed to the =
group
home at the end of each month. Orders can be faxed to the pharmacy and must=
be
recorded in the Medication Logbook.
Medical stock is also
available from Future Med: pl=
ease
record when stock is ordered and received in the Medication Logbook. Note t=
he
date, time, item, number of items and initial. Managers must approve billed
amounts, verifying they were delivered and then manager will forward to
accounting.
8.
Though the contracted
pharmacy must provide all oral medications, certain low-risk medicinal supp=
lies
may be available in large quantities from Product Distribution. These items=
are
limited to bowel care suppositories and enemas. Product Distribution requir=
es a
doctor’s order for these items, which is also given to the pharmacy w=
ho
will ensure this, is on the person’s MAR sheet. The Manager will also
need to estimate the quantity of these items used per year, and the Ministry
will approve a certain number of items. The approval for shipment will have=
an
expiry date and the approval process, should be initiated 3 months prior to
this date. Stock in the home must also be kept in a locked area. Labels mus=
t be
carefully checked before administration.
8.J.: Purchase =
and
Transportation
8.J.
1: Purchase and Processing of Medication/Pharmacy Supply Invoices
Bills
are checked and approved by the managers and then forwarded to accounting
department. Some items will b=
e paid
by individuals. If amounts charged are incorrect, the manager should indica=
te
the amount to be paid. In all cases, the manager should indicate the reason=
for
the adjustment. Upon receipt =
of the
approved statements, Accounts Payable processes for payment and attaches a =
copy
of the statement to the cheque, to assist the pharmacy in identifying what =
has
been paid, adjusted etc.
Future Med will provi=
de
packing slips with delivery; items are checked, initialed and crosschecked =
with
invoice before processing by accounting department.
8.J. 2: Transportat=
ion of
Medication
A pharmacy agent deli=
vers new
medication orders or refills orders to group homes as necessary. If narcoti=
cs are
delivered, the two staff members sign the Medication Logbook and indicate t=
he
total number of doses delivered and the date. The medication is to be checked us=
ing
the procedure for checking new meds and stored in the locked drug storage
cupboard. **Medication =
is not
to be left by pharmacy unless received by a staff member**
8.K.: Lab =
Work and
Alternative Therapies
8.K. 1: Lab W=
ork
It is the managerR=
17;s
responsibility to ensure lab work is done as required. Routine blood work must be schedul=
ed and
noted on calendar - fasting blood work is highlighted to alert staff
members. The manager discusses
results with physician as necessary and then files report in the binder of =
the
person supported. Results are
reviewed as needed with the physician.&nbs=
p;
The next date blood work is due is then marked in calendar.
8.K.=
2: Alternative Therapies
People may make purch=
ases of
their choosing using their own money, i.e.: comforts allowance. Informed
consent for the use of any alternative therapies e.g. herbs, multi-vitamin =
therapy,
magnets etc. must be made by the person themselves. If the person is not ab=
le
to give consent, consent would be given by their Committee, by their
Representative; or by the person designated as their Temporary Substitute
Decision Maker and/or interested family.
The person’s me=
dical doctor
and pharmacist must be informed of any and all alternative therapies and mu=
st
concur that the product would do no harm.
The support team surr=
ounding
the person must be trained in the administration and/or use of the product.=
In
the case of products that require significant staff time to administer, the
allocation of staff time is at the discretion and direction of the manager
based upon equity of service within the home for the needs of all persons. =
The manager
reserves the right to refuse the use of alternatives therapies.
Kardel does not endor=
se any
specific products. The cost implications of alternative therapies would hav=
e to
be considered. Consent for money to be used for payment for alternative
therapies would follow the same formula as consent for the use of the produ=
ct.
8.L.: Biohazard
Management
8.L.
1: Expired, Discontinued and Wasted Medication
All discontinued, exp=
ired and
wasted medication is to be returned to the pharmacy. The return of these items is noted=
in
the Medication Logbook and the manager is alerted regarding re-ordering. D/C
expired and wasted medication is to be secured in a locked cupboard until
returned to pharmacy.
8.L. 2: Sharp Object a=
nd
Needle Disposal
The laboratory provid=
es containers
for disposal of sharp objects and needles as required.
These containers are =
kept in
a locked cupboard and returned to the lab when they are full. The return of such items is also n=
oted
in the Medication Logbook.
___________________
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Section 8: Medication and Treatments