For those of you working with the developmentally

disabled in a community living situation, how are

medications administered?

Hi dingofred,

I work in a residential facility for the mr/cp population. We have several "on campus" homes and several "community" or "off-campus" homes.

What specifically did you want to know? In our off-campus homes in the community we have a staff member who is medication certified by our facility to administer the meds to the residents. In our on-campus homes, due to state regs only RNs and LPNs can administer meds.

I work in a State Facility and all meds are administered by an LPN or an RN. Each individual has an assessment performed on them to determine their ability for self-medication. Once it has been documented a personalized program based on their skill level is implimented. It may be something so simple as throwing away their cup in the appropriate recepticle. We have programs for some to identify the medication, reasons for taking the med and possible side effects of med. There are a few that open, administer and initial the MAR themselves . It all depends on their capabilities. But at all times a nurse must be present and the nurse has ultimate responsibility for that person and the administration of the mediction. Data is collected to determine the effectiveness of our patient teaching and the persons response.

[quote for those of you working with the developmentally

disabled in a community living situation, how are

medications administered?

i work at an icf/mr facility with 9 houses of 8 clients in each. we are fortunate, we have 12 nurses on staff. our facility does not provide 24 hour nursing. nursing staff are there from 7a-7p. then an oncall nurse takes over from 7p-6a. if they need medical care they call her and if it after 6a they call the nurse that is scheduled to work that day. nurses do all medications, treatments, assessments, and appointments. many states dont use nursing, they train the direct care staff.

I work at a large pediatric rehab hospital. The department I work in is for a campus of 10 group homes. For these houses meds are given by RNs or LPNs. There are some properties in the community that my hospital has purchsed with some students living there. Meds are given by med certified LNAs with a nurse who does chart, med sheet & documentation auditing. Pam

Missouri and Kansas only require certified med techs. Obtained by attending a short class taught by LPNs or RNs. (This is for contract facilities).

State facilities require LPNs or RNs.

Lots of bad mistakes made by poorly trained or supervised staff.

Some CMTs are trained to give gastrostomy tube feedings by other CMTs. (I witnessed a g-tube ballon with 45cc of liquid dilantin!!)

I'm a MR/DD caregiver at a contract agency (I presently work in a supported living home, just one person, but had LOTS of group home med admin experience at my previous employer) in Missouri, and as Mschrisco pointed out, the certification procedure is pretty skimpy IMO. No, thats not quite right. The recert is what sucks! Its a)easy to forget a lot of skills b) the company has the nasty habit of changing policy (something stupid like using a different color of highlighter or initialing meds one at a time before actually passing them) and c) too many people just don't pay attention to details, which is what matters most.

I can't tell you how many med errors I've had to followup on, chasing phantom doctors for instructions, QMRP's that ignore repeated pages, incident reports out the wazoo, and even state investigations. I'm convinced that med admin at group homes is one of the Nine Levels of Caregiving Hell. Worst time for me was last year at my previous employer, working a group home with 9 clients (hate that term), often shorthanded (usually 2 staff) or other staff just slacking off, 120 meds at AM pass, ranging from long term psychotropics to breathing treatments to topicals everywhere, combined with frequently combative and violent individuals who had no business in our facility (blame money, politics and the Q for that) and the utterly unreasonable expectation that it all had to be done in 15 minutes with perfect paperwork so you can now go run and change/shower/dress 4 or 5 frequently pissy individuals, cook meals for them and do 10 loads of laundry all by 9:00 am. My new job doesn't pay well but thank God we don't have group homes!

FYI - I'm certified as a Level 1 Med Admin aide, separate cert in insulin admin. There's MANDT, CPR/1st aid, health and safety as well but again, IMO its a joke. I think most agencies simply can't afford to provide more instruction and training in general, and when funding is cut or frozen, the first thing agencies use the X-acto knife on besides benefits is training. A damn shame IMO

Tom

Sorry, I gotta disagree about the money part. Most contract facilities make big bucks. There is soooo much money in group homes. State pays tons of $$$. I does cost to start one, but once it starts coming in.......

They can afford... why should they pay extra if the state doesn't require it???

You are very correct... it sucks.

In the State of WY, if meds need to be "administered" they are given by the nurse. For the most part however, meds are "accessed" by frontline staff, "with" the client involved/participating. There is a VERY fine line between administration and accessing, which is often crossed, but that is how we are (so far) dealing with having only two nurses in our town for approx. 6 residential sights.

In New York medications in the residences are administered by AMAP STAFF. These are staff members who have been trained to give medications and are recertified each year by the RN. The RN is responsible for their supervision. Some of them are very good, others are not so good. In the monthly staff meetings in the homes, I request from the house managers some time in which I do a short inservice on a particular aspect of medication administration. Additionally, I review the MAR weekly to pick up on any errors. I also have medical assitants in each of the houses that I cover, and thery are responsible on a daily basis to review the MAR, check medications, control drugs etc. and inform me of any problems. It is not a perfect system, but it works. And just remember that many of our state boards are in agreement with this arrangement - "The MEMORANDUM of UNDERSTANDING." This is what it is called in New York state.

in new york medications in the residences are administered by amap staff. these are staff members who have been trained to give medications and are recertified each year by the rn. the rn is responsible for their supervision. some of them are very good, others are not so good. in the monthly staff meetings in the homes, i request from the house managers some time in which i do a short inservice on a particular aspect of medication administration. additionally, i review the mar weekly to pick up on any errors. i also have medical assitants in each of the houses that i cover, and thery are responsible on a daily basis to review the mar, check medications, control drugs etc. and inform me of any problems. it is not a perfect system, but it works. and just remember that many of our state boards are in agreement with this arrangement - "the memorandum of understanding." this is what it is called in new york state.

can you give me more info. on "the memorandum of understanding?" would i go to the state board of nursing website for ny and download it? jleski

hi jleski,

you can go to the office of the professions, new york state education department, and look under current issues in nursing. i will also give you the website : http//www.op.nysed.gov/nurse-omrddadminmemo2003-1.htm

can you give me more info. on "the memorandum of understanding?" would i go to the state board of nursing website for ny and download it? jleski

I also work in DDS. LPNs give the meds where I work.

The clients we take care of are also on self administration of medication programs.

Very few of them can actually read, so they have to be taught over again each time their orders change.

I was not familiar with what was going on in these group homes in Arkansas, until we actually got some close to where I work/live. They discharged some of our clients into these homes of two clients each, and one staff person to supervise them.

Some of the people they placed there were never on a self administer program, so I don't know how now, they are getting away with giving the clients their meds.

My SBON says the person must be able to follow the directions on the bottle, but then it goes on to say that if the person can't open the bottle, can't take the pills out, then with the person's consent, the staff person may take the appropriate number of pills out and if the person is unable to place them in their own mouth, then the staff person may place them in his/her mouth.

Heck, they might as well just go ahead and say, "Yeah, unlicensed personnel can give the meds, no problem."

The policy on this at my SBON is a joke.