Medication administration for DD population - page 2

For those of you working with the developmentally disabled in a community living situation, how are medications administered?... Read More

  1. by   kimdd&psychRN
    Quote from dingofred
    For those of you working with the developmentally
    disabled in a community living situation, how are
    medications administered?
    Wow, from what I am reading here, it seems like most states have stricter rules than Oregon in regards to who can pass medications. I did direct care for about 10 years at variuos group homes within the same agency. All direct care staff pass meds, nurse for the agency has nothing to do with it, except disposing of CS. Well, years ago part of the new employee training (which new hires often attended 2-4 weeks after starting out at a site) consisted of a med training on the five rights, practice punching out M & Ms that were blister-packed to simulate a med pass, how to record on a MAR, and how to take a telephone order. The first time I passed meds I was scared to death because I didn't know anything about the meds I was giving, their intended efffects, side-effects, etc. At least I was scared, you know? A lot of new employees pass meds very nonchalantly. Anyway, sometime in the last 3 years the OARs (Oregon Administrative Rules) have changed saying in effect that most of that training that was done at a new employee training can now be done at the sites themselves. Exactly one hour gets spent on medication training at the new employees training now, and it is not even required to be done by a RN. I see this as a problem because, of course, by the time a home gets a new hire they have been operating understaffed for a while, meaning the manager of the house has probably been filling direct-care shifts, and needless to say, a very rudimentery training takes place before that new hire is thrown into shifts. As I am now the RN for this agency, I am out at the houses of those clients who administration has decided needs a nursing care plan. One house that has five residents has been having a rash of med errors lately. Interestingly, most of them are fairly new employees. One gal said to me the other day (who has worked for at least 6 months) "I don't even know what M. A. R. stands for." Scary.

    (Boy, I didn't mean to write a book!)
  2. by   sunnym
    I agree with Kim. Our state (or agency) had some lax rules.

    People ith NO degrees/certificate pass meds
    Of course you go to a med passing class the county offers (learn tthe 5 rights...) And have a supervisior as you set up and pass medas a few times then BAM they let you go!!!

    We also had the med book highlighted and color coded
    and the giver would initial
    And g tube meds was shown to us by an rn who would check on the folks once a month
    I often wondered how they could trust so many people to medicate them.. and with some of the folks who had to have crushed meds or thickened to different consistancies I always worried.

    But one of my jobs were to count pills everymonth and calculate to ensure we recieved the correct ammount then at the end of the month to re count and double check the right ammount of meds had been passed taking in mind I&A's if an individual refused or vomited the medication out.
  3. by   smilin_gp
    I'm also in oregon, but the agency that I work for reguires CNA's to take administration classes to administer meds to DD residents. An RN/Case Manager checks the MAR weekly and is available for questions. Still lots of room for mistakes though
  4. by   HeatherLPN
    I work LTC, but am a group home medpass nurse on the side. I worked on the floor before I got my LPN, then transferred to nursing dept. We have a supervisor who works 40 hours/week and is on call, and the rest of us just come in to pass meds. We have 20 people between the 2 homes, with one tube feed. All of our people have medpass programs that are relatively simple (I think it's a state thing for funding). We just go in and spend 2 hours passing meds, check over any incident reports, sign off seizure reports, ect. I was certified to pass meds when I worked the floor, and we got a decent amount of training, but not much on when there were changes with meds or treatments. The MAR's are a mess, aminly b/c delegateds don't care. They just see it as a little extra pay. Delegateds there are mainly for outings, trips, and PRN's unless there are no nurses available to pass that day. All of us nurses have other jobs, so there are around 5 medpasses/week that are covered by delegateds. I've caught so many things that aren't marked it's ridiculous. And most of the time, they skip the creams or don't do the programs.

    I don't think it's so much a problem to have delegateds pass meds, I think it's more of the staff that they choose to take the class for it. It's frustrating sometimes, but honestly, I don't work there still b/c I need to, I do it b/c I enjoy it and am attached to the people. Working MR/DD is the most rewarding thing I've ever done.
  5. by   up2funinsc
    I supervise 2 ICF/MR's and multiple CTH (community training homes) and multiple SLP (supported living placement). The ICF meds are given by licensed nurses. The others are given by staf that undergo less than 3 hours of training. There are of course multiple med errors. The agency is non-profit, but run by the state. The staff and nurses are poorly paid.
  6. by   butterflyball
    In this organization medication is administered via med certified direct care staff. Here, the staff begin the certification process during new staff orientation. Is it done differently elsewhere?
  7. by   hb4hikes
    I have worked in ICF MR in NC for close to 15 yrs. LPNs used to pass medications but as the company grew by adding new homes, med techs were used. Currently, in my facility the MTs are trained by an RN in classroom, 8 hrs and perform at least 3 observed passes involving the consumers they will be caring for. The MTs are recertified annually by an RN. Our facility houses 6 residents to 2 staff and some 3 or 2 to 1 homes. All staff must train for med tech or will be terminated in 6 mo. So there is pressure to certify everyone although everyone is not suitable to pass meds. I have refused to certify people and have gotten a lot of grief over it due to staffing needs as the turn over rate is very high. NC recently tried to go to only state certified MTs to pass meds in these facilities but the facilities fought back due to the expense of certifying staff, so now this plan is on hold. As an RN, I would welcome state certified MTs as they would have something more to loose by not following policy and procedures. Our staff work 8 hour shifts and provide 24h wake staff supervision. Our staff do not do any injections, but could be trained on insulin, which terrifies me. They must contact the nurse on call prior administering prn meds. They are trained to administer prn seizure medications including diastat rectal gels. We currently try to operate with 2 RNs & 1 LPN who oversee 75 residents & approxiamately 180 MTs also we provide occupational health & workers comp services. Of course there is constant nursing turnover. The nursing staff have been cut by almost half over the years. I am burning out and plan to move on soon as the paperwork & acuity is increasing as the promises of funding another nurse has fallen short again this fiscal year, amazingly serveral new corporate positions have manifest though....
  8. by   GLORIAmunchkin72
    "I'm convinced that med admin at group homes is one of the Nine Levels of Caregiving Hell."

    Scarry! Psych meds have to be so precise. It's not like giving Colace...
  9. by   hb4hikes
    I agree this oversight is part of caregiving hell, if I didn't enjoy the folks I work with so much the med techs would send me running out the door. Over the years though, we really have had 2 significant errors from med techs that resulted in ER visits but luckily no prolonged harm done. At least they caught their errors immediately and reported it for quick intervention which saved lives. The techs however were teminated for breaking policy.
  10. by   Chaoticdreams33
    Wow, I hope that some of these older posts have had changes made in their states and facilities! I don't work in DD community/goup homes but am applying for a position so I have done some research. In CT to be med certified you have to complete a 20-30 hr classroom portion by either state RN's or your facility RN/pharmacist/MD has to be certified by the state to teach the class. Then there are 3 exams you need to pass and a few med passes to observe and then a few med passes to demonstrate to the RN/pharmacist/MD teacher. Recert is required every 2 years. The RN also needs to observe each person's med pass at least once a year, but I would expect that other monitoring is more frequent.
  11. by   hb4hikes
    CT sounds to have a good practice standard. A couple of years ago NC proposed all techs in the group homes would have to become state certified but group home providers lobbied against it and won due to the financial impact. The nurses do not have to be state trained or "Master Trainers" but it does have to be an RN providing classroom education, testing, a final med pass and annual recertification. This is standard for ICF MR, other group home settings: DDA, CAP, Youth at Risk, etc have less stringent training requirements. I really would like to see state certified techs come in to pass meds for quality purposes but I don't see it happening in the near future due to the current state of the economy.
  12. by   MorgiesMa
    Hi everyone!

    I am new to the DD field and I am working as a RN for host home program. Bascially foster care for adults. The program itself is new to the area, so the coordinator and myself are still trying to figure things out ourselves. Can anyone give me some guidance as to how to write a medication self adminstration plan? I have an assessment tool, but we feel we need a written protocol as to teach the clients to be able to self admin. Any suggestions/resources??