The PCA's Role in Client's Medications

The PCA's Role in Client's Medications

THE PCAS ROLE IN CLIENTS MEDICATIONS Tender Loving Family Care, Inc. Semi-Annual In Service Spring 2012 Do you often wonder if you are doing exactly what you are supposed to do ? Are you afraid of making a medication error ?

This presentation will cover: NYS PCA Scope of Practice Review of proper medication procedure ( 5 rights) Common client medications PCA Scope of Practice New York State Department of Health Office of Long Term

Bureau of Quality Assurance and Licensure SCOPE OF PRACTICE IS: A term used by NYS DOH that dictates the procedures, actions, and processes that an individual is allowed to do, as long as that person has received specific education or training, AND demonstrates that he/she is competent in performing such tasks.

PCA task and function # 10 Defines what is allowable for the PCA to assist a client with SELF-ADMNINISTRATION OF MEDICATION DEFINITIONS ASSISTING INCLUDES REMINDING the client WHEN to take the medication READING the label for the client

BRINGING the medication AND any necessary supplies or equipment OPENING the container POSITIONING the client for appropriate administration

PROVIDING appropriate liquids for swallowing medication STORING, CLEANING, and DISPOSAL of used supplies and equipment STORING medication properly SELF-DIRECTING Means the client is capable of making choices about his/her activities of daily living, UNDERSTANDING the impact of the

choice AND assuming responsibility for the results of the choice OR The client has an individual, agency, or other formal organization assuming responsibility for making choices about activities of daily living Self Administration

Means the client directly swallows, applies, inhales, inserts, or injects a medication into his or her own body. What Is NOT Permissible

Placing medication in clients Mouth Drawing up or giving injections Disposing of syringes other than INSULIN syringes Inserting vaginal or rectal suppositories Applying prescription or non prescription medication to a stable or unstable wound Even though the PCA IS NOT permitted to ADMINISTER medications adequate knowledge is required to properly prompt and assist a client with medications.

Remember each case is unique and each client has their own medication routine NOT EVERY CASE IS THE SAME !! The prescription Label The FIVE RIGHTS The Right Person Ask the client their name

Check the Care plan Read bottle Labels Carefully be sure it has the clients name esp. if more than one person resides in the home The Right Medication o o o o

Ask client if they have most recent List ( you MAY assist them to make one) Assist the client to call their pharmacy Assist the client to call the Doctor Refer to the careplan notify TLFC nursing if there is changes The Right Medication AGAIN .. Read labels carefully If meds are prefilled in a box we do NOT know what medications are in there the responsibility falls on the designated person who pre-fills The PCA should NEVER pre-fill med boxes .. You MAY prompt/cue/assist/supervise

a client who is self directing.. How ? Reading labels, opening containers, observing that the client places the appropriate pill in the appropriate square Always believe the client if they report their pills look wrong call the person who pre-fills for clarification At times, the pharmacy may substitute generics so the pills may indeed be different in shape and/or color from what the client may be used to The Right Dose Pay Attention to the prescribed dosage milligrams, milliliters, number of tablets or capsules, teaspoons,

tablespoons, etc.. You are not allowed to pour liquid medication. AGAIN READ the label carefully !!! Some cases require you to count the number of pills pre-filled in the box The Right Route PO- By Mouth Oral

Tablets, capsules, liquids, powders Injections medication drawn into a syringe (or prefilled) and injected

Subcutaneous ( SC, SQ,subQ) preferred route of most self administered meds in the home care setting insulins , vit B12, lovenox , Intramuscular ( IM) longer needle, deep into muscle ( not common in the home care setting) Newer needless Air Cartridge systems The Right Route

Eye drops Ear drops Topical on the skin Oinment, linament, lotion, creams, rubs Patches apply / removal hand over hand

Nose sprays Inhalers / Nebulizers rinse mouth after use to prevent thrush, keep equipment clean The Right Time

Most often prescribed by the doctor Some medications have flexibility with timing, some do NOT PRNs as needed It is YOUR job to prompt the client at the RIGHT time, if unsure..ASK Documentation

Medication Administration Record in clients home Check box on medisked Document and Report client refusal, missing medications, changes in medication regime Some common medications Anti epileptic/Seizure medications

dilantin, keppra, trileptal, tegretol, depakote Therapeutic blood level must be maintained to prevent seizures Omitting doses must be avoided Common side effects drowsiness, inability to concentrate, weight gain, hair / teeth changes Antihypertensives

Lowers blood pressure lisinopril , toprol, diovan, norvasc, lopressor Many blood pressure medications have more than one use Common side effects dizziness, impotence, headache, insomnia Encourage clients to check their blood pressure regularly Diuretics

Water Pills lasix, HCTZ, aldactone, dyazide Rids the body of extra fluids to reduce swelling and lower the work load of the heart Causes a person to urinate large amounts frequently

Be mindful of planning activities with clients Common side effects leg cramps, low blood pressure, dizziness, potassium imbalances Narcotic Analgesics Pain medications - lortab, hydro / oxycodone, morphine , Opana

Controlled substances client should keep them locked Very specific laws regarding refills and illegal use Abuse and tolerance are problems Overdoses often lethal Common side effects dizziness, nausea and vomiting, itching, altered mental status

Steroids Used to reduce inflammation In the body prednisone, solumedrol, medrol dose pack Dosages usually start high and are weaned down over time long term use discouraged due to side effects Common side effects ravenous appetite, weight gain, swelling, high blood sugar, brittle bones, excitability

Anticoagulants Blood thinners warfarin, plavix, coumadin, lovenox injections

Given to treat and prevent blood clots Therapeutic blood level must be maintained weekly blood draws Causes the client to bleed more readily use of electric razor, soft tooth brush Report any excess bleeding immediately If levels too high, blood in urine, stool, bloody nose Foods high in Vit K ( the clotting vitamin) should be consumed in small quantities

Stool Softeners / laxatives Colace, senna, miralax, lactulose, ex lax, dulcolax Soften the stool for easier passage, stimulate peristalsis

Remind clients to drink plenty of fluids and get up and move around If client begins experiencing frequent stools, notify the MD the client or the doctor is the only one that can make the decision to HOLD laxatives Over the Counter medications ( OTC)

Many more available in todays times Tylenol, aleve, prilosec, cold and cough products, allegra etc.. The PCA is not permitted to suggest to a client to purchase and consume OTCs only to make sure the client is using it appropriately The client MAY make their on decision

regarding OTCs if they are self directing, or have a self directing other Drug interactions Every person reacts differently to medications and different combos Assist/ remind participants to speak with

their pharmacist / doctor and read any warning labels Application of PCA Scope of Practice Mrs. Z is 63 year old TBI client. She is aphasic, alert, oriented, but forgetful. She is self directing and has been pre-filling her own mediset for the past six months

What is the PCAs role to assist Mrs. Z appropriately ? Should the PCA assist Mrs. Z in calling her doctor to renew prescriptions ?

Should the PCA assist Mrs. Z in calling in refills to the pharmacy ? Should the PCA assist Mrs. Z in obtaining her prescriptions from the pharmacy ? Should the PCA pre fill the mediset for Mrs. Z ?

PCAs May assist the client in calling in refills, under the direction of the client. The client must be self directing enough (or have a designated friend or family member) to provide the PCA with the information needed . It is not the PCAs role to manage a clients medication regime, but only to PROMPT , ASSIST, and SUPERVISE.

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