A. RESPONSIBILITY FOR MEDICATION PROCEDURES
The Service Coordination Team is responsible to assure that Kokua’s medication procedures and staff training are effective and ensure client health and safety. Work Teams are responsible to ensure that proper medication procedures are followed by all team members. Team members who do not follow Kokua’s medication policy and procedures may face disciplinary action.
B. TRAINING REQUIREMENTS
All Life Skills Instructors, Team Leaders and Client Service Coordinators must complete Nurse Delegation Core Training and must maintain a current Nursing Assistant Registered (N.A.R.) Certification. Additionally, all Kokua employees must receive training on Kokua’s medication policies and procedures prior to assisting a client with self-medication.
C. SUPERVISION OF CLIENTS WHO CAN NOT INDEPENDENTLY SELF-MEDICATE
Supervision of medications for clients who are not self-medicating will be provided by the contracted delegating nurse. The nurse should be consulted when any questions arise regarding proper completion of a medical procedure or administration of medication. The nurse should also be informed of all serious medication incidents.
D. MEDICATION INCIDENTS
A Medication Incident Report must be completed whenever a medication is missed due to staff error or a medication has been given inappropriately. Medication Incident Reports must contain written follow-up by the Client Services Coordinator explaining the causative factors and any corrective actions taken. Any medication error or nurse delegation error that has or may result in injury/harm as assessed by a nurse, medical professional, or a pharmacist must be reported to DDD within one business day. Such errors must also be reported to the Department of Health as referenced in Chapter 246.841 WAC. DOH contact information Phone 360.236.4700 Email: HSQAComplaintIntake@doh.wa.gov
E. MEDICATION PROCEDURES
Each Kokua client will have a Master Medication List which records each of the client’s current medications.
Medications for each client shall also be recorded on a monthly medication log. The log will list each medication, the prescribing physician, the dose, the description of medication and method of administration, times and the possible side effects. All side effects noted will be reported to the physician. The medication log is used to record all medications taken by the client.
All medications obtained from the pharmacy will be checked against the medication log before administration to assure the correct medications have been received.
Assistance with self medication must conform to the proper time frames and dosages indicated on the Medication Log, unless directed otherwise by the physician or the Delegating Nurse.
Before any medication is given, the staff person must physically compare each medication to the Medication Log to assure that he or she has
- the right client
- right medication,
- right dose,
- right time
- and right route.
Any discontinuation, addition or dosage change will be recorded on the medication log.
All entries on the log will be initialed by the staff person administering the medication at the time the medications are given.
If a client refuses to take a medication or if a medication is not given for any reason, this must be recorded on the back of the medication log. This should include a description of the circumstances and the signature of the staff making the entry.
The Team Leader will review each client’s medication log weekly to assure that all entries are complete. If any entries are missing or incomplete, the Team Leader will ensure that the appropriate corrections are completed as soon as possible. All missing or incomplete medication charting requires a Medication Incident Report for missed charting. This incident report will be turned in to the Client Services Coordinator. The Team Leader will document their weekly check process on the bottom of the back side of the Medication Log.
F. MONITORING OF PRN MEDICATIONS
A supply of prescribed PRN medications must be available in the client’s home at all times. When PRN medications are given, the time of administration must always be noted on the back of the medication log. Follow-up charting should be done to report on the efficacy of the PRN medication.
The Team Leader will monitor the use of all PRN medications to be sure they are given appropriately.
G. SELF MEDICATION
All clients should participate as much as possible in the taking of their medications. Self-medication should be a goal for all clients. Clients should receive supportive training and any adaptations necessary to help them move toward independence. The process leading to self-medication should be fully documented and all self medication will be supervised until the client is reliably independent. Clients who are independent in self-medication should have this noted in both the DDD ISP and in Kokua’s IISP. Clients who become self medicating may sign the medication log indicating they have taken their medication.
For clients who receive less than 24-hour support and who are independent in self-medication, oversight will be provided by the client’s regular staff. Medication should be counted on every shift to ensure medications are being taken as prescribed. If discrepancies are noted, the discrepancies should be reported in writing to the Independent Living Team Leader who will provide documented follow-up.
H. MEDICATION REFUSALS
A client has a right to refuse to take their medication. All medication refusals must be documented on a Medication Incident Report. If a client has a pattern of refusing medication, staff must support the client to better understand the reason for the medication and the potential harm that could occur from repeated refusals. This training should be documented on the Important Information about Your Medications form. All health and safety refusals must be reviewed every six months.
I. STORAGE OF MEDICATIONS
Medications will be stored under proper conditions for safety, sanitation, temperature, moisture and ventilation and all medications must be in containers labeled by the pharmacist, the client or the client’s guardian or family member.
J. DISPOSAL OF UNUSED MEDICATIONS
Outdated, discontinued, contaminated or superseded medications will be stored in a locked storage box while awaiting disposal. As the Team Leader places medications in the storage box, he or she will document the date, the name of medication, the dosage, the prescription number and the amount of medication to be disposed of on the Disposition of Medications form. The Team Leader will then sign the Disposition of Medications form.
Disposal of expired or soiled medication shall be done on a weekly basis. Two trained staff persons will participate in the disposal process and will sign off to verify proper disposal. Medications removed for disposal will be taken from the clients’ homes to Group Health Cooperative in a locked container. Both staff persons participating in the disposal will sign off on the list of disposed medications.
K. OVER THE COUNTER MEDICATIONS
All over-the-counter medications present in a client’s home require written approval from the client’s physician. This approval must be renewed yearly.
L. WHEN A CLIENT IS NO LONGER ABLE TO SELF-MEDICATE SAFELY
When Kokua staff persons become aware that a client has lost the ability to safely self-medicate, the case manager will be notified in writing within 24-hours. The Services Coordinator will ask the DDD Case Manager to reassess the client to determine the level of support that is needed. The DDD Case Manager will authorize Nurse Delegation for the client if needed.
M. HOSPICE CARE AND NURSE DELEGATION
When a client has been authorized for hospice care, the delegating nurse should be notified. If the hospice nurse discontinues any of the client’s medications, these changes need to be reported to the delegating nurse. When the hospice nurse gives orders for comfort kit medications to be administered, the delegating nurse should also be notified. A delegated client remains a delegated client while on hospice services.
When a client is prescribed hospice services for end of life comfort:
- All staff working in the client’s home and all fill-in staff whom may work in the client’s home must attend hospice care training. The delegating nurse should also be contacted to provide a refresher training on the administration of liquid medications.
- Because the Comfort Kit contains controlled substances, the medication amounts will be checked or counted at every shift change. Kokua requires that a ledger be used for recording the medication checks and that staff sign the ledger to acknowledge the checks have been completed.
- When the hospice nurse orders the administration of pain medication from the Comfort Kit, there should be two staff present to ensure medications are given correctly. A staff on duty may
- Call the On-Call who will dispatch float staff to attend the administration for safety and accountability purposes, or
- Page the Administrative pager (413-6586) to notify the Director of Client Services, or designee that comfort care has been initiated.