Basic Medication Safety and Management
Service coordinators and quality assurance staff play a vital role in educating consumers, family and residential service providers in basic medication safety and management.
Reporting Medication Errors
Medication errors can occur both due to human error and because of procedural problems. The provider's program plan and staff orientation training program should be reviewed when there is a history of medication errors. It is important to encourage the reporting of medication errors in a non-punitive manner. Reported errors should be viewed as an opportunity to prevent more serious errors from occurring.
In independent living and supported living environments or when consumers live without the assistance of a caregiver or with their family, medication compliance becomes a more important factor. Personal ideas about medication need or effectiveness that may or may not be based in fact and the side effects influence medication compliance. A family member's decision to give a prescribed medication to a consumer may be influenced by their personal comfort with giving the medications. It is important that family members, consumers and staff follow the physician's treatment plan and not make medication changes on their own. Some ways to know if the consumer is taking medication as prescribed include asking the person and observing their behavior to see if there are signs of ineffectiveness or unusual behavior.
During the IPP process and anytime you see a consumer, it is important to observe for changes in the consumer's status, especially if there have been medication changes. Some common and observable side effects are: 1) changes in sleeping patterns, 2) changes in weight or eating patterns, 3) tremors, 4) problem with balance, 5) disorientation or confusion, 6) increased hyperactivity, 7) abnormal movements of the face, and 8) reduced interest in activities that the consumer normally finds enjoyable.
Documenting Medication Use
If a caregiver assists a consumer in taking medication, they should be well trained to assist. Anything less is a health and safety concern. When documenting medication use it is important to know the name of the medication, dose, name of the physician and the reason that the medication is prescribed. The indication (reason) MUST be based on a written order from the physician or psychiatrist. It is always better to write, "unspecified" than to assume the purpose of the medication. All medications must be associated with a diagnosis or behavior treatment plan. For example, if a consumer is taking Prozac 20 mg daily, you cannot state that it is for depression if there is no diagnosis of depression.
Things to Look For
It is not possible to make blanket statements about the appropriateness of medication usage, since in some cases multiple medications are needed to properly treat a condition. The following are examples of monitoring criteria that you may wish to keep in mind when reviewing a consumer's medication regimen:
- More than one medication from the same drug class, without justification from the physician or psychiatrist.
- Anti-convulsant medications and no reported seizures > 2 years and the anticonvulsant is not prescribed for a behavioral or mental health disorder.
- Long-term use of sleep medications.
- Long-term use of medications for behavioral control without an attempt at reduction > 1 year, and not prescribed for the treatment of a mental health disorder.
- Observed side effect.
- Medications do not appear to be effective.
Dependent on regional center policy, concerns about medications should be reported to the appropriate clinical team member for review and follow-up with the treating physician or psychiatrist.
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