North dakota department of corrections rehabilitation cmt ii
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NORTH DAKOTA DEPARTMENT OF CORRECTIONS & REHABILITATION CMT II. Correctional Medical Training II Previously Medication Assistant I PROGRAM IN COLLABORATION WITH MINOT STATE UNIVERSITY. Jo Ann Sund, RN. Constance B. Kalanek PhD, RN. November 16, 2007. November 16, 2007.

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NORTH DAKOTA DEPARTMENT OF CORRECTIONS & REHABILITATION CMT II

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North dakota department of corrections rehabilitation cmt ii

NORTH DAKOTADEPARTMENT OF CORRECTIONS & REHABILITATIONCMT II

Correctional Medical Training IIPreviouslyMedication Assistant IPROGRAM IN COLLABORATION WITHMINOT STATE UNIVERSITY


North dakota department of corrections rehabilitation cmt ii

Jo Ann Sund, RN

Constance B. Kalanek PhD, RN

November 16, 2007

November 16, 2007

NORTH DAKOTA BOARD OF NURSING

CERTIFICATE OF APPROVAL

Medication Assistant Program I

Offered by

NORTH DAKOTA DEPARTMENT OF CORRECTIONS AND REHABILITATION

BISMARCK, NORTH DAKOTA

Has met the standards for a medication assistant program I

And is approved by the North Dakota Board of Nursing

From November 2007 to November 2011


Requirements

Requirements

  • Passed CMT I

  • CPR certification

  • Detailed start and finish date of course work.

  • Clinical check list score of 90%

  • Student written exam of 85%

  • North Dakota Board of Nursing regulations allow no more than one retake without further instruction.


Medication

Medication

  • Prevent Disease

  • Aid in diagnosis of disease

  • Treat a disease or reduce symptoms

  • Restore normal body function

  • Maintain normal body function


Why training to give medications in corrections

Why training to give medications in corrections?

  • Medications can be dangerous

  • Medications may be unfamiliar

  • Rules and procedures are required by law in correctional facilities.

  • Correctional facilities must control medication storage and delivery.


Correctional delivery model

Correctional Delivery Model

  • Physician or dentist

  • Pharmacist

  • Nurse

  • Correctional staff or officer

  • ***As Correctional staff not allowed to make judgments about medication, only observe and report.


Medication cycle

Medication Cycle

  • Observation (observe the offender and report changes, report side effects)

  • Prescription (report any known complications such as an allergy)

  • Administration (Monitor correct dose to be given)

  • Documentation (check and record on MAR)


Correctional staff responsibilities

Correctional staff responsibilities

  • Adherence to laws and correctional facility policies

  • Observing for side effects

  • Ensuing safety and sanitation policies are followed.


What are your institutions policies

What are your institutions policies?

  • Prescription medication

  • Non prescription medication


North dakota department of corrections rehabilitation cmt ii

Laws

  • Food and Drug Act

  • Controlled Substance Act of 1970


Observation skills

Observation Skills

  • Visual

  • Auditory

  • Smell

  • Touch


North dakota department of corrections rehabilitation cmt ii

  • General Appearance

  • Body Posture

  • General State of Health and Appetite.

  • Physical Activity Level

  • Physical condition of skin

  • Facial expressions and speech

  • General emotional state and state of awareness

  • Bowel and bladder


North dakota department of corrections rehabilitation cmt ii

  • Report any observed concerns to licensed nurse or shift supervisor


Medication verification

Medication Verification

  • Proper label on medication

  • Name of pharmacy

  • Address of pharmacy

  • Number of prescription

  • Offenders name

  • Physician name

  • Date filled

  • Type of medication and amount

  • Instructions for taking medication

  • Initial of pharmacist


References for verifying medications

References for verifying medications

  • Call pharmacy

  • Call physician

  • Call nearest hospital or poison control

  • Call facility nurse

  • Mosby or Sanders Nursing Drug Reference Handbook

  • Facility nurse or supervisor should be notified if problems or questions.


North dakota department of corrections rehabilitation cmt ii

  • MAR or Medication Administration Record

  • Keep on person medications

  • Storage in a cool dry area unless otherwise instructed.


6 rights to medication delivery

6 rights to medication delivery

Right Individual

Right Documentation

Right Dose

Right Route

Right Time

Right Medication


North dakota department of corrections rehabilitation cmt ii

  • Before meals a.c.

  • Every q

  • Every hour qh

  • Every six hours q6h

  • After meals p.c.

  • Three times an day tid

  • Two times a day bid

  • As needed prn


North dakota department of corrections rehabilitation cmt ii

  • By mouth p.o.

  • Intramuscular I.M.

  • Intravenous I.V.

  • Suppository supp.

  • Pertaining to eyes Ophth

  • Pertaining to the ear Otic

  • Subcutaneous SQ

  • Sublingual SL

  • Inside cheek buc


Body systems

Body systems

  • Skeletal

  • Bones and joints

  • Body support, protect organs

  • Muscular

  • Muscles

  • Body movement


North dakota department of corrections rehabilitation cmt ii

  • Nervous

  • Brain and spinal cord

  • Control body activity

  • Circulatory

  • Heart and blood

  • Carry oxygen and nutrients to the cells


North dakota department of corrections rehabilitation cmt ii

  • Respiratory

  • Nose and lungs

  • Provide air

  • Urinary

  • Kidneys and bladder

  • Remove wastes


North dakota department of corrections rehabilitation cmt ii

  • Gastrointestinal

  • Mouth, stomach and bowel

  • Digest food remove waste

  • Endocrine

  • Thyroid and pancreas

  • Secrete hormones


North dakota department of corrections rehabilitation cmt ii

  • Skin

  • Skin

  • Protection

  • Sensory

  • Eye, ears, nose

  • Sight, hearing and sound


Effects of medication

Effects of medication

  • Follows the same route as food

  • Body Weight

  • Age

  • Sex

  • Pregnancy and lactation

  • Genetic factors

  • Psychological factors

  • Illness/disease


North dakota department of corrections rehabilitation cmt ii

  • Desired effects

  • Side effects (allergy)

  • No apparent effect


Medication interactions

Medication Interactions

  • Potentiation

  • Antagonism

  • Unique effect


North dakota department of corrections rehabilitation cmt ii

  • Any change in behavior or physical condition the first few days of starting a new medication should be reported to nurse or shift supervisor.


Medication names

Medication names

  • Trade or brand names

  • Generic names

  • Chemical names

  • Family or category


Steps in oral medication procedure

Steps in oral medication procedure

  • Correct time or medication times schedule

  • Hand washing

  • Unlock storage area

  • Check label, Remove right dose from container

  • Report changes in appearance of medication to nurse, supervisor, or pharmacist

  • Observe swallowing of medication

  • Replace medication in locked storage area.

  • Chart medication

  • Observe for desired or side effects


Steps in liquid medication delivery

Steps in liquid medication delivery

  • Time schedule

  • Hand washing

  • Unlock storage area

  • Check label

  • Shake before pouring and pour away from label side.

  • Pour at eye level and pour right before giving

  • Don’t mix other medications or with other liquid medication

  • Observe swallowing of liquid

  • Replace in locked storage area

  • Chart medication

  • Observe and report medication effects


Special medication procedures correctional staff

Special Medication ProceduresCorrectional staff

  • What is the purpose and desired effect of medication given.

  • Response time

  • Side effects

  • Possible interactions with other medications.

  • Special storage or administration procedures.

  • Controlled substance counted and controlled

  • Controlled substances are not advocated to be used in correctional facilities.


North dakota department of corrections rehabilitation cmt ii

  • What is your facility’s procedure if offender is away from facility regarding medication delivery?

  • Procedures for verbal orders. Only a licensed nurse can take a verbal order.

  • Procedures for prn medications. Most correctional facilities don’t allow. Must be documented appropriately.


Eye drops or ointments

Eye drops or ointments

  • Wash hands soap and water. Use gloves

  • Avoid touching around the eye with dropper or vehicle for dispensing. Keep dropper and eye area clean.

  • Lying down position or head tilted back.

  • Index finger pull eye lid down to form a pocket. Support rest of hand on nose and cheek.

  • Drop desired amount in pocket

  • Replace cap and have offender close eye gently

  • Wash hands after removing gloves and return to storage area.


Ear drops

Ear drops

  • Wash hands soap and water

  • Check medication delivery system

  • Medication bottle and ear are clean

  • Warm drops in hand shake

  • Tilt ear up. Hold ear lobe down and back

  • Place prescribed amount in ear.

  • Don’t put dropper into the ear canal.

  • Keep ear tilted awhile and then insert cotton plug.

  • Wash hands


Topical medication

Topical medication

  • Position offender in a comfortable position

  • Wash hands wear gloves

  • Check label

  • Follow directions on label can use a tongue blade

  • Creams rub gently

  • Lotions pat or dab on skin

  • Liniments rub vigorously

  • Aerosol sprays 3-6 inch away

  • Form medication place next to skin and spray

  • Remove gloves wash hands and store properly.


Nebulizer treatment

Nebulizer treatment

  • Wash hands: prepare supplies and set up equipment

  • Offender sit upright check heart rate and respiration rate and record.

  • Check MAR and appropriate dosage of medication

  • Place mouth piece in mouth and start machine. When medication is gone, shut off machine.

  • Check heart rate and respiration rate and record.

  • Wash equipment and hands


Transdermal patches

Transdermal patches

  • Wash hands wear gloves

  • Check medication label with MAR

  • Date and initial patch before applying

  • Remove old patch

  • Apply to non-hairy area as directed

  • Place patch on skin and hold down with palm 30 seconds

  • Remove gloves, wash hands and document in MAR


Difficulty swallowing

Difficulty swallowing

  • Sitting position

  • Small sips water

  • Take one tablet at a time

  • Rest between tablets

  • Put medication in a teaspoon of pudding etc.

  • Check if comes in a liquid.


Refusal of medication

Refusal of medication

  • Document the reason for refusal and follow facility policy for medication refusal.

  • Allow time to pass and reoffered medication?

  • Notify nurse or shift supervisor


Errors in medication administration

Errors in medication administration

  • Use facility policy such as an incident report or variance.

  • Wrong individual

  • Wrong medication

  • Wrong dose

  • Wrong time

  • Wrong route

  • Wrong procedure/documentation


Anticonvulsant

Anticonvulsant

  • Control seizures

  • Side effects

  • Drowsiness

  • Upset stomach

  • Constipations

  • Sore throat/infection

  • Dizziness/unsteadiness

  • Slurred speech


Antibiotic

Antibiotic

  • Purpose treat infections given for 4-10 days. It is important to take all medication.

  • Side effects

  • Rash or hives

  • Itching

  • Nausea or vomiting


Analgesics

Analgesics

  • Relieve pain

  • Side effects

  • Drowsiness

  • Constipation

  • Headache

  • Nausea/vomiting

  • Slow respirations


Psychotropic

Psychotropic

  • Reduce symptoms of emotional disorders

  • Side effects

  • Nausea and loss of appetite

  • Weight gain and metabolic syndrome (diabetes and high cholesterol)

  • Diarrhea


Hormones

Hormones

  • Stimulate metabolism

  • Birth Control

  • Insulin

  • Steroids

  • Hormone replacement therapy.


Antacid

Antacid

  • Relieve upset stomach

  • Side effect

  • Constipation


North dakota department of corrections rehabilitation cmt ii

  • Anti hypertensive

  • Cardiovascular

  • Anti-inflammatory

  • Protein pump inhibitors


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