Skill # 1 – Providing Assistance with Solid Doses of Oral Medication
- Wash hands and prepare any necessary items: Water, juice, cups, spoons etc.
- Obtain the medication observation record.
- Obtain the medication from storage. Verify medication has not expired.
- Verify the medication label with the medication observation record. Check the MOR, then the medication label, the the MOR before providing the medication to the resident.
- Take the medication to the resident and tell him/her what medication you are providing by reading the label to him/her. Open the container in the presence of the resident.
- Give the resident his/her medication, providing the type of assistance needed and with an appropriate liquid.NOTE: You may place an oral dosage in the resident’s hand or in another container and help the resident by lifting the container to the resident’s mouth. You may not place the medication directly in the resident’s mouth.
- Observe the resident swallow the medication.
- Record that assistance was provided on the MOR and return closed medication to storage.NOTE: You may place any unused medication back into the bottle as long as it hasn’t been contaminated. [If pills or other solid medications are dropped onto a clean surface, they are probably not contaminated. Do not touch the medication with your hands.]P.S. Never assist with a medication poured by someone else. You cannot be sure what it is.
Skill #2 – Providing Assistance with Liquid Medication
- Wash hands and prepare necessary items.
- Obtain medication from storage and verify medication has not expired.
- Verify the medication label with the medication observation record. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Always use a cup or container which contains lined measurements. You may ask the pharmacist to mark the correct dosage on the cup you will be using.
- Shake liquids enough to mix medication.
- Hold cup at eye level. Use your thumb to mark off the correct level on the cup.
- Pour medication into the cup and stop at the mark for the prescribed dose.
- Give the cup to the resident. If necessary, assist the resident to lift the cup to his/her mouth. Observe the resident swallow the medication.
- Record that assistance was provided on the MOR and return closed medication to storage.
NOTE: If the liquid is measured in drops, only use the dropper provided with the medication.
Skill #3 – Breaking Scored Tablets and Crushing Tablets
- Scored Tablets: Sometimes a medication label will read: take half a tablet. You may break tablets and caplets which are “scored.” A scored tablets has been imbedded for easier and even breakage; that assures the correct amount.
You may use a pill cutter or your thumbs to break a scored medication. You must wear gloves if you handle the pill. - Crushing a Tablet: You may crush a medication only when the medication label specifically directs you to do so. Some medications are not meant to be crushed. In general, medications which are “sustained-release”, “extended release” or which have an enteric coating may not be crushed. Pay close attention to the instructions on the label. It’s a good idea to check with the pharmacist to be certain a particular medication can be broken or crushed.NOTE: If a resident seems to be having difficulty swallowing medications, talk to the health care provider. Can the medications be crushed? Can the capsule be opened and mixed with food? Request specific directions for doing this. Could the medication be given in liquid form? Is there another medication which may be easier for the resident to swallow? Remember that you are assisting residents to take medications, not administering medications.
P.S. Medications cannot be “hidden” in foods for residents who are refusing them. Residents may only knowingly take a medication with food if it is easier for them.
To crush a medication, using a pill crusher:
(a) Wash hands and obtain necessary items.
(b) Verify the medication label with the medication observation record. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
(c) Place the pill in a souffle cup (paper cup).
(d) Cover the cup with another souffle cup.
(e) Lower the lid of the pill crusher onto cup top and press.
(f) Place crushed pill onto spoon with food (for example applesauce). Make sure you get all particles of medication from underneath the cup used on top.
(g) Record that assistance was provided on the MOR and return closed container to storage.
Skill #4 – Assisting with Nasal Drops and Sprays
Some residents may need assistance with nasal drops and sprays. Allow each resident to as much as possible for himself/herself. You may assist a residents with nasal drops or sprays in the following manner:
- Wash hands and prepare necessary items.
- Verify the medication label with the medication observation record. Check the MOR, then the medication to the resident.
- Ask the resident to gently blow his/her nose to clear the nasal passage.
- Ask the resident to either lie down or sit down and tilt his/her head back. If resident’s shoulders and allow the head to fall over the edge of the pillow.
- Ask the resident to elevate the nares slightly by pressing the thumb against the tip of the nose.
- Hold the dropper or spray just above the resident’s nostril. Place no more than three drops at a time, unless otherwise prescribed. Do not touch the dropper or spray bottle tip to the inside of the nostrils.
- Ask the resident to inhale slowly and deeply through the nose; hold the breath for several seconds and then exhale slowly ; and remain in position with head titled back for 1-3 minutes so the solution will come into contact with all of the nasal surface.
- Discard any medication remaining in the dropper before returning the dropper to the bottle.
- Rinse the tip of the dropper with hot water, dry with tissue and recap promptly.
- Wash hands.
- Record that assistance was provided on the MOR and return medication to storage.
Skill #5 – Assisting with Ear Drops
Some residents may need assistance with ear drops. Allow each resident to do as much as possible for him or herself. You may assist a resident with ear drops in the following manner:
- Wash hands.
- Verify the medication label with the medication observation record. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Ask resident to tilt head so that ear needing drops is up and tilted slightly back, so drops cannot roll into the eye.
- Ask the resident to gently pull the ear up and back.
- Place drops in ear according to prescription. Do not touch the ear with dropper.
- Hold head in position for approximately two minutes.
- Allow resident to wipe ear with a cotton ball or a tissue.
- Wash hands
- Record that assistance was provided on the MOR and return closed container to storage.
Skill #6 – Assistance with Eye Drops or Ointments
Some resident may need assistance with eye drops or ointment. Allow each resident to do as much as possible for himself/herself. You may assist a resident with eye drops or ointments in the following manner:
- Wash hands and gather necessary items.
- Verify the medication label with the medication observation record. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Assist the resident to a comfortable position, either sitting or lying down.
- If crushing or discharge is present, the eye should be cleaned with a clean, warm washcloth. Use a clean area of the cloth for each eye. When cleaning the eye, wipe from the inner eye to the outer eye. [From closest to the nose, to away from the nose.]
- Ask resident to pull lower lid down and out gently, or using for finger, gently pull lower lid down and out.
- Ask the resident to look up.
- Approach the eye from the side and drop mediation into center of lower lid. Do not touch the eye with the dropper. Do not drop directly onto the cornea. use care so that the medication does not roll into the other eye. If assisting with an ointment, gently squeeze medication along inner lower lid. Do not touch eye with end of tube.
- Instruct the resident to close eyes slowly, but not to squeeze or rub them.
- After at least 30 seconds, instruct the resident to open eye.
- Allow resident to wipe off excess solution with a cotton ball or tissue.
- Wash hands and return medications to the storage area.
- Record that assistance was provided on the MOR.
NOTE: If more than one medication is prescribed, wait three to five minutes between each medication.
Observe the resident’s response to the medication and report redness, drainage, pain , or itching, swelling, or other discomforts or visual disturbances.
Skilled #7 – Application of Transdermal Mediation
Transdermal medications are usually in the form of patches. You may assist a resident to apply a patch in the following manner:
- Wash hands and gather necessary items.
- Verify the medication label with the medication observation record. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Explain to the resident how you will assist him/her.
- Open the package and remove the patch.
- Date and initial the patch. (and time, if appropriate.)
- Remove the backing from the patch, using care not to touch medication with hands.
- Apply the patch to a dry, hairless part of the body, according to package instructions. Watch for old patches that should be removed or absence of a patch that should be present. Alternate the application sites to avoid skin irritation. Notify the health care provider of irritation.
- Wash hands immediately to avoid absorbing the medication yourself.
- Record that assistance was provided on the MOR and dispose of supplies appropriately.
Skill #8 – Providing Assistance with Creams and Ointments
- Wash hands and gather necessary items.
- Verify the medication label with the MOR. Check the MOR, then the medication label, then the MOR before providing the medication to the resident.
- Put on gloves or use an applicator, such as a wooden tongue depressor or Q-tip, so that your hands do not come into contact with medication or affected skin.
- Squeeze small amount onto a tongue depressor (or similar tool). [A 4×4 clean gauze pad may also be used to apply cream or ointment.]
- Spread onto affected area as prescribed by a physician until absorbed, unless the directions say to leave a film. Avoid rubbing the skin.
- Discard tongue depressor and gloves and wash hands.
- Record that assistance was provided on the MOR and return closed container to storage.
NOTE: YOU MAY ASSIST ONLY WITH CREAMS OR OINTMENTS THAT DO NOT REQUIRE A DRESSING.
