Medication Aide Training Course - Legal Implications and Medication Administration

Legal Implications

Negligence

• Clients have a right to be free from neglect.
• Negligence is the failure to provide the standard of care that a similarly trained person would provide in a similar situation (Guido, 1988).
• Example: Failing to administer ordered and transcribed medications is neglect.

Fraud

• Fraud involves dishonesty or cheating the system.
• Example: Documenting medication administration when the medication was not given is fraud.
• Misrepresentation of any aspect of a Medication Aide's job can be considered fraud.
• Consequences: Disciplinary action by the agency and potential legal charges.

Diversion

• Diversion is giving medications to someone other than the intended client while documenting that it was given to the correct client.
• Diversion includes stealing medications for any other use.
• Example: Giving a client's Tylenol to a coworker, even if it seems harmless, is diversion.
• Consequences: Disciplinary action and possible legal charges.

Medication Administration Errors

• Administering medications requires extreme care and a methodical approach.
• Medication errors are a common cause of harm to clients.
• Errors include:
  • Giving the wrong medication.
  • Giving the right medication in the wrong dose.
  • Giving the medication via the wrong route.
  • Giving the medication at the wrong time.
  • Giving the medication to the wrong client.
• A medication error occurs when a drug is given in any way other than prescribed.
• Errors can occur if instructions on the MAR, bottle, or approved administration methods are not followed.
• Potentially serious errors:
  • Giving a medication the client is allergic to.
  • Giving medication at the incorrect time.
  • Omitting a dose.
  • Giving the wrong dosage.
  • Giving an extra dose.
  • Giving medication by the wrong route.
  • Giving the wrong medication.
  • Giving an expired medication.
• Report errors immediately per agency policy and document after notifying the nurse.

Preventing Medication Errors

• Develop a careful method using the SIX RIGHTS of medication administration.
• If unclear about any instructions on the MAR, ask a supervisor before administering the medication.
• When in doubt, STOP and ASK.

Borrowing Medications

• Do not borrow medications from unit stock or other clients' supplies.
• Borrowing bypasses safety check systems (e.g., pharmacist checks for allergies or drug interactions).
• Skipping safety checks puts clients at risk of adverse reactions.
• Pharmacists contact the doctor (or other prescriber) if they find a problem to get the medication changed, therefore preventing medication reactions.

The Six Rights of Medication Administration

• Follow the SIX RIGHTS to prevent medication errors and act as the client's last line of defense:
  • RIGHT CLIENT
  • RIGHT MEDICATION
  • RIGHT DOSE
  • RIGHT ROUTE
  • RIGHT TIME
  • RIGHT DOCUMENTATION

Distractions and Interruptions

• Interruptions and distractions can cause medication errors.
• Minimize distractions by working in a distraction-free area.
• Focus on medication administration until the task is complete (unless there is an emergency).
• Alert staff to avoid interruptions during medication administration.
• The task of administering medications demands your full attention

Reporting Medication Errors

• Each agency has a specific procedure to follow for medication errors.
• Report errors to a supervisor immediately.
• Prompt reporting can help limit negative outcomes for the client.
• The agency will have a specific procedure for how to report and document the error.
• The physician must be contacted for most errors.
• Reporting details can help the agency identify systemic issues and prevent future errors.

Key Points for Good Medication Administration

• Develop good medication administration practice habits.
• Always read medication labels and compare them to the MAR.
• Perform the SIX RIGHTS for each medication, for each client, every time.
• Question unusual orders (e.g., more than three tablets or capsules for one dose).
• Red flags include:
  • Client stating they do not normally take a certain pill (e.g., a "blue" pill).
• If doubts persist, contact your supervisor for clarification before giving the medication.

Health Insurance Portability and Accountability Act (HIPAA), Privacy, and Confidentiality

• HIPAA, enacted in April 2003, mandates confidentiality and makes violations a crime.
• Medication Aides may be required to complete HIPAA training.
• HIPAA requires staff to keep client information confidential and only discuss it with the healthcare team or agency personnel, or with client consent.
• Do not share information about a client's medications with other clients or people without consent.
• Avoid discussing clients with coworkers (unless related to care), friends, or family.
• Do not discuss clients in public areas due to privacy concerns.
• Discuss sensitive information with your supervisor in a private area.
• Violation of HIPAA can result in fines up to 250,000 and up to 10 years in jail.

Independence and Refusal

• Encourage clients to be as independent as safely possible in their medication and treatment administration.
• If a client refuses or cannot take a medication, follow agency policy.
• Document any missed doses and the reason why the medication was not administered.
• Notify the supervisor about missed doses.
• For mentally impaired clients, seek advice from a supervisor on strategies to encourage medication adherence.
• Never force a client to take medication.
• Follow agency policy regarding medication refusal and notify supervisor as soon as possible.
• For clients unable to give consent (e.g., children or incompetent clients), a parent or legal guardian will provide consent.