Right Person

Before assisting a person with medications, make sure you have the right person. In some cases direct support professionals are asked to provide medication administration support to people they do not know well. Use caution in these instances. Be aware that some people may appear to be agreeing with the question "Are you James Billings?" when in fact they do not understand the question. Direct support professionals must take the time to ensure they have correctly identified the person. In addition, DSPs must be careful to ensure they have the correct container for that person.

Right Medication

It goes without saying that you must give the right medication. These types of errors happen when medications look or sound very similar to each other. It may happen that there is an error where a person does not receive medication at all. It could happen due to errors on the medication administration record (MAR).

Right Time/Date

Some medications must be given at specific times. Serious and negative consequences can be experienced if these medications are late or too early. Medications that help people regulate seizure activity, blood sugar, high blood pressure, symptoms of mental illness or antibiotics and birth control pills, are among the medications that need to be carefully timed. Other medications have a wider time period in which they will remain effective. In some cases it can be dangerous to "double up" a missed medication. If the time for giving a medication is missed, the direct support professional should speak to qualified medical professionals or a pharmacist regarding the timing of the medication and what can be done.

Right Dose

Dosage information is very important. The direct support professional must know how to correctly measure medications when needed. Sometimes the same medication is given in different doses at different times. Dosage errors are hard to track and can have serious and even life-threatening effects. It is very important that the correct dose of the medication is given.

Right Route / Preparation / Technique

Medications can be given in many different ways. A common way is by mouth which is known as orally. Some other methods include nasal (through the nose), topical (on the skin or through the skin), intramuscular (through an injection into the muscle) or intravenous (through an injection into the vein), vaginally (placing the medication in the vagina) or rectally (placing the medication into the rectum).  In addition, drops into ears or eyes are common.  In all cases, the correct route must be observed. In addition, medications must be given with the correct preparation and technique. For example, some medications must be taken on an empty stomach. Others must be taken on a full stomach. Some medications can be crushed, some cannot. Some medications need to be mixed, shaken, or otherwise prepared before administering. If the medications are given thorough the wrong route or are incorrectly prepared, they are not likely to be effective.

Right Medication To The Right Person

Usually when there is a problem with getting the right medication to the right person, it is because steps to prevent mistakes have not been taken.  The following things make errors more likely:

• Medications are not properly labeled.
• The medication administration record (MAR) is incorrect.
• Bottles or labels look very similar to each other.
• Several medications for different people are stored together.
• There are changes in routines, such as starting a new medication or discontinuing a medication.

Complex Routines

There are complex routines such as a person taking a medication every other day or taking an antibiotic medication package that requires taking a decreasing number of pills each day over a period of days.

• The direct support professional (DSP) is unfamiliar with the routine. 
• Situations where the DSP does not know all the people in the support sites well.
• There is more than one person at the site.
• The persons being supported have difficulty understanding or communicating.

Timing Errors

Timing errors occur when a medication is not taken at the time or on the day as required in the Medication Administration Record (MAR) or on the prescription label.  A timing error may cause a poor treatment outcome for the person. This means that he or she does not receive effective treatment for a specific health condition. It might also mean that he or she experiences harm or is made uncomfortable due to the error in timing. 

Medications vary a lot for the best response to timing errors. It is very important to get clear instructions from a medical professional regarding a timing error. You also need to know what to do if a timing error is made.  Each medication is different. For some medications, you might double up at the next dose. For other medications doing this could be a fatal error! Do not handle timing errors without clear instructions from the responsible healthcare professional.

Like many other types of errors, timing errors can be avoided by creating good medication routines and systems.

Dosing Errors

Errors in dosage are difficult to track and can lead to several problems. Be very careful with dosage each time you administer or observe a person self-administer medications to prevent the following problems.

• Signs or symptoms of a poor response to the treatment of a health condition. This can be very serious in many types of health conditions.
• Immediate problems for the person. These could include: discomfort and restlessness, sedation, coma, heart attack, panic attacks vomiting and nausea, headaches, or other unpleasant or even fatal reactions.
• Long term problems for the person. These could include damage to the heart, liver, kidneys, stomach, or other systems and organs.

Contact a supervisor, pharmacist or other medical professional if a dosage error occurs.  Immediately contact emergency services or poison control if a dosage error appears serious. If you take someone to the emergency room, always carry the labeled medication container with you. Document dosage errors so that the information can be shared with those who need the information.

Right Medication To The Right Person

To prevent problems with getting the right medication to the right person do the following:

• Find out as soon as you arrive in the support setting if there have been any changes in medications or the person's health.
• Review the Medication Administration Record (MAR) if there is one.
• Never give someone medications that belong to someone else.
• Do not give medications out of unlabeled containers.
• Do not give medications if the label and the MAR do not match. (Get clarification from a healthcare practitioner before proceeding. Follow all employer policies and procedures and the laws in your state regarding changes and communication in this area).
• Never give a medication to a person unless you are sure you have the right person.

Medication Preparation

It is important to know how each medication is to be prepared and administered.  Some examples of differences in preparing and administering medications include the following:

• Some liquids need to be shaken before giving. Others do not.
• Some pills need to be crushed or chewed. For other pills, chewing may change the medication's effect. It may cause an adverse reaction in the person. Never crush or chew a pill that is meant to be swallowed whole without clear directions from the prescribing practitioner that this will be acceptable. 
• Some inhalants need to be sprayed into the air several times before use in order to ensure the medication is flowing properly.
• Some nose drops or sprays must be alternated each day from one nostril to the other in order to keep the nostrils from becoming irritated.
• Some eye drops can be given with contact lenses in. Other times the contacts must be removed and remain out for a period of time.
• Some suppositories will melt causing them to lose shape or reduce the dosage if handled too much prior to administering.

Avoid Dosage Mistakes

To avoid dosage mistakes:

• When possible use pre-measured medications and prepackaged doses for pills ("bubble packs").
• Ask the pharmacist to split any tablets that need to be cut for dosage purposes.
• Don't rush your measurements and use only approved medication measurement devices.
• Watch out for measurement abbreviations! Look carefully! Is it tsp. (teaspoon) or tbsp. (tablespoon)? One letter can make a big difference! Think it through and look it up if needed.