Medication

Medication passing training is essential in adult foster care because it helps to ensure the safety and well-being of residents, while also promoting compliance with state and federal regulations. By caregivers being properly training on how to administer medications safely and accurately, adult foster care facilities can help to reduce the risk of medication errors.

Effects of Medication

Medications are substances that are taken into (or applied to) the body for the purpose of prevention, treatment, relief of symptoms, or cure. The DSP may only assist individuals with administration of medications that have been ordered and prescribed by a person licensed to do so by the Department of Licensing and Regulation (i.e., Doctor, Dentist, or Nurse Practitioner.) This includes both prescription and over-the- counter medications. The doctor’s signed, dated order or prescription provides instructions for preparation and administration of the medication.

Prescription medications are those that are always ordered by a doctor or other person with authority to write a prescription. Over-the-counter (OTC) medications are those that typically can be bought without a doctor’s order and include vitamin supplements, herbal remedies, and commonly used medications such as Tylenol and Benadryl. In licensed residential settings even “over-the-counter” medications must have a signed, dated order or prescription from the Doctor.

PRN medications are taken “as needed” to treat a specific symptom. PRN medications include both prescription and over-the-counter medications. PRN medications must always be ordered by a doctor. The doctor’s order should include the minimum and maximum number of doses, the number of days the medication may be used, under what conditions or the condition it is prescribed for and any other directions specific to the individual. The reason for each dose of PRN medication must be documented. Each dose of medication must be recorded on the individual’s medication sheet, and the DSP should assure that a.m. or p.m. is noted too. To prevent errors always check for the last time a PRN medication was given before dispensing and follow all individual medical protocols for that medication. When a PRN medication is administered the DSP must complete a follow up check in 30-45 minutes. This check involves talking to, and observing the individual for the intended effect, and documenting that effectiveness.

* Please note that AFC administrative rules require Initiation of a review process to evaluate an individual’s condition if the individual requires the repeated and prolonged use of a medication that is prescribed on an as needed basis. The review process shall include the individual’s prescribing physician, the individual or his or her designated representative, and the responsible agency.

AFC administrative rules R400.14312(4)(c-d) Resident Medications

Common Side Effects of Medication that You Should Report to the Doctor Include:

• Skin Rash

• Increased heart rate or feeling like the heart is racing

• Changes in sleep

• Decreased energy

• Sedation

• Changes in weight or eating patterns

• Tremors, shakiness

• Balance problems

• Shuffling when walking

• Confusion

• Changes in ability to concentrate

• Hyperactivity

• Abnormal movements (face, tongue, or body)

• Muscle pain

• Stooped posture

• Blank facial expression

• Feeling dizzy or light-headed

• Dry mouth

• Constipation

• Blurred vision

• Diarrhea

• Nausea

• Vomiting

• Increased risk of sunburn

Tardive Dyskinesia

Tardive Dyskinesia (TD) is a potential long-term neurological side effect of antipsychotic medications such as Mellaril, Thorazine, Risperdal, and Zyprexa. Symptoms may include rapid eye blinking, puckering, or chewing motions of the lips and mouth, or facial grimacing. Symptoms may worsen if the medication is not reduced or discontinued. TD can become permanent. Discuss this risk with the psychiatrist or doctor before starting anti-psychotic medications. You should monitor individuals for these serious side effects on a regular basis. Usually when an individual is taking antipsychotic medication an Abnormal Involuntary Movement Scale (AIMS) should be completed every six months.

Medication Interactions

Interactions between two or more drugs and interactions between drugs and food and drink may cause adverse reactions or side effects. Who would ever guess that taking your blood pressure medicine with grapefruit juice instead of orange juice could make you sick? Or that licorice could be lethal when eaten with Lanoxin or Lasix? How could cheddar cheese, pepperoni pizza, or pickled herring combined with an antidepressant create a hypertensive crisis? Yet all of these interactions are real and could lead to disaster.

Drug interactions may be between:

• Two or more drugs

• Drugs and food

• Drugs and drink

Drug interactions may also be caused by mixing drugs and alcohol. Alcohol in combination with any of the following is especially dangerous:

• Antianxiety drugs, such as Librium, Valium, or Xanax.

• Antidepressants.

• Antiseizure medicines.

• Antihistamines.

• Ulcer and heartburn drugs such as Zantac and Tagamet.

• Some heart and blood pressure medicines.

Tardive Dyskinesia

Tardive Dyskinesia (TD) is a potential long-term neurological side effect of antipsychotic medications such as Mellaril, Thorazine, Risperdal, and Zyprexa. Symptoms may include rapid eye blinking, puckering, or chewing motions of the lips and mouth, or facial grimacing. Symptoms may worsen if the medication is not reduced or discontinued. TD can become permanent. Discuss this risk with the psychiatrist or doctor before starting anti-psychotic medications. You should monitor individuals for these serious side effects on a regular basis. Usually when an individual is taking antipsychotic medication an Abnormal Involuntary Movement Scale (AIMS) should be completed every six months.

Medication Interactions

Interactions between two or more drugs and interactions between drugs and food and drink may cause adverse reactions or side effects. Who would ever guess that taking your blood pressure medicine with grapefruit juice instead of orange juice could make you sick? Or that licorice could be lethal when eaten with Lanoxin or Lasix? How could cheddar cheese, pepperoni pizza, or pickled herring combined with an antidepressant create a hypertensive crisis? Yet all of these interactions are real and could lead to disaster.

When you suspect that the individual is having an adverse reaction to a medication, urgent medical care may be needed. Report the suspected reaction to the doctor and follow the doctor’s advice. When you talk to the doctor, be prepared to give the following information:

• A list of current medications.

• Description of how the individual looks (pale, flushed, tearful, strange facial expression, covered in red spots).

• Description of any changes in individual’s behavior or level of activity.

• Description of what the individual says is wrong or is hurting.

• When the symptoms first started.

Description of any changes in bodily function:

• Is the individual eating or drinking?

• Does he or she have a good appetite or no appetite?

• Any nausea, vomiting, loose feces, constipation, problems urinating?

• Describe any recent history of similar symptoms, any recent injury or illness, or any chronic health problem.

• Describe any known allergies to food or medication.

Severe, Life-Threatening Allergies (Anaphylaxis or Allergic Reaction Shock)

Some individuals have severe allergies to medications, especially penicillin. The allergic reaction is sudden and severe and may cause difficulty breathing and a drop in blood pressure (anaphylactic shock). Anaphylactic Shock is a generalized systemic reaction, frequently fatal, which usually occurs within minutes after contact with an allergen. If an individual has had a severe allergic reaction to a medication (or insect stings or food), he or she should wear an identification bracelet that will tell health professionals about the allergy.

Call 911 immediately to get emergency medical care if signs of a severe allergic reaction develop, especially soon after taking a medication.

Some individuals have a severe allergy to insect stings or certain foods. If an individual shows any of these same signs of a severe allergic reaction soon after eating a food or being stung by an insect, call 911 immediately to get emergency medical care.

The Six Rights of Assisting with Medication Administration

Following the Five Rights is basic to medication safety. The DSP needs to be sure he or she has the:

• Right individual

• Right medication

• Right dose

• Right time

• Right route

• Right Documentation

Following the Six Rights each time is the best way for the DSP to prevent medication errors. When assisting an individual, you must read and compare the information on the medication label to the information on the Medication Sheet three times before the individual takes the medication. Checking three times helps the DSP to ensure that you are assisting the right individual with the right medication and dose at the right time and in the right route (way).

Never assist an individual with medication from a container that has no label! If, at any time, you discover that any of the information does not match, stop. You may have the wrong individual, be preparing the wrong medication in the wrong dose at the wrong time, or the individual may be about to take the medication in the wrong way.

Think through each of these possibilities and decide what to do. If you are unsure, you may need to get help. Ask another DSP, the home manager, or in some situations, you may need to call the doctor or pharmacist. Check the Six Rights three times by reading the medication label information and comparing it to the Medication Sheet as follows:

What time should a medication be taken when it is ordered for once a day? In the morning? At 12:00 noon? At dinnertime? 

Usually when a medication is ordered only once a day, it is given in the morning; however, it is best to check with the doctor or pharmacist.  

Some medications may be prescribed by the physician using the individuals "Standing Medication Order Form" (Ancillary Orders) to be given when certain conditions exist. Medications for headache, constipation, and upset stomach are some examples that may fall into this category. There should be specific written instructions from the physician regarding when and under what conditions the medication should be administered. 

Right Route

Read the medication label for the appropriate route or way to take the medication. The route for tablets, capsules, and liquids is “oral.” This means that the medication enters the body through the mouth. The oral route is the most convenient and most common route of medication administration. The oral route is the method by which you will be administering most medications.

Other routes include:

• Eye drops or ointment (ophthalmic)

• Nose (nasal sprays)

• Ear drops (otic)

• Topical (which includes dermal patches or ointments to be applied to the skin)

• Rectal (suppositories)

• Vaginal

• Injection

*Note: If you work in a residential setting where individuals need injections, tube feeding, or glucose monitoring you will receive additional training per the established medical protocol specific to the individual and the person-centered plan.

Drug Forms

Drugs are manufactured in several forms. Some of the common forms are listed below:

• Capsules are small containers made from gelatin. The medicine is placed in the capsule which readily dissolves in the stomach.

• Tablets are pressed or molded preparations of powdered drugs. When exposed to liquid, they expand and break apart. Some tablets have a coating these are called “enteric coated” tablets. The coating prevents the tablet from dissolving until it has passed through the stomach. Usually medications that have the potential (side effect) of stomach upset/distress come with this type of coating. Some tablets are “scored” which means there is a visible line and these tablets may be cut in half.

Note: Don’t crush tablets or open capsules unless the prescribing physician gives specific directions to do so.

• Ointments/ Creams are for external application to the skin or mucus membranes.

• Suppositories are drugs for insertion into the vagina or rectum. The suppository will dissolve or melt at room temperature releasing the drug for absorption through the mucus membrane. These are usually stored in a lock box in the refrigerator.

• Elixirs are liquid preparations of drugs.

Many drugs come in several different forms! If an individual has trouble taking a medication, talk to the individual about their needs and preferences and then talk with the Doctor about other forms of the medication or optional ways to take the medication.

Refusal of Medications

An individual has the right to refuse his or her medication. It is the DSP’s responsibility to work with and support the individual in taking his or her medicine. If an individual refuses to take the medication, ask “Why?” Do not try to crush or hide the medication in the individual’s food to get him or her to take the medicine. 99% of the time the DSP can figure out a way to encourage the individual to take his or her prescribed medication, without being coercive.

Reasons for Medication Refusal and Possible Helpful Suggestions

The following is a list of some common reasons an individual might refuse to take his or her medication and suggestions on how to provide assistance:

Unpleasant Taste

• Give the individual ice chips to suck on just before taking the medication. This will often help mask the bad taste.

• Ask the doctor or pharmacist if the medication can be diluted to cover a bad taste. Ask the physician or pharmacist if there is a juice compatible with the medication that can be used (for example, apple juice). A note to this effect should be on the prescription label.

• Provide crackers, apple, or juices afterwards to help cover up the bad taste.

Unpleasant Side Effect – Drowsiness

• Report the unpleasant side effect and ask the prescribing doctor if the individual can take the medication at a different time (such as before bedtime). Also ask about changing the medication or treating the side effect.

Lack of Understanding

• Provide simple reminders on what the name of the medication is and what the medication does. For example, “This is Depekene a medication that stops your seizures.” Remember, all the individuals you support should be involved in their health care. This involves providing information about medications, doctor appointments, healthy life style choices, etc. The role of the DSP is to support the individual in taking the medication by listening to what the individual’s concerns are and trying to address them.

Denial of Need for Medication

• Discuss the need for the medication, but do not argue. It may help to show the individual a statement written by the physician; for example, “Alma, you take your heart medication everyday.” 

Documenting and Reporting

Medication refusal needs to be documented on the medication sheet and brought to the attention of the prescribing doctor. The doctor may be able to accommodate an individual’s medication preference or special health consideration. Any unused dose should be set aside and destroyed in an acceptable way.

Remember: Never force an individual to take medication: he/she has the right to refuse medication. If an individual refuses medication often or has a history of refusals the physician can provide instructions on how the DSP should proceed.

Medication Errors

The Food and Drug Administration evaluated nationwide reports of fatal medication errors that it received during a five-year period and found that the most common types of errors involved:

• Administering an improper dose (41%)

• Giving the wrong drug (16%), and

• Using the wrong route of administration (16%).

Errors were caused by a lack of skill and/or knowledge and communication errors

Every medication error is serious and could be life threatening. The DSP’s job is to safely assist individuals to receive the benefits of medications. Preventing medication errors is a priority. In this training you have learned the best way to help individuals take medication safely and to reduce the risk of errors. But even in the best of situations, errors may occur. When they do, you need to know what to do.

A medication error has occurred when:

• The wrong person took the wrong medication.

• The wrong dosage was taken.

• Medication was taken at the wrong time.

• Medication was taken by the wrong route.

• Medication was not taken.

Every medication error is serious and could be life threatening.

If an error does occur, it must be reported on an Incident Report. The error must be recorded on the Medication Sheet by initialing the square or box and putting a circle around it in red ink. Check with the home manager for documentation requirements specific to your home. The documentation should include the date, time, medication involved, description of what happened, who was notified, doctor’s name, instructions given, and action taken.

The DSP may be able to determine what action to take when a medication error occurs by using the drug insert provided by the pharmacy. The drug insert will provide answers to common medication questions. The guidelines provided in the drug inserts do not give enough direction should the following medication errors occur: When a person is accidently given more of their own medicine than has been ordered, or if they are given someone else’s medications. In the event that either of these errors are made, call the prescribing physician(s) (Primary care Physician, Psychiatrist, Neurologist, etc.) immediately.

All residential settings should have drug inserts readily available for DSP’s to review and refer to as questions and concerns arise. Additionally, each residential setting may have policies and procedures related to medication errors, which will provide specific information to the DSP on how to document, who to notify, and how to proceed.

Remember Prevention is the #1 priority!

You can prevent errors by:

• Staying alert

• Following the Five Rights.

• Avoiding distractions. 

• Knowing the individual and his or her medications.

• Asking the home manager for help if you are unsure about any step in preparing, assisting, or documenting medications.

• Asking the home manager for help if you are unsure about any step in preparing, assisting, or documenting medications.

• Always completing the medication count before beginning to administer medications

Disposal and Destruction of Medication

Each residential facility should have a written plan for the disposal of medications. There are several acceptable ways to dispose of medications. The DSP should review the policy in the residential setting where they work. All medications which have been discontinued, contaminated, deteriorated, or expired will require disposal. Medications should be labeled for disposal and separated from the other medications in a locked cupboard or container.

DSP staff must complete the medication disposal sheet for all destroyed medications, if medications are returned to the pharmacy the pharmacist or designee should sign the form. The forms are located at the end of this unit. The following procedures are recommended when disposing of medications.

Check with local pharmacy to see if they have a “take back program”. Keep the medication in their original container, scratch out, or use permanent marker to make personal information unreadable. If NO “take back program”, keep the medication in the original container, scratch out, or use permanent marker to make personal information unreadable.

To reduce the opportunity for misuse, prepare the drugs for disposal by:

• For solid medications, such as pills or capsules: add a small amount of water to at least partially dissolve them. Seal the container with duct or other opaque tape.

• For liquid medications: add enough table salt, flour, charcoal, or nontoxic powdered spice to make a pungent, unsightly mixture that discourages anyone from eating it. Seal the container with duct or other opaque tape to prevent leaks or breakage.

• For blister packs: wrap the blister packages containing pills in multiple layers of duct or opaque tape.

  • Double bag the contained drugs in a closable bag or put it in another container with the lid taped closed and put it in the trash. This helps prevent immediate identification that the package contains drugs and helps contain any leaks if the container breaks during the disposal process, e.g., when plastic garbage bags tear, the trash can tips over, etc. Avoid putting drugs into any material or food that might be attractive to pets or wildlife. * (*From Michigan Department of Environmental Quality)

• Medications must be disposed of so that animals or humans cannot retrieve them.

• Controlled substances must be disposed of by the Admin or RN (with a witness) or by a pharmacist. 

  • If the pharmacy does not have a “take back program” medications, except controlled substances, may be destroyed by two DSP’s, one acting as a witness. Follow the home policy.

Medication Administration Guidelines

The following is the step-by-step process for assisting an individual with administration of medications.

Remember to complete the medication count before medication administration!

1. Help the individual whom you are assisting to wash his or her hands.

2. Wash your hands. Hand washing reduces the risk of contamination.

3. Get the Medication Sheet for the individual you are assisting.

   • Double check that you have the Medication Sheet for the right individual. It’s important for you to work with only one individual at a time and to complete the task with that individual before assisting another.

4. Gather supplies:

   • Take the medications out of the locked storage container or area. It is a good idea to keep all medications for one individual in one storage unit labeled with the individual’s name. Get paper cups for tablets and capsules and a plastic calibrated measuring cup or medication spoon for liquid. Get a glass of water. Gather tissues. Get a pen.

5. As you take each medication container from the individual’s storage unit, read the medication label and compare to the Medication Log for the Six Rights:

   • Right individual

   • Right medication

   • Right dose

   • Right time - check the time on your watch or clock.

   • Right route

   • Right Documentation

6. Tablets or capsules:

   • Pour the correct dose into the lid of the container and then into a small paper cup. Pour the correct dose into the bottle cap and then into a small paper cup or other container used for holding tablets or capsules before the individual takes them. Pouring a tablet or capsule into the bottle cap first reduces the risk of contamination. If too many pills pour out, return the pills from the bottle cap into the container. It is a good idea to use a separate disposable paper cup for each medication. Pouring all the medications in one paper cup increases the risk of medication errors.

7. For bubble packs, push all the tablets/ capsules from the bubble pack into a small paper cup.

8. For liquid medication:

   • Always shake liquid medications before pouring. Pour the correct dose into the plastic measuring cup held at eye level. View the medication in the cup on a flat surface. Pour away from the medication label to avoid staining it with spills. If any medication spills on the bottle, wipe it away.

9. When using a measuring spoon:

   • Locate the marking for the dose. Hold the device at eye level and fill to the correct dosage marking. Pour away from the medication label to avoid spills. If any spills on the bottle, wipe it away.

   • Additional tips for liquid medication:

     1. Use only a calibrated measuring cup or spoon. Regular eating spoons are not accurate enough and should never be used. If too much liquid is poured, do not pour it back into the bottle—discard it. Wash the calibrated measuring device and air dry on a paper towel.

10. Talk with the individual you are assisting about what you are doing and about why he or she is taking each medication.

11. Again, just before putting the medication within the individual’s reach, read the medication label and compare to the Medication Sheet for the SixRights:

    • Right individual

    • Right medication

    • Right dose

    • Right time (Again, check the time on your watch or clock.)

    • Right route

    • Right Documentation

12. Place the medication within the individual’s reach.

13. Offer a glass of water (at least four ounces).

    • It is a good idea to suggest to the individual that he tilt his head forward slightly and take a small sip of water before placing the pill in the mouth. Wetting the mouth may make swallowing easier and tilting the head slightly forward (as opposed to throwing it back) may decrease the risk of choking. If pills are not taken with liquids, they can irritate the throat and intestinal tract and they may not be correctly absorbed.

    • Some medications must be taken with food, and there may be other special instructions. Make sure that you have read any warning labels and are familiar with any special instructions for taking the medication.

14. Make sure that the individual takes the medication and drinks water.

    • Stay with the individual until you are sure that he or she has swallowed the medication.

    • If the individual has difficulty drinking an adequate amount of water or swallowing liquids, the DSP can ask the doctor about the individual taking the medication with: Jell-O that is semi-liquid or jellied apple juice or other “medication-compatible” juice thickened with cornstarch or other thickening agent.

    • Medications should never be disguised by putting them in food or liquid.

    • Tablets should never be crushed unless the prescribing physician gives the specific direction to do so.

    • Capsules should not be opened, and their contents emptied out. If the individual has trouble taking a medication, talk to the individual about their needs and preferences and then talk to the doctor about optional ways to take the medication.

15. Record that the individual took his or her medication by initialing the date and time in the proper box on the Medication Sheet.

16. Return the medication containers and/ or bubble pack to the individual’s storage unit. As you do so, read the labels to check that the individual’s name on the medication container label is the same as the name on the storage unit.

** Never leave the medication container unattended or give to someone else to return to the locked storage container or area. **

When assisting an individual with other types of medications such as topical creams and ointments, ear drops, nose drops, and eye drops, consult with the prescribing physician and the pharmacist for specific procedures for administration of the medication. Also, refer to the Administration Guidelines which describe the process for assisting with these types of medications.

** IF YOU HAVE ANY DOUBT AS TO WHETHER THE MEDICATION IS IN THE CORRECT FORM AS ORDERED OR THAT YOU CAN ASSIST THE INDIVIDUAL WITH ADMINISTRATION AS DIRECTED ON THE LABEL, CONSULT WITH THE PRESCRIBING DOCTOR OR THE PHARMACIST. **

Topical Medication Administration Guideline

Topical medications are those applied to an individual’s skin or mucous membrane surface.

Examples include: Eye, ear, nose, skin. Creams and lotions should be rubbed in well. Ointments should be applied to the surface of the skin.

1. Wash your hands and put gloves on. Provide explanation of procedure to individual. Frequently, if an individual has a problem requiring topical application of a liquid, cream, or an ointment, the skin will not be intact but will have breaks or sores on the surface.

2. Being mindful of privacy, assist the individual with having the area where the topical medication is to be applied exposed. Make sure clothing and bedding are protected.

3. Open the container and remove just a small quantity of the product to be applied. Remove medication from jars with tongue blade or cotton tipped applicators. DO NOT USE YOUR FINGERS. Insert applicator or tongue blade into container only once, NEVER RE-INSERT.

4. Use cotton tipped applicators, sterile gauze, or gloved hand. Apply the lotion or cream with gentle firm strokes. Be sure medication is rubbed in well.

5. Remove gloves carefully and dispose of using standard precautions.

6. Wash hands carefully.

7. Put lid back on container and return to locked storage area.

8. Wash hands and document administration.

Nose Drop/ Spray Administration Guideline

1. Wash your hands, and put on gloves.

2. Check the dropper tip for chips or cracks.

3. Tell the individual the name of the medication and its purpose.

4. Have the individual gently blow nose.

5. Have the individual tip their head back while either sitting or lying flat.

6. Draw up the medicine into the dropper.

7. Place the dropper just inside the nostril, about 1/3 inch and administer medication. Avoid touching the dropper to the sides of the nose.

8. Encourage individual to keep head tilted back for 3-5 minutes. Provide a tissue for nasal drainage.

9. Wash hands and document administration.

Ear Drop Administration Guideline

1. Wash hands, and put on gloves.

2. Shake the medication and warm it by rubbing the container between the palms of your hands.

3. Tell the individual the name of the medication and its purpose.

4. Position the individual with the affected ear up.

5. Draw the medicine into the dropper.

6. Administer the ear drops by pulling the mid-outer ear backward and upward then giving the prescribed number of drops. (Pulling the ear up and back helps straighten the ear canal so that the drops run in.) To prevent contamination do not touch any part of the dropper to the inner ear.

7. Encourage the individual to stay in the original position for 3-5 minutes.

8. Wash hands and document administration.

Eye Drop/ Ointment Administration Guideline

1. Wash hands and put on gloves.

2. Check the dropper tip for chips and cracks.

3. Tell the individual the name of the medication and its purpose.

4. Position individual with the head back and looking upward, or have them lie down if it is more comfortable.

5. Draw the prescribed amount of medicine into the dropper. OR apply the amount of ointment prescribed (usually about 1⁄2 long “ribbon” of ointment)

6. Separate lids by raising upper lid with forefinger and lower lid with thumb. Approach the eye from below with the dropper and remain outside the individual’s field of vision avoiding contact with the eye. The drop is applied gently near the center of the inside lower lid and is not allowed to fall more than one inch before it strikes the lower lid. To prevent contamination, do not touch the end of the bottle or the dropper on any part of the eye. 

If using ointment: Separate lids by raising upper lid with forefinger and lower lid with thumb. Approach the eye from below and remain outside the individual’s field of vision avoiding contact with the eye. Apply the ointment in a thin layer along inside of lower lid. Break off ribbon of ointment from the tube by relaxing the pressure and removing the tube. Do not use your fingers. To prevent contamination do not touch the end of the ointment tube on any part of the eye.

7. Allow the eyes to gently close. Have the individual remain in position for 3-5 minutes. He/she can keep eyes closed or blink gently.

8. Wipe excess medication from eye with a tissue.

9. If both eyes require treatment DSP must assure that there is no cross contamination from one eye to the other. After the medication has been administered and the excess wiped off the first eye, the DSP must change gloves before completing administration to the next eye.

10. Wash hands and document administration.

Rectal Suppository Administration Guideline

1. Wash hands.

2. Remove suppository from storage container. (Store suppositories in a cool place to avoid melting or in a locked box in the refrigerator if the label recommends refrigeration.)

3. Explain the procedure to the individual and provide privacy.

4. Have the individual remove undergarments. Position the individual on his/her left side With lower leg straight and upper leg bent forward toward the stomach. Cover the exposed area with a towel or sheet. Do not administer when the individual is in a sitting position.

5. Remove wrapper if present.

6. Put on disposable gloves. Lubricate the suppository, your finger, and the rectal opening with a water soluble lubricant.

7. Lift the upper buttock to expose the rectal area. Encourage the individual to take several deep breaths to help relax.

8. Slowly insert the suppository into the rectum beyond the muscle at the opening (sphincter), pushing gently with your gloved, lubricated forefinger. About one inch in adults. Place the suppository against the rectum wall. If not inserted past the sphincter muscle the suppository may pop back out.

9. After slowly withdrawing your finger, hold the buttocks together until the urge to expel the suppository is gone.

10. Leave the individual in a comfortable position lying down for about 15 minutes. Then provide assistance needed to the restroom, commode chair, or bed pan.

11. Wash hands and document administration. The DSP must also document results achieved after the prescribed length of time.

Vaginal Medication Administration Guideline

1. Wash hands.

2. Obtain the medication from the individual’s medication supply and any needed equipment. (Remember suppositories should be stored in a cool place to avoid melting or refrigerate if the label indicates refrigeration.)

3. Explain the procedure and ask the individual to empty their bladder.

4. Provide privacy and position the individual on their back with knees bent and legs separated unless another position is recommended by the Physician.

5. Place a towel under buttocks.

6. Remove the wrapper if present.

7. Put on disposable gloves.

8. Place medication in the applicator. If using a tablet or suppository, lubricate the tip according to the Physicians orders (usually a water-soluble sterile lubricant).

9. Identify vaginal opening, spread the labia with one hand and gently insert the applicator or medication into the vaginal canal with the other hand. Angle the applicator slightly toward the tail bone. It will usually go in about two inches. DO NOT FORCE.

10. If using an applicator, push the plunger in while holding the barrel of the applicator still.

11. Remove the applicator and encourage the individual to continue lying down for 15-30 minutes.

12. A sanitary napkin may be used if necessary.

13. Wash hands and document administration.