Assistance with Self-Administration: Medication Savvy for Nursing Assistants

In Florida, there is training for Certified Nursing Assistants (CNAs):

1. to assist with self-administration of medication or
2. to administer some medication

Administration means obtaining and giving a single dose of medicine by a legally authorized person to a resident for taking. You must have proof of the training, and the place where you work must approve you and assign you to assist with self-administration or to give medication. It is a huge responsibility, and there are specific Florida laws to address these positions. This course is about assistance with self-administration of medication.

CNAs who are trained are allowed to assist with medication self-administration in the home setting and Assisted Living Facilities. The laws are very specific about how CNAs can assist with medications. Assisting with medications is NOT giving medications; it is just helping the person take their own medicines.

The resident must be fully capable of self-administration of medication and must be medically stable. The resident's physician (MD or DO), physician assistant (PA), or Advanced Practice Registered Nurse (APRN) is the person who decides how much help a resident needs with medication administration. They must fill out a form called "Authorization for Medication Administration." It must be reviewed by the health care practitioner every year to determine if there is any change to the resident's medical condition or self-sufficiency that might change their ability to self-administer medication or to tolerate a particular administration route. A CNA cannot assist with medication unless the resident is designated as capable of self-administration and the CNA is trained to assist.

There must be a documented request for assistance with the self-administration of medication and a written informed consent form stating that the person assisting with the self-administration of medication is unlicensed. The consent must be signed by the resident or their surrogate. An unlicensed person means the person assisting is not licensed to practice nursing but has been trained to assist residents with self-administration of medication (The Florida Senate, 2024).

Residents who are "fully capable of self-administering their medications" may take their medicines without supervision. These residents may also need help reordering or getting medications from the pharmacy.

Assistance with self-administration of medications can be done for normal prescriptions (legend medication) and over-the-counter (OTC) medications. It must be taken by mouth, or in topical, transdermal patches, topical ophthalmic (eye), otic (ear), and nasal (nose) forms. Nasal forms of administration are solutions, sprays, inhalers, and nebulizer treatments (The Florida Senate, 2024).

Assistance with self-administration of medication includes moving a medication from storage to the resident. The medication must be dispensed from a pharmacy or a doctor's office. It must be in a properly labeled container. This includes a prefilled insulin syringe or pen. When you are in front of the resident, confirm that you have the correct medication. Tell the residents the name of the medication and its purpose. When the resident agrees that the medication is correct, open the container, remove the prescribed amount, and close the container. Put the medication in another container, like a medicine cup, or put the medicine in the resident's hand. Assist the resident in lifting the container to their mouth if they need help. Apply any topical medication. Return the medication to storage. Keep a record of when the resident received assistance with self-administration (The Florida Senate, 2024).

To assist with a nebulizer, remove the cap. Open the unit dose of the nebulizer solution. A unit dose means the container with the amount of medication prefilled. Pour the unit dose of medication into the dispensing cup of the nebulizer (The Florida Senate, 2024).

Assisting with medications as needed (PRN) cannot be done unless a competent resident or their representative requests it and there are clear directions (The Florida Senate, 2024). There can be no independent judgment when deciding to give the medication. Clear directions may be something like giving adult Aspirin 650 milligrams (mg) every 4 hours for a fever over 101 degrees Fahrenheit. Call the provider if the fever persists for more than 24 hours.

Assistance with self-administration of medication also includes the following other tasks, such as assisting with the following:

• Using a glucometer to perform blood glucose level checks
• Putting on and taking off anti-embolism stockings
• Applying and removing an oxygen cannula but not titrating the prescribed oxygen settings
• Using a continuous positive airway pressure device but not titrating the prescribed setting of the device
• Measuring vital signs
• Colostomy bags (The Florida Senate, 2024)

Assisting with self-administration does not include:

• Mixing, compounding, converting, or calculating medications
• Preparing syringes for injection or administering medications by any injectable route
• Administrating medications by way of a tube inserted in a cavity of the body
• Administrating parenteral preparations
• Irrigation or debriding agents that are used in the treatment of skin conditions
• Assisting with rectal, urethral, or vaginal preparations
• Assisting with medication where the time of administration, amount, or the strength of the dose needs independent judgment (The Florida Senate, 2024)

When assisting with pills and capsules, you must pay attention to the labels. Do not crush pills unless the prescription says to do it. Some pills cannot be crushed, and capsules cannot be opened. If the word "enteric" is on the label, it cannot be crushed. Enteric pills are coated to reduce stomach irritation. Certain pain medications are not to be crushed, especially MS Contin. This is a time-released medication, and if crushed, the entire dose is given at once. When using the liquid form, please be sure to measure accurately. Always keep the measuring cup at eye level, on a level surface, to ensure the correct amount is being poured. To assist with a patch, please remember to clean the skin and make sure it is dry before applying. Do not forget to wear gloves with topical medications because you do not want to get the medicine on your skin.

There are many different forms of medications. To be even more confusing, many medications come in more than one form. The following table shows which form you may or may not assist with:

Some medications are available in pill, liquid, or patch form. READ the prescription label to make sure you are assisting the resident in taking the correct medication in the correct dose and form.

Do:

• Read the label
• Provide water or juice to take pills
• Document the times the resident took the medication

Do not:

• Assist in giving medication if the label has been removed
• Touch medication with your hands
• Insert suppositories
• Put in eye drops
• Insert vaginal medications
• Attempt bladder irrigation

A person, like a nurse practitioner, must write a complete and readable order for a medicine before it is given or taken. The prescription should not have abbreviations, and all terms must be written out.

Complete prescriptions must show the following:

• date of the order
• the time of the order
• name of the medicine
• dose
• route
• form
• time or frequency that it should be taken
• signature of the MD or nurse practitioner

All medications must be stored safely, whether in the home or an assisted living facility. If the medication requires refrigeration, do not forget to put the medicine back in the refrigerator after each use. Never store medicine near heat; this would include storing it on a window shelf or near a stove. If medications are out of date, do not take it upon yourself to throw the medicine away. Ask your charge nurse and resident. If you are working in a home setting, please make sure that all medicine containers are out of the reach of children.

Residents may use a "pill reminder" box to store their medicines if they wish, but the CNA cannot help them fill it. If these residents live in a group home or a multi-person supported living environment, they must keep their medications in a locked storage area in their room. Residents who do not require medication assistance and live in their own homes with no other residents are not required to keep their medications locked up.

Understanding what types of medications your residents are taking is another part of assisting with medication self-administration. Learning about the different classes of medications and their most common side effects is an awesome responsibility.

Analgesics relieve pain, which can affect every aspect of a resident's daily life. They can be narcotics and non-narcotics. Keeping narcotics safe is another part of assisting with medications. You must follow instructions carefully and document them precisely. One of the most common but potentially severe side effects is sedation. If the resident becomes too sleepy, your observation is very important. Always make sure that you give the pain medication at the correct time. Given too early, the resident may become too lethargic; given too late, the pain may be hard to control.

Antacids, such as Maalox®, Zantac®, and Tums®, reduce indigestion and heartburn by slowing down the rate of stomach emptying and neutralizing stomach acids.

Antibiotics control infections. There are many types of antibiotics, and most are for specific infections. Infections can be deadly if not treated quickly and effectively. These medicines must be given exactly as the physician writes the order. If the order is to be given four times a day for seven days, that is exactly what you do. Another infection may occur if the medicine is stopped before the correct doses are given. Or, even worse, a "super" infection may result. The superinfections are very hard to stop once they begin. They are resistant to antibiotics.

Anticoagulants thin the blood, slowing clotting. The most common anticoagulant is Coumadin; this medication helps to prevent blood clots. It must be given exactly as ordered. In addition, side effects must be monitored closely. So, as a medication assistant, you must look for new bruises or actual bleeding.

Anticonvulsants control seizures. When anticonvulsants are given routinely, the chance of seizures is less. These medications should be given on schedule and at the same time every day. If seizures increase, the physician must be notified.

Antidepressants are used to treat depression. They must be taken every day. Stopping them or skipping them can cause increased depression.

Antihypertensives control blood pressure, which should be monitored for highs and lows. If it is too high or low, tell the charge nurse immediately.

Diuretics help the body get rid of excess fluids through the urine. Try to give these medications as early in the day as possible because otherwise, the resident will not feel comfortable going out for activities. If given late in the day, the resident may lose sleep because of the need to urinate at night.

Antihyperlipidemic medication helps reduce excess fat in the blood (high cholesterol). These medications should be given at 5 p.m. unless the physician orders a specific time.

Hypoglycemic oral medications lower the level of glucose in the blood. You cannot give insulin. If a resident's blood sugar is too low, it may become hard to wake them up. If so, notify the charge nurse.

Antipsychotics treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder (sometimes called manic-depressive illness), anxiety disorders, and attention deficit hyperactivity disorder (ADHD). Side effects from these medications are usually severe, so watch the resident closely. If a resident begins new behavior like shuffling while walking or drooling, notify the charge nurse.

Laxatives increase the frequency and ease of bowel movements. Laxatives come as pills, liquids, or suppositories. Laxatives may be a prescription or over-the-counter. Too many laxatives can reduce essential electrolytes and minerals. They can become dehydrated, which can lead to more severe illnesses such as urinary tract infections.

Side Effects

When watching for side effects, if the resident is having a severe reaction to a medication, call for help immediately. Severe reactions can happen to anyone at any time and include trouble breathing, tongue swelling, rashes, severe dizziness, nausea, and vomiting. An extremely severe reaction is anaphylaxis, a medical emergency that requires immediate attention. If you are alone, call 911 as soon as you observe any of these reactions.

Significant side effects to watch for are:

• Dizziness/fainting
• Nausea/vomiting
• Rash/hives/itching
• Difficulty breathing
• Headache
• Drowsiness
• Any other unusual sign

The seven rights of medication administration are the backbone of giving medications safely.

1. Right resident: always ask the person's name, and if in a facility, check armband or photo identification.
2. Right medicine: always look at the container the medicine is in and read the label!
3. Right dose: Again, read the label. After checking the provider's order, reread the label to make sure the dose is correct.
4. Right time: Make sure you give the medicine at the time the provider wants it. Many medications can only be given at a specific time of day.
5. Right route: This is very important! You will be assisting with all types of medications.
6. Right form: You are only permitted to assist with oral, topical, ear, and nasal medications. You will not be involved in any other form.
7. Right documentation: You will be asked to document which medications you assisted with, what, if any, reactions are noted, and you will note which controlled medications were given.

Medication misuse may be accidental or deliberate. If you suspect an overdose or if you notice that the resident has been drinking alcohol while using a narcotic medication, notify the charge nurse.

Medication savvy is a very important role for the CNA. Federal and state laws dictate how to manage your practice. You must be aware of what you can and cannot do and never deviate from these laws. Assisting with medications is an awesome responsibility that can also be scary at times. Remember to call for help in any situation that makes you uncomfortable. This ensures that your resident is safe and that you are giving the best care possible.

Scenario/situation

You are in a hurry because your shift is almost over, and you have been "behind" all day. Mr. Smith was hard to find, but you finally spot him in the hallway. You pick up a medicine bottle, and because you are in a hurry, do not look at the label. After giving Mr. Smith the medicine, you realize that it was a mistake. You had given him pain medicine (which was another resident's medication) instead of his blood pressure pill.

Intervention/strategies

Report the error to the charge nurse, who needs to call the doctor and complete an incident report. The resident must be monitored for side effects.

Discussion of outcomes

All of this could have been prevented if you had taken the time to read the medicine bottle label.

Strengths and weaknesses of the approach

So, you have the right resident and the correct form. But you did not have the correct dose, the right medicine, or the right time. Do not allow yourself to be rushed. Create a standard way to do things and follow it every time so you avoid mistakes.

CNAs can assist with self-administration of medications after completing training. The resident must be able to do self-administration, and the correct documentation must be done. CNA assistance with self-administration of medication has standards that must be followed. In assisting with the self-administration of medication, CNAs must follow the seven rights of medication administration and know prescriptions and abbreviations. The CNAs must know the classification of medications, how to store medications, and identify the symptoms of medication misuse.

• The Florida Senate. (2024). Florida Statute, §400.488: Assistance with self-administration of medication with other tasks. The Florida Senate. Visit Source.