Ohio Standards of Safe Medication Administration by a Certified Medication Aide

In the state of Ohio, Medication aides can give medication to residents in a nursing home, residential care facility, or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) if they have a current valid medication aide certificate. The requirements for applying to be and working as a medication aide are in the Ohio Revised Code Section 4723. The Ohio Board of Nursing issues the certificate. Still, it is the facility's responsibility to make sure the medication aides follow the requirements for giving medication (Ohio Revised Code (ORC) 4723.64, 2016).

To be eligible to apply for a medication aide certificate, the applicant must be at least 18 years old, have a high school diploma or equivalent, and have completed a medication aide training program. If the aide is going to work as a medication aide in a nursing home, they have to be a nurse aide in the nursing home. Suppose a person is going to be a medication aide at a residential care facility or ICF/IID. In that case, they need at least one year of direct care experience in a facility. These certified medication aides can only work in the type of facility where they have one year of experience. Some situations may cause you to be ineligible, for instance, a felony conviction (ORC 4723.651, 2023).

If you have a certificate or license from another state, you may be issued a certificate. The board may issue a certificate if someone has good work experience, a government certification, or other private certification (ORC 4723.651, 2023). The certificate is valid for 2 years unless it is suspended or revoked. There is a renewal fee (ORC 4723.651, 2023).

• Intermediate care facility and an ICF/IID is a group home for individuals with intellectual disabilities (ORC 5124.01, 2023).
• Medication is a drug.
• Medication error is a failure to follow the prescriber's instructions when giving medication.
• Prescription medication is a drug that can only be dispensed using a prescription (ORC 4723.61, 2016).

A medication aide with a current, valid certificate may give prescription medications to residents of a nursing home, residential care facility, or ICFs/IID. This responsibility is delegated to a mediation aide by an RN or LPN acting at the direction of a registered nurse (ORC 4723.67, 2016). A nurse can only withdraw delegation from a medication aide in cases of resident safety.

A medication aide can give prescription medications using the following methods of administration.

• Oral
• Topical
• Drops to the eye, ear, or nose
• Rectal
• Vaginal
• Inhalants delivered by inhalers, nebulizers, or aerosols when using a single dose of a fixed, pre-measured dose (ORC 4723.67, 2016; OAC Rule 4723-27-02, 2014).

A certified medication aide cannot give an as-needed medication (PRN) until after a nurse assesses the resident.They can split pills if the prescription requires the pill to be split, but the medication aide cannot split pills for the purpose of changing the dose being given. An example of this situation would be if the doctor wrote a new prescription for a lower dose of the same drug. The decision to split a pill to meet the new prescription dose requires nursing judgment and medication dose calculation, so the medication aide has to wait for the new dose to be dispensed (ORC 4723.67, 2016).

A certified medication aide cannot give:

• Schedule II controlled substances
• Medications requiring dosage calculation, including inhalants delivered by inhalers, nebulizers, or aerosols
• Medications that are not approved drugs
• Medications being administered as part of clinical research; or
• Oxygen (ORC 4723.67, 2016; OAC Rule 4723-27-02, 2014).

Also, certified medication aides cannot give injections, intravenous (IV) therapy, or through a jejunostomy, gastrostomy, nasogastric, or oral gastric tubes (ORC 4723.67, 2016; OAC Rule 4723-27-02, 2014). The facility must prevent the medication aides from having access to controlled substances (ORC 4723.67, 2016).

Certified medication aides cannot:

• Receive, transcribe, or alter medication orders
• Give the initial dose of a medication ordered for anyone
• Give medications to a person other than a resident of a nursing home or residential care facility
• Give any medication without the task having been delegated by a nurse
• Give medications to pediatric residents (OAC Rule 4723-27-02, 2014)

A certified medication aide must always show their title when giving medications. They are responsible for demonstrating competence and accountability. They are also responsible for maintaining knowledge of their responsibilities and accountability.

Documentation of the medication has to be done immediately after giving the medication. This documentation must include the name of the medication, dose, route, date and time, the certified medication aide’s name, or refusal of the resident to take the medication. Most medication administration records (MAR) contain all this information.

The certified mediation aide is responsible for following the seven rights of medication administration:

• Right Resident. Are you giving the medication to the person it was prescribed for?
• Right reason. Do you know why you are giving the medication? Is it the reason for which it was ordered?
• Right medication. Is the medication you are giving the correct medication? Check the name on the medication label. Is it the name of the medication on the prescription or order? What should you do if the name is not the same?
• Right dose. Are you giving the right amount of the medication that is prescribed? Check the number of milligrams (mg) or other units (mcg, IU, etc.) to ensure the dose matches the order. If directed by a registered nurse, you might need to break a scored pill in half or give two capsules to get the correct dose.
• Right time. Is it time to give this medication? Medication should be given on time. “On time” means that the medication should be given within one hour before to one hour after the scheduled time. Be careful to give at the right time of day. Is the medication supposed to be given in the morning or at night? It is easy to give a medication ordered for 9 in the evening at 9 in the morning. Some medications must be given at specific intervals. You may not rearrange the schedule for these medications for the convenience of the staff or resident.
• Right route. Make sure that oral medications are swallowed, eye drops are dropped into the eye, and ear medications are administered in the ear.
• Right documentation. You must document on the MAR immediately after giving each resident their medication, including PRN medications, why they are given, and the resident's response. Be sure to document missed medications correctly.

Certified medication aides are responsible for giving medications in accordance with the standards discussed in this course. They are also responsible for maintaining a safe environment, including reporting problems, correctly storing and preparing medications, verifying the resident’s identity, witnessing the resident consuming the medication, and reporting medication errors.

Report to a nurse in a timely manner if the resident is uncomfortable and may need PRN medication. Let the RN know if there is any deviation from routine drug administration. Examples are refusing medication or having an unexpected reaction. Report anything about the resident that concerns you. For example, the resident does not look as good as usual or is acting funny (OAC Rule 4723-27-02, 2014).

Certified medication aides are responsible for correctly preparing and storing all medications. All medication must be kept centrally stored in a locked cabinet, locked cart, or locked storage area at all times. Controlled medications must be double-locked. Only use the medication delivery process that is currently being used by the facility. You can give medications that a nurse gives you to administer. Over-the-counter medication should be retrieved from and stored in the manufacturer’s originally labeled container. Remove the prescribed medications only if they are in the correctly labeled container in which they were dispensed. A proper medication label includes the medication name, dose, resident’s name, and expiration date (OAC Rule 4723-27-02, 2014).

Before giving a medication, check to see that you have the correct resident. Some residents will nod or say yes no matter what name you call them; therefore, have the residents tell you their name. If the resident cannot tell you their name, rely on a picture in the MAR or ask other staff to confirm the resident’s name. Make sure the resident swallows any oral medication. Sometimes, residents will hide the medication in their mouths and spit it out after they leave (OAC Rule 4723-27-02, 2014).

“Medication error means a failure to follow the prescriber's instructions when administering a prescription medication (OAC, Rule 4723-27-01 | Definitions., 2017).” Medication errors include giving outdated medications, giving the wrong medication, giving the wrong dose, taking the wrong route, administering to the wrong resident, and using the wrong technique or method. A medication error also includes failure to give the medication as ordered, incorrect preparation, storage, or administration, or giving a medication that a nurse did not delegate you to give. Immediately report and document medication errors (OAC, Rule 4723-27-01, 2017).

Distractions cause medication errors! Find a quiet place to work without a lot of noise or activity. Distractions include talking to others, talking on a cell phone, texting, watching TV, looking at social media, or listening to music. Always prepare, give, and document medications for one resident at a time. Preparing multiple residents' medication ahead of time causes medication errors.

A certified medication aide cannot accept any care assignment that would interrupt or conflict with the process of giving medication. You can be assigned to care that will not prevent you from giving medication (OAC Rule 4723-27-02, 2014).

The Ohio Administrative Code Section 4723-27-02 and the federal law Health Insurance Portability and Accountability Act (HIPAA) protect the privacy of residents. Certified medication aides can only read information about the resident that they need to know. They cannot tell others about their residents. They cannot share stories at home, even if they do not tell the resident's name. When discussing a resident’s care, do it in a private setting (OAC Rule 4723-27-02, 2014).

Professional boundaries are guidelines, expectations, and rules. They set limits for safe, acceptable, and effective behavior. You learn many of these boundaries in your training and will learn other boundaries in your workplace. As a healthcare worker, you set boundaries between yourself and others. You communicate boundaries by attitude, activity, and communication. Communication is verbal, written, and non-verbal. Non-verbal communication includes facial expressions, body posture, and hand movements. A certified medication aide is expected to establish and maintain professional boundaries with each resident (OAC Rule 4723-27-02, 2014).

A certified medication aide is responsible for ensuring resident privacy. Do not use social media, texting, emailing, or other forms of communication with or about a resident for anything that is not part of your job. The residents should be treated with courtesy and respect. Do not seek or obtain personal gain or inappropriate personal involvement with a resident. Do not make false, misleading, or deceptive statements (OAC Rule 4723-27-02, 2014).

Do not cause physical, verbal, or emotional abuse or anything that may appear to be abuse. Do not have sexual relations or anything that looks sexual with a resident, including physical or verbal behavior. These residents are, in general, not capable of giving full and free consent for sexual relations (OAC Rule 4723-27-02, 2014). Therefore, that behavior will be seen as sexual abuse by the certified medication aide. The residents are vulnerable and dependent on your care. Additionally, you have access to their healthcare and personal information (Gamble, 2022). So, they think you hold much power. Maliciously withholding medication is a form of abuse.

An RN or LPN acting at the direction of a registered nurse who delegates giving medication to a medication aide “is not liable in damages to any person or government entity in a civil action for injury, death, or loss to person or property that allegedly arises from an action or omission of the medication aide in performing the medication administration (ORC 4723.68, 2016).” This limitation of liability is contingent on the delegation being made appropriately and the medication aide holding a current, valid certificate (ORC 4723.68, 2016). A certified medication aide does not have the authority to delegate any task about giving medication to anyone else (OAC Rule 4723-27-02, 2014). Anyone who reports a medication error in good faith is not subject to disciplinary action by the board of nursing or government entity (ORC 4723.68, 2016).

Medication aides are required to complete 15 hours of continuing education for each certificate renewal period. Continuing education topics must include one hour related to Chapter 4723 of the Revised Code; one hour about establishing and maintaining professional boundaries; ten hours related to medication and medication administration; and the remaining three contact hours can be related to other things in your practice (OAC Rule 4723-27-06, 2024). If you earn more continuing education hours than needed, you cannot use those hours in another renewal period.

You have to keep your certificates of completion and provide them to the board if requested. If you fail to meet the continuing education requirements, you may be ineligible to renew, reactivate, or reinstate your certificate until the requirements are met (OAC Rule 4723-27-06, 2024). If you are in the active military, you can apply for an extended time to complete the continuing education (OAC Rule 4723-27-06, 2024).

The certificate has to be renewed every two years. The certificate may be suspended or revoked (ORC 4723.651, 2023). No one can work as a medication aide unless they are certified (ORC 4723.653, 2013).

The Ohio Board of Nursing is required to investigate evidence showing a violation of the code has occurred. There is a process that the board uses to investigate evidence showing that a certificate holder has failed to practice following acceptable standards of safe practice. Once the evidence has been gathered, a review by the board determines wrongdoing, lack of wrongdoing, or the presence of a deficiency in practice without actual harm or risk of severe imminent harm (ORC 4723.28, 2023).

The board has the authority to deny, revoke, suspend, or place restrictions on any certificate issued by the board. They can reprimand or otherwise discipline and impose a fine of not more than five hundred dollars per violation. During the investigation, the board can compel the subject of the investigation to submit to a mental or physical examination. If the board finds that an individual is impaired, the individual may have to submit to care, counseling, or treatment as a condition for initial continued, reinstated, or renewed authority to practice. The individual shall be allowed to demonstrate to the board that the individual can begin or resume the individual's occupation in compliance with acceptable and prevailing standards of care under the provisions of the individual's authority to practice (ORC 4723.28, 2023).

Scenario:

• Sue, a medication aide, has been delegated medication administration for hall A in a skilled nursing facility. One patient, Mary, had her prescription for armor thyroid changed this morning from 240 mg to 120 mg. The LPN, John, notifies Sue of the changed dose. He tells Sue to split the armor thyroid in half to give to Mary today.

Intervention/strategies:

• Sue wants to be a team player, but she knows her standard of safe practice does not allow her to split pills for the purpose of changing the dose due to a new prescription. Sue tells John she wants to help, but she is not allowed to split pills for the purpose of changing the dose due to a new prescription. And requests that John give that dose today. John is annoyed. He had seen Sue split pills when the provider ordered the medication that way. Sue and John checked with the nursing supervisor to be sure who was correct.

Discussion of outcomes:

• The nursing supervisor has to look up Ohio Revised Code Section 4723.67 Administration of Medications by Aides - Delegation by Nurse Required. The supervisor educated Sue and John about the standard, and he gave them 120 mg of armor thyroid that day. The tension between Sue and John is resolved.

Strengths and weaknesses:

• There was a lack of knowledge between John and the nursing supervisor, but now they are educated and will probably discuss the issue with other staff. Sue was nervous about confronting John, but the experience improved their mutual trust and working relationship.

Medication aides can give medication to residents in a nursing home, residential care facility, or ICF/IID. They have to work within set standards of safe practice for resident safety and to avoid disciplinary action. Continuing education is required for certificate renewal every two years.

• Gamble, J. (2022). Professional boundaries in healthcare: Be aware of these red flags. Nursing Practice, 41(3), 6–7. Visit Source.
• Ohio Administrative Code, Rule 4723-27-01 Definitions. (2017). Visit Source.
• Ohio Administrative Code, Rule 4723-27-02 Standards of safe medication administration by a certified medication aide. (2014). Visit Source.
• Ohio Administrative Code, Rule 4723-27-06 Continuing Education Requirements. (2024). Visit Source.
• Ohio Revised Code, § 4723.28 Disciplinary actions. (2023). Visit Source.
• Ohio Revised Code, § 4723.61 Medication aide advisory council definitions. (2016). Visit Source.
• Ohio Revised Code, § 4723.64 Administration of medications by medication aides. (2016). Visit Source.
• Ohio Revised Code, § 4723.67 Administration of medications by medication aides- delegation by nurse required. (2016). Visit Source.
• Ohio Revised Code, § 4723.68 Limitation of liability nurse or person reporting medication error. (2016). Visit Source.
• Ohio Revised Code, § 4723.651 Eligibility for medication aide certificate-issuance-duration. (2023). Visit Source.
• Ohio Revised Code, § 4723.653 Medication aide; Certificate required. (2013). Visit Source.
• Ohio Revised Code, § 5124.01 Definitions (2023). Visit Source.