Seven Rights of Medication
1. Right Person
When assisting an individual with any medication, it is essential that you identify the right individual. First, read the name of the individual on the pharmacy label for whom the medication is prescribed and compare it to the MAR.
• To be certain of an individual’s name or identity, consult another staff member who knows the individual, ask the individual “What is your name?”
• Use 2 identifiers such as a photo or name and date of birth.
• Best Practice: Confirm identity by placing a current photo of the individual on the MAR cover sheet.
2. Right Medication
After you have verified that you have the right individual, read the name of the medication on the label. To make sure that you have the right medication for the right individual, read the label three times and compare it to the information on the individual’s MAR.
3. Right Dose
Read the medication label for the correct dosage and compare it to the MAR. Be alert to any changes in the dosage.
• Question the use of multiple tablets providing a single dose of medication.
• Question any change in the color, size, or form of medication.
• Be suspicious of sudden large increases in medication dosages.
4. Right Time
Read the medication label for directions as to when and how often the medication should be taken and compare it to the MAR. Medication must be taken at a specific time(s) of the day. Stay with the individual until you are certain that he or she has taken the medication.
You need to know:
• How long has it been since the individual took the last dose?
• Are foods or liquids to be taken with the medication?
• Are there certain foods or liquids to avoid when taking the medication?
• Is there a certain period of time to take the medication in relation to foods or liquids?
• Is it the right time of day, such as morning or evening?
• 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 taken in the morning; however, it is best to check with the doctor or pharmacist.
5. Right Route
Read the medication label for the appropriate route or way to take the medication and compare it to the MAR. The route for tablets, capsules, and liquids is “oral.” This means that the medication enters the body through the mouth. Other routes include nasal sprays, which are inhaled through the nose, topical, which includes dermal patches or ointments to be applied to the skin, eye drops, ophthalmic, and ear drops.
Note: Other more intrusive routes, such as injections, suppositories, or enemas, are only to be administered by a licensed health care professional.
6. Right Reason for PRN and Routine Medications
Every medication has a condition/reason for why it is prescribed. Most medication labels have the condition/reason printed on the label. It is the physician’s responsibility to write the correct information on the prescription for the pharmacy, whether it be a medication that is routine or a PRN.
For PRN medications, there must also be a PRN Authorization Letter from the prescribing physician. A PRN medication label must indicate that it is taken on an “as needed” basis. Staff must review the MAR to identify when the last PRN dose was taken and count the hour to make sure when the next dose may be safely taken.
For example: the PRN is Tylenol and it is prescribed for headaches. It can be taken every 4 hours for pain as needed. This does not mean every 4 hours during the day. If an individual tells you they have a condition other than a headache, this medication cannot be taken.
• If there is any doubt about when the PRN is taken, check with your administrator.
• Once the PRN was taken what were the results?
• Did the PRN relieve the condition?
7. Right Documentation
Documentation must be completed on the individual’s MAR every time a medication is taken.
• Documentation of medication includes noting self-administration, missed dosages, errors, side effects, drug interactions, refusals, and whether the individual was off site.
• Staff must complete a one-time signature, their intial, and their title at the bottom of the MAR.
• Staff must initial the right time/date the medication was taken.
• Initial the MAR as soon as the medication is taken.
• Document the results after the PRN medication was taken.
• Check to make sure the PRN medication relieved the condition.
• The information on the MAR must match the information on the prescription label from the pharmacy.
• MARs can look differently.
• Whenever a prescription is changed, the MAR must be updated (this policy or procedure can be done differently at each facility; follow the policy and procedures at your facility).
https://psi-ceu.com/courses/medication-documentation-rights-prn-and-storage/
CCL Technical Support Manual Medication
Breakdown of the Seven Rights
What are Antecedents?
In applied behavior analysis (ABA), we talk a lot about the events that precede and follow target behaviors. An antecedent is something that happens immediately before a behavior. Similarly, a setting event is something that happened some time (not immediately) before the behavior. Setting events might have carryover effects on someone’s behavior. For example, an antecedent could be telling a child to do his or her homework, which then results in the child engaging in aggression. A setting event could be not getting enough sleep the night before. Therefore, the child may be tired, making aggression more likely to occur.
Taking antecedent-behavior-consequence (ABC) data provides information about what tends to evoke problem behaviors. When analyzing this data, you can identify the hypothesized function of a behavior. Read our previous post about the 4 functions of behavior for more information. Once you have identified a potential function, you can develop antecedent interventions to decrease the occurrence of the behavior.
What are Antecedent Interventions?
Based on a hypothesized function of a behavior, you can develop antecedent interventions. The goal of these interventions is to alter the environment so the targeted problematic behaviors are less likely to occur. Many antecedent interventions don’t completely prevent the problem behaviors from happening. Instead, they decrease the likelihood of occurrence.
Studies such as Haley et al. (2010) and Kruger et al. (2015) have shown that the use of antecedent interventions significantly reduce the likelihood of problematic behaviors. These interventions are even more effective when chosen based on the hypothesized function of the problem behavior. Antecedent interventions such as those discussed below have been used in a variety of situations. These include feeding problems, repetitive behaviors, and aggressive behaviors.
The best way to understand how you can use these interventions is to break down some common antecedent interventions based on the determined function of a behavior.
What does word function mean in ABA?
“Function” is an oft-used term in Applied Behavior Analysis (ABA). If you have contact with individuals receiving ABA then you might read a statement like “the function of the behavior is…” or you may even be asked to participate in a “Functional Behavior Assessment (FBA)”. While this language can seem unfamiliar, the concepts on which it is based are actually quite common and comprehensible. In this article, you will learn about what is meant by function, and the 4 functions of behavior.
Escape
Allow choices between work tasks
Provide more frequent breaks
Incorporate the person’s interests into the work tasks
Use behavior momentum (i.e., have the person complete several easy tasks before asking them to do a more difficult one)
Provide different methods of completing assigned tasks
Attention
Non-contingent reinforcement (i.e., provide attention on a fixed time schedule)
Allow for frequent opportunities to respond
Provide high-quality verbal praise (e.g., enthusiastic, behavior-speci
Tangible
Use a visual schedule to indicate when the preferred item will be available and for how long
Non-contingent reinforcement (i.e., allow access to the item on a fixed time schedule)
Provide adequate opportunities to have access to the preferred item
Sensory
First, address any potential medical concerns
Enrich the learning environment
Provide a set time for sensory behaviors
Provide more socially acceptable way to access the same sensory input
Include sensory activities in instructional tasks
“Function” is a useful term because of its flexibility. A Behavior Analyst can use the term to describe the likely reason why a problem behavior is occurring (i.e., the function of behavior), they can use it to identify a beneficial replacement for a challenging behavior (i.e., a functional alternative), or they can use it in the design of a program to teach essential skills (i.e., a functional repertoire). In each of these cases, the Behavior Analyst is more concerned with how the behavior impacts the life of the client than what the behavior physically looks like. This concept is one of the hallmarks of intervention in ABA. Check out some of our resources for teaching functional skills in our educational products store.
How do we assess the function of a behavior?
Behavior Analysts most often describe function in terms of the context in which a behavior occurs. The most common format for describing this relationship is the three-term contingency or, as it is more commonly referred, the ABC contingency. “A” stands for “Antecedent” or the events that occurred right before the behavior began, “B” stands for “Behavior” or the actions of the person we are observing, and “C” stands for “Consequence” or the events that occurred immediately following the behavior. By viewing behavior in this frame, we can start to discover the patterns that play a role in forming or maintaining a behavior over time.
For example:
Antecedent: Billy was presented work from his teacher
Behavior: Billy cried and threw his work to the ground
Consequence: Billy’s teacher gave him a break from work
In this scenario we would say that the event that triggered the behavior was the presentation of work, the behaviors were crying and throwing, and the result was that Billy got out of doing work. As a shorthand, a Behavior Analyst might say that the function of behavior was Escape from a work demand. This function would then be the starting point in the development of an intervention to reduce the challenging behavior (e.g., we might teach Billy a more appropriate way to request a break such as saying “Break please!”).
https://youtu.be/DVavwQSFWPQ
Title 17 Reporting Requirements
Abuse Reporting
Please be advised that Adult Protective Services has eliminated its Centralized fax number, and the procedure for reporting suspected Elder and Dependent Adult Abuse and Neglect to Adult Protective Services (APS) has changed.
You may report an incident of suspected Elder and Dependent Adult Abuse and Neglect to APS, by choosing one of the two options listed below:
1. Verbally report the incident by calling the:
a) 24-hour Elder Abuse Reporting Hotline at (877) 477-3646 or
b) APS Mandated Reporter Hotline at (888) 202-4248.
2. Complete the SOC 341 form and mail it to:
Adult Protective Services – Center Intake
Community & Senior Services
3333 Wilshire Blvd., 4th floor
Los Angeles, CA 90010
OR
1. Submit an Electronic Report.
Please note: if you submit a report electronically, you do not need to verbally report the incident. Additionally, currently there is no option to print the electronic report, and once submitted, you will not be provided with a confirmation number. APS is currently working on adding a print option and other improvements.
Follow-up Instructions:
After submitting the written report, please call APS after a couple days at (213) 351-5401 to inquire about the status of the case.
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