There are consistent steps that must be followed no matter what kind of medication is being given. In addition, when medication tasks are delegated, each type of medication will include more specific steps to be followed in that medication procedure and listed on the DOT Standard Care Plan provided by the agency. 

General steps to follow each time you assist a client with medications are outlined below:

1. Each time, read the Care Plan carefully to ensure you know what task is being requested, directions specific for the client and the procedure specific for the type of medication you are assisting with.
2. Discuss what task you are about to assist the client with and ensure they are in a comfortable position. Remember, the client always has the right to refuse any of the tasks you are authorized to perform.
3. Gather all the supplies that you will need and verify what you will be doing with the Care Plan or the DOT Standard Care Plan, and the Blister Pack or medication container. 
4. Complete the three medication safety checks, and then check:
   • Right Client
   • Right Medication
   • Right Time
   • Right Dose
   • Right Route
   • Right Documentation
5. Ensure your hands and the client’s hands (if taking oral meds) are clean.
6. Perform delegated medication tasks according to the specific steps in the Care Plan.
7. Document on the appropriate agency documentation form that the task was completed. If the task was not completed, ensure you document this as well.
8. Report to the Supervisor or RN as needed.

Routes of Administration and Assisting with Medications (DOTs)

There are many forms medications can come in. No matter which form the medication is in, the HCA can only assist with the medications that are prescribed and listed in the care plan or medication administration record. Should a client ask the HCA for their assistance with medications not listed, including over-the-counter or alternative/complementary medications, do not give and notify the agency supervisor.

Oral

• taken by mouth & swallowed
• can be solid (pills or capsules) or liquid
• CHWs do not crush meds
• liquid medications must be in a pre-measured single dose container from pharmacy

Sublingual

• sublingual refers to medication that is absorbed through the lining of the mouth & under the tongue
• could be provided in pill or spray form

Eye Medication

• can be supplied in drops or ointment
• blurring of vision may be present for a short time after the med is given
• it may be necessary to clean the eye area before giving the medication
• if drops are stored in the fridge, re warm to room temp before instilling

Ear Drops

• Internal Ear Structures are very sensitive to temperature extremes – drops should be at room temperature to prevent dizziness
• The tip of the dropper should not touch the skin to help prevent infection from occurring
• The tip of the dropper must not cover the ear canal – this can cause increased pressure in the ear and can cause injury to the ear drum

Inhaled Medications

• Medications in the form of aerosol spray, mist or fine powder are inhaled into the airway.
• Metered dose inhalers (MDI)
  • Without spacer/chamber – requires coordination of breathing with delivery of medication
  • With spacer/chamber – no coordination of breathing required, makes it easier to inhale medication within the chamber with 2-3 breaths
• Small Volume Nebulizers
  • Provide medications in an aerosolized form that is inhaled into the lungs
  • Coordination of breathing and medications delivery is not required

Topical – Lotions, Creams, Ointments & Patches

• Skin must be clean before applying

• Medicated Lotions, Creams or Ointments
  • Can be absorbed through the skin of hand applying, so gloves must be worn
  • Read DOT Standard Care Plan to ensure you understand exactly where the product is to be applied – if this is not clear contact the RN
  • Attention to the amount of the product used is important

Transdermal Patches

• Adhesive pads that are placed on the skin so that the drug is absorbed slowly through the skin
• Rotation of the site is needed to reduce skin irritation

Vaginal Applications

• May be delivered in different preparations
• Foam, Jelly, Cream or Suppository

Rectal Applications

• Suppository
• Pre-packaged Enema

Subcutaneous Injections

• Medication is delivered via an injection into the fatty tissue beneath the skin
• Insulin is delivered via subcutaneous injections
• HCAs do not perform injections, but with a delegation of task, HCAs may at times assist some clients who are able to direct their care so that client can self-administer their own insulin injections

Medication DELIVERY 

Health Care Assistants must always follow the health authority or agency policies for medication administration and assistance. In long-term care, most HCA will assist the healthcare professional with the administration of some medications such as topicals or suppositories, again follow the agency policy. When working in assisted living or home support, HCAs will receive client-specific training for medications. When working these settings, some clients will require the use of a lockbox for their medications. The need for a lockbox in the client’s home will be assessed by the RN. They will advise the client/family on what items to purchase. Medication lockboxes will have either a combination or keyed lock on them. Directions for accessing medications in these lockboxes should be provided in the clients care plan as per the agency guidelines.

Pharmacists often pre-package oral medications into daily doses for ease of use for clients. These pre-packaged medications come in the form of blister packs like the one in Figure 12.4.2. Other packages that HCAs may see weekly pill dispenser to help the client know which day to take their medications (see Figure 12.4.3).

Administration Procedures

There are many different steps in the procedures for assisting clients with medications. The following videos produced by Alberta Health Services for their Medication Assistance Program (MAP) show the procedures for each type of medication.

• Oral Medications (63) MAP Module 2 – YouTube 
• Transdermal Patch (63) MAP Module 3 – YouTube
• Topical Medications (63) MAP Module 4 – YouTube
• Eye Medications (63) MAP Module 5 – YouTube
• Ear Medications (63) MAP Module 6 – YouTube
• Inhaled Medications (63) MAP Module 7 – YouTube
• Assisting Clients with Dementia (63) MAP Module 10 – YouTube