Webinars, welcome to our 1st.
Webinar in the fall series of health, healthy brain healthy brain webinar series healthy brain webinar series is presented by the health matters program.
We're at a department of disability in human development at the University of Illinois, at Chicago, in partnership with national task group on intellectual disability.
And dementia practices, and we're funded by the Centers for Disease Control and prevention.
Through the healthy brain initiative award contents are solely the responsibility of the authors of the webinar and do not represent the official views of the CDC.
Couple of other pieces of information. Today's webinar would for today's webinar. We do not offer see use each live.
Webinar will be recorded and available to view on YouTube with resources to download, including the PowerPoint deck.
An email will be sent to you once the content's become available. So that usually takes about a week and I will send the email.
So, for today, I wanted to introduce Susan she will be discussing improving improving medication administration oversight for people with intellectual and developmental disability.
Um, the webinar will cover.
The training that she developed for home managers, and discuss challenges with medication administration,
explore styles of adult learning and design proposed training to better equip home managers to complete oversight of medication administration.
a little bit about susan our presenter susan graduated with her bsn in nursing from kent state university and had spent her entire twenty five year nursing career in developmental disabilities nursing currently she's
employed by the summit county board of developmental disabilities as a quality assurance registered nurse she completes reviews where medications are administered by licensed personnel she also serves as a resource to providers
Administrators and other nurses in Summit County, and throughout the state.
Susan has served as 1 of 6, Ohio, developmental disabilities, registered nurses instructors since 2012 in 2022. Susan was a member of the inaugural class of the galiano Institute for developmental disabilities nursing Susan.
Welcome and take it away. nursing susan welcome and take it away
Thank you, I'm excited to be with you all today. Um, and what I wanted to share with you is, um, what yasmine was mentioning is, um, a training.
That I, um, developed to hopefully better equip on licensed home managers, um, for the task of overseeing medication administration.
So, as you asked me to mention, I'm going to skip slide order here a 2nd, I currently work in Summit county at the county board of developmental disabilities.
So, Summit County encompasses the city of Akron if you've heard of Akron, it could possibly be from our, um, 1 of our most famous residents, which was V, LeBron James. So, it is the hometown of LeBron James. Um.
In terms of people with, um, intellectual and developmental disabilities are county board.
Serves about 5,000 people with intellectual developmental disabilities throughout their whole life cycle. Um, so while Summit County.
As a general population is not very big. We do serve quite a few individuals. Um, we are actually 4th in the state. Um.
Behind where you would picture the bigger cities like Cleveland, Columbus and Cincinnati we are right behind that.
And we have, and this is kind of a fluid number again right now, we have about a 1000 agency and independent providers that provide services to again. Those persons serve with intellectual and developmental disabilities.
So, in terms of medication administration, um, everything starts.
Um, with our State Department of developmental disabilities, so the Ohio Department of developmental disabilities, or DoD, um, has established rules.
In terms of what medication administration looks like, and they also publish curriculum to train those unlicensed personnel of how to administer medications. Um.
And then nurses go through registered registered nurses actually clarify.
Take a training course to be able to train the unlicensed personnel.
How to administer again? Oral topical is our main course of medications and then there's additional add ons that.
Personnel can take to for medications or insulin if needed.
So, then they earn a state certification and that state certification is valid for a year. And so then every year they have to go through a recertification process.
So 1 of the things that I was noticing.
Um, as I was completing quality assurance reviews, so I go out, um.
As the nurse as a representative of our county board and apply our States.
Quality assurance tool, um, that looks at how medication administration is going for those unlicensed providers. Um, what's going well, um, and also what needs to be worked on.
And 1 of the things that I was seeing, um.
Was some challenges and some lack in.
Overstate of medication administration.
So, in terms of oversight, how that works once somebody earns a certification, and I know this chart doesn't copy super well to a PowerPoint. But if you see those settings in yellow.
Are all where medication administration can be done?
With out nursing delegation, which also translates to.
Without nursing oversight so again, those unlicensed providers earn that certification.
They go back to the settings that they're working in, um, and those settings in yellow or where the bulk of our services are typically provided.
They go back to their settings, administer medication and they don't really ever have to come in contact with a nurse again going forward.
So, the oversight function is then done.
By licensed personnel, so.
There is no state course in Ohio.
To train somebody to oversee medication administration.
Um, and especially now with the state of our field, you know, the supervisor.
Tends to be calm, or tends to be.
The person who hasn't quit the longest, right? So.
proof your supervisor now you have to oversee medication administration
And while someone may be good at administering medications and may be a dependable employee, it's a whole nother thing to take on this oversight function that.
They really aren't necessarily always equipped to do.
And so then we're starting to see, we're definitely seeing medication administration completed with incorrect technique, which obviously then leads to more medication errors, which endangers the health.
Of the people that we serve with ID so what my goal was.
Was to create a training for a manager so I was trying to think of how I could help. I thought, well.
could i potentially put together a training for these unlicensed managers
To kind of give them more tools to help them.
Better oversee medication administration.
So my initial design was something that lasts around 4 hours. Right? So that managers could hopefully come again. Definitely. We need everybody to be working right now. So I knew I couldn't tie them up for an extended period of time.
But, hopefully they had a block in their day where they could come for 4 hours.
and involve some lecture elements so that they could hear from me as a nurse in terms of what correct medication administration procedure looks like but also some hands on elements so that they could practice things and not just
listen in here um but actually do things hands on to hopefully segmented more and then they could have peer feedback you know this sometimes is a really lonely field to work in and if
The whole manager just sort of feeling like they're by themselves. Like, could you talk to other people who are doing the same thing as you what are you seeing? What questions do you have? Because maybe other home managers have that those same questions as well.
So, and as you saw from my side about our provider community, we have a decent.
Amount of providers, um, so while I would have loved to offer this to everybody, um, I knew I needed to start small right. To see how this was going to work.
So, I picked 2 of.
Our larger provider agencies, just to have a base to start with.
Um, to see how it would go with them and whether it would be a worthwhile thing to sort of roll out to our county as a whole.
So, again, potential long term outcomes, um, from this training, but hopefully be, um, that we would see improve technique. Right? That people who are administering medications would do it correctly.
Every time that they would do those 3 checks of the 6 rights as they would know why they're administering the medication that they're administering that they would remember to document right all of the things that go into medication administration.
That would hopefully, then lead to decrease the medication errors right again then again better health and safety.
For our person served, um, and then ultimately for this to be successful, I knew what I would need it to be.
It's something that became internal.
To the providers themselves, um, that I could start it out, but again for it to be dependent upon me.
Um, to continue, would not have any chance of success.
So, what I was hoping was that the providers would see that this would be a benefit to them and would then want to take it on internally as a part of their processes.
So, in terms of the demographics of those agencies, so I have agency a agency.
So agency a, has 1 main residential director.
They do have a training coordinator that also goes out to all of their residential locations. They have about 12 home managers, and about 125 to 150 staff.
And then agency B, has 1 residential director in addition to that, they have 2 regional directors. Um.
So, they split they have 14 homes and that's the way there's 14 home managers. So those 2 regional directors.
Split those 14 homes between the 2 of them. So, 1 is responsible for 7. the other is responsible for the other 7.
They have about 20,250 staff, so again, they're pretty substantial agency.
They also have 3 nurses on staff.
Um, now, with the way our field is designer in Ohio again, with that.
Nursing oversight, not being required.
Um, it also means that there's really not any funding, um, for those nursing positions. So, while there's nursing there.
They primarily fill other roles. Um, this agency also has a clinic where they see they have doctor's appointments, appointments, things like that. Um, so the nurses are pretty involved with that clinic.
They are available for questions and concerns that the staff might have. Um, but in terms of actually day to day oversight, function of medication administration, that's not really what their primary role is.
Um, so I did do some delving into literature.
Um, in terms of different aspects of setting up this training. So, 1 of the biggest things that I looked at is medication administration challenges.
Which we all know there are quite a few.
When it comes to our field, um, so the biggest 1, I think is that the people that we serve.
Get large amounts of prescription medications when I observe a medication administration, the average time that it takes.
Is about 2 hours. Um, so.
Again, it's a decent chunk of time, a decent chunk of medications. I have seen some person serve, get upwards of 17 to 20 medications at 1 time.
So that is a lot for anybody to be responsible for.
Um, they're also complex and changing drug regiments, you know.
Doctors are constantly changing the medications that they're trying with. Our person served in a lot of times they'll be tied trading 1, med up and weaning another med down. So there's a lot of times.
The medications will change frequently there's a lot of different doses.
So, keeping track of what are we giving this date at this time again can be challenging.
Definitely confusing medication, administration, rules and guidelines. Um, so.
The laws and rules for our state for any state really are written in what we call. So I think they're challenging for almost anybody who's not an attorney to try to figure out. Let alone are unlicensed providers.
And rules change all the time. So, again, I'm keeping up.
On what the current rules and regulations are is challenging as well.
And then navigating a health system unprepared to work with people with intellectual and developmental disabilities. So it is a lot, right? For that unlicensed person.
Um, to be responsible for doctor's appointments.
Because they have to communicate with that doctor.
understand what the doctor is saying back to them make sure that all the issues were addressed and then go back and communicate all of that information to all the other staff
That work at the home and, like like it says.
And, like, the literature shows, our health system really isn't still prepared to work with people.
With intellectual and developmental disabilities so that is a whole.
big hurdle that everyone has to try to climb
Now, in terms of adult learning, that was 1 of the other things that I looked at right. I'm planning a training session for adults.
So, what are some keys of adult learning?
So, 1 of the biggest things is adults need to be involved in planning and evaluating their instruction. You know, adults learn what they want to learn, they learn what they're interested in. So, if you're planning something for them.
You need to try to involve them and what is going to be taught.
So, what do they want to learn about? What questions do they have? Right? Are we addressing that?
They're also most interested in learning things which have immediate relevance to their job or personal life. So that was 1 of the things that I really tried to look at when I was designing this, could we do something.
That they would immediately be able to.
To take back to where they're working translating it to the Mars that they have to again to the medication administration to all the things that they're doing in their job.
Because if it didn't feel relevant to them, then they really weren't going to be engaged or take a lot away from it.
Um, definitely problem centered, so we want to make sure we're addressing like, here's the issues that we see. Right and here's how we're going to try to address them and the same thing kind of.
As I talked about in the 2nd point transfer of learning has to occur. Right? So how are you going to take this?
What we're doing in this setting, which is not where you work. Um.
And translate it to where you do work, so this more that we're going to practice with, how do you use it with an actual mark? Right? And when we're practicing our skills, how are you going to.
Translate that to the actual staff that you oversee.
And then definitely hands on activities and I knew from the start if all I did was get everybody together.
And lecture to them about what? Correct? Medication administration oversight looks like.
That the takeaway wasn't going to necessarily be what I wanted um, you know, could you forget a lot of what you just hear,
but what you hear and see and do you have a much greater chance of retaining. So that is what I wanted to try to do, make sure they heard and saw and did.
And then the other thing I looked at in terms of the literature is what is good supervision look like.
Um, so good supervision helps staff.
Feel supported and valued, you know, that is a crucial need in our field right now. We're trying to obviously meet or retain as many personnel as we can. So, how do we help them?
Feel supported and valued? Can that home manager.
Fields help those staff feel supported and valued and then also, how do we.
Have that home manager feel supported and valued in the role that they have?
Makes expectations clear from the beginning and 1 of the things that I read a lot about was using skills checklists.
Um, and how skills checklist kind of pulled everyone to the same standard.
I know everyone's still really wants everything to be fair. Right?
So, we're holding people to the same by using that skills checklist. That is the same for everyone. Things don't seem as arbitrary.
These are the standards that you're held to, and when I found with a lot of the managers, um.
Is they really weren't aware that skills checklist existed.
Or how do you use them with the staff? So, that was 1 of the things that we really tried to work on is, Here's this checklist that holds everybody.
to the same standard this is the standard set out by the state that everyone has to do
A regular feedback is important.
Good and bad, you know, I think when people only hear feedback.
Of what they're doing incorrectly.
Um, that can be challenging, you know, they need to hear when they're doing things. Well, so we talked about giving good feedback.
Um, but also feedback in terms of.
Things that need to change, needs to be given immediately.
right so that that person doesn't groove those
Bad patterns over and over and not have a way to get out of them.
Um, and also needs to be in a way where that person doesn't feel like they're being attacked right? For doing something incorrectly.
So, again, we want to show respect to each person as an individual that we value them and then it keeps the communication.
So the challenges of setting up this program, as you can imagine.
The staff increases, um, was the biggest 1 so we actually, since the pandemic, um, came out of that.
With lower staffing than we did going it.
Um, so since the pandemic, we have staffing at historic lows. Um, and so most of the time now.
Where managers are, they're basically being called upon to provide direct care.
And cover shifts, um.
So, setting it up was challenging. Um, I started.
Setting up this program in September of 2021. um, and did not get to complete.
Any actual training sessions until May of 2022 and it wasn't for lack of trying both providers really, really wanted these sessions to happen. Um.
It just couldn't happen because of staffing.
Um, the other thing with managers is there, you know, because they're the manager, anybody calls off if you can't get somebody to cover.
That shift, then you have to cover it no matter how many hours you have worked that week.
So we have a lot of managers that are working 80+hours a week, so again could not get away, um, from the setting for any length of time, not even 4 hours to come to a training session. And they really were not, you know, we looked at the literature in terms of. terms of
Giving inputs for what they wanted to learn and that was something that was really challenging.
And for me to get any input back from the managers, they just.
Didn't have time to even think about what they wanted to learn, because everyone was just focused on more day to day survival.
So, finally, like I said, in May.
with agency b right which was the provider that had the two hundred to two hundred and fifty staff and the three nurses and the two regional directors
I was able to hold, um, 2 times.
That we did for our training sessions, um, I did send out an anonymous questionnaire to the manager's prior to the training session.
Um, and then reviewed effective procedures. The managers had dialogues with each other and then they got paired up to practice things hands on. So, just to break down a little bit more with that. Look like impractical.
So, the questionnaire I sent out.
Um, to the regional manager who then distributed it to the staff, um, so it asks them to rank.
What's your level of confidence in medication supervision? How confident do you feel giving feedback to people and do you feel like you're prepared.
For this medication oversight rule.
And then I had open ended questions in terms of again. Do you have any questions? What do you hope.
When is training session is over what do you hope that you will have learned?
And as I mentioned earlier, I really didn't get a great.
Rate of return on the questionnaires. 1 of the things that I would like to think about going forward is maybe how to do that a little bit differently in terms of getting input from the managers. Because I definitely want that to happen. I want them to learn what they want to learn.
Um, but having them complete that questionnaire and get it back. To me.
Really did not work the way that I had hoped it would I did get feedback from some of them and then sort of went based on what I was seeing in reviews in terms of designing the bulk of the training.
So then, like I said, I did a, a little bit of lecture.
And gave them things to write on. They could ask questions. I asked them to share there examples of things that they may have seen as I was talking. So we discussed.
Okay, so this is what medication administration should look like um.
And how do you review staff technique again? How do you give that immediate feedback?
So that somebody doesn't group those patterns of doing things incorrectly.
You know, some of the other challenges that they have, how do you schedule doctor's appointments during the pandemic doctor's appointments were something that really, really got offline.
So it's very hard still for the managers to kind of track who should be seeing what doctor and when.
And then, how do you communicate with that doctor if you have questions, or you're not understanding what the doctor's staying and then how do you communicate the results back to everybody else?
Um, and things like reviewing the supply of medications. 1 of the things that I was noticing as well, was that people were running out of medications that they should not ever be out of.
Um, so how do you make sure that you're getting that information that you're reviewing it as a manager that we're getting those medications for? Those persons served? So that they never go without.
We also talked about reporting unusual incidents.
So the managers as a whole were pretty good at recognizing. Okay, this is a medication error.
Um, and we need to report it, but.
In terms of what you need to do about it from that point, how are we going to.
Make things different so that this medication error doesn't happen again. Um, that was where they were struggling.
So we talked a lot about that, um, about how do you go forward to insure correct technique when a medication error happens.
And then obviously, the big challenge documentation, um.
Transcribing new orders onto and making sure that they have all of those.
Different rates that need to be on there and not just the name of the medication. Um.
Reviewing documentation for medications administered.
Um, and what do we do about blank spots right? And how do we make sure going forward that blank spots don't happen? Um.
And then again reviewing those Mars as well.
So, again, they got to take notes they got to ask questions, they got to dialogue with each other during that time. So going to try to make it as interactive.
Um, as possible, um, so that it wasn't just them sitting listening to me talk. Um, and then after this point, um, I didn't include this in a slide, but we did break for lunch.
Um, I felt like it was super important. Um, if I'm asking people to come for 4 hours that I gave them food, um.
So that it was 1, last thing that they had to think about, you know, when people don't learn well hungry. Um, so we did provide lunch for them.
And then after that, we had them pair up.
And do some hands on practice um.
So, I had prepared a Mar that had built in errors.
Um, and then I did a medication pass.
And made mistakes myself.
So, as I was making mistakes, I'd say, okay, so did anybody catch what I did.
And what would you say, if you saw somebody doing this? What would you say to them?
And then when they paired up with each other, I gave them the DoD checklist. So, like I said, that was something they weren't Super familiar with to say, Here's your standard. This is what you should be reviewing everybody on.
I want you to observe each other.
Give feedback to each other, you know, and there's something when you pair up here.
Where they really can talk to each other more than they would talk to mice.
To me, or to the other nurses that work at that agency, because they feel better asking questions of each other. So, the nice thing was with the nurses.
While I mentioned that those nurses don't really have a ton of oversight responsibility. They did come to the training.
And so we all, sort of wandered around the room while the hands on practice was going on to sort of listen to how interactions were going.
And then to make sure that no incorrect information was being shared between the 2 managers. Um.
So, again, they observed each other, they looked for the errors on the Mars and talked about what they would do to address those. And then we have them practice transcription.
So we had a sheet with different orders that they had to write on the Mar, they discontinued 1 order. They started another order.
Um, they did a time sensitive order for 10 days to sort of Mark off how that time frame would be. Um.
And then they switched which our protocol in Ohio is that someone else then has to review it that more. So they switched with each other. Um.
To look at each other's transcription and again, we're able to tell each other. Yes, that was correct or hey, wait a minute, you need to do this, or you need to do that. Um, so those sets that actually might really well, they interacted great with each other.
Everybody really gone into, um.
Doing the observation and and trying to find the things in the Mars um.
and doing the transcription so i was actually very pleased with how well everyone was engaged and how well they interacted with each other
And then at the end of the session, I have them fill out an anonymous evaluation and ask them. Did they.
Did you now have increased confidence in your role?
Um, what did you learn and how are you going to implement what you learned?
Um, in your actual day to day settings, so that transfer of learning again, how are you taking what you learned here?
And keep, transferring it to.
Where you're at, so if some of the feedback that I got.
Um, these are some direct quotes from the evaluations. Um, we don't know what you don't tell us.
So, 1 of the things that became clear, and again, why I was really happy that the nurses had attended, um, was that there was sort of an expectation.
Um, that the nurses had of things that managers knew that they didn't know.
And so the managers communicated, um.
To the nurses, hey, we don't always know if you don't tell us directly. We don't know this information.
And then on the flip side of it, the nurses also said that to the managers. Um, there were a lot of situations that came up that we discussed that.
Nursing would say, well, you should call us about this. Well, you should call us about this. Um, and the managers hadn't really even thought.
That that was something that they could do. So, the nurses sent that to the managers. Hey, we don't know what you don't tell us if this, you know, these sort of things are going on, you need to call us.
Um, so it made the agency sort of see where their gaps in communication might be, and how they could work on that.
Somebody said they liked learning to give feedback in real time again that was 1 of the takeaways that I really wanted people to have was giving that real time immediate feedback. So, again, somebody doesn't groove those incorrect patterns.
I did not want to come today, but I'm still glad I did. So, just to clarify that feedback.
I'm sure a lot of managers maybe initially felt like that,
but this was directly this person and unfortunately had had to work a whole overnight shift thought that she was going to be able to get home and sleep and then the agency told her. No.
Well, we really need you to come to this training so made total sense why she didn't want to be there. She did not.
Present that she had been up all night. I actually didn't know that until the training was over. She was super engaged to ask questions the whole time, but I'm glad that she was honest, you know, like, hey, this is a lot still.
Um, and then remembering to set a good example. So, 1 of the things that I talked about, um, when we did lecture.
Um, is that you're an example whether, you know it or not.
As a manager, everyone is always watching, you.
So, as soon as you model in, correct.
Practice that becomes the new standard.
So, if when you're administering medications.
You do it correctly every time because if you're doing shortcuts.
Everyone else is going to start doing it too, because you modeled it as a manager. Um, and 1 of the things actually that came out of the training as well was that sometimes the managers were the ones that were administering medications with incorrect technique.
Um, so we made sure, okay, let's get you back on where you're supposed to be. This is how you need to give meds and how you would expect everyone else to give meds as well.
So, again, working around the pandemic was a big lesson. Um, and that training needed to be flexible. 1 of the things that, um, I am considering as we look at potentially rolling this out to the county. Um.
Is How can we do this fitting into staff schedule and.
Um, will it involve something that's recorded and so how can we record that and also keep that.
Interactive element, um, with the peers, and, you know, if I'm not in person, or will the people who I interest to do the hands on part, or oversee the hands on for.
Make sure that they understand what correct medication administration looks like.
Um, as they complete that parts.
And then, like I said, training and staffing issues have turnover and staffing issues have continued.
Um, since the training, unfortunately, so a lot of the managers who I worked with, um, are actually no longer at that agency anymore.
So, what we're potentially looking at is starting from the bottom and doing it all over again.
So agency, um, through the span of trying to do this, um, agency, a realized.
That this is not something their staff could do right now that medication administration oversight was just too much to ask the managers to do.
So, they hired a nurse and her only responsibility to them. Um.
Is to teach the medication administration courses to their staff and then go to every setting that they have.
And do oversight of medication administration, so she's taking on that oversight function right now. Um, and that has worked out really well for them again. They just decided right now, that was a cost, they were willing to incur to sort of burden on their staff.
So, since that, like I said, the training went really well and as I interacted with the different managers and the different sites with those agencies, um, they were super excited. They took.
So, Mars back to their staff, um.
And had them look at, like, hey, can you find the errors on this? They had them practice transcription. They were doing really well with observations.
And, like, I mentioned, the further, we got away from the training, the more people started to leave the more staffing issues are arising again. And so it's sort of taken a back seat again.
Um, 2 day to day survival, which I understand. So, like I said, we are working with the agency at this point to the next steps. Um.
And may have to start all over again and that's something that I was sort of aware of that this may take awhile.
Um, before it sticks, and, like I said, my goal ultimately.
Um, is for the agencies or the providers to take ownership of this themselves.
Um, so that we don't have to repeat the same process that it would just become something that's internal to them.
So, again, once we, um, get more settled, we're going to.
Roll this out, hopefully to the rest of our provider community. Um.
Working on the partnerships we have with our provider and again I'm working on what went well, um, with that 1st agency, and that 1st agency does want us to train all of their staff.
But, like I said, I think what we need to do is kind of go back to the beginning work with the new managers that they're getting in place go from there and then look at offering it to all the agencies. And.
So, what I wanted to end with with this, and a lot of you may know from looking at this picture, what this video is. So, this is a video that I actually showed.
Um, to the managers in class, which is obviously Lucy and Ethel and the chocolate factory um.
And, to me, it's a really good sort of metaphor if you will, um, of what.
our medication administration systems can look like where the chocolate starts out really slow and they're wrapping it slowly you know and lucy makes comment of well this isn't too bad we can do this
Um, and then it starts coming faster and faster and faster and faster. Um.
And Lucy and Athol basically do anything and everything that they can do to make it look like.
They're doing their jobs correctly um, and Lucy again makes a comment.
I think we're fighting a losing game.
And that's kind of what.
Our medication administration, I feel like I can feel like, sometimes, like, oh, my gosh, we have to give this many meds in this little period of time. Um.
And this is, there's no way we can be successful at this.
So that was 1 of the things actually that I asked.
The managers was, do you think Lucy and Apple would ever have success? Um, and everyone pretty much agreed that they would not and it wasn't that Lucy and Apple were not good at their jobs.
Um, it was that the systems around them were not set up.
Um, for them to ever have any success so we look at oversee as 1 of the.
Effective systems that we can put in place of oversight is completed.
Well, then hopefully medication administration will be completed while the staff will feel more supported and our persons with intellectual and developmental disabilities will have better outcomes.
So, it's all in putting those systems in place that are effective.
Um, for everything to go the way that we hope it will.
So, it did include, um, some references from some of the materials that I used. Um, and then this is my contact information. So, thank you. Everyone who joined. Um, I, I appreciate.
Everyone's time today, um, and it did look like maybe.
There were some questions in the chat that were coming up as I was talking.
Thank you, Susan so much. I, I, it really thoroughly enjoy listening. You talk about this. There are some questions, so please feel free to put any questions you have in the chat and I will.
I'm monitoring and then I would try to ask them. The 1st question is, thank you for a very helpful presentation. Are any of the providers you work with certified as ICF facilities by CMS?
We do have some providers that are ICF. We just don't work as much with them.
Um, so, yes, we do have some.
Okay, next question we have a high number of medication error reports after switching from a paper to an E.
M, a.
R, sorry if I'm not saying that correctly, most of the reports are due to giving the meds outside of the 2 hour window, and also forgetting to document Amanda was given,
how could we reduce our med errors in regards to these 2 examples.
So we've seen that's something we see a lot. Um.
And sometimes, it just takes that period of time to people adapt to that change if they've always had a paper. Mar, um, and now all of a sudden, and they're using that, right?
If somebody's comfort level with technology and remembering their password, and is the device charged so it's kind of sending those reminders, um, some programs and it depends on which 1 you use sets up an app on somebody's phone. That's secure.
So, we've seen some decrease errors with that, because people typically remember.
Again, their password for their phone, or what they have on their apps on their phone. So initially you may have to set and more built in reminders.
Um, until somebody gets used to using that technology, um, and having that paper more as a backup um.
Is can work, but also be more confusing at the same time, because in terms of reconciling documentation, but that paperwork sometimes as a backup can help. Um, because people remember to document on that. If they don't document on the.
Thank you, uh, can you share how long the agency with the dedicated nurse trainer has had this in place? Does it seem like a sustainable system? Long term?
Um, yes, the nurse has been in place for about, um.
Almost a year now, so they started with her in January. Um, and it does seem like she has really built a good relationship with them. I think part of the key is finding the right person. Right?
So, the nurse really understands the DoD rules understands the curriculum. She has built a good relationship with them. Um, and I think they see it as such a value. Um.
That that is a relationship that they are going to continue for. Sure.
Is there an interested in state of Ohio to have your training available across all of the county boards?
Well, that would be the long, long term goal. Um, for sure. I would like to get it set up a little bit better in Summit County. But then definitely, um, my big big picture vision is to approach the state with this.
Thank you, um, how do you train unlicensed personnel to recognize possible side effects of medications and understand and address the possible implications of a med error for an individual to maintain safety?
Yeah, side effects are challenging. So what we look at is having that side effect, information available, um, so that they can look at it. Um, but honestly.
What we expect them to do kids recognize if that person doesn't feel well.
And then contact somebody who is.
A health care professional um, so we don't really expect them to say, oh, this is a side effect from their medication. Um.
but it might be what we want them to do is talk to somebody who has a little bit more knowledge a little bit more authority and then they can follow that information and i think that was one of the things that we talked about as well and the training is comfort level and
calling the doctor right when you think something is wrong um a lot of managers are hesitant to do that but hey you know when you see something going on that doesn't seem right you need to be reaching out to that doctor that pharmacist you know
At this agency was those nurses to call and say, hey, it's, something's up with this person. Um.
This is what I'm reading. Are there side effects? Could it potentially be that.
How long is the original training for certification to administer meds in Ohio and how long for recertification and what is the procedure? If a person who is certified does not rectify every year.
So, there is, um, the initial course, has to be a minimum of 14 hours and that covers.
Oral topical, um, and there's 13 specific health related activities and, like I mentioned that is taught by a registered nurse trainer.
Um, so then every year that staff needs to complete.
2 hours of continuing education and have these skills check completed. Um, and like I mentioned in the settings where nursing delegation is not required, or we're nursing oversight is not required. That does not have to be completed by a nurse.
If that person does not research.
They have 60 days where they can.
Um, complete those requirements, they cannot be administering medications during that time.
Um, but they have 60 days of grace period if you will, where they can complete those requirements, and then resume medication administration um, after those 60 days, then they have to repeat the entire course again.
Thank you a follow up question. What are the 13 activities? Okay, that's my brain here. Okay so they are vital signs that includes temperature Pulse, respiration, blood pressure pulse. Oximetry.
Application of prescribed compression.
See happened bipap.
cough assist which is that device that sort of simulates a cough for someone who can't cough on their own a percussion best
Um, gosh, now I'm drawing a complete blank, um.
So, I'm going they are available on the DoD website, and I apologize. I usually do know them.
Um, I am just drawing a blank on the rest of them right now but if you get the general idea, that that's what, um.
What those healthy related activities when involved.
Thank you, um, couple more questions, um, does Ohio nurse practice act mandate that all have nurses for medication? Oversight?
No mm. Hmm. Again it goes back to the settings that people are providing services in.
And we're nursing delegation is not required also means nursing overstate is not required.
Oh, that's interesting. Um.
Does the program include introduction to calculations related to dosing of medicines especially liquids.
Health numerous is often a problem in general when it comes to dosing.
Yes, and that is actually something our unlicensed personnel are not allowed to administer medications where they have to calculate the dosage.
So, that does go back to when we did mention that with our, with the, the doctor appointment training that we did. Like, hey, if a doctor gives you an order like this.
Then you need to have that conversation with them of why you can't accept that order.
um and what fits for our requirements
Thank you can you speak a little about creating a culture of safety around reporting medication errors, non punitive, but still maintaining a high level of expectations around safety.
Yeah, I think we always just try to communicate, you know, that that person served has to come. 1st.
Um, you know, and the reason that you should be in this job is because you want to keep them as healthy and safe as possible.
Um, so even if you made a mistake and you're afraid to admit it.
Um, again, you need to think about their health and safety what's going to happen to them.
Um, you know, and if you own it, honestly, it's much better.
Owning it from the start.
Then, having somebody figure it out later, and you didn't say anything.
Um, because that could lead to there are there is a place in Ohio where you can the system that keeps track of everyone who has medication certification, um, where we can.
Put what we call notations so when somebody would do something like that, that would get recorded on their certification that, hey, they made a matter or they did not, uh.
You know, own up to it so, that goes to then, should that person be certified in the future?
Thank you. Oh, so, and just wrote a basic clean dressing, Ah, external catheter care.
Um, estimate here asks me Karen, I'm seeing a catheter bag.
Yeah, so, um, Beth also found Ohio DD curriculum, um, that it's approved approved for medication administration certification so I'll just put the link there.
Um, so, uh, you can, uh, the attendees can use it as a reference. Yeah. And then also, if you go to the DoD website, um, in addition to the curriculum, they also have skills checklist.
For everything that's in the curriculum, so the oral topical skills, checklist skills, checklists for all the health related activities. So if those would be a benefit to, you.
Um, at all their public documents on the DoD website as well.
Another question, my organization here in Iowa is about to start rolling out an in house and licensed medical manager class that I'm currently coming up with the curriculum for.
Do you think it would be beneficial to add an additional class for the unlicensed supervisors? If so, what do you believe was the most beneficial component of your training of Supervisors and what you believe was the biggest takeaway from the 4 hour class.
Um, so, yes, I do believe it's benefit again.
As I mentioned at the beginning, I think managers are often.
Put in that supervisor role without really knowing what all of that responsibility entails. Um.
I do feel like honestly the hands on practice.
Was the most beneficial to everybody again and sort of cemented everything in their heads? Um.
They got to engage with each other and that seemed to be again, the biggest takeaway for me, just seeing in the settings, you know, where they took those Mars back to the staff,
and we're having them look at them and practicing transcription with them and things like that that they really.
Felt like, those were a benefit, not only to them, but to share with their staff as well.
Thank you, um, what if someone has a GT who administered administers the meds and feeding.
So g, tube is a little bit.
More involved, so that is not 1 of the settings. Um, that does not require a nursing delegation that actually does. Um, so what would happen is a person would earn their certification 1.
so that basic oral on topical 1, they wouldn't then need to.
Um, earn an additional certification, so there's another class.
That is a 4 hour add on, they refer to it as to learn how to administer medications and nutrition through to.
And then a nurse has to come out.
And delegate that nutrition, and that medication administration to that staff. So they have to follow procedures for a nursing delegation.
The nurse then has to be available, has to come out and see how the staff is doing, um, with that task and that medication. So, definitely, when someone has YouTube, nursing is much more involved.
Thank you, um, any other questions or any other last sort of parting words from you, Susan.
If you, um, I think you're gonna share this, the slides with everybody, right? As well. Yes. Um, and then my, my email is on this last night if you think of something later or want to reach out to me, um, definitely emails the best way to reach me. Um.
So, thank you so much. Thank you again for everyone's time today.
I wanted to thank you, Susan, and thank you all for who have joined. We had a really nice turn out over 300 people actually registered.
It's an important topic, and I actually received a lot of emails about it as well as Susan mentioned that we are recording this and I will make everything available,
including the PowerPoint within about a week and it's going to be emailed to you. So you will know where to go um, 1, more thing. thing
Next week we are, um.
Oh, um, I wanted to announce our 2nd, webinar, which is the topic is improving access to home hospital for people with intellectual and or developmental disabilities. It's going to be on November 15th the same time.
I will put it in the chat. So, um, if you have interest to join us, please, do. do
Um, for that webinar again, thank you so much, Susan, and thank you all for coming to our 1st webinar have a great rest of the day.
Bye, thank you, Susan. Thank you.