eval administrate medication posted

EVALUATION FOR SELFADMINISTRATION OF MEDICATION Resident Name: _____________________________________ Evaluation Type: In...

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EVALUATION FOR SELFADMINISTRATION OF MEDICATION Resident Name: _____________________________________ Evaluation Type: Initial Routine Instructions: Review with the resident the "interview" content below, noting answers/observations as applicable. Record details

Other

if the resident is unable to respond appropriately or to include other information/sources related to this evaluation.

Yes

INTERVIEW the resident about the following:

No

COMMENTS

1) Does the resident record contain a current MD order to self-administer all or part of their medications/treatments? 2) Will the resident be self-administering ALL medications (prescription and OTC) and treatments? ( If not, list in "comments" ONLY the medications/treatments that WILL be self- administered. Indicate " Partial self-administration" on the service plan, with reference to MAR for which will be self administered.) 3) Does resident have any medical/physical condition that might affect ability to self- administer medications? [circle all that apply:] impaired vision

dementia

limited range of motion

other/specify:

4) Can resident identify the purpose of each medication (s) by name or sight? [Ask: How do you tell your medications apart?] 5) Does the resident know the purpose of each medication? [ Ask: Can you tell me what each medication is for?} 6) Can resident properly describe or demonstrate the correct amount and time for each medication dosage? [Ask: How much and what time of day do you take each of your medications?) 7) Can resident safely and consistently store the medication (s) in their apartment if the room is shared with a spouse/resident who cannot self-administer? [Request demonstration: Show me where you store your medications? What is your routine when you finish taking them?] 8) Can resident describe understanding of the need for communicating with his/her doctor for questions or concerns about the medications, and about taking other medications not prescribed ( including herbal, nutritional or other supplements and OTC drugs)? [Ask: How often do you talk with your doctor about your medications? What do you do if you think you are having a reaction to one of your medications?] Determination: Based on this interview, is resident capable to manage/control medications safely and consistently AND communicate effectively with their doctor or other prescriber? NOTE: Whenever a resident has been able to self-administer in the past but indicates during this evaluation that self-administration may no longer be safe, the interviewer must notify appropriate staff in the community, the resident's responsible party, and the physician/prescriber.

Evaluator signature:

Date: [Keep the most current completed evaluation form behind the resident's current service plan; move any prior form to the resident’s health record under the tab for assessments.