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Medication Competency


Vicodin
Zocor
Lisinopril
Synthroid
Norvasc
Prilocec
Zithromax
Amoxicillin
Metformin
Hydrochlorothiazide
Xanax
Lipitor
Furosemide
Metoprolol
Ambien

This list of the top 15 drugs prescribed in the United States thus far in 2011.  The good news is that they are all generics meaning they are available at a lower cost.  The bad news is that because they have become so common, we forget that these are major pharmaceuticals that can cause major problems.

If you’ve been paying attention, you will realize that the key to doing well in 2012 is directly related to your ability to keep patients out of the hospital.  In reviewing hospitalizations and  Reason for Transfer OASIS assessments, I would bet the farm that medication errors are a direct or indirect cause of a lot more hospitalizations than are reported.

When I read charts, I also see very vague medication teaching.  In reviewing clinical records it is not unusual to see ‘teaching’ such as:

  • Taught patient to take meds exactly as MD ordered.
  • Call MD for any side effects.
  • Take insulin at the same time each day.
  • This medicine helps to lower your cholesterol

I understand that patients have different learning abilities and that sometimes the best we can do is teach the patient the bare minimum.  But whether we teach a lot or a little about medications, it isn’t working.

The first step in providing really effective teaching about medications is to know your medications.

To see how well you or your staff know your meds, click here to take a basic medication competency test.  Until you are able to answer the questions with complete confidence, keep researching.

Of course, not every can know every medicine but there are tools that can be used.  My favorite for when I work offsite is the Medscape app (available for iPhone, Droid and Blackberry) which has two options for download.  One is a smaller download and the larger download includes the entire database for use offline.  Using the larger download option, nurses are able to look up drugs and interactions on their phone even when the internet isn’t available.  It is amazing the things I find when I use it.  The downside of the app is that it does provide every possible drug interaction in the world.  I try to focus on the most serious interactions and read through the remainders to see if they apply to a particular patient.

By really looking at meds and planning teaching as you write a careplan, you can gather all sorts of appropriate teaching materials for the patient.  Medications are also my favorite hunting ground to see if any diagnoses have been missed.

Let me know what you think about the competency test and how you scored.  If you have any other questions to add, please feel free to email them to me or to post below.  Heaven forbid I made an error in the test.  If that’s the case, please post below.

14 Comments Post a comment
  1. Dori #

    Where do we obtain the answers for the test? Can we use this to educate our clinicians?
    Thanks!

    Like

    October 20, 2011
    • Answers will be posted over the weekend. I just got back in town. Of course you may use it to educate nurses! That’s why I shared it with you.

      Like

      October 21, 2011
  2. Gail #

    This is such an exciting time to be a nurse!! In our training session yesterday for our new EMR Point of Care computer system, we added medication from a formulary (type in “metop” and all the drugs that begin with those letters pop up); dose, form (tablet, capsule, etc.), route, frequency, etc. to our care plan. After two medications were added, we could just click on a tab to see any drug-drug interactions. We can also view and/or print out an entire medication teaching sheet for each drug!!! Of course we can’t print it out in the home, but we can print it out before we leave the office to see the patient or on our personal printer at home. NOW….there are no excuses for not teaching medications properly. It will be right there at their fingertips with automatic updates. Literally…their fingertips! I am almost giddy by this point. Then, after we were all finished with the OASIS, comprehensive assessment, medications, demographics, and the whole shebang for SOC, we clicked on a tab and there it was…the completed 485, care plan, MAR, orders, a narrative of the visit…everything. OMG. I must be in heaven. But I remembered what you said on a blog once before….”Garbage in, garbage out.” Monitoring will be easier, quicker, and I won’t have to decipher various handwriting anomalies. (Like is that a “7” or a “2”????)
    I can hardly contain myself right now. So, I’ll finish by saying, “Onward and upward, ladies and gents. Work smarter, not harder.”

    Like

    October 21, 2011
  3. Gail #

    Oh, and let me P. S. this. You can’t “Sync” until all elements of the SOC have been completed! So, if you accidentally forgot to write down the weight, it won’t let you finish until you do. Yep. It’s true. It certainly won’t let you turn in your SN visit without the assessment being completed…have seen those; amazing that somebody actually turns in a blank assessment, but it’s happened. Anyway…this is going to be amazing. A few bugs to work out and we’ll be live soon. It doesn’t get any better than this!

    Like

    October 21, 2011
  4. Jeanine Thibodeaux #

    Jules,
    where are the answers….
    Nean

    Like

    October 21, 2011
    • In the medication teaching guides! Will post over the weekend.

      Like

      October 21, 2011
  5. Maricelis #

    CAN YOU POST THE ANSWERS TO THE MEDICATION COMPETENCY TEST

    Like

    October 21, 2011
    • I will post over the weekend.

      Like

      October 21, 2011
  6. Dwelia Boyce #

    I wanted to let you know what I thought of the medication competency.I did horribly off the top of my head, But now I have done the research I know the anwsers. I have to agree, some of the visit notes that I review are about as bad as I did on the competency. I do own a smart phone and I have several apps for Medication and they are very helpful, so for me I would find the correct information before giving bland information as I have view in some of the notes with copies that for the most part are too difficult for the patient to read. Anyway, loved the compentency and hopefully my Director will allow me to provide our nurse with this test. Thanks again

    Like

    October 21, 2011
  7. Mona #

    One way to manage this process is with a EMR that has the feature to:
    1. Patient teaching information available for clinician to use during viist
    2. Drug to Drug interaction warning when mediation is entered into system
    3. Care Planning Interventions that populate to the visit note to remind the staff to teach
    4. Medication Profile with drug reference information for staff

    Check out CareAnyware EMR program.
    Mona

    Like

    October 21, 2011
    • Dwelia Boyce #

      I am not clear on what you are saying about Careanywhere, would you mind eloborating?

      Like

      October 24, 2011
      • That information provided about CareAnywhere was from a reader. She works for the company that designs the software which is available on a Point of Care system. Her point was that the software itself has mechanisms built in to provide nurses with information relevant to their patients.

        Like

        October 24, 2011
  8. Gail #

    I did pretty well on the test. Before I got the answers today, I really thought I got #14 right because I take Synthroid, but according to the answer sheet I missed it!!!! I’ll have to check that out. I didn’t put that Norvasc caused bradycardia because I was just thinking “Beta-blockers.”

    I missed # 8 because in the real world (where I come from) the patient may starve to death before we got a lab order from the doc. The doc (or his/her surrogate) would tell us to “send the patient to the emergency room.” So that’s what I put. One reason our ACH rate is so high.

    Pretty good general knowledge test. I think I’ll give it to the staff, since you already said it was OK.
    Thanks.

    Like

    October 24, 2011
    • Beta blockers are expected to lower the heart rate. Norvasc is not nearly as pronounced. Some athletes use beta blockers for training. since beta blocker prevent the heart rate from increasing in response to demand, the heart muscle itself becomes much stronger. I have tried that exactly once. At first I was afraid I would die. Later I was afraid I wouldn’t. So, when you see a patient on metoprolol who normally runs in the 60’s and suddenly, with no apparent cause, it is up in the 80’s while he is relaxed, investigate (read: interrogate) compliance to beta blockers.

      Like

      October 24, 2011

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