Med Competency

Seen something like this before?

Here are the long awaited answers to the Medication Competency test.    For those who asked, I am delighted that you think enough of the test to want to use it in your agency and I grant to you my full permission.

The test was hard but honestly, I chose most of the questions from medication monographs that should be used in teaching meds.  Mona Landry made an excellent that they were available in their CareAnywhere program.  They are also available on every point of care software I have used with clients.  So, let that be a lesson.  Just because nurses have the tools does not mean that they will use them.  For agencies without point of care, you certainly have the internet.  In fact, over 85 percent of homes in the country are wired to the information superhighway so information is available everywhere.  Even on smart phones, drug information is available.

So why aren’t we looking up medications?

In order for me to make an effort to learn something new, I must first be aware that I don’t know something.  But that isn’t enough.  Surprisingly, there is much I do not know about nuclear physics  and stamp collecting.  I am only motivated to learn when something interests me or the information will help me in my daily activities.  I am one of the most fortunate people on earth that what interests me is also part of my work.

Periodically testing competency accomplishes only the first part of the learning process.  I believe that nurses do not regularly research medications because they are unaware that they lack knowledge.  I know I am frequently surprised when I research common medications.

Unlike nurses in the field, I am pretty confident that anything I write down for this blog or anything that goes into a report for a client will be read and analyzed.  In order to ensure that I offer only good information, I look things up regularly.  I read the program integrity manual (ZPIC work), Medicare Beneficiary Manual (chapter 7, I believe is home health these days but it may be 6), the State Operations Manual, the OASIS manual and various state regs all the time.  I keep copies on my iPad for when I visit client offices.

Because my work is reviewed (at times scrutinized), I am made aware almost immediately when I make a mistake.  Field nurses who chart inaccurately about medications may assume that they are correct in their teaching because they have taught this way for years and nobody has said anything about it.

A field nurse may assume that he or she knows what is required to Proton Pump inhibitors.  After all, most patients take at least one.   Do they really need to be on them or are they left over from a prior illness?  Manufacturer’s information states that these meds should be taken for 14 days.  Our patients take them for years.  But because no one has ever died of proton pump inhibitor overdose (to the best of my knowledge), we assume they are safe.

In addition to the safety of the medication, there are costs involved which are burdensome to the patient and to the payor sources.

In doing ZPIC work, I see tons of opportunities for agencies to have provided reasonable and necessary care that were overlooked.  From a ZPIC perspective this costs money.  From a nursing perspective it costs our patients more than they can afford in quality of life and potential side effects.  Although it doesn’t seem like it at times, we are being a ton of money from Medicare to provide reasonable and necessary services to patients.  Reasonable and Necessary means that only a skilled nurse can perform the skill safely.  When it comes to teaching and training, my general rule of thumb is that if the information is available to anyone who watches Oprah, it really doesn’t required the skills of a nurse to teach.

Examples

Good:  Taught patient that Coumadin is given to prevent blood clots but it can also cause excessive bleeding.  In order to take the medication safely, blood tests must be performed periodically so the medication can be adjusted.  Because large amounts of vitamin K affect the medication, you should not increase or decrease the amounts of green leafy vegetables normally eaten as this will affect your lab results.  If you miss a dose of Coumadin, be sure to call the agency.  After missing a dose, the lab results may be low for a few days following the missed dose.

Bad:  Taught patient to take Coumadin exactly as ordered and to keep all follow-up MD appointments.

Email me any questions or comments.  If you have any competency tests you would like to share that are in the public domain (not subject to copyright laws), please send them to me.