Running head: MEDICATION DISTRIBUTION 1

Lighthouse Mission Ministries Medication Distribution

Harpinder Cheema, Brittani Fiscus, and Katherine Sellards

Western Washington University

NURS 422 Organizational Care for Patient Safety and Quality

Bonnie Blachly, MN, RN

30 May 2017
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Lighthouse Mission Ministries Medication Distribution

In 1999, the Institute of Medicine (IOM) issued a report regarding the safety of the

American healthcare systemor, really, the lack of safety. They reported that up to 98,000

people die each year, on average, from preventable errors at the hands of the healthcare system

(IOM, 1999). Thats astounding given that the first rule of healthcare is Do no harm and the

aim of healthcare is to save lives. The reports conclusion was that no one person is at fault for

medical errors, but that the systems, processes, and conditions set up individuals for error, and

staff should be looking to improve these rather than stake blame on one person. The same

principle needs to be applied outside of a controlled healthcare system when errors occur.

Lighthouse Mission Ministries (LMM) approached Western Washington University

(WWU) RN-to-BSN students to use their expertise to enhance its medication distribution process

and to essentially reduce errors. Currently, LMM requires Agape House guests to release their

medications to staff and requires Mens Ministries guests to release only particular medications

to staff for safe keeping. LMM then distributes the medication back to guests once a day.

Through interviews with multiple staff and review of surveys distributed to guests and staff (see

Appendices C, D, &E ), students were able to identify specific problems. Among staff, there is a

lack of continuity with distributing and lack of knowledge in best practices in giving out

medications. Handling discrepancies was a major issuehow can staff best prevent these and

what is the best way to handle them? Generally, LMM staff want to empower guests to regain

their independence, but also want to maintain a safe environment and discourage poor habits

regarding medications. With these concepts in mind, WWU students used Lewins Change

Theories to identify LMM readiness for organizational change.

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Change Theory and Planning Phase

LMM directors, managers, and staff had identified problem areas in the medication

distribution process and recognized that a change was essential. For the LMM project, the

WWU students established that Lewins Change Theory seemed the most appropriate change

theory model to utilize. The first stage in Lewins Change Theory is unfreezing, meaning the

agency determined that there are problematic areas in the distribution process and they are ready

to make changes that would be more beneficial to staff and guests. The group conducted a force

field analysis to identify the driving forces calling for change and restraining forces that could

inhibit or delay the change process. Change is the second stage in Lewins model. It will consist

of LMM implementing the recommended changes to improve the medication distribution

procedures as well as staff working within those changes to establish the goal of a more

standardized process and continuity with distribution. The last stage consists of refreezing,

which includes the evaluation of the effectiveness of the changes and maintaining them so that

staff and guests sustain the new procedures.

The group used the Plan, Do Study, Act (PDSA) cycle to assist in establishing quality

recommendations for the medication distribution procedures. During the Plan stage, the group

interviewed agency leaders and staff to discuss problems in current procedures, observed

distribution at Agape House and the Main Mission building, conducted a survey of staff and

guests, and identified resources to support any changes. The Do stage includes providing in-

services regarding new procedures to inform all staff involved in distribution of medications and

then, LMM directors and managers implementing the updated and improved distribution policy

and procedures. Study of the results will include LMM leaders assessing the effectiveness of the

changes by conducting additional surveys of staff and guests to ensure that the changes improved
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the distribution process. The last stage of the cycle is Act and involves refinement of the

procedures if deemed necessary and continued encouragement of all staff and guest to maintain

new procedures.

Organizational Readiness for Change/Likeliness to Adopt Innovation

Lewins Force Field Analysis proposes two major forces influencing an organizations

ability to implement and enforce changeforces driving change versus forces opposing change.

Once the strength of these forces is assessed, the easiest way to manipulate the forces into

encouraging change is to lessen the degree to which the opposing forces affect the plan. The

assessment of LMM for organizational readiness concluded that this it ready to adopt the

proposed changes to their medication system because the forces encouraging change are stronger

than those halting change. The expected outcomes of the plan delineated below in

recommendations is that, one, the time surrounding medication distribution be more organized

and, two, the process of distributing medications be safer and discrepancies be reduced.

According to Lewins Force Field Analysis, there are two distinct categories of factors

influencing the likeliness for an organization to make effective and enduring changes (Alanis

Business Academy, 2014). Factors that push to reform a system and make changes happen are

forces driving change. The major force driving change at LMM is directors, managers, and

varied staff realizing the need for improvement to their current system. From conversations with

staff and analyzing staff surveys, staff are aware of the precarious and inconsistent system that

puts them at risk when discrepancies are found. As observed and reported, the staff experience a

congestion and chaotic environment when handling medications. There are specific times

allotted to distribute medications, giving way to a bottleneck effect clogging the lobbies of the

buildingsguests come and go while one staff member is left to unlock the door, handle
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medications, and interact with the many guests bombarding the staff with questions. Some staff

handle the chaos in a more controlled manner than others. The staff are open to suggestions to

improve the distribution system to benefit both staff and guests.

The attitudes of the guests towards medication distribution are both driving forces and

opposing forces. From the survey results, some guests are requesting more independence with

their medications while most have no qualms with the current process. Staff, on the other hand,

would like guests to have more independence with medications to encourage a smoother

transition to life outside of LMM. Guests attitudes around medication time, though, is an

opposing force as their natural attitudes tend toward a chaotic environmentsomething hard to

control, but manageable given the right tools and education.

The most influential factors against change are the limited budget and limited staff.

There is enough staff for a small overlap at the beginning and end of a shift at any location, but

only a very small overlap for a hand-off reportnot enough to handle medications at that time.

Volunteers are available to fill spots, but not all volunteers can be counted on to show up

consistently. Further, there is only a minimum number of staff on weekends and no overlap

occurs with the shifts. As with most non-profit organizations, the budget is tightbuying things

to improve the medication process is unforeseeable. It is also unlikely that money can be found

to have more than one staff member present during medication distribution. These are factors

that must be taken into account when giving recommendations.

Recommendations

Safety and Accountability

One recommendation to consider is to improve the safety and accountability with

medications. This can be accomplished by setting up a quiet zone, having two individualsone
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staff member with either another staff member or volunteerpresent during the medications

distribution times, and counting medications more frequently. A quiet zone can be accomplished

by setting a perimeter with a red-taped area on the floor and the use of signage (Klejka, 2012).

Only one guest at a time may enter the quiet zone during the distribution time, reducing the

interruptions and distractions and letting staff focus on the task at hand. The use of signage

would serve as a reminder for staff and guests of the quiet zone. Another method of increasing

focus would be to require two staff members present during medication times each with their

assigned duty. One staff member would handle the medications, while the other staff member or

volunteer would supervise the entering and leaving of guests, as well as answer any questions.

This would decrease the amount of pressure staff may feel when handling medications. A peer

reviewed article noted that increased amounts of time pressure was associated with skipping

necessary steps (Storli, Ingebrigtsen, Nakrem, & Elstad, 2017). We recommend using volunteers

to watch the door during the medications times as way to utilize resources while containing

costs.

Finally, frequently counting medications and/or conducting a randomized audit of

medications would increase the safety and accountability with medications as well as reduce the

occurrence of medication discrepancies. This would also allow discrepancies to be caught

earlier. Involving the guest in the counting of the medication would increase accountability as

well as strengthen the staff-guest relationship and reduce the possibility of blame.

Organization

The organization and structure of the LMM can be improved by introducing a consistent

method of organizing the guests medications arranged in alphabetical order and with the

implementations of a standardized medication form at both buildings. Arranging the

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medications in the drawers by last name would make distribution times more efficient. Staff

members would be able to quickly locate and keep track of the correct medications. Another

consideration would be to store the medications in small bins rather than plastic zip-lock bags.

The use of small bins would create a designated space for the medications to be stored. The bins

could be easily removed to allow guests access to their medications. Lastly, the use of a

standardized form for keeping track of mediations would also increase efficiency and allow for a

smoother transition for a staff member who picks up a shift at the other building.

Conclusion

Interruptions and distractions during the handling of medications are associated with the

high prevalence of medication errors (Klejka, 2012). Research suggests the use of quiet zones

and increasing the number of staff working would decrease interruptions and distractions. The

implementation of a standardized process, quiet zones, increasing the number of staff, and

auditing medications can create a structured environment with improved safety and accountably.
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References

Alanis Business Academy. (2014). Episode 156: Lewins force field analysis. [Video File].

Retrieved from https://www.youtube.com/watch?v=tRAKmzsYLG8

Institute of Medicine (1999). To err is human: Building a safer health system. Retrieved from

http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is-

Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Klejka, D. E. (2012). Shhh! Conducting a quiet zone pilot study for medication safety.

Nursing2012. 9. 18-21. doi:10.1097/01.NURSE.0000418623.06842.59

Storli, M., Ingebrigtsen, O., Nakrem, S., & Elstad, T. A. (2017). Safety measures for medication

in nursing homes. Norwegian Journal of Nursing Studies / Sykepleien Forskning, 1-13.

doi:10.4220/Sykepleinf.2016.59801
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Appendix A

Logic Model FOCUS PDCA

RESOURCES ACTIVITIES OUTPUTS SHORT LONG

OUTCOMES IMPACT
In order to In order to We expect that We expect that We expect that if
accomplish our assess our once if accomplished accomplished
set of activities, problem or asset accomplished these activities these activities
we will need the we will these activities will lead to the will lead to
following: accomplish the will produce the following following
following following changes in 1-3 changes in 7-10
activities: evidence or then 4-6 years: years:
service delivery:
Carrie and Education on Increased Decreased wait Medication wait
SteveAgape proper knowledge of time for times have not
house and Mens medication medication medications increased since
ministries distribution distribution as implementation
managers evidenced by a
more organized
medication pass
time
Staff completing Add picture of Ensure all Increases safety No error in
admissions guests to their guests are only and privacy of medication
medication sign- receiving their guest distribution
out page own medications
medications
Katherine and Organize To more Medications are Medications are
Carrie medication efficiently and not lost always found
drawers easily find a where expected
guests according to
medications policy
when needed
Carrie and Steve Determine a Decreased No disputes
specific privacy chaos in related to
area when medication privacy of
receiving distribution medications
medications
Directors of Develop policies Reduction of Increased No staff or guest
operations and and procedures medication accountability is unfairly
programs to have available discrepancies and blamed for error
for staff for improvement of of medications
reference staff-guest
relations
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Pharmacists and Education on Increased All staff are Decreased
law enforcement medications at awareness of aware of high- chances of
high-risk for high-risk risk medications discrepancies and
abuse and quick medications illegal
reference in med distribution
book
Carrie and Steve, Audits on high- Decreased All No discrepancies
managers risk medications discrepancies discrepancies found
and increased are found within
accountability a weeks time
for medications
Directors and Skills check on To verify All staff adhere
managers how staff competency in to the same
distribute medication structure and
medications distribution process
Directors and Retraining on To ensure all Errors found in No retraining on
managers proper staff are procedure are procedures is
distributing consistent when corrected necessary
medication handling immediately
processes medications after training

FIND A PROCESS TO IMPROVE

Improve medication distribution policies and procedures for continuity among staff
involved in distribution of medications
Provide education for staff to increase knowledge of medications
Increase guest privacy during medication distribution times
Maintain/enhance staff/guest relations
Decrease medication count discrepancies
Better organization of medication cabinet (Main Mission)
ORGANIZE TO IMPROVE THE PROCESS

Guest and staff surveys

Observe medication distribution times at Agape House and Main Mission
Review of current policies and procedures for medication distribution
Verbal input of director and manager on processes/needs for change
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Agape-

All prescription medications kept in locked cabinet

Two morning times for distribution
Log book contains a log sheet for each medication. Guest signs out medications needed
in 24hr period
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Staff hands medication bottle to guest and guest takes medication from bottle, showing
the staff how many tablets are taken
Main Mission-

One medication distribution time in the evening

Narcotic and psychotropic drugs are only medications kept in locked cabinet
Log book contains a log sheet for each medication
Staff member signs out medication and hands medication bottle to guest. Guest takes
medication needed for 24hr period
UNDERSTAND THE CAUSES OF PROCESS VARIATION

Investigate why there is so much variation in how medications are handled at the Agape
House vs. Main Mission building. This includes investigation of:
o The difference in policy and procedures?
o The difference in the goal for the guests?
o The difference in training for the Agape House vs Main Mission Building?
o The difference in who the trainer was?
o Is there a standard process for training?
o What is causing the lack of organization for medications at the Main Mission
building?
o Why do they keep curtain medications vs. others?
o What is the current level of staffing?
o Can volunteers assist with opening and closing of the door while the staff member
focuses on the medication distribution?
o What is the current staffs knowledge on medications?
o Is there a set policy and procedure on how to deal with medication
disposition/destruction?
o Why are the medication records different at Agape House vs. the Main Mission
building?
SELECT THE PROCESS IMPROVEMENT

Implement a new set of pilot policy and procedures at the Agape House.
Educate and train all staff to the new set of pilot policy and procedures.
This pilot session will give staff and the administrative team a chance to see and evaluate
how the new set of policy and procedures will work. It also gives the staff a chance to
work out any kinks and make adjustments so that when they roll out the new set of policy
and procedures they will already know what will work and how to do it.
PLAN THE IMPROVEMENT

Research literature to see what is important to include in a set of policy and procedures.
Discuss the difference in goals at the Agape House vs. Main Mission building and
determine how to create a standardized process.
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Identify the goal for the guests at both locations and determine how to better assist the
guests in becoming independent.
Identify what resources and tools are available.
Determine how much time and if there is a budget the administrative staff had in mind for
this project.
Identify a group of staff members are embrace and adapt well to change, get them on
board with the program, and have them sell it to the rest of their staff. This group of staff
members can be the leaders or champions for this improvement project.
DO THE IMPROVEMENT PROCESS

Inform managers Carrie of Womens Ministries and Steve of Mens Ministries of updated
and improved medication administration process
Give in-service on procedure to staff administering medications
Implement organization tactics to simplify and streamline medication administration
process
Extra staff be available for implementation to ensure a smooth transition to new process
CHECK AND STUDY THE RESULTS

Survey staff and guests again a few weeks after the new the process has been
implemented to review for improvement
Talk to Carrie and Steve to understand if the new process is still used and if it is
improving the overall med distribution time
Observe the medication distribution time to see if less chaotic
ACT TO HOLD THE GAIN AND TO CONTINUE TO IMPROVE THE PROCESS

Tweak the process as necessary to what works best with the staff
Reward staff who follow the process and retrain those that need improvement
Reward guests who follow the new process and continue to encourage those to follow the
new rules
Encourage those who are champions of the new process to encourage others to follow the
new process
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Appendix B

Force Field Analysis

FORCES DRIVING PLAN FORCES OPPOSING

CHANGE CHANGE
1. Directors, managers, staff 1. Implement quiet zones 1. As many non-profits, the
want to improve the 2. Implement standard budget is very strapped
medication system policy and procedure
2. Guests want more OUTCOME 2. There isnt much overlap
independence in handling in staff, especially on
their medications weekends; volunteers are
not always consistent with
showing up
3. The time around 1. More organized 3. The culture of the guests
medication distribution is medication distribution time leaning toward chaos during
congested and staff 2. Increased safety with medication distribution
experience many disruptions medications and reduced
to handle while handling discrepancies
medications
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Appendix C

Guest Survey

Western Washington University nursing students are assessing the procedures for medication
dispensing at Lighthouse Mission Ministries. We would like your feedback to improve the
current system. Your answers will be kept confidential and will only be used for the
improvement process. You may leave your name for follow-up (see the bottom of the page), but
this will not be shared. Your privacy is important to us. Thank you!

1. Are you satisfied with current medication dispensing process?

YES SOMEWHAT NO (please explain)

2. Do you feel your privacy is protected while receiving medications?

YES SOMETIMES NO (please explain)

3. Do you feel judged about what medications youre taking?

YES SOMETIMES NO

4. If you answered yes to #3, who do you feel judged by?

STAFF GUESTS OTHER (please explain)

5. Do you feel your medications are safe the way they are stored right now?
YES SOMEWHAT NO (please explain)
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6. Is the current medication process helping you become more independent in managing
your own medications?

YES SOMEWHAT NO (please explain)

7. Would you like more independence in taking your medications?

I NEED MORE INDEPEDENCE THIS AMOUNT IS GOOD

I NEED MORE HELP WITH MEDICATIONS

8. Do you feel you have to wait long times to get your medications?

YES SOMETIMES NO

9. When do you normally get your medications?

6:15-7:15 am 9:00-9:30 am 6:45 pm Other

10. Do you feel more staff need to be available at medication dispensing times?
YES SOMETIMES NO

Optional: Other questions/comments/concerns:

If you would like to participate in follow-up questions, please leave your name and staff will
arrange a follow-up meeting:
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Appendix D

Guest Survey Results

Questions (Mens) Main Mission Building

1. Are you satisfied with current medication dispensing process?
2. Do you feel your privacy is protected while receiving medications?
3. Do you feel judged about what medications youre taking?
4. If you answered yes to #3, who do you feel judged by?
5. Do you feel your medications are safe the way they are stored right now?
6. Is the current medication process helping you become more independent in managing your own medications?
7. Would you like more independence in taking your medications?
8. Do you feel you have to wait long times to get your medications?
9. When do you normally get your medications?
10. Do you feel more staff need to be available at medication dispensing times?

Question Yes Sometimes/somewhat No More IND No Change More Help 615-715am 900-930am 645pm Other Staff Guests
1 5 3 1
2 6 3
3 _ 1 8
4 _
5 7 2
6 2 6 1
7 _ 2 5 1
8 _ 2 7
9 _ 2 2 6
10 3 6
Other questions/comments/concerns:
I would be happier filling my meds for the week with staff and follow up with them during one-on-ones; successes or short comings
I think medications should be poured into a cup then given, I could take as many pills as I wanted
have another line for those usually wait, have 2 medication lines
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Appendix E

Staff Survey with Answers

Western Washington University nursing students are assessing the procedures for medication
dispensing at Lighthouse Mission Ministries. We would like your feedback to improve the
current system. Your answers will be kept confidential and will only be used for the
improvement process. You may leave your name for follow-up (see the bottom of the page), but
this will not be shared. Your privacy is important to us. Thank you!
AGAPE HOUSE: answers A-F MENS MINISTRIES: answers G-I
11. What is your role with the medication dispensing process?
a. I receive, count-in, log in/out with guests, and lock up guests prescriptions
medications
b. Upon occasion, I count in and dispense
c. Guests turn them in to me in the evenings when they have a refill or new script. I
also will count in medication at night when I work a night (overnight) shift, but
this is NOT often. I also work during med times as well sometimes and make
meds available to guests
d. Receive meds, count in meds, maintain meds safety, security, provide meds to
guest to self dispense. Documentation, usual accountability, guest privacy
e. I am a staff person who occasionally dispenses and counts in medications
f. Dispense (on occasion); counting in (rarely)
g. I dispense them
h. I dispense and oversee
i. One, we do not dispense meds (no license) we just med monitor and log and lock
up for guestI occasionally will take in meds and occasionally hand guests their
meds to take

12. Are you satisfied with current medication dispensing process?

a. SomewhatI see the benefits of it for safe community living, but ultimately think
it is not equipping our guests for future independence
b. No, there are lots of (too many) errors by staff it seems. Inconsistent process;
training/retraining needed.
c. Improvements could be made
d. Yes
e. Not really. It is slow and lacks privacy.
f. In general, yes
g. No, I think there could be a better process
h. No
i. No, too many staff are involved or dont monitor correctly or write down
correctly
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13. Do you feel the privacy of the guests is protected during the medication pass times?
a. Not completely, because though we request guests to stay away from the counter
where someone is checking out meds, it is still an open space with people coming
and going
b. Mostlydepends on individual staff and their process. If our process is followed,
then I think its private enough. Turning to correct page, not handing them the
binder. Not saying meds; maintain safe distance
c. No. The lobby is an open room where meds are given during med times. Often
guests overhear another guest talking about what med theyre getting/taking
d. No
e. Not really
f. Sometimesbut often not depending who is presentsome guests/staff have
more discretion than others
g. No, no privacy
h. No
i. No, but I do feel we do the best we can under our current situationwe do done
person at a time and have the others wait in the staircase

14. Do you feel the guests are judged about what medications theyre taking?
a. I believe our staff culture is one to not judgethat being said I dont have the
privilege of working with every staff member, let alone observe their execution of
the med time procedures
b. By staffno? Mostly not; not often do we know what everything is for.
Potentially by other guestsDoes this person have 3 sleeves of meds vs 1 sleeve?
c. Yes, sometimes. Not by staff, but by other guests
d. Not by staff
e. By staff? No, absolutely not
f. No
g. At times, or how many they take
h. No
i. No not the least bit

15. Do you feel rushed during medication pass times?

a. When I first was hired I did, but then realized that ultimately I would rather have
it take slightly longer for guests so that we all achieve accuracyI aim to take my
time while also respecting theirs
b. No, I take charge and dont let guests rush me. I think its fair to give each guest
my undivided attentionand however long it takes, so be it
c. YES!!!
d. No
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e. Guests attempt to rush other guests, but I hold to boundaries with this.
f. No
g. Yes, too many distraction
h. Yes
i. I rarely do it but when I did definitely rushed

16. Do you feel medications are safe the way they are kept right now?
a. I do feel medications are safe when the procedures are followed correctly
b. Mostly. Camera could be adjusted better? Although more than once cabinet left
unlocked. I think meds in office should be disposed of ASAP.
c. Anyone could pick these locks! So, no! also, the camera is NOT fully on the meds
going into the cabinet, so theres no real verification of them going in the cabinet,
its more faith/trust based than anything
d. No
e. Yes
f. Yes
g. Yes, it is hard to monitor what is actually being taken though
h. I think we could do better. Too much room for error.
i. No too many staff w/ access and sometimes they are rushed and forget to lock the
drawers when finished

17. Is the current medication process helping the guests reach their goal of becoming
independent with managing their own medications?
a. No, I believe that when someone takes care of something for you (almost
completely), you start to lose your sense of responsibility in that area in some
cases take on a victim mentality
b. Mostly. I think we still overseemeds skipping, preventing abuse. I dont know
what some guests wouldnt abuse pain meds, for example, if we didnt keep theirs
c. In certain ways, it makes them realize the correct dosages they should take, when
to take them, etc.standing in a long line though does NOT help this, though!
d. I hope so
e. Those who want to manage their meds well, will. I feel our scheduled med time
is more about saving staff time
f. Noit controls too much
g. Yes and noyesthey are responsible for taking the proper amount. Nothey
have to report what they are taking
h. Again, I think we could do better
i. Yes, but only when we are tracking correctly by taking the extra seconds/minutes
to watch and ask questions w/ the guests

18. Would you like to see more independence with guests taking their medications?
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a. I think we should at least be giving guests the independence to decide if they are
not going to take a medication or take a lower dose than is prescribed. I dont feel
were equipped/trained to tell someone how much of a med they have to take and
ultimately if it effects their ability to living in the community, that will play out in
their behavior and our accountability system
b. Maybe except narcotics, etc. we could have a list of the exceptions that we
dispense (20%?)
c. YES!
d. No
e. Yes and no. some guests have a habit of leaving pills everywhere. I worry about
theft and the misuse of certain meds, but it is really an honor system. What
actually stops guests from keeping meds on their person anyway?
f. Yes
g. For some, yes.I would have concerns with some guests.
h. Yes
i. No we only currently hold onto narcotics and psychotropic medsNorco can be
easily sold or stolen and we want to make sure they are not overtaking or
undertaking psychotropics

19. Do you feel that medications should by audited or counted more frequently?
a. Yes
b. Yes. Could this prevent the missing meds? I hate it when staff are accused.
We lose respect and credibility.
c. They should be counted in/audited at least 2x monthly for everyone!
d. No
e. Yes. If we maintain our system is designed for accountability then we should be
auditing our system
f. Maybedepending on what consequences would be if we found discrepancies.
would guests move along the accountability process when there are discrepancies
in that case? Would we able them to leave for that?
g. If we are going to hold them, then yes. This will help w/ accountability, but not
independence.
h. Yes, let the guest control their own meds and staff has periodic pill counts
i. Yes, once a week

20. Do you feel more staff need to be available at medication dispensing times?
a. I dont think this is necessary, at least with the current method.
b. In case there are issues? Accountability? Not necessarily. For speed?maybe.
But average wait time10-15 min? I think thats acceptable
c. YES!
d. No
e. No. I feel we trip over each other when two people are in that tiny space.
f. No
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g. Yes, one to handle it all is a lot
h. No
i. I believe 2 people should be presentone to hand out meds. The other to help
keep lobby empty for privacy

21. Do you feel that medication discrepancies are handled appropriately?

a. I dont see all of them being followed up on and completely resolved, but it could
be that it is just not getting logged for other staffgenerally though I think these
things should be logged to completion so that staff are on the same page
b. No. But maybe I dont know all the infoor need to. Mostly I hear It been
handled but I dont feel confident in this answer
c. I THINK we TRY our best to handle them well, but mistakes can happen and
theres always room for improvement!
d. Yes
e. Not always. We review camera footage and count meds, but this rarely offers any
explanation
f. Seems like they are not really addressed because we dont have the facts on what
happened
g. Yes
h. Yes
i. For the most part

22. Do you have any other suggestions to improve the medication process?
a. I dont know that this is the right option but it could be good for staff to discuss
what it would look like to only lock up narcotics and opioid medications. Maybe
GAs could still be made aware of what other prescriptions guests are takingnot
positive how we would enforce thisjust a couple of thoughts.
b. Training! And more training! I am baffled when people, for example, give more
meds than whats allowed per dayjust bc a guest says Another staff let me or
something. We should know the rules and feel confident in enforcing them. (no
matter what guests say).
c. *Having guests come one at a time for med time and having set times each day
would be very helpful. *Better documentation of meds/check in/check out/etc
would be good. *Better privacymaybe bring guests to office one at a time
d. More secure lock up
e. Maybe doing away with med system and trusting our guests, as adults, to navigate
their meds on their own and with their Dr. or offering med lock-up as a chosen
recovery path? Optional accountability
f. Allowing guests to keep their own insulin and needles (stored appropriately)
g. For guests with numerous medsrequire a mediset
h.
i. Just to have 2 people present at hand out time/this can be a volunteer as well
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MEDICATION DISTRIBUTION
Optional: Other questions/comments/concerns:
a. My hope would be that there would be a high-level of consistency among staff in our
procedures, including the dispensing of medications. That being said, I have heard from
multiple guests that there is not always consistency amongst staff, which can bring up
concerns of inaccuracy or a questioning of the rules from both staff and guests
b. In a perfect worldI would love it if Gas could have more influence and the freedom to
address issues of narcotic/prescribed meds abuse. I think its rampant here, and we seem
to turn a blind eye to it
c.
d.
e.
f.
g.
h.
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MEDICATION DISTRIBUTION
Appendix F

Updated Medication Sheet

Name: Check-In Date: .

Medication: mg/mL: Pills in bottle: Refilled amt.: .

Refills: By Date: Directions: .

Rx #: Prescribing Physician: Daily Max: ..

Month: .Year: .
Date Time Amount taken Amount Remaining Guest Initials Staff Initials
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Medication Audit Date: Guest Verification (signature): Staff Initials: .

Correct Count: Yes No If count is off, who was notified: ______________________________

Medication Audit Date: Guest Verification (signature): Staff Initials: .

Correct Count: Yes No If count is off, who was notified: ______________________________