Medication administration and treatments
Medication questions test the safety checks, the monitoring responsibilities, and the judgment calls specific to this population - polypharmacy, psychotropics, swallowing difficulty, and rescue protocols.
Rights
Right person, right drug, right dose, right route, right time, right documentation - and, in practice, the right reason and the right to refuse. Verify against the current order, not a memory of it.
Population-specific concerns
- Psychotropic use is common and needs active monitoring. Antipsychotics require attention to metabolic effects (weight, glucose, lipids), sedation, falls, and movement disorders including tardive dyskinesia; structured movement assessments should be done at defined intervals and after dose changes. Off-label use should have a documented rationale and a plan to reduce.
- Polypharmacy and drug interactions. Antiepileptics interact widely; sedation multiplies when antipsychotics, benzodiazepines, and antihistamines are combined. Ask whether each drug still has an indication.
- Swallowing difficulty. Never crush a tablet without checking with the pharmacist - extended-release, enteric-coated, and some anticonvulsant formulations must not be crushed. Different formulation, not a crushed tablet, is the answer.
- Rescue protocols. Seizure rescue medication (for example, rectal diazepam or intranasal midazolam) requires a written protocol with a time-based trigger, individual training, and documentation of each use.
- Bowel regimens and PRN medications need parameters that define when the PRN may be given and when the nurse is called.
- Errors are reported through the agency system, the person is assessed, and the prescriber is notified promptly.
Worked example
A 38-year-old on two antiepileptics and an antipsychotic has gained 18 pounds in six months and is sleeping through day program. Do not simply attribute it to "his disability." Complete a medication review (indications, doses, interaction and side-effect profile), obtain metabolic monitoring, assess for constipation and sleep apnea, screen for depression, and bring the findings to the prescriber with a request to reconsider the antipsychotic. Document the assessment, the communication, and the follow-up.
Traps
- Crushing an extended-release tablet to make it easier to swallow.
- Accepting a standing PRN order with no parameters.
- Missing tardive dyskinesia or metabolic change because no one is looking.
- Counting tablets from a card without checking the label and the order.
- Failing to notify the prescriber and the family after an error.
- Assuming a behavior is baseline when it began after a medication change.