Title Page

  • Conducted on

  • Team Name

  • Clients Name

  • Prepared by

  • Location

Facility Medication

  • All medications are in the original packaging?

  • Individual medication in blister pack or bottles?

  • Eye drops opened are dated/ not expired?

  • Medication in the cupboard/ folder are current and not expired?

  • Medication being stored in cupboard/ drawer/folders is below 25 degrees in temperature?

  • Medications required to be in a fridge is sealed and within the 2-4 degrees temperature range?

Individual PRN Usage.

  • Documentation of when PRN medication is given?

  • Documentation of what symptoms the PRN is given for?

  • An entry in the progress notes indicating effectiveness of PRN?

Individual Regular Medication.

  • The prescription and the blister pack are aligned with a signed and dated medication signing sheet?

  • The prescription is in the medication folder and within 3 months of being prescribed?

  • Allergies are documented?

  • Bowel motions documented three times per week?

  • Specimen client signature written on the medication signing sheet?

  • All entries are signed by person giving the medication and signed by client?

  • Antibiotics given for full course with no gaps in the medication signing sheet?

Individual Self- Supervising of medication

  • Was the medication storage area secure and locked?

  • The plan of days being self-supervised and when staff check progress?

  • The client only has medication for the supply of medication that aligns with self-supervising plan?


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