Roles and Rules

Our job roles, workplace rules and State certification as a CRMA in Maine is governed and regulated by the Maine Department of Health and Human Services (DHHS), Division of Licensing and Regulatory Services. You must take responsibility to fully review the job roles from the Maine State CRMA curriculum and the workplace rules from the Chapter 113, level 4, as part of this course.

Study tip-Take a look at Ch. 113, Level 4, section 7.1.7 that explains how psychotropic medication ​orders legally expire in 3 months, unless otherwise written by the prescriber.

CRMA- Certified Residential Medication

Roles and Rules

Your CRMA certificate legally expires every 2 years and you must take an 8-hour recertification course within 30 days of expiration to continue working as A CRMA. (please come back and see us for your recert!)

Enter your first and last name and last 4 digits of social security #

Roles and Rules

Your support-staff role follows written directions from the:

• CRMA curriculum/textbook for staff role
  
• Ch. 113 workplace rules/regs
  
• doctor’s/prescriber med orders
  

As a CRMA, yes you can:

• Follow written prescriber orders from handwritten, electronic or a faxed documents
• Transcribe(copy) the doctor’s orders onto a paper or electronic medication ​administration record (MAR)
• Administer non-injectable medications- oral, sublingual, inhalers, topical, eye/ ear/ ​nose drops, vaginal/rectal creams/suppositories
• Observe, document and report the client’s observed or verbally stated response/ ​effects to medications to the supervisor, prescriber and other care staff
• Request medication refills from the prescriber or pharmacy, receive pharmacy ​deliveries, count medications
• Practice quality assurance and good infection control
• Check vital signs

Roles and Rules

Your support-staff role DOES NOT include making clinical ​assessments, independent judgements or final decisions about care

As a CRMA, no you can not:

• Take verbal orders by phone ( ask for a written or faxed order)
  
• give any med without a current and complete med order (1-6)
• Deviate from any part of the order in any way, for any reason without ​documenting and reporting the incident
• Change, add or stop giving medications that the client or guardian wants without ​an updated order
• Give injectable medications- insulin or epi pen medication by the injection route ​without first getting additional training by an RN
• Re-label medication packaging (call the pharmacy for a new label if needed)
• Treat a deep skin wound or pressure ulcer
  

Information resources

Professional resources

Emergencies:

CALL 911 IF CLIENT OR CO-WORKER IS:

• UNRESPONSIVE
• SEVERELY SHORT OF BREATH
• UNCONTROLLED SEIZURE
• EXCESSIVE BLEEDING OR INJURY

Maine Poison control: (800) 222-1222

REPORT the following - ALWAYS KNOW THIS INFO WITH EVERY MED YOU GIVE:

• MED
• DOSE
• TIME
• RESPONSE
  

Professional Resources

Prescriber/physician/ doctor/ provider- The licensed person who writes the orders for medications and treatments

• Gives the order to the Pharmacist to package and dispense medications

• Gives the same order for medications to then be administered by the CRMA or nurse

• Determines the diagnosis and reason for each medication that they order

• Explains the diagnosis and reason for each medication that they order to the patient

Professional Resources

Pharmacist- the licensed person who packages and dispenses medications

• Answers your questions about medications, dosing, side effects, special instructions
• packages and dispenses medications
• Labels and Re-labels medications
• May prepare medication for residents going on LOAs
• Checks for potential medication allergies, interactions, and contraindications
• Takes verbal order from physician
• Advises on storage, disposal, and drug expirations
• Advises on special precautions such as “take with food.”

Professional Resources

Supervisor- program manager and Agency manager

• Answers questions about workplace issues
• Handles problem- solving and decision making
• receives incident reports and medication error forms
• assigns Staff duties
• manages Staff schedules and program coordination
• coordinates access to outside services (dentist, doctor, etc.)
• arranges transportation and services from other agencies
• skills teaching, problem-solving, motivating, working with individuals to achieve goals
• Offers general support to Staff and Clients

Professional Resources

Nurse Consultants- Registered Nurses who serve as on-call medical experts and in an advisory capacity when necessary, answers medication questions

• help with medication or medical- related problem- solving and decision making
• Administration Records (MARs)

Experienced co-workers-

• Offer insight to usual and unusual Client behavior
• work with Client while you prepare medications
• Report unusual behavior of Clients and observe possible side effects of medications
• Assist with information surrounding incident reports
• Assist with transport Clients to provider appointments

Guardian/ Case Manager/Family-

• answer questions about Client’s history with medications, behaviors and routines

Written resources

Nursing drug book- reference guide for all medications-

generic/ brand name, classification, what the drug is used for

and a list of potential side effects.

Drugs.com- a reliable internet source

Written resources

.....and don't forget these guys!!

Maine State curriculum

employee roles

Ch. 113, level 4

workplace regulations

Written resources

Pharmacy pamphlet- paper instructions that come with the medications, can also give information about side effects, contraindications

There are four links in the infection chain that must be present before infection can be spread:

• A germ, such as a virus, bacterium, fungus, or parasite
• A place for the germ to live and multiply, such as a person, animal, plant, food, soil, or water
• A susceptible host – a person who does not have resistance (immunity) to the germ
• A way for the germ to enter the host

Different germs may require different routes:

• Direct contact – when people touch each other
• Indirect contact – when food, water, feces, bandages, common surfaces, objects (cell phones!!!!) or other substances contaminated by the germ enter the host
• Droplets – such as those produced by a sneeze or cough
• Particles in the air

Infection Control

Removing any one of the infection links breaks the “chain of infection”:

Good hand washing

Good housekeeping

Using protective barriers (gloves, masks, gowns, etc.)

Immunizations

Store food carefully

Wash fruits and vegetables

Use separate cutting boards

Use hot soapy water to wash dishes

Not sharing personal items (razor, toothbrush, etc.)

Infection Control

One of the most important ways to stop the spread of infection is proper handwashing!!!

Follow these instructions for washing with soap and water:

• Wet your hands with warm, running water, apply clean soap and lather well
  
• Rub your hands vigorously together for at least 15 seconds, scrub all surfaces, including the backs
  

of your hands, wrists, between your fingers and under your fingernails

• Rinse well
  
• Dry your hands with a clean or disposable towel, use the towel to turn off the faucet
  
• Hand sanitizers are not a replacement for actual handwashing
  

Infection Control

We are all responsible for washing our hands and changing gloves frequently, disinfecting common surfaces and covering coughs and sneezes.

Infection Control

Potentially infectious body fluids:

• Blood
  
• Semen
  
• Vomit
  
• Saliva
  
• Feces
  
• Urine
  

Potentially infectious body fluids are anything you wouldn’t want to touch

without wearing gloves

and washing your hands afterward!

Infection Control

Signs any symptoms of infection may include:

• Inflamed skin (red, hot, swollen or a rash)
  
• Fever or chills
  
• Pus (green or yellow drainage from a wound)
  
• Nausea or vomiting
  
• Persistent diarrhea
  
• Sore throat or a cough
  
• Painful urination
  

Vital Signs

"Vital signs" Are clinical measurements of the vital body functions, such as the heart pumping blood ​(cardiovascular) and the lungs breathing air (respiratory).

• We measure/check vital signs before giving some medications, or for signs of infection. ​Additionally, we also may check the resident’s weight on a monthly schedule.

• The human body is capable of maintaining a balance of physical and general health and ​everyone reacts differently to physical and emotional changes.

• Physical activity can temporarily increase the work of the heart and lungs, but increased ​measurements can also be signs of infection if the person is at rest.
  

increased heart and lung function

is needed to support increased physical activity

decreased physical activity requires less heart and lung function

Normal resting adult vital signs:

• pulse/heart rate: 60-100 is the average number of times the adult heart ​beats per minute to circulate blood throughout the vessels to support ​physical activity
  

• blood pressure: 120/80- the measurable amount of pressure created in ​the vessels with physical activity, measurable when b/p cuff is inflated ​and deflated:
  

120 = resistance pressure/cuff inflated

80 = relaxed pressure/ cuff deflated

• respirations/breaths: 14-20 breaths per minute (observe to count)
  
• temperature (oral): 98.6 F/ 37*
  

Vital Signs

Pulse - average is 60-100 beats per minute

Also called the heart rate or heartbeat- the number of times the heart muscle squeezes and relaxes per ​minute to keep the blood circulating throughout the body, transporting oxygen. This is part of the ​cardiovascular system and pairs with the blood pressure.

• Carotid pulse- is taken at both sides of the neck, using your 2 fingertips
  
• Apical pulse is often taken before giving heart meds because it is the most accurate. The apical pulse is ​checked for a full minute, using a stethoscope, placed over the heart in the left chest area.
  
• Brachial pulse is taken with a cuff wrapped around the arm, just above the elbow and placing a ​stethoscope over the brachial artery at the bed of the elbow
• Radial pulse is taken at the wrist using your 2 fingertips
  

Vital Signs

Blood pressure- Average is 120/80

Force of circulating blood flowing through your blood vessels-

this is part of the cardiovascular system that creates the pulse

Blood pressure is measured using two numbers- remember your heart is a constantly working muscle:

• Systolic-the “top” number (120/80), measures the pressure in your arm vessel when your heart ​muscle squeezes to push blood through the vessels, causing pressure in the vessel.

• Diastolic- the “bottom” number (120/80), measures the pressure in your arm vessel when your ​heart muscle relaxes to fill up with blood again before the next contraction

120/80= resistance/release

120 systolic cuff squeeze causing resistance/ 80 diastolic cuff at rest

Vital Signs

Blood pressure- Average is 120/80

Force of circulating blood flowing through your blood vessels- creates the pulse

Vital Signs

Proper positioning to measure the blood pressure

Vital Signs

Respirations/breaths- Average adult breathing rate is 12-20 breaths per minute

You can check the number of breaths per minute

by watching the chest rise and fall while pretending to continue checking another vital sign

Vital Signs

Internal human body Temperature- Average is 98.6 F or 37* C

There are several locations where you can take a person’s temperature-

• orally- in the mouth
  
• axillary- armpit
  
• otic- ear
  
• transdermal- over the skin
  
• rectal
  

REMEMBER: temperatures may be in Fahrenheit (F) or Celsius (C). Check the user manual for the device

you use….the readings may be different depending on the type of device you are using.

Vital Signs

Internal human body Temperature- Average is 98.6 F or 37* C

Introduction and Unit 1 review

• How often does your CRMA certificate need to be renewed?
• Under what circumstances can A CRMA give insulin or epi-pen injections?
• Can a CRMA take verbal orders over the phone?
  

Take the Unit 1 practice quiz to test your learning progress.

If you are in the live in-person session then you will take the actual State quiz on Tuesday , the first day of class.

If you are in the online session, then you will take the actual State quiz when we meet in-person at the end of the course.