Design Document for Medication Assistance Program Annual Review

By Judy Galenza Purpose of the Course Health Care Aides in home care programs are delegated to assist clients with medications. There has been an increasing number of incident reports of ongoing medication errors primarily due to staff not following proper procedure. It is therefore important to ensure Health Care Aides who provide medication assistance to clients receive updated information and knowledge assessments annually to ensure correct procedures are understood and followed so that errors with medication assistance are minimized or eliminated. The target audience is composed of both male and female Health Care Aides ranging in age from the late teens to the mid-sixties. They have one or more years in health care experience and come from various ethnic and cultural groups. Other audience members include home care Case Managers and Home Support Supervisors who need to know updated procedures and policies to follow when delegating medication assistance to a Health Care Aide or observing the Health Care Aides medication assistance skills. Major Course Objectives (Terminal) 1. Terminal Objective: After completing the online unit of instruction, the learner will be able to identify steps included in all medication assistance procedures and how they relate to safe practice. (cognitive domain) 2. Terminal Objective: After completing the online unit of instruction, the learner will be able to identify the steps specific to each of the 4 restricted medication procedures. (cognitive domain) 3. Terminal Objective: Given a home care client unable to self-medicate, medication supplies and a medication assistance care plan, the learner will be able to perform medication assistance with 100% accuracy (optional assessment by manager). (psychomotor domain) 4. Terminal Objective: Given case studies based on real-life scenarios depicting medication errors during medication assistance, the learner will distinguish the root cause for the incident with 100% accuracy. (cognitive domain) 5. Terminal Objective: Following completion of the annual recertification training in medication assistance, the learner will value the role and responsibility he or she has in ensuring safe and competent medication assistance as indicated by an absence of medication errors over the coming year. (affective domain)

Audience Description

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Course Enabling Objectives

Terminal Objective 1: a) Recall the steps included in the basic medication assistance procedure b) Identify the steps within the medication assistance procedure where medication errors can occur Terminal Objective 2: a) b) c) d) Identify the steps required in the procedure for assisting with rectal suppositories Identify the steps required in the procedure for assisting with rectal enemas Identify the steps required in the procedure for assisting with vaginal suppositories Identify the steps required in the procedure for assisting with vaginal creams

Terminal Objective 3: a) Recall previous medication errors that have occurred b) Apply knowledge of root causes and past medication error experiences Terminal Objective 4: a) Prepare to assist with medication b) Perform medication assistance as instructed c) Provide follow up care and documentation Terminal Objective 5: a) Examine personal beliefs and attitudes regarding factors that may contribute to medication errors b) Create a checklist of strategies for personal use that will help prevent future medication errors RLO Enabling Objective Learning Assessment for Course Identify the steps required in the procedure for assisting with rectal suppositories.

Certification will follow completion of all online components (case studies, quizzes, reflection questions), successful evaluation of actual medication assistance performance (as deemed necessary by the supervisor) and face-to-face performance discussion with the supervisor.

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Learning Assessment for RLO

This lesson has 2 knowledge checks: The first knowledge check concludes the branching part of the course on the medication assistance steps common to all medication assistance procedures The second knowledge check concludes the primary section on the rectal suppository assistance procedure

Instructional Instruction will be blended using an online component for knowledge transfer and review, in addition to a face-to-face Delivery method for component for performance discussion and evaluation. Course (overall) Instructional Strategy for RLO Media The primary instructional strategy is an online tutorial that will present the description of the steps specific to medication assistance in addition to 2 knowledge checks using a crossword puzzle and drag and drop exercise. This RLO will use text, graphics and animation. To mimic real life situations, I would like to create an office scene to start then move to a clients home that would include a bedroom scene where this procedure would take place and include animation for the explanation of the procedure. The audio will include the exact narration of the text because most learners will not have access to speakers at the workplace. The learners range in age from late teens to mid-sixties and come from various cultural backgrounds. Consideration will be given to: Font size, ensuring it will be large enough for all ages of learners Not using flashing or blinking text, objects or other elements Keeping layout consistent and uncluttered with clearly marked navigation and menus Providing a text equivalent for every non-text element Allowing the user to have control over the timing of the content changes Utilizing the accessibility check feature for readability and/or requesting review of the course by other educators and/or learners prior to implementation

508 Accommodations

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Course Structure Description

The entire course consists of 5 modules and 9 lessons. The 1st module focuses on medication assistance steps common to all medication assistance procedures. 1. Within this module there is 1 lesson presented as a tutorial to identify the steps and then a knowledge check will ask the learner to select the steps that could potentially cause a medication error if not followed correctly. The 2nd module focuses on medication assistance steps that are specific to 4 restricted activities rectal suppositories, rectal enemas, vaginal suppositories and vaginal creams. 1. Within this module there are 4 lessons, one for each restricted activity that will present tutorials on each procedure. The knowledge checks will consist of crossword puzzles to enter answers to questions and to confirm the learners understanding of procedure specifics. The 3rd module focuses on the learners recall of previous medication errors. 1. Within this module there is 1 lesson where the learner is asked to recall previous medication errors prior to completing a knowledge check that presents case studies for identifying why and how the medication errors occurred. The 4th module is optional depending on the assessment of the supervisor and focuses on the learners ability to correctly perform any medication assistance procedure. 1. Within this module there is 1 lesson that will provide the opportunity for the learner to demonstrate one or more medication assistance procedure/s. Observation of learner skills by the supervisor will provide the learning assessment. The 5th module focuses on the behavior and attitudes of the learner towards the value they place on assisting with medication and preventing medication errors. 1. Within this module there are 2 lessons: The first lesson uses a likert scale to ask the learner to give a rating of his or her attitude/belief toward various aspects of medication assistance. The second lesson asks the learner to develop a written list of strategies that they will personally adhere to in the coming year to prevent medication errors. This personal assessment will be reviewed during the learners annual performance review.

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Seat Time of Course

The online component of the entire course should take approx. 120 minutes to complete. The face-to-face component (procedure demonstration and performance discussion) should take between 15 and 45 minutes to complete.

Seat Time of RLO RLO Outline RLO Flowchart

This lesson will take between 10 and 15 minutes to complete. A detailed outline for the lesson is provided in Appendix A

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Screens/Pages in RLO Knowledge Checks or Other Assessments or Practices

There are an estimated 20 screens in this RLO project.

The estimated number of knowledge checks or other interactions are: ____Dichotomous (T/F, Y/N, etc.) ____Multiple Choice ____Multiple Select __1_Drag and Drop ____Custom describe; if appropriate, supply flowchart in an Appendix and reference it here. __1_Other crossword puzzle created using Soft Chalk (not sure if this will import), may need to create another way

Rollovers/click events

The estimated number of individual rollover or click event items/objects (outside of navigation elements) are: _12_ Rollovers _10_ Click Events

Course and Project Navigation

This course will require a mixed page type with a menu outlining each of the five modules, their respective lesson/s and knowledge checks on the left hand side with the content screen on the right. The learner should have the capability to go directly to the knowledge checks if they do not wish to review the tutorials. (This is a group of experienced learners who should have knowledge of the medication assistance procedures so the knowledge checks may be the only area of interest to some learners) Navigation from screen to screen will consist of forward (next) and backward (previous) arrows, exit button, progress bar and/or page numbers. Branching will require yes and no buttons.

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Screen Layouts

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Development Tools

The following tools will be used in the design and development of the course: Microsoft Word Microsoft Powerpoint Articulate Soft Chalk (? Crossword)

Ownership Development Time

Rural Clinical Learning Central Zone will develop the initial course; and, Rural Clinical Learning Central Zone will maintain the course. The course is being developed for Alberta Health Services. Given that I am a SME for this lesson, I may save some time because I know the content and might avoid ongoing review of draft materials. However, I have not worked with any authoring tool so this is where the greatest amount of my time will probably be spent. With this in mind, I believe the RLO for this 1 lesson that is estimated to be 10 to 15 minutes in length, will take approximately 40 - 50 hours to complete. (Divide this by half if I had proficient working knowledge of the authoring tools) Review of tutorials for authoring tools will be needed prior to development.

Support requirements Project Sign-off [optional]

Please sign below indicating agreement with the proposed course plan and approving start-up of the storyboard and development phases.

Instructional Designer

Date

Project Manager/Sponsor

Date

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Appendix A: Detailed Course Outline

Topic 1. Lesson Introduction Importance/Overview Objective: Identify the steps required in the procedure for assisting with rectal suppositories Relationship of restricted medication activities to basic medication assistance procedure steps Branching screen Do you know medication assistance steps common to all medication procedures? Method Presentation of facts Objective & Assessment Storyline Visuals

2.

Presentation of facts

Buttons for Yes/No; No takes them to the common medication assistance steps branch (see row 6); Yes continues them in the primary course line. Identify specifics in the steps required in the procedure for assisting with rectal suppositories Create bedroom scene and actors (with ?animation) to introduce client. Create another room to review supplies and procedure)

3.

Medication assistance steps specific to rectal suppositories Check medication for defects Obtain additional materials Assist with rectal suppository insertion according to MAP care plan Follow up client care

Description of procedure

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4.

Knowledge check

Application of procedure specifics

Crossword puzzle to enter answers to the following questions: 1. The type of lubricant to use (water based) 2. The side of the body the client should be lying on before insertion (left) 3. This helps relax the client and the anal sphincter prior to insertion (deep breath) 4. The finger to use for insertion (index) 5. Putting the suppository into this will not allow adequate absorption in the bowel (fecal matter) 6. You need to do this if resistance is felt during insertion (stop) 7. The number of inches to insert the suppository (three to four)

Crossword puzzle format

5.

Summary and additional resources

Presentation of facts

None

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6.

(Branching) Medication Assistance steps common to all procedures Recall steps

Description of steps

Recall the steps included in the basic medication assistance procedure Drag & Drop: Drag 7 pictures into the order they should be performed according to all medication assistance procedures. Each drag will be assessed individually for accuracy as placement occurs. Pictures to Drag: Hand washing Checking the chart Client identification Check the packaging Check the expiry date Medication poured into cup Girl documenting in chart

Create classroom scene with actor (with ?animation) to provide tutorial of steps in procedure Chalkboard with 7 pictures of items included in medication assistance procedure. Continue button takes them back to primary course line.

7.

(Branching) Knowledge Check

Application of basic steps

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