CIRCULAR LETTER DHCQ 12-98-386 

TO:	Administrators, Licensed Long Term Care Facilities	
FROM:	Paul Dreyer, Ph.D., Director, Division of Health Care Quality	
DATE:	December 21, 1998	
RE:	Best Practice Recommendation #1: Assessment of the Medication Knowledge of Individuals Administering Medications in Long Term Care Facilities.	

This is the first in a series of Best Practice Recommendations from the Department of Public Health, Division of Health Care Quality ("Division"). The purpose of these recommendations is to reduce medication errors in Massachusetts Long Term Care Facilities. 

Several of the medication errors that the Division has investigated in the past two years resulted from a lack of basic drug knowledge on the part of the nursing staff and others who administer medications. In response to this knowledge deficit, the Division strongly recommends that each facility: 
•	Work with its consultant pharmacist to develop an examination that will assess the level of basic drug knowledge of all staff involved in medication administration.
•	Administer the examination as part of the pre-employment screening process and to all staff that are currently administering medications.
The examination should be aimed at testing medication knowledge, identifying educational needs, and helping staff members understand their own knowledge deficits. At a minimum, the examination should include the following elements: 
1.	The use of a medication based upon a resident's diagnosis.
2.	The common use of a medication.
3.	The identification of a medication by both its brand and generic names.
4.	Medication contraindications.
5.	Basic medication calculation questions-including dosage conversions.
6.	Adverse drug reactions associated with a particular drug.
7.	Appropriate dosing levels.
8.	Common Latin abbreviations.
The Division encourages all facilities to incorporate the testing of staff involved in medication administration into their medication administration policies and procedures. The Division further recommends that facilities have a plan to develop appropriate interventions when the test results identify the need for further education. 

If you have any further questions, please contact your regional manager at (617) 753-8000.