Mock Medication Administration Observation Checklist Mock Trial Comments Areas of Demonstration Date: Yes No 1. Employee washed hands and gathered all necessary supplies (e.g. cup, water, etc). 2. Employee obtained key and opened box. 3. the Medication Sheet, the employee found the correct medication to be administered. 4. Employee compared the pharmacy label to the copy of prescription to the Medication Sheet to assure correct medication was to be administered. 5. Employee counted the correct dosage of medication and poured into cup without touching the medication. 6. Employee compared the pharmacy label to the copy of prescription to the Medication Sheet to check again that the correct medication was to be administered. 7. Employee handed the cup to the individual receiving medication. Encouraged the individual to put medication directly in mouth from cup. 8. Employee offered water to the individual (unless otherwise prescribed). 9. Employee watched for the person to swallow the medication and followed any special administration instructions (food, sit upright, etc). 10. Employee initialed the Medication Sheet for the correct medication, day, and time. 11. Employee signed and initialed the Medication Trial if administering medications for the first time that month on that sheet. 12. Employee ensured the packaging is secure and put everything back in the medication box. 13. Employee locked box and secured key. ___________________________________ Supervisor/Authorized Agency Personnel
Mock Medication Administration Observation Checklist Areas of Demonstration Mock Trial Comments Date: Yes No 1. Employee washed hands and gathered all necessary supplies (e.g. cup, water, etc). 2. Employee obtained key and opened box. 3. the Medication Sheet, the employee found the correct medication to be administered. 4. Employee compared the pharmacy label to the copy of prescription to the Medication Sheet to assure correct medication was to be administered. 5. Employee counted the correct dosage of medication and poured into cup without touching the medication. 6. Employee compared the pharmacy label to the copy of prescription to the Medication Sheet to check again that the correct medication was to be administered. 7. Employee handed the cup to the individual receiving medication. Encouraged the individual to put medication directly in mouth from cup. 8. Employee offered water to the individual (unless otherwise prescribed). 9. Employee watched for the person to swallow the medication and followed any special administration instructions (food, sit upright, etc). 10. Employee initialed the Medication Sheet for the correct medication, day, and time. 11. Employee signed and initialed the Medication if administering medications for the first time that month on that sheet. 12. Employee ensured the packaging is secure and put everything back in the medication box. 13. Employee locked box and secured key. ___________________________________ Supervisor/Authorized Agency Personnel Trial
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