Module 2 of 7

Legal & Ethical Responsibilities

The 7 Rights of Medication Administration

Every time you administer a medication, you must verify all 7 Rights. These rights must appear on every label, every physician order, and on the MAR.

  1. Right PERSON — Confirm the client's identity before every administration
  2. Right DRUG (Medication) — Confirm the medication name matches the order and label
  3. Right DOSE — Confirm the amount matches the physician's order
  4. Right ROUTE — Confirm the correct route (oral, topical, etc.)
  5. Right TIME — Confirm the time and frequency are correct
  6. Right to REFUSE — Every client has the right to refuse medications at any time, for any reason
  7. Right DOCUMENTATION — Document accurately, completely, and immediately after administration
Key Rule: Rights 1–5 must appear on all medication labels, physician orders, and the MAR. Rights 6 and 7 reflect legal and ethical obligations that apply to every interaction.

Right to Refuse

No matter the age or cognitive/mental disposition of the client, all clients have the RIGHT TO REFUSE medications or treatments at any time, for any reason.

  • A QMAP is NOT obligated to guarantee that a client consumes a medication or accepts care
  • A QMAP's obligation is to be available to offer and provide services that support the client's safety and well-being
  • A refusal must be documented on the MAR and reported to the supervising agency

MANE — Mistreatment, Abuse, Neglect & Exploitation

MANE is the acronym used to identify a group of abuses that caregivers have a legal and ethical obligation to protect clients from and report.

M — Mistreatment

Any action or inaction that causes harm, injury, or distress. This includes verbal, emotional, and psychological mistreatment.

A — Abuse

Intentionally causing physical pain or injury. Examples include (but are not limited to):

  • Substantial or multiple skin bruising, burns, or lacerations
  • Inappropriate physical restraint
  • Any act that a reasonable person would find cruel or threatening

N — Neglect

Failure to provide necessary care, supervision, or services. Neglect can be intentional or unintentional.

E — Exploitation

Taking advantage of a person's property, finances, or vulnerability. This includes unauthorized use of a client's money, credit, or belongings.

🚨 Drug Diversion: Diversion is the misuse, theft, or unauthorized use of a client's medications. This is a criminal offense. QMAPs must report any discrepancies in medication counts immediately to their supervisor.

Mandated Reporter Obligations

QMAPs — even Host Home providers — are considered health care workers and are Mandated Reporters under Colorado law.

  • Mandated reporters are legally required to report any known or suspected MANE
  • This includes police, medical personnel, and anyone in a position of authority over an at-risk person
  • Failure to report is a criminal offense

An "at-risk" person under Colorado law includes:

  • Adults 70 years of age or older
  • Adults with disabilities
  • Adults with mental illness

Misappropriation of Resident or Client Property

Taking, misusing, or failing to account for a client's belongings, money, medications, or any personal property without the client's consent or authorization. This includes unauthorized use of a client's funds, credit, or belongings.

How to Report

Follow your agency's or facility's reporting policy and procedure. In the event of an immediate safety threat, call 911. You must also notify your supervisor and document the report on the client record.

Colorado Adult Protective Services (APS): For reporting abuse, neglect, or exploitation of at-risk adults, visit www.coloradoaps.com for information and online reporting resources. Colorado law requires that mandated reporters file reports promptly — do not wait to gather more information if you have a reasonable suspicion.

Privacy & Confidentiality (HIPAA)

Under HIPAA (Health Insurance Portability and Accountability Act), QMAPs are responsible for protecting each client's personal health information (PHI).

Protected information includes — but is not limited to — the client's:

  • Name
  • Address
  • Diagnoses or medical conditions
  • Medications

Sharing this information in written documents, verbal conversations, or electronic communications is prohibited without proper consent. Always obtain consent before sharing client health information with anyone outside the care team.

Self-Administration vs. Monitoring vs. Administering

TermDefinitionQMAP's Role
Self-Administration The client is in control of their own medications and property. They take the medication themselves. No medication label required. QMAP may observe but does NOT open containers.
Monitoring QMAP watches the client self-administer. Does NOT include opening a container. Document on the MAR that medications were observed to be taken.
Administering Begins when a QMAP opens a medication container. QMAP prepares and provides the medication to the client. Full 7 Rights verification, documentation, and adherence to all protocols required.

Medication Errors

A medication error is any deviation from the physician's order. This includes giving the wrong medication, wrong dose, wrong time, wrong route, or to the wrong person. Common errors include:

  • Preporing medications in advance (NEVER pre-pour)
  • Not comparing the pharmacy label to the MAR
  • Sitting pills down and walking away
  • Administering medication without a signed physician order
  • Failing to document after administration

If an Error Occurs

  1. Immediately notify your supervisor and physician
  2. Know and follow your facility's policy for medication errors
  3. Review your mistake and identify the point of error — learn from it
  4. Document specifically on the MAR: date, time error was discovered, who was notified, details, observed reactions, emergency services if called
Remember: As a QMAP, it is NOT within your scope to judge whether an error will or will not harm the client. Report every error immediately and follow your facility's policy.

Drug Diversion Awareness

Drug diversion is the theft, misuse, or unauthorized use of a client's medications — by anyone, including caregivers, family members, other residents, or visitors. It is a criminal offense and a serious violation of QMAP responsibilities.

Common Signs of Drug Diversion

  • Medication counts that don't match records
  • Pills that appear to have been replaced with similar-looking tablets
  • Clients reporting they don't feel like their medication is working
  • Tampered packaging or containers
  • Missing medications or missing documentation

Prevention

  • Always count controlled substances at shift change — document counts on the controlled substance log
  • Never leave medications unattended or unsecured
  • Store controlled substances in double-locked storage at all times
  • Never prepare medications for multiple clients at the same time
  • Document waste and partial doses immediately and according to agency policy

Your Obligation to Report

Report Immediately: If you suspect drug diversion — even if you're not certain — you must report it to your supervisor immediately. Do not investigate on your own, confront the suspected person, or wait to gather more evidence. Document what you observed with specific details: date, time, what was missing, what was witnessed.

Drug diversion that goes unreported puts clients at risk of under-treatment of pain and other symptoms, and exposes the facility and the QMAP to serious legal liability.

Communication & Interpersonal Skills for Elderly & Cognitively Impaired Clients

A significant portion of QMAP clients are elderly or have conditions affecting cognitive function, including dementia and Alzheimer's disease. Effective, respectful communication is essential to safe medication administration.

Understanding Unique Needs

  • Physical limitations: Decreased hearing, vision impairment, slower processing speed, and reduced manual dexterity are common — give clients extra time to respond and take medications
  • Cognitive impairment: Clients may not understand what they are being given, may forget they took a medication, or may refuse without explanation
  • Behavioral issues: Agitation, confusion, or resistance to care is common — never force medications; always document refusals and notify your supervisor
  • Dignity and autonomy: Always treat clients with full respect regardless of cognitive level — never speak about them as if they are not in the room

Communication Tips for Clients with Dementia or Alzheimer's

  • Approach calmly and slowly — sudden movements or loud voices can trigger anxiety or resistance
  • Introduce yourself each time — the client may not remember you from one visit to the next
  • Use simple, short sentences — give one instruction at a time ("Please open your mouth. Good! Now swallow.")
  • Make eye contact — position yourself at the client's eye level when possible
  • Allow extra time — don't rush; a calm, unhurried approach greatly reduces resistance
  • Use distraction and redirection — if a client refuses, gently redirect to something pleasant, then return to the task
  • Validate feelings — "I understand you don't want to take this right now" before moving forward
  • Never argue — if a client is adamant about refusing, document and report rather than pushing
Remember: Behavioral issues are often a form of communication. A client who is resisting, agitated, or confused may be in pain, afraid, or simply having a difficult day. Your calm, patient, person-centered approach is itself a form of care.

Impaired Physical Capacity

  • Clients with swallowing difficulties (dysphagia) may need liquids thickened per a physician's written order
  • Clients with limited hand control may need assistance positioning tablets or cups
  • Always remain with the client until all medications are confirmed swallowed
  • Positioning is important — keep clients upright during and for a few minutes after oral medications to prevent choking or aspiration

📝 Module 2 Quiz

Answer all 6 questions. You need 85% or higher to complete this module.

1 How many "rights" of medication administration must a QMAP verify?

✓ Correct! There are 7 Rights of medication administration.
✗ There are 7 Rights: Person, Drug, Dose, Route, Time, Right to Refuse, and Documentation.

2 What does the "N" in MANE stand for?

✓ Correct! MANE = Mistreatment, Abuse, Neglect, Exploitation.
✗ MANE stands for Mistreatment, Abuse, Neglect, Exploitation.

3 A client tells you they don't want to take their blood pressure medication today. What should you do?

✓ Correct! Every client has the right to refuse at any time. Document the refusal and notify your supervisor.
✗ Every client has the Right to Refuse at any time. Document the refusal and notify your supervisor.

4 QMAPs are considered which type of reporter under Colorado law?

✓ Correct! QMAPs are Mandated Reporters — legally required to report known or suspected MANE.
✗ QMAPs are Mandated Reporters under Colorado law — meaning they are legally required to report MANE.

5 Under HIPAA, which of the following is considered protected health information (PHI)?

✓ Correct! Diagnoses and medications are protected health information under HIPAA.
✗ A client's diagnoses, medications, name, and address are all protected health information (PHI) under HIPAA.

6 When a QMAP discovers a medication error, what is the FIRST thing they should do?

✓ Correct! Immediately notify your supervisor and physician — then document and follow your facility's policy.
✗ The first step is always to immediately notify the supervisor and physician. Then follow your facility's policy and document.
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