Module 5: Administration Routes | QMAP

The 11 QMAP-Approved Routes

ROUTE is a mandatory item on every medication label and MAR. Check labels carefully. The following routes are approved for QMAP administration:

#	Route	Description	Example Forms
1	Topical (Skin)	Applied to the surface of the skin	Creams, ointments, liquids, sprays
2	Ophthalmic (Eyes)	Instilled into the eye	Eye drops, eye ointments
3	Otic (Ears)	Instilled into the ear canal	Ear drops
4	Nasal (Nose)	Instilled into nasal passages	Drops, sprays, aerosol, creams/ointments to mucosa
5	Oral (Mouth)	Swallowed; most common route	Tablets, capsules, liquids
6	Sublingual (Under Tongue)	Placed under the tongue to dissolve	Sublingual tablets, drops, powder
7	Inhaled (Upper Airway)	Breathed in through mouth or nose	Aerosol spray, inhaler
8	Topical Cream/Ointment	Applied to skin for local or systemic effect	Prescription creams, ointments
9	Topical Patch (Transdermal)	Adhesive patch releasing medication through skin	Nicotine patch, pain patch, hormone patch
10	Rectal	Inserted into the rectum	Suppositories, creams, ointments
11	Vaginal	Inserted into the vagina	Suppositories, creams, ointments, dissolvable tablets

NOT approved routes for QMAP: Intravenous (IV), intramuscular (IM), subcutaneous injection, G-tube, J-tube, or NGT administration are all outside QMAP scope of practice.

Oral (Solid) Medication Procedure

Some clients have swallowing difficulties — ask if they prefer to take one pill at a time or several
Always bring a cup of water for the client to drink with medications
After all medications are swallowed, encourage additional sips of water
Remain with the client until all medications are swallowed
Never leave medications unattended (NEVER sit pills down and walk away)

Altering Medications — Critical Rules

You may NOT cut, crush, split, or open capsules, or mask medications in food — without a written order from an authorized practitioner. If such an order exists, it must be reflected on the MAR for each client.

If a client cannot swallow a tablet and no liquid form exists, the physician may write an order to crush. Acceptable crushing methods: mortar and pestle or a pill-crushing device.

Oral Liquid Medication Procedure

Extra care is needed when measuring liquids — plan for more time
Check labels for special instructions: "Shake Well," "Requires Dilution"
Do NOT mix different liquid medications together
Never approximate — measure accurately using an appropriate measuring device
Always set the bottle cap upright on a surface to prevent contamination of the lid edges
Laxatives must be taken with sufficient fluids to work properly
Measure liquids at eye level for accuracy

Eye Drops and Eye Ointments

Eye drops are dosed by the number of drops given
Wash hands before and after; wear gloves when there is redness, drainage, or possible infection
Wait 3 to 5 minutes between two or more different eye drops administered at the same time
Do NOT touch the eye with the dropper or medication container tip
Eye ointments are dosed by measurement in strips (e.g., "¼ inch ribbon")
Have client tilt head back and look up; gently pull down lower eyelid to form a pocket

Ear Drops

Ear drops are dosed by the number of drops given
Wash hands before and after; wear gloves if there is redness, drainage, or infection
Have the person sit or lie with the affected ear facing UP
Adults: Gently pull the outer ear back and UP to straighten the canal
Small children: Gently pull the outer ear slightly down and back
Instill the drops; wait 3 to 5 minutes before administering to the other ear

Nose Drops

Wash hands before and after; wear gloves (sneezing creates body fluid exposure risk)
Client should lie down on their back with head tilted
Ask or support the client to remain in position for about 2 minutes after instillation
Do not touch the nasal mucosa with the dropper tip

Oral Inhalers

Spacing and proper sequence of inhalers is important for maximal drug effectiveness
The prescribing practitioner may specify the sequence for multiple inhalers
Wait at least 1 minute between puffs for multiple inhalations of the same inhaler
An aerochamber (spacer) improves delivery — use if prescribed
Rinse the client's mouth after using certain inhalers (e.g., corticosteroid inhalers) to prevent thrush

Transdermal Patches

Wear gloves to avoid absorbing medication into your own skin
Remove the old patch before applying a new one — document removal site
Rotate application sites per order to prevent skin irritation
Never cut a patch — altering the dose in this way is NOT permitted without a written order
Dispose of used patches in a sharps container (fold sticky side in first)

PRN vs. Routine Medications

Type	Definition	Assessment Required?
Routine	Given regularly in a predictable pattern (e.g., Digoxin 0.25mg daily)	No assessment by QMAP required; follow the schedule
PRN (as needed)	Given only when the client needs it for a specific circumstance (e.g., pain, anxiety)	Yes — the QMAP must recognize the need (e.g., client reports pain) and document the reason given

        PRN Timing Rule: Do NOT schedule PRN medications for administration at specific times — they are given only when the resident "needs" them based on a recognized condition or symptom.
      

PRN medications must NOT be placed in MRBs (Medication Reminder Boxes) or blister packs. Because PRN medications are administered only as needed and at variable times, placing them in a pre-filled MRB would create documentation confusion and dosing errors. PRN medications should be kept separately in their original pharmacy container with the physician's order accessible.

Psychotropic Medications

Psychotropic medications affect the Central Nervous System and alter thought, behavior, and perceptions. These medications can be considered a chemical restraint.

Critical Rule: QMAPs may NEVER administer psychotropic medications on a PRN (as-needed) basis. For some Medicaid-funded services, specific written consent by the client or their legal representative is required for psychotropic medication use.

Special Situations

Epi-Pen (Emergency Only)

A QMAP may administer an epi-pen in an emergency anaphylaxis situation — but ONLY with completion of an approved anaphylaxis training program (nationally recognized) and authorization under §25-47-103, C.R.S. Always follow your facility's policy and procedures.

Oxygen

If a client is short of breath and requests that their oxygen liter flow be turned up, the QMAP may NOT do so simply because the client requested it. Oxygen levels are a physician order and may only be adjusted per written order.

Insulin Pens

A QMAP may NOT dial up and inject insulin even if the client has an insulin pen. Insulin administration by injection is outside QMAP scope of practice.

Safety & Emergency Procedures

QMAPs work in settings where medical emergencies can occur. Knowing your role — and your limitations — in an emergency is required by Colorado Chapter 24 regulations.

The QMAP's Role in Emergencies

In any emergency, the QMAP's role follows a clear set of priorities:

Remain Calm — Your calm demeanor will reduce the client's fear and allow you to think clearly and act effectively
Call or Send for Help — Call 911 immediately for life-threatening emergencies. Notify your supervisor as soon as possible
Know Your Limitations — QMAPs are not nurses or emergency responders. Do not attempt procedures outside your scope of practice
Do Not Move an Injured Resident — Unless the person is in immediate danger (e.g., fire), do not move someone who may have a spinal or serious injury. Wait for trained emergency personnel
Reassure the Resident — Stay with the client, speak calmly, and let them know help is on the way
Take Direction from Nurse or Doctor — If a licensed professional is on-site or reachable by phone, follow their instructions until emergency services arrive

Specific Emergency Types

Emergency	Signs	QMAP Action
Choking	Unable to speak or cry out, clutching throat, turning blue, weak or no cough	Call 911 immediately. If trained in Heimlich maneuver, perform it. Stay with the client. Never leave them alone.
Seizure	Sudden muscle spasms, loss of consciousness, stiffening of body, rhythmic jerking	Call 911. Clear the area of hard objects. Do NOT restrain the person or put anything in their mouth. Time the seizure. Stay calm and reassure the client when consciousness returns.
Anaphylaxis (Severe Allergic Reaction)	Hives, throat swelling, difficulty breathing, rapid drop in blood pressure, loss of consciousness	Call 911 immediately. If you are trained and authorized per §25-47-103 C.R.S. and a prescribed epi-pen is available, administer it per your training. Follow emergency operator instructions.
Fall	Client on the floor, in pain, confused, or unresponsive	Call 911 if there is any sign of serious injury. Do NOT move the client. Stay with them and keep them calm. Notify supervisor and document the incident.
Medication Overdose / Wrong Medication Given	Unusual drowsiness, difficulty breathing, confusion, loss of consciousness	Call 911. Do NOT induce vomiting unless directed by Poison Control (1-800-222-1222). Notify supervisor immediately. Bring the medication bottle to the ER if possible.

Critical Rule: A QMAP is NEVER expected to perform CPR, intubation, or other advanced medical procedures unless they hold a separate certification. Your role is to recognize the emergency, get help, keep the client safe, and provide comfort until trained responders arrive.

        After Any Emergency: Complete an incident report per your agency's policy, document on the MAR if a medication was involved, and notify the client's family or legal representative as appropriate. Follow up with your supervisor.
      

Medication Administration Routes