QMAP Student Study Guide

Section 1: QMAP Overview & Prerequisites

What Is a QMAP?

A Qualified Medication Administration Person (QMAP) is an unlicensed person trained and tested to administer medications to clients in Colorado residential and community-based care settings.

Prerequisites to Attend QMAP Training

• Be at least 18 years of age
• Understand, follow, and communicate verbal and written instructions in English
• Pass a criminal background check once hired
• Present a valid government-issued photo ID at class and testing

QMAP Scope — What You CAN Do

• Monitor — watch client self-administer (does not include opening containers)
• Administer — open container and provide medication to client (begins when you open the container)
• Administer via all 11 approved routes (oral, topical, ophthalmic, otic, nasal, sublingual, inhaled, transdermal patch, rectal, vaginal, topical cream/ointment)
• Administer epi-pen in emergency with approved anaphylaxis training

What You CANNOT Do

• Administer IV, IM, or subcutaneous injections
• Administer via G-tube, J-tube, or NG-tube
• Administer psychotropic medications PRN
• Adjust oxygen liter flow without a physician order
• Inject insulin (even from an insulin pen)
• Cut, crush, or open medications without a written order

Section 2: The 7 Rights

Every medication administration requires verification of all 7 Rights. Rights 1–5 must appear on all labels, orders, and the MAR.

1. Right PERSON — Verify the client's identity
2. Right DRUG — Verify the correct medication name
3. Right DOSE — Verify the correct amount
4. Right ROUTE — Verify the correct administration method
5. Right TIME — Verify the correct time and frequency
6. Right to REFUSE — Every client may refuse at any time, for any reason
7. Right DOCUMENTATION — Document accurately and immediately

Section 3: Legal & Ethical Responsibilities

MANE — Mandated Reporting

QMAPs are Mandated Reporters — legally required to report known or suspected MANE:

• M — Mistreatment
• A — Abuse (intentionally causing physical pain or injury)
• N — Neglect (failure to provide necessary care)
• E — Exploitation (taking advantage of a person's property or money)

Drug Diversion = misuse, theft, or unauthorized use of a client's medications. This is a criminal offense. Report discrepancies immediately to your supervisor.

HIPAA — Privacy & Confidentiality

Protected health information (PHI) includes: client name, address, diagnoses, medications. Sharing requires consent. Written, verbal, and electronic sharing are all covered.

Medication Errors

Any deviation from the physician's order. When an error occurs:

1. Immediately notify supervisor and physician
2. Follow your facility's policy
3. Document specifically on the MAR and incident forms

NEVER pre-pour. NEVER sit pills down and walk away. ALWAYS compare pharmacy label to MAR before giving.

Section 4: Infection Control

Universal Precautions

• Hand Washing
• Gloves
• Masks
• Gowns

Chain of Infection — 5 Links

1. Infectious Agent
2. Reservoir
3. Portal of Exit
4. Mode of Transmission
5. Portal of Entry

Breaking any one link stops the spread.

Hand Washing — 20 Seconds

The primary act to prevent infection. Sing "Happy Birthday" twice = 20 seconds. Gloves do NOT replace hand washing — they are semi-permeable.

Glove Use — Doffing

Outside of gloves is contaminated. Grasp outside of glove with opposite gloved hand → peel off inside-out → slide fingers under remaining glove at wrist → peel off → discard → wash hands.

Section 5: Medications — Types, Forms & Storage

Prescription vs. OTC

Both require a physician's written order before a QMAP can administer them. OTC does NOT mean no order is needed.

Controlled Substance Schedules

• Schedule I — No medical use (heroin, LSD)
• Schedule II — High abuse (oxycodone, morphine, Adderall)
• Schedule III — Moderate abuse (codeine combos)
• Schedule IV — Lower abuse (Xanax, Ambien, tramadol)
• Schedule V — Lowest (cough syrups with small amounts of codeine)

ALL controlled substances must be double locked. Refrigerated controlled meds: locked box in a LOCKED refrigerator.

Medication Forms

Solids: Plain tablet, scored tablet, caplet, enteric coated (never crush), capsule (never open without order), spansule (extended release — never crush), troche/lozenge

Liquids: Elixir (alcohol base), solution (clear), suspension (cloudy — shake well), syrup (sweet water base), emulsion, tincture, concentrate

Other: Suppository, transdermal patch, inhaler, gel cap, cream, ointment

Disposal

Patches → sharps container. Follow agency's written disposal plan.

Section 6: Administration Routes & Procedures

11 Approved QMAP Routes

1. Topical (Skin)
2. Ophthalmic (Eyes)
3. Otic (Ears)
4. Nasal (Nose)
5. Oral (Mouth — swallowed)
6. Sublingual (Under tongue)
7. Inhaled via upper airway (mouth or nose)
8. Topical cream/ointment
9. Topical patch (transdermal)
10. Rectal
11. Vaginal

Key Procedural Tips

• Eyes: Wait 3–5 minutes between different drops; do not touch eye with dropper tip
• Ears: Adults — pull back and UP; children — gently down and back; affected ear UP; wait 3–5 min between ears
• Nose drops: Lie on back with head tilted; remain in position 2 minutes
• Inhalers: Wait 1 minute between puffs; use spacer if ordered
• Patches: Wear gloves; remove old patch first; rotate sites; dispose in sharps container
• Oral liquids: Measure at eye level; never approximate; set cap upright; never mix different liquids
• Altering meds: Never cut, crush, split, or open without a written order

PRN vs. Routine

Routine = predictable schedule; no QMAP assessment needed. PRN = only when client needs it for a specific circumstance; document reason given.

Psychotropic PRN — NEVER administered PRN by a QMAP.

Section 7: Dosage Calculations

Strength vs. Dose

• Strength (S) = how strong each tablet/mL is (e.g., 5mg per tablet)
• Dose (D) = how much the physician ordered to give (e.g., 10mg)

Formula — Solids

Dose ÷ Strength = Number of Tablets to Give

Formula — Liquids

(Dose ÷ Strength) × Volume = mL to Give

Equivalencies — Chant: 5 · 15 · 30

• 1 tsp = 5 mL
• 1 Tbsp = 15 mL = 3 tsp
• 1 oz = 30 mL = 2 Tbsp
• 1 cc = 1 mL
• 1,000 mg = 1 gram
• 1,000 mL = 1 Liter

Practice Problems

• Lasix 10mg ordered; have 5mg tablets → 10 ÷ 5 = 2 tablets
• KCl 20mEq ordered; have 40mEq tablets → 20 ÷ 40 = ½ tablet
• 50mg liquid ordered; have 5mg/cc → 50 ÷ 5 = 10 cc
• 1 ounce of Milk of Magnesia → 30 cc
• 1 Tbsp of Pepto Bismol → 15 mL
• 0.5 Gm = 500mg; have 250mg tablets → 500 ÷ 250 = 2 tablets

Section 8: Documentation & Medication Orders

7 Parts of a Valid Medication Order

1. Client's name
2. Date of order
3. Drug name
4. Dose
5. Route
6. Frequency/schedule
7. Prescriber's signature

Documentation Rules

• Document immediately after each administration
• Never leave a blank on the MAR — document refusals, missed doses, and reasons
• Documentation errors: single line through error, correction, initials, date — never white-out or black out
• D/C = Discontinued

Common Abbreviations — Must Know

Quick Reference — Key Numbers