MACE Exam Format, Timing & Scoring

The aide must ensure medications are in-date during the standard checks; if expired, the correct action is to hold the drug and notify the nurse so a replacement can be ordered. It is a common misconception that over-the-counter medications do not expire, but no medication should ever be administered past its expiration date due to lost efficacy or chemical changes. Adjusting a dose might seem logical for a weakened drug, but a Medication Aide is never allowed to calculate or change a dose. Throwing the medication away immediately solves the immediate problem, but medications must be disposed of according to strict facility policy, never in a regular trash can, and the nurse must be notified first.

A sudden change in mental status (confusion, slurring, lethargy) is a significant change in condition that must be reported to the nurse immediately before giving any medications. Giving water might seem helpful to wake a resident, but giving any oral intake to an unusually sleepy and slurring resident poses a severe choking and aspiration risk. Crushing medications might make them seem easier to swallow, but it does not eliminate the aspiration risk for a lethargic resident, and crushing requires a specific order. Skipping the dose without notifying anyone avoids the choking risk, but it neglects the resident's potentially urgent medical situation which requires immediate nursing assessment.

Medications requiring refrigeration can lose effectiveness or spoil at room temperature; the aide must withhold the dose and notify the nurse so the pharmacy can be contacted for a safe replacement. Returning the bottle to the refrigerator seems like the right way to fix the error, but the medication has been left out for an extended period and may have already spoiled. Shaking liquid medications is often required, but it does not fix the fact that the medication was stored at the wrong temperature and may be degraded. Documenting the error is important, but administering improperly stored medication is unsafe and could result in the resident receiving an ineffective or harmful dose.