Medical Assistant Mnemonics: 12 Memory Tricks for the CCMA

Rights of medication administration

“Please Don't Drop Red Tablets, Doc”

1. PRight Patient: two identifiers, such as name and date of birth
2. DRight Drug: compare the label with the order
3. DRight Dose: check the calculation and units
4. RRight Route: oral, IM, subcutaneous, intradermal, topical and so on
5. TRight Time: and right frequency
6. DRight Documentation: recorded after the dose is given

Use it when: When a stem describes a medication error and asks which right was violated, or what to check before giving a dose.

Careful: Textbooks list anywhere from 5 to 10 rights; the extras are right reason, right response (evaluation) and the patient's right to refuse. Documentation always comes after administration, never before. Check the label three times: when you take the drug from storage, when you prepare it, and before you give it.

Injection angles

“Deeper goes steeper: ID 5-15, SubQ 45, IM 90”

1. IDIntradermal: 5-15 degrees, bevel up, raises a wheal (TB skin test)
2. SCSubcutaneous: 45 degrees, 23-25 gauge, 5/8-inch needle
3. IMIntramuscular: 90 degrees, 22-25 gauge, length chosen by site and patient size

Use it when: When an item asks for the angle, gauge or site for a given injection type.

Careful: Infants under 12 months receive IM injections in the anterolateral thigh, not the deltoid (CDC). Short insulin-pen needles are often given at 90 degrees subcutaneously, so follow the product instructions. CDC says aspiration is not necessary before giving a vaccine.

Exam positions

“Fowler breathes, Sims sees the rectum, Lithotomy for the pelvis, Dorsal bends the knees, Prone shows the back”

1. FFowler's (sitting, head raised): breathing difficulty, head and chest exams
2. SSims' (left side, right knee drawn up): rectal exam, enemas
3. LLithotomy (on the back, feet in stirrups): pelvic exam and Pap test
4. DDorsal recumbent (on the back, knees bent, feet flat): vaginal or rectal exam when stirrups are not tolerated, catheterization
5. PProne (face down): back and spine exam

Use it when: When an item names an exam or procedure and asks how to position and drape the patient.

Careful: Sims' is on the left side. Keep a patient in lithotomy only as long as needed and keep her draped. Trendelenburg (head lower than feet) is no longer recommended as a first-aid position for shock; current first-aid guidance keeps the person lying flat on the back.

Low vs high blood sugar

“Cold and clammy, give them candy; hot and dry, sugar's high”

Low blood sugar (hypoglycemia) comes on fast: cool, pale, sweaty skin, shakiness, confusion. If the patient is conscious and can swallow, give 15 grams of fast-acting carbohydrate and recheck in 15 minutes (the rule of 15). High blood sugar (hyperglycemia) develops gradually: warm, dry skin, thirst, frequent urination, fruity breath.

Use it when: When a diabetic patient becomes unwell in the office and the item asks what is happening or what to do first.

Careful: Never give food or drink to a patient who is unconscious or cannot swallow; call for help, and the provider may give glucagon. If unsure and the patient is conscious, treating as low is the safer choice. The ADA treats a glucose below 70 mg/dL as hypoglycemia.

Chain of infection

“In Really Poor Manners, People Spread”

1. IInfectious agent
2. RReservoir
3. PPortal of exit
4. MMode of transmission
5. PPortal of entry
6. SSusceptible host

Use it when: When an item describes an infection-control action and asks which link it breaks, or lists the links in order.

Careful: Breaking any single link stops the infection. Hand hygiene breaks the mode of transmission, vaccination protects the susceptible host, and covering a cough blocks the portal of exit. Do not mix up the two portals: exit is how the agent leaves the reservoir, entry is how it gets into the next host.

Putting on and removing PPE

“Gloves on last, off first; doff in alphabetical order: Gloves, Goggles, Gown, Mask”

Donning (CDC): gown, mask or respirator, goggles or face shield, then gloves. Doffing (CDC Example 1): gloves, goggles or face shield, gown, then mask or respirator, which happens to be alphabetical. Perform hand hygiene right after removing all PPE, and any time your hands become contaminated in between.

Use it when: When an item asks which PPE item goes on first, comes off first, or what comes next in the sequence.

Careful: CDC's Example 2 removes the gown and gloves together, then goggles, then mask; both examples are acceptable. A respirator is removed after leaving the room and closing the door. Some study materials put the mask before the gown during doffing, which is not CDC's sequence.

Sanitization, disinfection, sterilization

“Clean it, then kill most, then kill all”

1. SSanitization: soap, water and scrubbing remove debris; always first
2. DDisinfection: chemicals kill most microorganisms, but not all spores
3. SSterilization: destroys all microorganisms including spores; the office autoclave uses steam under pressure

Use it when: When an item asks which level of cleaning an instrument needs, or what must happen before the autoclave.

Careful: Instruments are sanitized before they are disinfected or sterilized; leftover blood or tissue shields organisms from the process. Anything that enters sterile tissue must be sterile. Indicator tape that changes color shows the item went through a cycle, not that it is sterile; biological indicators confirm sterilization.

Pain assessment

“OPQRST”

1. OOnset: when did it start, sudden or gradual?
2. PProvocation and palliation: what makes it worse or better?
3. QQuality: sharp, dull, burning, crushing?
4. RRegion and radiation: where is it, does it spread?
5. SSeverity: rate it, for example 0-10
6. TTime: how long, constant or comes and goes?

Use it when: When an intake item asks which question to ask next about pain, or how to document a complaint.

Careful: Match the scale to the patient: a 0-10 numeric scale for most adults, the Wong-Baker FACES scale for young children. Chart the patient's own words rather than your interpretation. Chest pain or sudden severe pain goes to the provider immediately, not to the end of intake.

Blood pressure errors

“Small cuff, sky high; big cuff, bottoms out”

A cuff that is too small reads falsely high, and one that is too large reads falsely low. The bladder should be about 80% of the arm's circumference in length and about 40% in width. An arm below heart level, an unsupported back or arm, crossed legs, talking and recent caffeine or tobacco also raise readings.

Use it when: When an item describes how a blood pressure was taken and asks whether the reading is accurate, or how to correct the technique.

Careful: Systolic is the first Korotkoff sound you hear (phase I); diastolic is when the sounds disappear (phase V). An arm held above heart level reads falsely low. Under AHA/ACC categories, normal is below 120 systolic and below 80 diastolic.

Temperature by route

“Rectal reads highest, armpit lowest”

Compared with an oral reading, a rectal temperature is typically about 0.5-1 degree F higher and an axillary temperature about 0.5-1 degree F lower. Average oral temperature is about 98.6 degrees F (37 degrees C).

Use it when: When an item compares readings taken by different routes, or asks whether a reading is a fever for that route.

Careful: Always document the route with the number. Hot or cold drinks, eating and smoking skew oral readings, so wait about 15-30 minutes. Do not take rectal temperatures when it is contraindicated, such as after rectal surgery, and follow office policy for infants.

Elements of negligence

“The 4 Ds”

1. DDuty: a provider-patient relationship created a duty of care
2. DDereliction: the standard of care was not met
3. DDirect cause: the breach directly caused the harm
4. DDamages: the patient suffered an actual injury or loss

Use it when: When an item describes a mistake and asks whether it is negligence or malpractice, or which element is missing.

Careful: All four must be proven; an error that caused no harm is not a negligence case. Malpractice is negligence by a professional. Do not confuse it with assault (a threat that causes fear of harm) or battery (touching without consent).

Informed consent

“BRAN: Benefits, Risks, Alternatives, Nothing”

1. BBenefits of the procedure
2. RRisks of the procedure
3. AAlternatives that are available
4. NWhat happens if Nothing is done

Use it when: When an item asks what a patient must be told before signing a consent form, or who is responsible for it.

Careful: Explaining the procedure and obtaining informed consent is the provider's job; a medical assistant may witness the signature, but does not answer questions in the provider's place. Implied consent covers routine acts, such as a patient rolling up a sleeve for a blood pressure. Minors generally need a parent or guardian's consent unless state law allows otherwise, for example for emancipated minors.