Lesson L3-1 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Okay — step two, let's gather your supplies. Here is the one habit that protects your clients more than any other: work with ONE client at a time. Pull out just this client's medications, their MAR, and one cup. That's it — nobody else's meds on the counter yet. Now keep the space calm: put the phone away, turn off the TV, and let coworkers know you're passing meds so they hold the side conversations. You want your full attention on this one client. Here's the part people rush: never pour a dose ahead for later, and never set a poured cup down and walk away. A cup sitting out on the cart — even a labeled one — is not safe. And if you do get interrupted, say the phone rings or someone knocks, just stop. Secure this client's medications so no one else can reach them. Then start this same client over, from step one — don't try to pick up where you left off. Why are we this strict? Because distractions are a leading cause of medication errors. It's usually not about training — it's one busy moment that split someone's attention. Protect that attention, and you protect your client.
18 of 18 critical claims are verified_by: null (Gate-2 SME sign-off pending → preview only, production-blocked under the Rule-3.6 waiver). · runtime budget: 4:30
# Concept mirror — MA.L3-1.B (One Client at a Time) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-1.B`** > (Instructional Domain Model), with the cross-cutting worked example in **docs/42 §G**. This file is > the local traceability ledger + decision queue for the derived-asset bundle; if it ever disagrees > with docs/42, **docs/42 wins** (docs/43 §22 authority flow). | Field | Value | |---|---| | `concept_id` | `MA.L3-1.B` | | `competency_id` | `C-3.1` | | `lesson_ids` | `[L3-1, L3-2, topical, inhalation, ophthalmic, otic, L4-1, annual-review]` (cross-cutting — docs/42 §G worked example; authored once, presented many) | | `clinical_risk` | **High** → ≥90% KC mastery, spaced repetition; sim distraction event logs a **warning** (not a force-fail — this concept is not Critical) | | `medication_error_prevented` | Wrong-client / double-dose from divided attention and pre-pouring | | `sme_status` | `in_review` | | `apd_traceability_status` | sourced — softened "leading cause" resolved to `[APD]` (docs/42 §E item 9; superlative prohibited/unused) + one recovery-wording anchor (`TODO(source-L31B-1)`) + one `[Waiver360-added]` de-identification | ## Rule-3.6 author-ahead waiver (recorded 2026-07-05) The concept is `in_review`, not `approved`. Per docs/42 §I.1 / docs/43 §4, this bundle is authored **ahead of concept approval under a Rule-3.6 waiver** as part of the Oral Route reference implementation. Consequence: **every fragment in this bundle is `sme_status: "draft"`, preview-flag only, and production-publish-blocked** until (a) the concept reaches `approved` and (b) a Gate-2 SME sign-off is recorded in `content_revisions.sme_signoff_*`. ## Source ledger (projects into `payload_json.sources`) - `curriculum_source`: "APD BMA Module 3 s33–35 (one client at a time; pre-pouring danger) + Module 2 s58 (one client's meds at a time). Checkpoints: Mod3 v2 Q9 (wrong-person), v3 Q3 (distraction)." - `form_reference`: "APD Form 65G-7.008 A (MAR)" (referenced; no MAR mechanics authored in this concept) | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | Prepare, give, and document for **ONE client at a time**; only one client's medications are handled at once | `[APD]` | Mod3 s33–35; Mod2 s58 | null | | C2 | **Pre-pouring is dangerous** — a pre-poured / labeled cup, or a poured dose left on the cart, is not safe | `[APD]` | Mod3 s33–35 (pre-pouring danger) | null | | C3 | If interrupted, **stop, secure the medications, and restart that client from step one** | `[APD]` | Mod3 s33–35 — **`TODO(source-L31B-1)`**: SME to confirm the exact "restart at step one" recovery wording is APD-stated vs. instructional scaffolding | null | | C4 | **Distractions are a leading cause of medication errors** (softened; the superlative "the #1 / number-one cause" is PROHIBITED and unused) | `[APD]` | Mod3 s33 — docs/42 §E MA.L3-1.B item 9 authorizes the softened "a leading cause" phrasing as APD-aligned; the superlative stays out of scope (APD lists distractions as #2/#6). verified_by null pending Gate-2 | null | | C5 | The poured dose stays under the MAP's control until the client has swallowed it (basis for "secure the med, never leave it out") | `[APD]` | Mod2 s64 (⇄ `MA.L3-1.E`) | null | | C6 | Scenario dose de-identified to "a 5 mL oral solution" — the drug name is dropped to avoid a drug-specific clinical-pharmacy claim | `[Waiver360-added]` | Compliance de-identification of legacy `TODO(source-10)`; synthetic client only | null | ## Patient-safety chain 1. **Medication error prevented.** A MAP sets out more than one resident's medications at once — or pours a dose ahead and leaves the cup on the cart — and then attention is divided. The poured dose reaches the **wrong resident**, or a resident is given a **second dose**, because the med pass was no longer one-resident-at-a-time. Wrong-client / double-dose from divided attention and pre-pouring. 2. **Why staff make this mistake — the real-world reason.** It is almost never "forgot." A group-home med pass is busy: several residents waiting, the phone ringing, someone at the door. Pouring a few cups ahead and setting them out *feels* efficient and *feels* kind — the MAP is trying to get everyone their meds faster, not cut corners. And it looks safe: most shifts nothing goes wrong, the pre-poured cup gets to the right person, so the shortcut gets repeated until the one shift a distraction sends the wrong cup to the wrong resident. 3. **How the lesson/transcript prevents it.** Block `l31-gather-supplies` sets up the **single-client space** as a hard habit: only this resident's medications, MAR, and cup are out; the space is kept calm (phone away, TV off, side conversations held). It names the two pre-pouring traps out loud — a poured dose left on the cart and pouring ahead for later are **not** safe — and gives the one interrupt rule: **stop, secure the medications so no one else can reach them, and start that resident over from step one.** 4. **How the simulator reinforces it.** In the Don Montana scenario a phone-ring / distraction event fires mid-pass. Because this concept is **High** risk (not Critical), failing to dismiss and recover from the distraction **logs a warning**, not a force-fail — the sim flags the divided-attention moment and the expected recovery (secure, restart at step one) without blocking the scenario. 5. **How the KC verifies mastery.** `KC-L3-1-B-Q1` (the phone rings right after 5 mL is poured for the resident) and its doorbell variant `KC-L3-1-B-Q1B` key mastery as **stop, secure the medication, and restart that resident at step one** — not "finish quickly" and not "leave the cup and step away." The correct-answer logic does **not** depend on the softened "leading cause" magnitude claim; it verifies the behavior, so the item stays valid regardless of how that wording resolves at M+N. ## Decision queue → owner / SME (Michele + Nicole) 1. **The "leading cause" wording — RESOLVED by docs/42 §E item 9 (no longer gating).** docs/42 authorizes the softened **"a leading cause of medication errors"** as `[APD]` (Mod3 s33); the non-APD superlative "the #1 / number-one cause" is prohibited and is **not used** anywhere (APD lists distractions as items **#2 and #6**, not #1). The block and KC now tag this `[APD]` (verified_by null pending the normal Gate-2 sign-off, like every bundle claim). No standalone SME decision remains for this item beyond Gate-2. 2. **`TODO(source-L31B-1)` — recovery procedure.** Confirm "stop, secure the medications, restart that client from step one" is APD-stated (Mod3 s33–35) vs. `[Waiver360-added]` instructional scaffolding of the one-client-at-a-time principle. The legacy script flags "start THAT client over" (not "the next client") as deliberate SME wording — carry it forward exactly. 3. **Scenario drug de-identification (C6).** Confirm dropping "Risperidone" for "a 5 mL oral solution" is acceptable, or supply an SME-approved synthetic drug + realistic adult dose (resolves legacy `TODO(source-10)`). We must not imply clinical-pharmacy review of a named drug/dose. ## Bundle scope Authored here: `blocks/l31-gather-supplies.json`, `knowledge-checks/KC-L3-1-B-Q1.json`, `knowledge-checks/KC-L3-1-B-Q1B.json` (doorbell variant), `sim-rules/don-montana--distraction-warning.json`. No exercise-type proposal: the KCs use the base `mcq4` type (docs/43 §7), already a CMS item type — not a registry exercise. Storyboard (`V-L3-1-03`), video-meta, manifest, and README are owned by the later lesson-aggregation step.
You have just measured a 5 mL oral solution into a medicine cup for Ellen (a synthetic training client). Before you give it to her, your phone rings — it is the program manager calling. What should you do?
Why: Right. Secure the medication and finish Ellen first. The dose stays under your control until she has swallowed it, and the call can wait. Handling one client at a time is how you avoid a wrong-client or double-dose error.
Error prevented: Wrong-client administration or a double-dose caused by divided attention and an unattended poured dose.
Misconception: "Labeled pre-poured cups are safe" and "a poured dose on the cart is fine" (docs/42 §E.9) — and the belief that a med pass can be safely interrupted mid-dose.
You have just poured a tablet into a medicine cup for Joe (a synthetic training client). The doorbell rings — it is a delivery. What should you do?
Why: Right. Secure the tablet and finish Joe first. One client at a time, from step one through the swallow — the door can wait. Securing the dose before you step away prevents a wrong-client pickup or a lost, unaccounted dose.
Error prevented: Wrong-client pickup or a lost/unaccounted dose from leaving or handing off an in-progress administration.
Misconception: "A poured dose on the cart is fine" and "an in-progress dose can be handed off" — retested in a second interruption context.
Entry: Learner is mid-pass in the Don Montana MAR Simulator; a phone-ring distraction event fires while a dose is being prepared (before the client has taken it).
Mastery: >=90% with spaced repetition (docs/42 §H). The distraction event logs a warning, not a force-fail; there is no 100% hard gate on this concept.
Shot: Overhead 'one-client zone' on the cart: this client's meds + MAR + cup lit; everything else greyed. Insert B-roll: a phone lighting up, a hand pausing.
Camera: Top-down establishing shot of the zone; quick push toward the ringing phone on the interrupt beat; back to the zone on 'restart at step one'.
Avatar: Voiceover; Michele off-screen.
Visual: Show a single-client workspace and the recovery move when interrupted (MA.L3-1.B visual: one-client zone overhead; animation: interrupt → STOP, secure, restart step 1).
Animation: Phone rings → the poured cup and MAR get a red lock overlay (secured) → the zone resets to an empty step-1 state. A poured dose left on the cart is stamped and cleared.
Infographic: Greyed-out everything-else overlay; red 'STOP · SECURE · RESTART STEP 1' banner on interrupt; printable [Waiver360-added] 'DO NOT DISTURB' cart sign as a corner take-away card. No magnitude/superlative text ('leading cause' softening kept out of on-screen copy, [Needs Owner Review]).
One-client zone (everything else greyed) with an interrupt → STOP·SECURE·RESTART overlay, plus a print-ready 'DO NOT DISTURB' cart sign.
🖼 image prompt: Top-down flat-vector med-cart 'one client at a time' zone: one client's medications, MAR, and a cup lit; all other items greyed out; a red 'STOP · SECURE · RESTART STEP 1' banner; inset a stylized print-and-laminate 'DO NOT DISTURB' cart sign. Neutral clinical palette, synthetic content only, no logos. Do NOT render any 'number-one / #1 cause' magnitude text ([Needs Owner Review]). [APD] Module 3 s33-35 + [Waiver360-added] DO NOT DISTURB sign.
🎬 video prompt: A phone rings; the poured cup and MAR gain a red lock overlay (secured); the zone resets to an empty step-1 state; a dose left on the cart is cleared; transparent background. [APD] one-client-at-a-time recovery.
Target runtime: 4:30 · 7 chapters · not rendered (url: null)