Lesson L3-1 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Step four is where you become the last safety check for your client. Before you pour anything, you compare three things: the medication label, the MAR, and the prescription. At Waiver360 we call this the triple check — that is our name for it, not an APD term. Look at all three and make sure they match on four things: the Right Medication, the Right Dose, the Right Route, and the Right Time. Then ask one more question — the Right Reason. If a medication is ordered for a certain reason, like for pain, you may not give it for anything else without a new order from the prescriber. Right Time has a little room built in. A dose is still on time from one hour before to one hour after the time on the MAR — a two-hour window. But if the order sets a schedule, like "with meals," you follow that schedule. You cannot move it for convenience. Six of the seven Rights happen right here, before the dose ever leaves your hand. The seventh — documentation — comes after the client takes it.
17 of 17 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.D (Label ↔ MAR ↔ Prescription — the Triple Check) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-1.D`** > (Instructional Domain Model). 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.D` | | `competency_id` | `C-3.1` (⇄ `C-2.3` / `C-2.4` / `C-2.5` / `C-2.6` / `C-2.7`) | | `lesson_ids` | `[L3-1, L2-3, all route lessons]` (cross-cutting — the pre-hand comparison recurs on every route) | | `clinical_risk` | **Critical** → 100% KC mastery, sim force-fail, SME-protected KC keys | | `medication_error_prevented` | Wrong drug / dose / route / time / reason reaching the client (the MAP is the last line of defense) | | `sme_status` | `in_review` | | `apd_traceability_status` | sourced — window rewrite pending M+N (`[Needs Owner Review]`) + one `[Waiver360-added]` term | ## Patient-safety chain Owner directive (2026-07-05): MA.L3-1.D is a **patient-safety concept**. The chain below states, in five explicit lines, how this concept protects a resident end-to-end. Nothing here asserts beyond the concept's sources; it is the safety rationale that binds narration, sim, and KC into one loop. 1. **Medication error prevented.** The wrong drug, wrong dose, wrong route, wrong time, or wrong reason reaching your resident's mouth. At the pour step the MAP is the *last line of defense* — after this, the resident swallows and the error is inside a person who cannot always tell you something is wrong. 2. **Why staff make this mistake (the real reason — not "they forgot").** On a busy med pass the three documents almost always agree, so staff stop *comparing* and start *glancing*. They trust the pharmacy label alone, or the MAR alone, because "it's always been right before." The dangerous cases are the silent ones: a pharmacy relabel, a dose change the prescriber phoned in, a PRN a resident asks for by name — where one artifact no longer matches the other two and nobody re-checks all three under time pressure. 3. **How the lesson/transcript prevents it.** `l31-triple-check` turns the comparison into a *named, deliberate ritual* — the "triple check" — instead of a glance: put the label, the MAR, and the prescription side by side and confirm they match on Right Medication, Dose, Route, and Time, then Right Reason, and hold the dose in the two-hour window unless the order sets a schedule. It names the MAP as the last line of defense so the step feels consequential, not clerical. 4. **How the simulator reinforces it.** `don-montana--triple-check-forcefail` makes the learner perform three click-to-compare confirmations (label -> MAR -> prescription) before the pour unlocks. A planted discrepancy is seeded; pouring on a mismatch — or skipping a comparison — is a **force-fail critical error** that cannot be clicked past, mirroring the real bedside stakes rather than a warning toast. 5. **How the KC verifies mastery.** Two SME-protected, 100%-gating items prove the resident is protected before the simulator or mastery test opens: `KC-L3-1-D-Q1` verifies the Right Time two-hour window (catches both the too-strict and the too-loose timing error), and `KC-L3-1-D-Q2` verifies Right Reason (a fever-ordered PRN is not given for a headache; the MAP escalates instead of expanding the indication). ## 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 build. 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 2 s58 (compare LABEL to MAR to prescription — Right Medication/Dose/Route/Time) + Module 1 s66 (Right Reason), s69 (two-hour window); checkpoints Mod2 v2 Q31, Mod3 v3 Q10" - `form_reference`: "APD Form 65G-7.008 A (MAR)" | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | Compare the medication label to the MAR and the prescription; confirm Right Medication, Dose, Route, Time | `[APD]` | Module 2 s58; Mod2 v2 Q31 | null | | C2 | Right Reason — a medication ordered for one reason may not be given for another without a prescriber order | `[APD]` | Module 1 s66 — scope framing is legacy **SRC-12**, `TODO(source-D2)` | null | | C3 | Right Time is a two-hour window (one hour before to one hour after); a set-schedule order overrides it | `[Needs Owner Review]` | Module 1 s69; Mod3 v3 Q10 — **the pending time-rewrite**, `TODO(source-D1)` | null | | C4 | Six of the seven Rights are verified before the dose leaves the hand; Documentation is the seventh (after) | `[APD]` | Module 2 s58 + Module 1 s65–71; legacy SRC-6 (⇄ MA.L3-1.F) | null | | C5 | "Triple check" is Waiver360's name for the three-artifact comparison — not an APD term | `[Waiver360-added]` | docs/42 MA.L3-1.D item 7; legacy SRC-4 (phrase absent from Modules 1/2/3) | null | | C6 | The planted discrepancy used in the Don Montana triple-check sim (which artifact, which Right) | `[Needs Owner Review]` | Sim-authoring detail, `TODO(source-D3)` — SME to specify before the scenario is built | null | ## Decision queue → owner / SME (Michele + Nicole) 1. **`TODO(source-D1)` — the two-hour-window time-rewrite (C3).** docs/42 flags this as pending M+N. The bundle carries "one hour before to one hour after — a two-hour window" in narration and as the `KC-L3-1-D-Q1` answer key, but as **draft / preview-only** with `verified_by: null`. SME to confirm the exact window phrasing and the tighter-interval caveat before this concept can move `in_review → approved`. **This item gates KC-L3-1-D-Q1 and the l31-triple-check narration to production.** 2. **`TODO(source-D2)` — Right Reason scope framing (C2, legacy SRC-12).** Confirm APD's wording for an unlicensed MAP refusing an off-indication dose and escalating to the prescriber. Gates `KC-L3-1-D-Q2` and the pain-medication example in narration. 3. **C5 — the "triple check" name is `[Waiver360-added]`.** docs/42 says *keep the bridging line* that labels it as Waiver360's own term. Confirm the bridging line is acceptable, or choose Option B (drop "triple check" and use APD's "compare the label to the MAR to the prescription" phrasing). 4. **`TODO(source-D3)` — the Don Montana triple-check planted discrepancy (C6).** Specify which artifact mismatches and on which Right (kept drug-agnostic here to avoid clinical-pharmacy review) before the force-fail sim is built. ## Bundle contents (this concept) - `blocks/l31-triple-check.json` — narration (Step 4) - `knowledge-checks/KC-L3-1-D-Q1.json` — two-hour-window item (mcq4) - `knowledge-checks/KC-L3-1-D-Q2.json` — Right-Reason PRN item (mcq4) - `sim-rules/don-montana--triple-check-forcefail.json` — three click-to-compare confirmations, force-fail - Visual `triple_check_diagram` is a **registered** block (docs/41 §8 registry) — referenced by the storyboard (`V-L3-1-05` + `triple_check_diagram`), which a later aggregation step owns. No new exercise type is proposed by this concept.
Don Montana's medication is scheduled for 8:00 AM. You are running behind on the med pass. Under the Right Time rule, when is this dose still counted as "on time"?
Why: Right — the Right Time rule gives a two-hour window: one hour before to one hour after the scheduled time. For an 8:00 AM dose that is 7:00 AM to 9:00 AM. A dose a few minutes late is not a medication error. Remember: if the order sets a schedule (like "with meals" or "every 8 hours"), you follow the order instead.
Error prevented: A wrong-time administration — a dose given so early or so late that it stacks with the next dose or falls outside the ordered schedule.
Misconception: "The two-hour window is too strict (must be to the minute)" and "the two-hour window is too loose (any time on shift is fine)." (docs/42 MA.L3-1.D: 45-min-late is not an error; 6:30-for-9:00 is an error.)
Don Montana has a PRN (as-needed) medication with an order that says to give it for a fever. Don tells you he has a headache and asks for that same medication. He has no fever. What is the Right Reason thing to do?
Why: Right — Right Reason means you give a medication only for the reason it was ordered. This order is for fever, and Don has no fever. You are not authorized to give it for a headache on your own. You stop and contact the prescriber to see if the order should change.
Error prevented: A medication given for an indication it was never ordered for (a Right Reason violation), and a MAP overstepping scope by changing the indication or dose instead of escalating.
Misconception: "A PRN medication can be given for any reason" — specifically that a fever order can cover a headache (docs/42 MA.L3-1.D).
Entry: Learner reaches Don Montana's oral dose in the MAR Simulator and moves to pour. A triple-check gate opens: the medication label, the MAR row, and the prescription are presented side by side with three click-to-compare confirmations (label -> MAR -> prescription).
Mastery: 100% — force-fail on the triple-check gate; no partial completion.
Force-fail: FORCE-FAIL. The scenario cannot complete until all three comparisons are done and any mismatch is caught and the dose held. The sim surfaces the same compassionate-framing modal as the KCs, with a direct link to the Step 4 re-anchor clip (l31-triple-check) and a 'Try again' CTA; it does not silently fail.
Shot: The registered triple_check_diagram: three artifacts side by side — medication label, MAR, prescription — with click-to-compare lines. A horizontal seven-Rights strip beneath.
Camera: Push in on each artifact as it is compared (label → MAR → Rx); pull back to show all three matched, then to the Rights strip.
Avatar: Voiceover.
Visual: Consolidate the pre-hand Rights into one repeatable comparison of three artifacts (MA.L3-1.D visual: triple_check_diagram registry block; animation: six Rights light on the strip, #7 dark until after administration). Critical concept. On-screen label uses APD-verbatim 'compare the label, the MAR, and the prescription' — the [Waiver360-added] name is NOT rendered.
Animation: Three compare-lines confirm in order (label→MAR→Rx). Six of the seven Rights light on the strip as each is verified; Right #7 (Documentation) stays dark until after the dose is given.
Infographic: triple_check_diagram (registered content block) as the frame's live infographic; match-on badges: Right Medication · Dose · Route · Time · Reason. NO numeric time window rendered ([Needs Owner Review], TODO(source-D1)). Off-indication note: 'ordered for pain ≠ give for anything else without a new order'.
Three-artifact compare (label · MAR · prescription) with click-to-compare lines and a seven-Rights strip that lights six-then-holds-#7. Built on the registered triple_check_diagram block.
🖼 image prompt: Flat-vector three-panel compare: medication label, MAR row, and prescription side by side with click-to-compare connector lines; match badges 'Right Medication · Dose · Route · Time · Reason'; beneath, a horizontal seven-Rights strip. Layout faithful to APD Form 65G-7.008 A and to the registered triple_check_diagram. Label the action 'compare the label, the MAR, and the prescription' — do NOT use the phrase 'triple check'. Do NOT render any numeric time window ([Needs Owner Review], TODO(source-D1)). Neutral clinical palette, synthetic content only, no logos. [APD] Module 2 s58 + Module 1 s66.
🎬 video prompt: Three compare-lines confirm in order (label→MAR→prescription); six of the seven Rights light on the strip as each is verified; Right #7 (Documentation) stays dark until after the dose is given; no numeric window shown; transparent background; no camera move. [APD]
Target runtime: 4:30 · 7 chapters · not rendered (url: null)