MA.L3-1.E

# Concept mirror — MA.L3-1.E (Administer / Supervise — prepare & give)

> **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-1.E`**
> (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.E` |
| `competency_id` | `C-3.1` |
| `lesson_ids` | `[L3-1, L3-2]` (oral-specific technique; contrast with route-specific give-steps) |
| `clinical_risk` | **High** → ≥90% KC mastery + spaced repetition (docs/42 §H); observed-intake sim gate; KC answer keys are **not** SME-locked (SME-lock is Critical-only, docs/42 §D.2) |
| `medication_error_prevented` | Contamination of the dose; unobserved or incomplete intake; wrong-client pickup of an unattended dose |
| `sme_status` | `in_review` |
| `apd_traceability_status` | sourced — three concrete APD steps (s62 no-fingers/bottle→lid→cup, s64 preferred-drink + only-as-many-as-swallowable, s58 relock/keys) + **four open anchors** carried from legacy: SRC-7 (direct observation), SRC-8 (responsibility framing), SRC-13 (administer vs. supervise scope), L31-R01/s57 (STOP-ask chip) + one `[Waiver360-added]` escalation chip |

## 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 2 (oral administration technique — s58, s62, s64) + APD BMA Module 2 s57 (ASK your supervisor)"
- `form_reference`: "APD Form 65G-7.008 A (MAR)" (documentation of the given dose lives in MA.L3-1.F)

| # | Claim | Tag | Source | verified_by |
|---|---|---|---|---|
| C1 | Get the pill into the cup without touching it: "pop" it into the cup, or pour bottle→lid→cup; do not touch the pill with your fingers | `[APD]` | APD BMA Mod2 s62 | null |
| C2 | Hand the cup with a drink the client prefers; give only as many pills as the client can swallow at one time | `[APD]` | APD BMA Mod2 s64 | null |
| C3 | Watch the client take the dose (for pills, watch the swallow) and confirm the medicine cup is empty | `[APD]` (do-list, docs/42 §E field 4) — **specific slide anchor open** | docs/42 §E field 4; **`TODO(source-1)` = legacy SRC-7** (confirm APD requires direct observation of consumption for pills and liquids) | null |
| C4 | Return all medications to locked storage and keep the keys when done (relock) | `[APD]` | APD BMA Mod2 s58 | null |
| C5 | The dose stays under MAP control until the client has taken it — never leave a dose on the table for the client to take later | `[APD]` (KNOW, docs/42 §E field 4; reading of Mod2 s64) — **responsibility-framing wording open** | docs/42 §E field 4; **`TODO(source-2)` = legacy SRC-8** (confirm the "responsible until the client has taken it" phrasing) | null |
| C6 | Whether the MAP gives the dose (administer) or watches/helps the client give it to themselves (supervise self-administration) is set by the client's approved level, not the MAP's choice | `[Needs Owner Review]` | docs/42 §E field 9 misconception; **`TODO(source-3)` = legacy SRC-13** (confirm APD BMA distinguishes MAP-administered from MAP-supervised self-administration and how the level is set) | null |
| C7 | When unsure about a dose, a client's identity, or whether something belongs in the cup: STOP, ask your supervisor, never guess | `[APD]` (ASK your supervisor) + `[Waiver360-added]` ("STOP … never guess" chip + its placement) | APD BMA Mod2 s57 supports "ASK your supervisor!"; the chip wording/placement is Waiver360 scaffolding. **`TODO(source-4)` = legacy L31-R01** | null |

## Decision queue → owner / SME (Michele + Nicole)

1. **`TODO(source-1)` — SRC-7 direct-observation anchor.** The bundle narrates "watch them swallow /
   confirm the cup is empty" (docs/42 §E do-list). Confirm APD requires *direct observation of
   consumption* for both pills and liquids, and pin the slide. Until then C3 stays `verified_by: null`
   and the sim's observed-intake gate is preview-only. **This is the primary anchor gating the bundle
   to production.**
2. **`TODO(source-2)` — SRC-8 responsibility framing.** Confirm the exact phrasing "you are
   responsible until the client has taken the medication" against APD source (currently a defensible
   reading of Mod2 s64).
3. **`TODO(source-3)` — SRC-13 administer vs. supervise scope (C6, `[Needs Owner Review]`).** Confirm
   APD BMA distinguishes MAP-administered dose from MAP-supervised self-administration and how the
   client's level sets which applies. **Per docs/43 §15 this may NOT be locked into narration or a KC
   answer key** — narration only *describes* both actions ("give the dose, or watch and help the
   client take it themselves"); it asserts no scope rule. No KC answer key tests C6.
4. **`TODO(source-4)` — L31-R01 STOP-ask chip (C7, `[Waiver360-added]` portion).** APD Mod2 s57
   ("ASK your supervisor!") supports the ask pattern; the "STOP … never guess" wording and its
   placement at the end of the administer step are Waiver360 scaffolding, shared with MA.L3-2.C /
   MA.L3-3.B. Confirm the chip and its placement.
5. **Gel-cap / oral-form technique note.** This concept is oral-generic (bottle→lid→cup) and defers
   form-specific handling (crush/open/sublingual/chewable) to C-3.2; confirm the L3-1↔L3-2 split.

## Patient-safety chain

Owner directive: treat MA.L3-1.E as a patient-safety concept. The chain below is concrete and
specific to THIS concept (prepare-and-give technique), not generic.

1. **Medication error prevented.** A contaminated dose (fingers on the pill), an unobserved or
   incomplete intake (you never saw your resident actually swallow it), or a wrong-client pickup of a
   dose you poured and left sitting out — the wrong person swallows it, or your resident never takes it
   and you signed as if they did.
2. **Why staff make this mistake (the real-world reason).** It is not forgetfulness. On a busy morning
   med pass you have four residents waiting, a phone ringing, and a cup already poured. Setting the cup
   on the table and moving on *feels* efficient — "he always takes it, I'll come back." And you touch
   the pill with your fingers to double-check it is the right one, because that is how you handle every
   other object in the house. Time pressure and multitasking, not carelessness, are what put a dose out
   of your control.
3. **How the lesson/transcript prevents it.** Block `l31-administer` coaches the exact safe moves:
   bottle→lid→cup (or pop it straight in) so your fingers never touch the pill; hand the cup *with a
   drink*, give only as many pills as your resident can swallow at once, watch the swallow, and confirm
   the cup is empty. It names the rule out loud — "the dose is your responsibility until the client has
   taken it; do not set it down and walk away" — and ends with the shared STOP-ask chip.
4. **How the simulator reinforces it.** The `don-montana` observed-intake pass force-fails the pass the
   moment the learner touches the pill to prepare it, sets the poured cup down and steps away, or drops
   the documentation initials before Don's swallow is observed. The learner cannot "click past" an
   unattended dose; they must keep control, observe intake, and confirm the empty cup first.
5. **How the KC verifies mastery.** `KC-L3-1-E-Q1` tests the no-fingers pour with distractors that model
   the two real slips — clean-hand contact and pour-and-walk-away. `KC-L3-1-E-Q2` tests hand-with-a-
   drink / watch-the-swallow / confirm-empty-cup, with distractors for hand-off-and-multitask,
   set-it-down-and-step-away, and all-pills-at-once (choking). Passing both at the High ≥90% bar (with
   spaced repetition) is the mastery signal that the control-and-observe habit has taken.

## Bundle manifest + human index

`../MA.L3-1.E.manifest.json` and `../MA.L3-1.E.README.md` are **owned by the later lesson-aggregation
step**, not this concept bundle (per the authoring task scope). This mirror is the bundle's local
authority ledger only.