Lesson L3-1 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Okay -- here is where the whole med pass clicks into place. You just learned six steps for an oral med pass. Before that, you learned the 7 Rights. Here is the good news: those are not two separate lists to memorize for a test. They are the same thing, in the order you actually work at your resident's side. Let me walk you through it. Step one, wash your hands. Step two, one client at a time. Those two steps keep the pass clean and focused. They protect the Rights, but neither one is a Right by itself. Step three, verify the client. That is the Right Person -- the resident in front of you is the one this med is for. Step four, compare the label to the MAR and the prescription. That one check covers five Rights at once: the right medication, the right dose, the right route, the right time, and the right reason. Step five, give the med and watch your resident swallow it. Step six, document it right away. That is the Right Documentation. Now count them with me. Person. Medication. Dose. Route. Time. Reason. Documentation. That is all 7 Rights. Six of them are done before the pill ever leaves your hand. The last one, documentation, comes right after the swallow. Here is why this matters on your shift. When you carry two separate lists in your head, one of them slips the minute you get busy -- you skip a check, or you forget to chart. When it is one workflow, nothing slips, and your resident gets a clean, safe pass. Remember the steps, and the Rights come with them. Remember the Rights, and the steps fall into place. Do the procedure right, and you have already honored all 7 Rights.
15 of 15 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.G (The Procedure IS the 7 Rights) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-1.G`** > (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.G` | | `competency_id` | `C-3.1` (⇄ `C-2.1` the Seven Rights; ⇄ `MA.L3-1.A…F` — the six procedure steps) | | `lesson_ids` | `[L3-1]` (synthesis capstone of the oral med-pass procedure) | | `clinical_risk` | **Moderate** (retention/transfer) → **≥80% KC mastery** (docs/42 tiers, line 542). **Not** Critical: no SME-protected KC key, no sim force-fail | | `medication_error_prevented` | Retention failure — carrying two half-learned lists (the six steps AND the 7 Rights) instead of one internalized structure, so a step or a Right gets dropped under pressure | | `sme_status` | `in_review` | | `apd_traceability_status` | sourced — one APD synthesis anchor (Mod1 s76); the step→Right **mapping/ordering** and the "triple check" step name are `[Waiver360-added]` instructional overlays that need SME confirmation | ## 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_*`. ## Patient-safety chain (owner directive, 2026-07-05) This is a synthesis/retention concept, but retention failure at the med pass is a **patient-safety event**: a dropped step or a dropped Right is a real omission on your resident's dose. The chain, in five explicit links: 1. **Medication error prevented.** A step or a Right silently dropped during a live oral med pass — the client is not re-verified (wrong-person risk), the label/MAR/prescription is not fully compared (wrong med/dose/route/time/reason risk), or the dose is not documented (missed/duplicate-dose risk). The concept exists so that *none of the seven falls off* under real-shift pressure. 2. **Why staff make this mistake (the real reason — not "forgot").** New MAPs are taught the **seven Rights** for the written test and the **six procedure steps** for the skills check as if they were two unrelated lists. At the bedside, with a resident waiting and time pressure on, working memory can reliably hold *one* structured list — so the second list quietly loses an item. It is not carelessness; it is **cognitive overload from carrying two competing checklists**, a training-design gap surfacing as a bedside omission. 3. **How the lesson/transcript prevents it.** The `l31-procedure-is-rights` block reframes the two lists as **one structure** — the steps you physically perform *are* the Rights, in the order you work (verify = Right Person; compare = five Rights at once; document = Right Documentation). One internalized workflow means recalling the steps recovers the Rights, and recalling the Rights recovers the steps — nothing to drop because there is only one list. 4. **How the simulator reinforces it.** The Don Montana post-sim **debrief overlay** (`don-montana--procedure-rights-debrief`) retro-maps the learner's *own logged actions* from the oral med pass onto the 7 Rights — the learner sees that their verify action *was* Right Person and their compare *was* five Rights, proving from their own performance that the two lists were one all along. 5. **How the KC verifies mastery.** `KC-L3-1-G-Q1` (`step_rights_matcher`) requires the learner to place each Right on the step where it is verified — collapsing five Rights onto the single compare step, leaving the connective steps (wash / one-client / administer) empty, and refusing the "Right Temperature" distractor. You cannot pass by holding two separate lists; you must demonstrate the **integrated mapping at ≥80%**, and misplacing the temperature distractor hard-fails the item. ## The six steps ↔ seven Rights mapping (the synthesis this concept teaches) Workflow order (reconciled from `MA.L3-1.A…F` + legacy L3-1 line 314 "wash, clear, verify, triple-check, administer, document"): | # | Procedure step | Concept | Right(s) it satisfies | |---|---|---|---| | 1 | Wash hands | `MA.L3-1.A` | *(safety prep — not itself one of the 7 Rights)* | | 2 | One client at a time (clear the space) | `MA.L3-1.B` | *(focus/error-prevention — not itself one of the 7 Rights)* | | 3 | Verify the client | `MA.L3-1.C` | **Right Person** (C-2.2) | | 4 | Compare label · MAR · prescription | `MA.L3-1.D` | **Right Medication, Right Dose, Right Route, Right Time** (C-2.3–2.6) + **Right Reason** (C-2.7) | | 5 | Administer / supervise + observe the swallow | `MA.L3-1.E` | *(execution of the give — not itself a single Right)* | | 6 | Document immediately | `MA.L3-1.F` | **Right Documentation** (C-2.8) | Rights covered: Person + (Medication, Dose, Route, Time, Reason) + Documentation = **7**. Six of the seven are verified **before the dose leaves the hand**; Documentation is the seventh, after the swallow. Steps 1, 2, 5 are connective steps that *enable* the Rights without each being one — this asymmetry (one step can cover five Rights; some steps cover none) is the exact "make the invisible structure visible" payoff, and the part that is a Waiver360 overlay, not APD-verbatim. ## Source ledger (projects into `payload_json.sources`) - `curriculum_source`: "APD BMA Module 1 (s76 the-MAR-is-the-7-Rights payoff; s64–71 the Rights; s65 verify + s66 reason) + Module 2 (s58 compare label↔MAR↔Rx — the six pre-hand Rights)" - `form_reference`: "APD Form 65G-7.008 A (MAR)" | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | Completing the MAR / med-pass procedure correctly means the 7 Rights were observed | `[APD]` | Mod1 s76 | null | | C2 | The oral med pass is six steps in order: wash · one-client · verify · compare label/MAR/Rx · administer & observe · document | `[APD]` steps / `[Waiver360-added]` packaging | Mod2 s44/s51–52 (wash), s58 (one-client + compare), s62/s64 (administer); Mod1 s65 (verify), s71 (document). Six-step *grouping/labels* = Waiver360 spine (`MA.L3-1.A…F`) | null | | C3 | Six of the seven Rights are verified before the dose leaves the hand; Right Documentation is the seventh (after the swallow) | `[APD]` | Mod2 s58 (compare = med/dose/route/time) + Mod1 s65 (person)/s66 (reason)/s71 (document) — **corrected from an earlier "Mod3 s39" cite; Module 3 is not the oral-route source** (legacy SRC-6 re-verify) | null | | C4 | The compare step (step 4) satisfies five Rights at once — Medication, Dose, Route, Time, Reason | `[APD]` | Mod2 s58 (MEDICATION, DOSE, ROUTE, TIME) + Mod1 s66 (Reason) | null | | C5 | The specific step→Right mapping AND the workflow ordering of the Rights are an instructional overlay; APD's canonical numbering differs (Mod1 s66 places Right Reason at #2, this bundle groups it under the compare step) | `[Waiver360-added]` | Instructional synthesis of C1–C4; not an APD-stated mapping. Legacy L3-1 SRC-6 note flags the ordering divergence | null | | C6 | Steps 1 (wash), 2 (one-client), 5 (administer) are connective steps that are NOT individually one of the 7 Rights | `[Waiver360-added]` | Instructional decomposition; APD does not enumerate "which steps are not Rights" | null | | C7 | "Triple check" as the name for the compare step | `[Waiver360-added]` | Waiver360's nickname (MA.L3-1.D); NOT an APD term — kept out of the KC answer key, used only as an aside | null | ## Decision queue → owner / SME (Michele + Nicole) 1. **Confirm the step→Right mapping (C4/C5).** The bundle grades: Verify → Right Person; Compare → Medication/Dose/Route/Time/Reason; Document → Right Documentation. Each correspondence is APD-traceable, but the *arrangement into one matcher* and the *workflow ordering* are a Waiver360 overlay. SME to confirm before `in_review → approved`. **This gates the KC answer key.** 2. **Confirm C5 ordering divergence.** APD's canonical numbering (Mod1 s66) puts Right Reason at #2; this bundle folds Reason into the step-4 compare group. Is the workflow ordering acceptable as `[Waiver360-added]` scaffolding, or must the KC/overlay follow APD's numbering exactly? 3. **Confirm C6 framing** — teaching that wash/one-client/administer are "connective steps, not Rights" acceptable as `[Waiver360-added]`? (This drives the "empty step" and temperature-distractor design in the matcher.) 4. **Confirm C7** — keep "triple check" as an on-screen aside only (never a graded label)? The KC uses the APD-verbatim "Compare label · MAR · prescription" as the step label. 5. **Confirm the six-step packaging (C2).** The step *actions* are APD; the "six steps" grouping and the WASH/CLEAR/VERIFY/COMPARE/ADMINISTER/DOCUMENT labels are the Waiver360 L3-1 spine. Acceptable? ## Bundle contents (fragments authored in this pass) - `blocks/l31-procedure-is-rights.json` — the single synthesis transcript block. - `knowledge-checks/KC-L3-1-G-Q1.json` — `step_rights_matcher` (drag each Right onto its step). - `exercise-specs/step_rights_matcher.json` — proposed exercise type (engineering via CMS registry). - `sim-rules/don-montana--procedure-rights-debrief.json` — post-sim debrief overlay (Moderate; non-gating). ## Storyboard frames referenced (owned by the later aggregation step) - `V-L3-1-01` — the single overlay mapping each step to its Right(s) (the 6-step rail + 7-Rights strip locking like gears). Shared asset `V-L3-1-05` (the horizontal 7-Rights icon strip) is authored by sibling concepts but re-surfaces here; flagged for the aggregator.
You have finished the six-step oral med pass. Drag each of the 7 Rights onto the step where it is verified. One step covers five Rights. Some steps carry none. Not every card is a Right — leave anything that is not one of the 7 Rights in the tray.
Why: Six of the seven Rights are verified before the dose leaves your hand — Right Person at 'verify the client', then Medication, Dose, Route, Time, and Reason all in the single 'compare label to MAR to prescription' check. Right Documentation is the seventh, at 'document immediately.' Wash, one-client, and administer are the steps that make those Rights possible, but none of them is itself one of the 7 Rights — and temperature is not a Right at all. The procedure IS the 7 Rights.
Error prevented: Retention failure — dropping a step or a Right under pressure because they were memorized as two disconnected lists instead of one workflow.
Misconception: "The six steps and the 7 Rights are two separate lists to memorize," plus "every step is a Right / every Right is its own step," and "temperature is a Right."
Entry: The learner finishes the Don Montana oral med-pass sequence in the MAR Simulator (verify -> compare -> administer -> document). The debrief overlay opens automatically on scenario completion, before the score card.
Mastery: >=80% mapping accuracy in the debrief; non-gating (no force-fail).
Shot: Split reference: a six-step procedure rail (Wash · One client · Verify · Compare · Give · Document) and a seven-Rights strip; the two lock together like gears. Close on Michele + disclaimer footer.
Camera: Pull back to show both rails; the gear-lock animation plays center-frame; end on a centered Michele medium shot for the sign-off.
Avatar: Michele on-camera for the payoff line and close; calm, slight lean-in on 'the six steps ARE the seven Rights'.
Visual: Reveal the six steps as the seven Rights in workflow order — the course's signature 'make the invisible structure visible' payoff (MA.L3-1.G visual: single overlay mapping each step to its Right(s); animation: 6-step rail and 7-Rights strip lock like gears). Moderate synthesis capstone. Compare step labeled APD-verbatim, not 'triple check'.
Animation: The six-step rail and seven-Rights strip slide together and mesh like gears; each step lights its mapped Right; the two connective steps pulse without a Right token. Closing chip 'the procedure IS the 7 Rights' fades in.
Infographic: Mapping overlay: Verify → Right Person; Compare label·MAR·Rx → Right Medication/Dose/Route/Time/Reason; Document → Right Documentation; Wash and One-client shown as connective steps that carry no single Right. Disclaimer footer 'APD-aligned educational content. Not an APD-approved training program.'
Gear-lock synthesis overlay: six-step procedure rail meshing with the seven-Rights strip; each step maps to its Right(s); two connective steps carry no Right.
🖼 image prompt: Clean flat-vector split diagram: left, a vertical six-step rail labeled Wash · One client · Verify · Compare label/MAR/prescription · Give · Document; right, a horizontal seven-Rights strip (Person, Medication, Dose, Route, Time, Reason, Documentation); connecting lines mesh the two like interlocking gears. Neutral clinical palette, high legibility, synthetic content only, no logos, no real names. Compare step labeled 'compare the label, the MAR, and the prescription' (do NOT use the phrase 'triple check'). [APD] Module 1 s76 + [Waiver360-added] step packaging.
🎬 video prompt: Two rails slide together and mesh like gears; as they lock, each step lights its mapped Right on the strip; the two connective steps (Wash, One client) pulse without a Right token; closing chip 'the procedure IS the 7 Rights' fades in; no camera move; transparent background. [APD]+[Waiver360-added]
Target runtime: 4:30 · 7 chapters · not rendered (url: null)
Learner drags each token from a tray onto one of an ordered list of step drop-zones. A step may accept multiple tokens, one token, or none. Tokens that belong to no step (the 'not-a-member' distractor) must be left in / returned to the tray. Grading is per graded token: each graded token is correct only when placed on its correctStepId (or left in the tray when correctStepId is null). Wrong placements fire the token-specific rationale and route to remediation.