Lesson L3-2 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Here is something you'll do on every med pass, and it trips up a lot of new folks. There are two ways a medication gets taken, and your resident's care plan tells you which one to use. First way: you administer it. You place the pill in their hand or their mouth, you watch them take it, and you chart it. Second way: you supervise self-administration. Your resident takes their own medication, and you are right there — up close, watching, making sure it actually goes down — and then you chart it. Both are real. Both go on the MAR the same way. Now burn this in: which one you do is NOT your choice. It is set by your resident's authorization level in their care plan. You do not pick the faster one because you are busy. And supervising does not mean glancing over from across the room — you are standing right there. Don Montana's plan says administer, so you hand it and watch. If a resident's plan says they self-administer, you let them, you verify, and you STILL chart it. Skip that charting and it looks like a missed dose. Do the mode the plan says — every resident, every pass.
16 of 16 critical claims are verified_by: null (Gate-2 SME sign-off pending → preview only, production-blocked under the Rule-3.6 waiver). · runtime budget: 12:00
# Concept mirror — MA.L3-2.F (Administer vs. Supervise Self-Administration) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-2.F`** > (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.L3-2.F` | | `competency_id` | `C-3.2` (⇄ `C-1.3`, sibling of `MA.L1-3.A` five-levels concept) | | `lesson_ids` | `[L3-2, L1-3, all route lessons]` — cross-cutting (mode choice recurs on every route) | | `clinical_risk` | **High** (scope / authorization) → NOT 100%-gating; no force-fail sim; keys not SME-locked | | `medication_error_prevented` | Over-/under-assisting (wrong mode for the resident's authorization level) + undocumented self-administration | | `sme_status` | `in_review` (concept); every derived fragment in this bundle is `draft` | | `apd_traceability_status` | sourced — level definitions defer to `MA.L1-3.A`; one legacy anchor `TODO(source-L32-9)` + one `[Waiver360-added]` | ## 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 1 (s48 five authorization levels; s5/s10 perform both correct supervision and administration; checkpoints v5 Q2 Level-2 documentation, v4 Q2 independence)" - `form_reference`: "APD Authorization Form 65G-7.002 A (authorization level) + APD MAR Form 65G-7.008 A (documentation)" | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | There are two authorized modes at the med-pass moment: the MAP **administers** the dose, or the MAP **supervises self-administration**; both are legitimate | `[APD]` | Mod1 s5/s10, s48 | null | | C2 | The resident's **care-plan authorization level** — not MAP preference or speed — selects which mode is used | `[APD]` | Mod1 s48 (five levels); Form 65G-7.002 A | null | | C3 | Level 3 authorization = the MAP administers the dose | `[APD]` | docs/42 §E MA.L3-2.F #12 (Don Montana = Level 3); Mod1 s48 | null | | C4 | Level 2 authorization = the resident self-administers **with supervision**, and that dose is documented | `[APD]` | Mod1 s48; checkpoint Mod1 v5 Q2 (Level-2 documentation) | null | | C5 | Both an administered dose and a supervised self-administered dose are documented on the MAR the same way | `[APD]` | Mod1 s5/s10; MAR Form 65G-7.008 A — **`TODO(source-L32-9)`** (confirm APD phrasing that both are charted on the same MAR) | null | | C6 | Supervising self-administration means observing at close range and verifying the resident actually takes the dose — not watching from across the room | `[Waiver360-added]` | Instructional elaboration of "observe/supervise" to break misconception #2; APD states no distance rule | null | **Precise definitions of authorization Levels 1–5 are owned by `MA.L1-3.A` (Mod1 s48–58), which does not yet have a full 18-field docs/42 entry.** This bundle asserts only the Level-2 and Level-3 mappings its sources support (C3, C4) and defers the full five-level definitions to `MA.L1-3.A`. ## Patient-safety chain > Owner directive: treat this as a patient-safety concept and state the chain in five explicit lines. 1. **Medication error prevented.** A dose given the wrong way for the resident's authorization level — the MAP either administers a med the resident is authorized to take themselves (**over-assisting**, acting outside the care plan and stripping authorized independence) or lets a resident self-administer who is authorized only for hands-on administration (**under-assisting**) — and/or a supervised self-administration left off the MAR (an **unaccounted dose** that reads as a missed dose in an audit). 2. **Why staff make this mistake (the real reason).** On a busy med pass it is faster to hand every resident their cup and move on, so a new MAP defaults to one habit for everyone and treats the authorization level as paperwork instead of an instruction. And because the resident "took it themselves," the dose doesn't feel like something the MAP *did* — so it feels like there is nothing to chart. 3. **How the lesson/transcript prevents it.** Block `l32-admin-vs-self-admin` teaches the two modes, that the **care-plan authorization level (not MAP speed/preference) picks the mode**, that supervising means being right there to verify intake, and that **both** modes are documented on the MAR the same way. 4. **How the simulator reinforces it.** In the Don Montana MAR Simulator, Don (Level 3) requires *administer + document*; a Level-2 contrast client on the same pass requires *supervise self-administration + document*. Choosing the faster mode, or skipping the self-administration documentation, is flagged and named in the debrief as over-/under-assisting or an undocumented dose. 5. **How the KC verifies mastery.** `KC-L3-2-F-Q1` — given a Level-2 resident, the learner must pick "supervise self-administration (up close, verify, document)" over the faster / across-the-room / undocumented distractors. `KC-L3-2-F-Q2` — the learner must chart a supervised self-administration on the MAR just like an administered dose, breaking "only administering is documented." ## Decision queue → owner / SME (Michele + Nicole) 1. **`TODO(source-L32-9)` — confirm C5.** Does APD BMA state that both an administered dose and a supervised self-administered dose are documented on the same MAR the same way? Legacy L3-2 flagged this. docs/42 marks the concept `sourced` (#13 "note both are charted"), so the bundle narrates it, but C5 stays `verified_by: null` until SME confirms the exact APD phrasing. 2. **Confirm C6 framing** — is "supervising = observe at close range + verify intake, not across the room" acceptable as `[Waiver360-added]` instructional framing, or does APD state a specific supervision standard for self-administration? No APD distance/standard is asserted. 3. **Confirm C3/C4 level mappings against `MA.L1-3.A`.** Level 3 → administer and Level 2 → supervised self-administration are used as the concept's two concrete anchors (from Mod1 s48 + the Don Montana scenario + checkpoint v5 Q2). SME to confirm these two mappings and to authorize the full five-level definitions when `MA.L1-3.A` gets its docs/42 entry. Until then Levels 1, 4, 5 are **not** asserted. 4. **Deferred remediation variants** (owner decision 2026-07-05): `KC-L3-2-F-Q1B` and `KC-L3-2-F-Q2B` are deferred until the full route is authored; `onWrong` references them as "(deferred — authored on concept approval)". Aggregator to record both in the manifest `deferred_variants`. ## Bundle manifest → `../L3-2.manifest.json` (lesson-level aggregate) · human index → `../L3-2.README.md`
Ms. Alvarez's care plan lists her at authorization Level 2 for her morning tablet — she self-administers with supervision. It is a busy pass and you are behind. What do you do?
Why: Level 2 means she self-administers WITH supervision. You stay right there, verify intake, and document. Supervised self-administration is charted just like a dose you give.
Error prevented: Over-assisting (administering a dose the resident is authorized to self-administer) and an undocumented self-administration.
Misconception: "The MAP picks whichever mode is faster," "supervising = watching from across the room," and "only administering is documented."
You just administered Don Montana's 8:00 AM tablet (his plan authorizes Level 3 — you administer). Down the hall, Mr. Bell self-administered his own 8:00 AM tablet while you supervised at his side (Level 2). How do you document the two doses?
Why: Both modes are legitimate and both are charted on the MAR the same way. Whether you placed the med or supervised the resident placing it, a documented dose is a documented dose.
Error prevented: An undocumented supervised self-administration (an unaccounted dose in an audit).
Misconception: "Only administering is documented" — a supervised self-administered dose does not need to be charted.
Entry: Learner reaches the 8:00 AM oral pass in the Don Montana MAR Simulator with a Level-2 contrast client (Mr. Bell) on the same pass.
Mastery: Correct mode for each client's authorization level + both doses documented; error events are flagged and debriefed, NOT force-failed. No 100% hard gate (docs/42 §D.2: force-fail is reserved for Critical concepts such as the MA.L3-2.C crush rule).
Shot: Split-screen: left = MAP administering the dose (Level 3), right = MAP supervising self-administration at close range (Level 2).
Camera: Static split-screen; a level chip flips the active panel from one mode to the other.
Avatar: Voiceover; Michele returns on-camera briefly for 'the level picks the mode, not you'.
Visual: Split-screen administer vs. supervise self-administration; the client's authorization LEVEL (not MAP preference) selects the mode; both modes are documented on the MAR.
Animation: The authorization-level card flips the screen to the correct mode; a shared MAR row highlights under both panels to show both modes are documented the same way (C5 carried as TODO(source-L32-9), shown generically).
Infographic: Left chip 'Level 3 - administer'; right chip 'Level 2 - supervise self-administration (observe at close range, verify intake)'; shared chip 'document either way - both are charted'.
Split-screen administer (Level 3) vs. supervise self-administration (Level 2); an authorization-level card flips the active mode.
🖼 image prompt: Flat-vector split-screen: left panel 'Level 3 - administer' (MAP gives the dose); right panel 'Level 2 - supervise self-administration' (MAP observes at close range and verifies intake); a shared chip 'document either way - both are charted'; a level card between the panels; neutral clinical palette; synthetic staff/client silhouettes only, no faces, no PHI. Level mappings [APD] Mod1 s48/s5/s10; close-range supervision wording [Waiver360-added]; same-MAR documentation TODO(source-L32-9).
🎬 video prompt: An authorization-level card flips the active panel from administer to supervise (and back); a shared MAR row highlights under both panels to show both modes are documented; no specific documentation wording asserted. [APD]+[Waiver360-added]
Target runtime: 12:00 · 7 chapters · not rendered (url: null)