Download Segment 3 Safe Practices

Medication: Introduction and Safe Practices
Script
Contents
Segment 1
Introduction ..............................................................................................................................................................1
Segment 2
Administering Medications ......................................................................................................................................3
Segment 3
Safe Practices ......................................................................................................................................................... 10
Note: this script may vary slightly from the recording
Segment 1
Introduction
Slide 2
To understand the importance of medication and medication administration you also need to understand about
the Acts and Regulations that govern and apply to medication management. I will also explain what medications
are and where you can get resources to help you in your work. This will help you administer medications safely and
understand why you need to be trained in this role.
Slide 3
Understanding the regulations and Acts can be confusing but essentially they control the advertising of medications
which means they determine what can and cannot be advertised. Acts and regulations also control labelling which
includes what has to be or can to be put on the labels, whether they have to be prescribed or purchased over the
counter and also controls the licencing of pharmaceutical sales representatives.
Slide 4
So let’s look at the Medicines Act first. This was first written in 1981 and it still remains as it is today. So in New
Zealand it governs the manufacturing of medicines. Not just anyone can manufacture medications. The person or
their company have to be licenced to do this. There are very strict criteria for the manufacture of medicines, how
they are marketed, sold and distributed. It doesn’t only apply to medications, it applies to medical devices and any
related products used for medical purposes. The company also has to be certified just like your facility or
organisation has to be and they are audited on a regular basis and assessed as meeting the standard required by
Ministry of Health and the Government. On top of this the product has to be tested and deemed safe for the
consumer to use or take.
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So the Medicines Act 1981 then consolidates, which is to fuse together or combines or merges, and amends the law
relating to the Manufacture of medicines, the sale and distribution of medicines, the manufacture and sale of
medical devices and any other related products.
Slide 5
So what does the Medicines regulations 1984 do? Well these regulations decide which products can be legally sold
and distributed as therapeutic products which essentially mean does it work the way it is designed to work, will it
help to keep New Zealanders well, healthy and is it safe for the consumer to use?
Slide 6
The regulations also dictate where medicines can be manufactured, issues licenses to approved companies and
outline the distribution requirements. It also dictates the quality standards for the medicines and their packaging.
So as I said earlier, not just anyone can manufacture medicines of medical devices in New Zealand. They have to
meet strict criteria, meet required standards and the company has to have a licence to do it.
Slide 7
So who monitors the Act and regulations? Well this is Medsafe which is New Zealand’s medicines and medical
devices safety authority. It is a business unit attached to the Ministry of Health and has two offices; one in
Auckland and one in Wellington. The head office in Wellington looks after administration, product approval and
standard setting while the Auckland office is responsible for investigation and Border Control functions.
Slide 8
So why do we need the acts and regulations? Well the aim of these are to enhance the health of new Zealanders
by regulating medicines and medical devices to maximise safety and benefit which means try and make sure you
are kept as safe as possible with the medicines and equipment that are used in this country. Now not every
country has these sorts of regulations and controls. Some countries allow all sorts of medicines and devices to be
used that have not been tested or proven to be safe. So beware if you purchase some medications or devices over
the internet as they may not be safe or actually work. Some countries will market a medication really cheap when
in fact the only thing that looks like the medication is the packaging or colour of the pill or capsule. What is actually
inside it may not even be a medicine. If you do purchase from the internet you are not necessarily protected by
New Zealand legislation and you could become very unwell. So Acts and Regulations are there to protect you, the
consumer.
Slide 9
You also need to know about another Act and Regulation. This is the Misuse of Drugs Act 1975 and Misuse of
Drugs Regulations. Now you know that an Act is set of rules set by the government and this becomes the law of the
land and the regulations are what control that law.
Now the misuse of drugs is applied to controlled drugs. These are any drugs that have the potential to become
addictive or subject to being abused or illegally sold by criminals. These are drugs like morphine or other pain
killing drugs. You may have been on duty when you have had to count the number of pills or measure the amount
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of liquid before these medicines can be given to a person. This law is a way of controlling or knowing where these
drugs are and how many are on site at one time. They need to be accounted for.
Now in home care there are not the same controls because they are dispensed to the person for use at home.
However it is easy to see if these medications are going missing because the person will have pain and most of
these medicines are designed to relieve pain.
So you see any drugs that come under this category are required to be labelled as such, so you will know what they
are, and used according to the Act as well as another Act called the Medicines Act.
Now you don’t need to know all about these Acts and Regulations. But you do need to know what they are, why
they exist and why it is so important for you give the medications as prescribed, administered, and recorded
appropriately for the comfort of the person in your care AND to keep yourself safe. People who abuse these acts
can and do end up in prison if found guilty of misusing medicines. Remember that all drugs have the potential to
be abused or misused so it is important that all medications are kept in a locked cupboard and administered from a
lockable trolley at all times.
Slide 10
So what are medicines? Well these are any substance given or used on a human or animal to either prevent the
user getting sick or helping them to get well or to maintain a level of wellness. So if what they are taking is not
improving or restoring their health the medicine is not working but they are still medicines.
Medicines include prescription or non-prescription drugs. That is it includes those that you can only get by
prescription from your doctor and take to the pharmacy to get dispensed and those that can be purchased over the
counter from your pharmacy or health food shop, supermarkets and even service stations so it includes herbal or
natural remedies as well.
So you see anything that you take to either restore or improve your health is a medicine.
Segment 2
Administering Medications
Slide 1
In this segment we will talk about how medications are administered, who can administer medications, discuss
abbreviations and what they mean and why you should know them. There are limitations for enrolled nurses, care
assistants and caregivers who come under the supervision of a registered nurse who has overall responsibility to
ensure medications are administered safely. However if the administration policy is not followed correctly then the
administrator or manager may be charged with negligence.
Slide 2
So who can give mediations? Well in residential care facilities anyone who has been trained by the organisation can
give out medications. The person who does the training will do so to the policies and procedures of the facility and
also to your scope of practice, which means what you are permitted to do, and you will also be subject to in house
auditing. It is important to know that if you are a caregiver, you are not a registered nurse who has a specific body
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of knowledge and skills that enables the registered nurse to understand and administer medications. Do not under
any circumstances step outside your skill level or your scope of practice.
Registered nurses are responsible for medication administration and are responsible for ensuring that you have
received the right training and understanding of medication administration before you are allowed to administer
medications. It is not as simple as opening a blister pack and giving it to the person to take. You have to be
competent and the Registered Nurse is responsible for ensuring this.
Slide 3
When are medications administered?
There are many different times and ways that medications are administered. Some are given only once a day and
this can be at a specific time like morning, lunch time, dinner time, or evening.
They may also only be given on specific days like Monday, Wednesday or Friday or some other combination of days.
Other drugs are given monthly and this may also be on a specific day.
Slide 4
Medications may also be given weekly and may also be given on specific days.
Some medications are only given when required and this is usually at the discretion of the Registered Nurse or
written instructions on when to use them. Be very careful with using PRN medications for without the knowledge
of how the drug works and why the drug is being used you could cause harm to the resident or client. You need to
know what the medication is for and when it can be used safely and what the desired effect of the drug is.
Some medications may be charted to be given several times a day and could be at odd times that don’t correspond
with a drug round for examples Sinemet for Parkinson’s disease or antibiotics before a meal
Slide 5
Medications are given as per the instructions the doctor has written. It may be that they have to be given before a
meal like an antibiotic 30 mins before eating or anti-nausea medication Domperidome or anti-reflux medication
Omeprazole 20 minutes before a meal.
Some may need to be given with a meal as it may make them feel unwell if they take it on an empty stomach for
example Metformin
Some may need to be given after meals like lactulose, an aperient should never be given with a meal as it slows
down the action of the drug so should be given 2 hours after a meal. If you give it with food it is pretty near useless
and you wonder why a person is constipated.
Other medications may need to be given at very specific times like Sinemet for Parkinson’s Disease as I mentioned
in the last slide.
So you can see it is not just about doing a drug round, it is about knowing what you are giving and giving the
medications at the correct time for it to do what it was designed to do.
Slide 6
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There are also many different routes or ways medications can be given as well. Some are tablet that is swallowed
with water while others are in a liquid which are taken by mouth.
Some are put under the tongue and left to dissolved or sprayed into the mouth.
Others may be given rectally which means in through the anus and into the rectum where it acts by coming into
contact with the wall of the rectum.
Slide 7
Some medications can only be given by injection and this could be into the muscle or into the sub-cutaneous fat
layer just under the skin.
Women may have to have the drug administered vaginally and others drugs may come in the form of creams and
lotions that have to be applied to the skin which is call topical application and some medications are absorbed
through the skin using patches.
So there is a lot to know about giving out or administering medications and it is important that you know this so
that both you and the receiver of the medication is kept safe.
In the next slides I will go through the various abbreviations that you will come across to help you to understand
how medications are given and when.
Slide 8
You need to know these abbreviations as sometimes you will see them on the prescribing sheet written in this way.
While you may not remember them all, you do need to know where to find out the information as nurses and
doctors have a habit of talking in jargon forgetting that you do not know what they are talking about.
AC means before meals. This may be a specific time before a meal, like some antibiotics need to be given ½ hour
before meals for them to work. Some other medications like Domperidom, which aids digestion also needs to be
given before a meal or the drug won’t do what it supposed to do and the person will continue to have symptoms
like nausea as I mentioned earlier. The drug needs an empty stomach for it to work. Others may need to be given
just before a meal is started so if you are not sure, ask your registered nurse.
PC means after meals which means they need to be given on a full stomach. Some medications can make people
feel sick so if they are given on a full stomach they will not. For example Metformin given on an empty stomach is
one of these medications so it may need to be given after the meal or with the meal as I mentioned earlier.
BD or sometimes it is written as BID means twice a day. This is usually means morning and dinner time however
sometimes it may be midday and night or some other combination. So know what the BD times are for the person
you are administering medications to.
Slide 9
TDS or TID means 3 times a day. Typically this is breakfast, lunch and dinner but there may be other combinations
of this too like lunch, dinner and bedtime.
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QID means 4 times daily. This usually means breakfast, lunch, dinner and bedtime but again check that this is the
correct time.
QQH means 4 hourly. What is important to know here is that some medications, like Paracetamol for instance, may
be given 2, 3 or 4 times a day in a pack but they may also have it charted as QQH - PRN. Now this is a trap because
you could be overdosing a patient on Paracetamol which could make them really unwell and they could even die if
given over a long period. If someone has a headache and you run to get some Paracetamol, check the chart that
they haven’t already had some. Now medications like Paracetamol are designed to be given 4 hours apart even if
charted 4 times a day. This means there has to be 4 hours between doses. So if a person on Paracetamol 4 times a
day is the last person to receive their medication in the morning at 9.30am, they should not have their next does till
1.30pm. Giving them at 12 Midday with lunch is not 4 hours apart and overtime can actually do harm to the
person.
Another trap is that Paracetamol can also be found in things like Lemsip so if they are taking Paracetamol 3 or 4
times a day and Lemsip you are exceeding the safe dose of Paracetamol. It is important for you to know what you
are giving and why.
Slide 10
PRN which means as required. I have already mentioned this and you need to be very careful here as if you do not
understand what the drug is supposed to do or why it is being given, you could be giving the person too much
medication or even the wrong medication. For example, some drugs that are charted for behaviours management
and may be charted PRN. If you are having difficulty with a person, you may think that by giving this medication a
person may be easier to manage. Drugs don’t actually change behaviour, they may make them a bit calmer but not
always. It is actually easier for you to change YOUR behaviour than the person in your care. Besides the quickest
acting medication to calm a person down takes about 20 mins to work and the behaviour has usually subsided by
then. The other problem you may experience is actually getting them to take the medication anyway. So make
sure you know what and why a medication is being given and never give on your own bat. Always check with you
RN before using PRN medication.
“O” means Oral so the medication can only be given by mouth and must be swallowed with water.
SL means sub lingual which means it must be placed under the tongue and dissolved in the mouth. It can be a
tablet or a spray. So if they swallow the table whole it will not do the job it is supposed to do.
Slide 11
PV means it has to be inserted into the vagina of women only.
Topical means it has to be applied to the skin. Some topical ointments or creams cannot be applied if skin is
broken, so you need to read the instructions with the creams and apply only as prescribed and check with your
registered nurse. Some of these are actually very dangerous medications and if a person is given more than is
prescribed will cause harm to the person while others can be applied as often as required with no ill effects. So
always check with your registered nurse.
PR means it has to be inserted into the rectum. They are designed to dissolve once in the rectum and be absorbed
by the rectal blood vessels. Sometimes drugs like Paracetamol are given this way as especially if a person cannot
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take it orally for some reason. They may not be able to swallow or have severe nausea which means they could
vomit it up. This way they can get the dose of medication which usually works quite fast, and are less likely to
cause nausea. You will be more familiar with suppositories or enemas which are given this way for constipation or
to facilitate bowel evacuation. However you need to make sure you don’t inset the medicine into faeces as it won’t
work. It has to actually touch the rectal wall for it to work.
Slide 12
Guttae means a drop. You may see it shortened as gtt. Now this means a medicine is administered by drop. Now
mostly it is written as a “drop” e.g. instil 1 drop in each eye so you may not see this abbreviation but if you do and it
is shortened to gt or gtt or gutta you know what it means. Now when medications are to be given by a drop(s) they
will come in a bottle with a dropper or type of bottle that allows a drop at a time to come out. It is a common way
to give eye and ear drops but other medications may also come in a dropper bottle. It is important here to give s
prescribed – if it says 1 drop it means 1 drop so you need to be careful the drops don’t come out too fast.
IM means intra muscular. Now this applies to injections only which are given directly into the muscle but this is
likely not to concern you as it is a registered or enrolled nurse responsibility anyway but it is good for you to know
what the abbreviation stands for.
SC means into the subcutaneous layer of fat under the skin. This is an injection where the needle is inserted into
the subcutaneous layer of the skin. You will see a diagram of the skin in the Ageing Process – Skin topic. Again this
is not something you would do unless you have been trained to give insulin which should never be given into the
muscle as it will work too quickly. Insulin has to be given into the subcutaneous fat so that is absorbed slowly.
However on some occasions for dehydration, a resident may receive fluid sub-cutaneous. Now you would not
insert the needle but may have to look after the person so you need to know how to handle a resident if or when
these fluids being administered.
IV means intravenous. Drugs or fluids administered this way can only be given directly into a vein. Again this is not
something a caregiver would do but it is good for you to know what the abbreviation means.
Slide 13
Now we are going to look at the scope of practice of the people.
Firstly let’s look at Enrolled nurses. They can check and administer oral, topical and rectal medications. They can
also give intramuscular and subcutaneous infections under the direction of registered nurse.
Slide 14
Now Caregivers or healthcare assistants are able to check and administer oral medication, topical ointments,
creams and lotions and rectal medications like suppositories and enemas but only under the direction of the
registered nurse.
Oral medications may be administered from blister or robotic packs that have been dispensed by a pharmacist.
When topical ointments and creams are prescribed as medications, caregivers and healthcare assistants can apply
these. However it is important that you know how to apply them and what precautions you need to take and also
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why they are to be applied and using a safe method of application. Check with your Registered Nurse for
instructions.
You can also be trained to insert suppositories or enemas into the rectum but again you need to be shown what to
do and how to use them.
Slide 15
You are also allowed to insert pessaries into the vagina but you need to be trained by a registered nurse first. In
some instances you can give insulin but again only after being trained by the registered nurse and they know you
are safe to do this.
You also need to operate within the policies and procedures of you facility or organisations. That is where all the
do’s and don’ts of medication administration are.
Slide 16
The Registered Nurse has overall responsibility for the safe administration of medication so this means they have to
ensure that you are properly trained and supervised. They also have to audit you so you remain safe in
administering medications. You cannot give out medication without being trained so if you are asked to give them
out, and you have not received tuition and instruction, don’t give them out.
They also have to ensure all medication orders are forwarded to the pharmacy after the doctor has charted or
prescribed them in the resident’s medication charts and or written prescriptions. The Registered Nurse is also
responsible for checking the medications are correct to the script after the pharmacist has dispensed them.
Slide 17
All medications that are prescribed as required or prn, need to be approved by the Registered Nurse before they
can be given to a resident i.e. if a resident/client requires a medication like Paracetamol or lactulose or Mylanta,
something that is not given on a regular basis, then you have to check with the registered nurse that is okay for
them to have the medication. You do not have the authority to just give out prn medications. Without this
authorisation, you have no protection.
The storage of medications is also important as medications must be stored safely, correctly and securely this
means they need to be a locked cabinet or medication trolley when not in use.
They also need to be stored correctly. By that I mean, some medications need to be kept in the fridge, others while
others at room temperature.
The Registered Nurse must also be familiar with all the Acts and Regulations surrounding medications so that they
are adhered to at all times.
Slide 18
The registered must operate in accordance with the policies and procedures of the organisation which will outline
what they are expected to do.
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They also must assess the person and monitor the client/resident for any untoward signs of drug reactions,
overdose or toxicity or if the medication is having the desired affect for the resident and report to the prescriber
So therefore the registered nurse must have a good understanding of the medications that are being given out to
every resident/client which includes knowing the generic name of the medications which is the approved or
common name the drug is known by. This is a group of drugs that have a similar actions with similar sounding
name for example penicillin, amoxicillin, flucloxacillin that is the same active ingredient in the medication and the
brand name which is the name chosen by the company to market or sell it under.
They also need to know the purpose of the drug, that is what it is designed to do, what is the usual dose and how it
should be taken, that is the route in which is it given for example oral, intramuscularly etc.
They also need to know the side effects of the medication as well so that if the medication is not working or causing
a toxic reaction in the person, they know what to look for. Now there can be several different side effects or
adverse reactions to a drug and it is really difficult to know all of them but the registered nurse need to know
where to look for them. You also need to be alert to changes in a person and pass this on to the Registered Nurse
so that if they become unwell quick action can be taken to ensure they do not get worse.
Slide 19
The registered nurse has to manage medication stock in the facility also. This means they must know what
medications can be kept as stock in the cupboard and what can’t. Also they must check the expiry dates on
medications and return any outdate stock to the pharmacy to the organisations policies and procedures.
Any person who leaves the facility to go home or to another facility can take their medications with them and if
they don’t, they need to be returned to the pharmacy. Medication for any deceased persons must also be returned
to the pharmacy. It is illegal to keep medications belonging to a person who no longer resides in the facility and to
use them for another person.
If in homecare, while it may not be your responsibility, be aware that if a person’s medication has been
discontinued or changed, they should be returned to the pharmacy by a family member. However if this does not
happen, shift it away from the other medication so that the person does not take it. Polypharmacy, which is lots of
medications, can be the cause of an older or disabled person becoming really unwell and sent to hospital so make
sure only the medication they are supposed to take is left out for them. It is preferable for medications to be
dispensed by the pharmacist into single unit dose packs which I will talk about in the next segment.
Slide 20
So what are Management’s responsibilities?
They need to know that you have been trained to give the medications and are competent to do so. They will
delegate the training to the registered nurse as the manager is not always a registered nurse but they have to know
you are safe. They are also responsible for ensuring that you are audited and evaluated as still being competent.
Records need to be kept as well. They have to keep the documented proof of your training which has to be carried
out annually.
They need to be reassured that you are competent to give out medications and they can prove that you are.
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Slide 21
They are also responsible to ensure that all staff work with in their scope of practice and that includes caregivers,
enrolled and registered nurses so it is important that you do not give out any medications unless you have been
trained to do so and that you know what you are doing.
If bureau staff works in the facility or organisation, it is up to management to make sure they are aware of the
policies and procedures in the organisation and know where to find them for referencing.
They also need to make sure that information is readily available and accessible and up to date for all staff as
reference material. It is about being fully informed so you can do your job safely for not only yourself but for the
residents in your care.
Slide 22
They are responsible for making sure that policies and procedures are reviewed as per the review schedule to
ensure the policies and procedures are always kept current. They also need to review and analyse all medication
incidents. This includes such things as missed, dropped, lost medications or any errors relating to residents. We will
look at this in more depth in Segment 7
Segment 3
Safe Practices
Slide 1
Now we will look at all that is required around safe practice and administration of medication. I will also discuss
what checks you need to make plus what to do and not do when giving out medications or when an error occurs.
Slide 2
I know I have talked a bit about maintaining safe practice in medication administration but now we will look at
what this really does entail. Well essentially it includes following policies and procedures and accurate
documentation.
Slide 3
It also means that you practice the correct checking procedures which we will discuss when we discuss the check
you are required to do before giving out any medications.
It also means that if you ever have to calculate a medication that you do so correctly. Now the only things you are
likely to calculate really as a caregiver or support worker, is to measure the correct amount of mixture a person
may need to have like Paracetamol elixir or Lactulose. Now near enough is not okay. If the instruction is to give 10
mils it is 10 mils not 12 or 15 so you need to be very accurate in what you giving.
It also means that you must get consent from the person as the person has the right to refuse medication. So
getting consent is about safe practice and it is also about telling the Registered Nurse that they refused the
medication. Refusing some medications may not have a disastrous effect on the person but for others it may have
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a catastrophic effect. So while getting consent is important, refusing the medication needs to be recorded and
reported to the registered nurse and for you to get instruction as to what to do next.
Slide 4
You also need to be competent culturally which means that you need to understand any cultural consideration that
applies to a person regarding the medication. So you may need to talk to an interpreter which may or may not be a
family member.
Being safe means also that you do not go outside of your scope of practice. We talked about that in the last
segment. It also means that you need to check that all the information in accurate and up to date on the person
and the medication they are being given.
Slide 5
Make sure when you are using any medical aids like blood glucose monitors or blood pressure monitors, that you
know how to use them properly and correctly. So when it comes to taking a person’s blood sugar measurement,
you know how to use the machine correctly, how to store it correctly and keep it clean. If there are any problems
with the medical aid you are using, then you must report immediately so it is always functioning correctly
Maintaining safe practice also means that when you are giving out medications that you do so free of distractions.
This is where the most errors occur. When you get distracted you make mistakes so do not take phone calls, or
leave the trolley unattended. This is what we are talking about.
To keep safe you need to know what you are doing and you need to be trained to do it. I know it looks quite simple
but there is a process involved in giving out medications. While you may not know the medications you are giving
or their side effects you can at least do the right checks you are required to do and report accurately any
observations you may have of a client/resident.
Slide 6
Medications are packed in a variety of ways. They can be in separate containers, which you may find happens when
people come in from home for respite care or at live at home. However in these cases it is best that the family are
asked to get them put into the system your facility uses as it is much safer. If this is not done, then you need to be
very careful as to how you administer these medicines so check with your registered nurse. It is not considered to
be safe practice but sometimes the families do not know the policies and procedure of your facility and they arrive
with medications in bottles or packets. The registered nurse should get them to the pharmacy for repacking but it
that doesn’t happen make sure you are properly trained by your registered nurse before you give them out.
The most common form of medication packing is in blister packs where the medications are put directly into a pack
at the pharmacy and sealed. They will have written on them the name of the tablet, the dose and the time it is to
be given on the back of the pack. This should match the prescribing sheet.
However a family member may have dispensed them into a box that has the day of the week on each lid and the
medication in the little box. They may have them in different coloured boxes so the person, while at home will
know what to take at what time of the day. While this method is commonly used at home, it is generally not
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considered the best option as the boxes may not be airtight and medications can alter if they are not kept in an
airtight pack.
They may also be robotically packed which is like for the blister pack, but are in little plastic packets which have the
medications written on the pack with the dose and time to be given. This again has to match the prescribing sheet
so you can check the correct medications are in the pack.
Slide 7
When a pharmacist dispenses the medications they will more commonly dispense a month supply. However some
medications are only to be used for a short course like in antibiotics so the pack will only be for the specific length
of time the medication was prescribed for. Medications like morphine or severdol will only ever be dispensed on a
weekly basis as it is a dangerous drug so only small amounts of the drug are ever kept on the premises. You still
need to count the medication and record it though and it does need to be checked and signed by two people.
Sometimes a person is put on a short course of medication for a week for an ailment or for a trial so it may only be
dispensed for a week while at other times you may have a full pack of prn medication to be dispensed when the
person needs it as directed by the registered nurse. So you see medications come in a variety of ways to meet the
prescriber’s directions.
Slide 8
Pills, capsules or tablets, suspensions and elixirs or liquids are to be stored in a secure place. This means they can
be locked in a trolley or cupboard depending on the system you are using. So when they are not in use that is you
are not doing the drug round they need to be secure.
Antibiotic suspensions are when antibiotics are in a liquid form, must be stored in the fridge between uses as is
insulin that is not in the pen being used.
All lotions, creams and ointments just need to be stored in a cupboard unless the manufacturer’s guidelines or
instruction tell you otherwise.
Slide 9
As I mentioned in the last slide, all manufacturers will have instruction on how to store their product. Some will
need to be kept in the fridge while others can just stay in the locked cupboard. It is pretty safe to say that all blister
or robotic packs can be kept in a cupboard.
All expired medications need to be sent to back to the pharmacy which means you need to check cream and lotions
before you use them to make sure they are still current especially if they are used intermittently. Insulin you must
check the expiry date before you administer it every time. Medications that you give out in blister or robotic packs
are generally okay as the pharmacist will have made sure that the medications wasn’t expired before they packed
them and they are usually only made up for a up to a month anyway.
However where you do need to be careful though is with the prn packs. Sometimes they can sit in the cupboard for
a while and may have expired without you knowing but it is up to the Registered Nurse to ensure they are all
current.
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Medications also need to be stored in an area that is not hotter than 25 degrees Celsius. This means they should
not be stored in an office or area that gets a lot of sun or perhaps near a kitchen where the temperature may rise.
Now in my experience, most areas where medications are stored are in the centre of a building where it is cool but
on occasions, a medication trolley may be left in a hot area so just be aware that they need to be in a cool dry
place.
Slide 10
All medicines need to be checked each month to make sure they haven’t expired. This means everything that is
classed as medicine which includes tablets, mixtures, cream, ointments, lotions drops or injections that have
expired dates on them need to be returned to the pharmacy.
You also need to check the medicines the expiry date before you administer, apply or instil them. as sometimes
they get missed being checked.
Some medicines only have a short shelf life or can only be used for a specific time before they expire. For example,
eye drops expire one month after opening. Now you have two expiry dates to look for. One is the expiry date on
the actual bottle and one when it was opened and when it must be discarded and a new one opened.
Things like ointment, creams and lotions, may not be used every day and be kept in storage. An example of this
may be a skin complaint a person gets from time to time so the ointment, cream or lotions is only used till it clears
up and the Registered Nurse may decide to keep it to be used in case it happens again so you will have to check it
hasn’t expired before it is used again.
People who are receiving eye drops long term like for Glaucoma, still only last for one month after opening so it
must have the date opened &/or the date it expires on the dropper bottle or the box. If you are in doubt as to what
to do always check the policies and procedure of the organisation. In my opinion, if you are the one that opens the
bottle then you put both the opening date and expiry date on the bottle and the box. This will make sure that it is
not used after it has expired. Now if you are doing the administration of medicines, applying topical preparations
or instilling drops, and you notice that they are to expire in say week or less, then you must tell your Registered
Nurse so that they can make sure a fresh supply is ordered either from the pharmacy or by a script from the doctor.
When you are giving medicine like insulin, you have to check the expiry date before you administer insulin every
time you give it. Don’t think, well the last person checked so it must be okay. What if the other person thought like
you? You could be giving expired medication which means it may not work for the person.
The reason you do not give or apply anything that has expired is because what is known as the efficacy of the
medicine is reduced. Efficacy means the capacity or the ability of the medicine to be therapeutic or to fix the
problem. Outdated medicines may not work as well and give the desired affect which is why you check the expiry
date. We want people to get or stay well and healthy.
Slide 11
Blister packs or robotics generally had a viable life which means a workable life of one month unless stated
otherwise. It is also important that medicines especially tablets are kept airtight as if air gets into the blister pack,
their efficacy may be affected so the person does not get the dose required to be well.
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Slide 12
So what happens to medicines of people who get discharged, die or are transferred? Well the most important
thing you must know is that the medicines actually belong to the person they are prescribed for. This means you
cannot keep them to use for another person. I will talk more about this when we talk about administering
medicines.
So those who go home take their medicines with them. If they do not go with them and it is not possible to get
them to the person, then they must be sent back to the pharmacy.
If people are transferred to another facility they should take them medicines to their new facility. Now in
homecare, if they are being transferred to hospital or residential care, they must take their medicines with them
too so as the place they are going too will know what medicines they are on. In some cases people have not
thrown out old medicines when they have been put onto to new medicines and the keep taking the old and the
new which could actually be making them very unwell as I mentioned before. So if you are the person who helping
the person go to hospital or residential care, make sure you send ALL the medicines with them so they can be
reviewed and they return home only with the medicines they are currently on.
Any person who dies must have their medicines returned to the pharmacy. They cannot be left in the facility as
“stock” medicines to be used for other people as I have already mentioned. As I said, medicines are prescribed for
the person only, not for general use.
Slide 13
So now let’s talk about medicines that have been discontinued. It is the same as I have been talking about in the
last slide – they must be sent back to the pharmacy. This ensures that these medications cannot be used by
mistake for the person nor can be used by another person.
I have talked about this before but medicines with the person’s name on are the only medicines they can receive.
In homecare, if you are the person that collects the new medicines, the discontinued medicines need to be
returned to the pharmacy. Now I know it is not your responsibility to do this but it would be a good idea if you
leave a note for the family member or person who has overall responsibility for the person to advise them that
there are new medicines and that they old medicines need to be discarded or returned to the pharmacy.
Slide 14
Now I think you know by now that medicines can only be given to the person they are prescribed for. That means
that medicines like lactulose are prescribed for a person and should be used for that person not use one bottle for
everyone on the round. I know it does become an issue when you have only so much room on your trolley but
medicines like lactulose should not be given with food. They need to be given on an empty stomach – I will talk
about this in more depth in a later segment. So the rule is don’t share medications. If in doubt you should always
refer to your policies and procedures or check with you Registered Nurse.
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