Download 3 Supply and Storage of Medicines

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Contents
1.
Introduction ................................................................................................................. 4
1.1. Purpose .................................................................................................................. 4
1.2. Scope ..................................................................................................................... 4
1.3. Elements of the care home medicines policy .......................................................... 5
1.4. Medicines Management Systems within Woodchurch House ................................. 6
1.5. Responsibilities of the Care Home Manager ........................................................... 6
2. The Pro-active Care System and arrangements for pharmaceutical services ....... 8
2.1. The Pro-active Care System ................................................................................... 8
2.1.1. Fundamental requirements for using the PCS device ...................................... 8
2.2. Support for the PCS device..................................................................................... 9
2.3. Arrangements for the pharmaceutical service ......................................................... 9
2.3.1. Dispensing of medicines .................................................................................. 9
2.4. Service Level Agreement (SLA) ............................................................................ 10
2.5. Customer support and escalation procedures for resolving issues ........................ 11
3. Supply and Storage of Medicines ............................................................................ 12
3.1. Introduction ........................................................................................................... 12
3.2. Supply of medicines .............................................................................................. 12
3.2.1. Dispensing of medicines and label requirements ........................................... 12
3.2.2. Prescribed medicines - the property of the resident .................................... 113
3.3. Records of medicines, dressings and appliances received ................................... 13
3.3.1. Booking out medicines in periods of absence from the care home ................. 13
3.4. Records of disposal of medicines.......................................................................... 14
3.4.1. Storage and collection of medicines for disposal............................................ 14
3.4.2. Disposal of controlled drugs ........................................................................... 15
3.5. Storage of medicines ............................................................................................ 15
3.5.1. Expiry dates ................................................................................................... 16
3.5.2. Expiry dates for “in use” medicines ................................................................ 16
3.5.3. Items requiring refrigeration ........................................................................... 17
3.6. Controlled Drugs (CDs)......................................................................................... 17
3.6.1. Storage of Controlled Drugs .......................................................................... 17
3.6.2. Controlled Drugs Register .............................................................................. 18
3.6.3. Controlled Drug Register entries .................................................................... 18
3.6.4. Dealing with discrepancies ............................................................................ 18
3.7. Use of oxygen in care homes................................................................................ 20
3.7.1. Storage of oxygen.......................................................................................... 20
4. Medicines Administration ......................................................................................... 21
4.1. Introduction ........................................................................................................... 21
4.2. General requirements relating to administration of medicines ............................... 22
4.3. Medicines administration procedure...................................................................... 23
4.3.1. Resident refusal and covert medication requirements ............................... 298
4.3.2. Administration of controlled drugs .................................................................. 27
4.3.3
Injections
30
4.3.4
Dressings
31
4.3.5
Enemas
31
4.3.6
Suppositories, Pessaries, Vaginal/Rectal creams and Ointments
31
4.3.7
Eye drops, ear drops, Nasal Sprays and Inhalers
32
4.3.8
Creams, Ointments and Gels
32
4.3.9
Percuataneous Endoscopic Gastrostomy (PEG)
33
4.3.10 External Diagnostic Procedures
36
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4.3.11
4.3.12
4.3.13
4.3.14
4.3.15
4.4
4.4.1
4.4.2
Subcutaneous Infusion
Syringe Drivers
Nutritional Supplements
Use of Thick and Easy / Fluid thickeners
Oral anticoagulants
When Required Medication (PRN)
Structured PRNs
Non- structured PRNs
36
36
37
37
37
39
40
41
4.5. Regular prescribed medicines............................................................................. 432
4.5.1. Specific times for administration .................................................................... 42
4.5.2
Hand written MAR sheets
42
4.5.3
Discontinued Treatment
42
4.5.4
Change of dosage
42
4.5.5 Telephone/verbal instruction
43
4.5.6
Prescriptions obtained out of hours
43
4.6. Records of medicines administered using PCS..................................................... 43
4.6.1 Audit of medication administration records
45
4.6.2 Clinical readings and monitoring
46
4.6.3 Access to medicines information
46
4.7. Self-administration of medicines ........................................................................... 44
4.8. Homely Remedies ................................................................................................ 48
5. Ordering and receiving medicines in to the care home.......................................... 51
5.1. Introduction ........................................................................................................... 51
5.2. Determining which medicines are needed............................................................. 51
5.3. The prescription ordering process ......................................................................... 51
5.4. The prescription collection, dispensing and delivery process ................................ 53
5.5. Interim prescriptions.............................................................................................. 53
5.5.1. Urgent supplies .............................................................................................. 54
5.5.2. Receiving an interim supply of medicines ...................................................... 55
5.6. Monthly medication cycle ...................................................................................... 55
5.6.1. General Requirements ................................................................................... 55
5.6.2. Monthly process using the PCS device .......................................................... 52
Step 1 Placing orders on PCS ..................................................................................... 56
Step 2 Ordering the monthly prescriptions................................................................... 56
Step 3 Collecting your monthly prescriptions and reconciliation against PCS order ..... 53
Step 4 Checking of missing prescriptions and discrepancies....................................... 57
Step 5 Dispensing, packaging and delivery ................................................................. 57
Step 6 Booking in your monthly medication supply with the PCS device ..................... 57
Step 7 New medication cycle ...................................................................................... 58
5.7. Checking of authorized prescriptions on the Invalife web portal ............................ 58
5.7.1. The Invalife Invalife web portal....................................................................... 59
5.8. Communicating with the Pharmacy ....................................................................... 60
5.8.1. New Resident Registration Form (PP14) ....................................................... 60
6. Special considerations ............................................................................................. 61
6.1. Introduction ........................................................................................................... 61
6.2. Promoting Independence ...................................................................................... 61
6.3. Informed consent and freedom of choice .............................................................. 61
6.4. Confidentiality and data protection ........................................................................ 61
6.5. Care home inspections and medicines ................................................................. 62
6.6. Residents Medication Reviews ............................................................................. 62
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7. Procedure for dealing with medication errors and drug alerts .............................. 63
7.1. Medication errors...................................................................................................... 63
7.2. Drug and Safety alerts .............................................................................................. 63
8. Staff Training for medicines administration and assessment of competence ............... 64
9. Damaged medicines
65
10. Responding to adverse drug reactions and medicine alerts
65
11. Day care and respite service users
66
12. Unplanned outings for residents
66
13. Holidays and planned outings for residents
66
14 Residents leaving the care home
67
15. Specials Medication
67
16. Emergency evacuation of the care home
68
17. Failure to comply with Medication Policy
69
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Introduction
It is Woodchurch House policy to ensure that medication management promotes residents’ safety
and wellbeing and provides a framework of safe practices by all Care Staff and Nurses.
Compliance with this medicines policy and procedures within will promote safe administration of
medication to residents, efficient medicines management and compliance with legal and regulatory
requirements.
In writing this policy the following regulations and guidance have been taken in to account:
 The Medicines Act 1968
 The Misuse of Drugs Act 1971
 Mental Health Act 2005
 In England: Health and Social Care Act 2008 – Regulation 12
 In Wales: CSSIW: National Minimum Standards for care homes for older people: Standard
17- Medication
 NICE – Developing and updating a Care Home Medication Policy – May 2014
 NICE Quality Standard 85 – Medicines Management
 CQC – ‘How we inspect and regulate’ – May 2015
 Royal Pharmaceutical Society – The Handling Medicines in Social Care - 2007
1.1. Purpose
This policy ensures a safe framework for the correct ordering of prescriptions, receipt, storage and
administration and disposal of medicines in Woodchurch House.
The promotion of safety and the enhancement of the wellbeing of residents must be considered
and upheld at all times.
1.2. Scope
All registered managers and all qualified nursing staff involved in medication management in care
homes with residents with nursing needs and all senior carers in residential settings who deal with
medication including all agency staff.
1.3. Elements of the care home medicines policy
It is recommended that all care homes should possess a Medication Policy document which will
assist care home owners, care home managers and care home staff to:
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inform the development of care home/organisational structures, systems and processes
clarify existing lines of accountability between the care home and wider members of the
care team to include for example GPs, Pharmacists and community nurses
identify training and competency needs of care home staff
improve the transfer of care between service providers to include hospitals and other care
homes
The National Institute for Health and Care Excellence (NICE) has produced a Guideline for care
homes to support them in developing and updating a care home medicines policy and this
Guideline (dated March 2014) can be accessed in full via the NICE website at:
http://www.nice.org.uk/guidance/SC1
The NICE Guideline can fully viewed and printed by clicking on the Download tab at the top right
hand corner of the page.
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NICE has also published a Quality Standard 85 issued in March 2015 relating to medicines
management in care homes and reference should also be made to this document when developing
a care home policy. The document can be located at the NICE website (www.NICE.org.uk ) and
use the search facility for NICE QS 85 Medicines Management.
Areas that should be covered by a Care Home Medicines Policy
The NICE Guideline has recommended that the following areas should be covered within a care
home medicines policy:
 Sharing information about a residents medicines, including when they transfer between
different care settings to include discharge summaries and availability of medicines on the
day that they transfer to a new setting
 Ensuring that records relating to residents medicines are accurate and up to date
 Identifying, reporting and reviewing medicines–related problems
 Keeping residents safe (Safeguarding)
 Accurately listing a residents medicines and reconciling them with the prescribers current
intentions
 Reviewing residents medicines with multidisciplinary teams
 Ordering medicines
 Receiving, storing and disposing of medicines
 Helping residents to look after and take their medicines themselves if appropriate (selfadministration)
 Care home staff administering medicines to residents , including staff training and
competency requirements
 Care home staff giving medicines to residents without their knowledge (covert
administration)
 Care home staff giving non-prescription and over the counter products (homely remedies)
to residents if appropriate
The Medicines Policy Checklist (dated May 2014) provides more information about these areas
and processes that should be covered within a care home medicines policy. The checklist can be
located from the same page that the NICE Guideline is accessed at:
http://www.nice.org.uk/guidance/SC1
Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print
the Medicines Policy Checklist.
Using the Medication Policy Checklist
Care Home providers may wish to consider:
 how they can use the checklist as a tool for the development and improvement of practices
and processes within the care home
 how each section and topic area applies to the scope of practice within the care setting
 how care home providers will ensure that the care home staff are aware of the content of
the care home medicines policy and understand how to put it into practice
 whether any changes to their care home medicines policy are needed to reflect the care
setting in which it is being used
 how often they will review and update the care homes medicines policy, taking into
accounts new evidence on best practice
Baseline Assessment Tool
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NICE have also produced a baseline assessment tool which can be used by care homes to
evaluate their current practices against the recommendations in the NICE Guideline on Managing
Medicines in Care homes. This tool can also be used to help care homes plan any activity to meet
these recommendations.
The baseline assessment tool (dated March 2014) can be located from the same page that the
NICE Guideline is accessed at:
http://www.nice.org.uk/guidance/SC1
Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print
the baseline assessment tool.
In England - A care home policy should also contain reference to Regulation 12 (Safe care and
treatment) of the Health and Social Care Act 2008 and to the new CQC inspection guidance
(updated in May 2015) to include the standard set of key lines of enquiry (KLOE) that relate to the
five key measures of service provision – are services safe, effective, caring, responsive and well
led – with a key focus for medicines management being included in the ‘safe’ category.
This guidance now replaces the previous reference to Outcome 9 – Management of medicines
In Wales – There have been no changes and CSSIW will continue to make reference in their
inspection visits and reporting to the National Minimum Standards – Standard 17 (Medication).
CSSIW are currently reviewing the Policy guidance which has been issued by NICE (March 2014)
For Information
Beacon Digital takes no responsibility for the medication policies of individual care homes and it is
recommended that a reference to the use of the Proactive Care System (PCS) is included within
the care home medicines policy with cross referencing to PCS processes and procedures available
via Invatech e-learning and on line help guides. Care homes are responsible for ensuring that any
NICE or other guidance used in the development of medicines policy is obtained from the latest
available versions.
Beacon Digital are able to offer limited assistance in signposting care homes to the appropriate
documentation referenced in this guidance.
1.4. Medicines Management Systems within Woodchurch House
It is a key aim of Woodchurch House to provide safe, efficient and accountable systems of
medicines management.
Woodchurch House has entered into an agreement with Beacon Digital and Well Pharmacy and
introduced an electronic medication management system called the Proactive Care System (PCS).
This consists of a hand held device that is used by nurses and carers to support the administration
and documentation of medicines and a range of supporting services that ensure the company’s
aims under section 1.3 are met.
All medicines related activities within the care home will therefore be processed using the PCS
system and the adoption of the use of original pack dispensing in place of previous Monitored
Dosage Systems.
1.5. Responsibilities of the Care Home Manager
This medicines policy requires the care home manager to be responsible for the delivery of the
organisations aims under section 1.3 and for the following tasks which protect residents from harm
due to medicines administration:
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To ensure that a safe environment exists at all times in the home in relation to the
ordering, storage, administration and the disposal of medicines
In discharging this responsibility, the manager must promote a safety conscious
approach in which all members of staff involved understand what is expected of them
and the procedures that need to be followed and complied with.
To ensure members of staff are adequately trained and competent in the use of the
PCS device for the administration of medicines to residents and in the associated
systems and processes in the care home for medicines management
Assessing at induction and the subsequent monitoring of the competency of all
appropriate staff to administer medicines safely
Checking of on-line medication administration records every week and assessment of
performance of staff in relation to medicines management as well acting on the various
management information reports available.
Ensuring that all staff members know how to access the electronic drug information that
is available on the PCS device and on the on-line Invalife service.
Arrangements for the preparation of orders for medication from the surgery and
forwarding of the requests to the GP surgery in line with the Service Level Agreement
(SLA) which is in place between the pharmacy provider and care home.
Arrangements for the collection of the prescriptions, dispensing and delivery as agreed
within the SLA provided by the pharmacy provider. This will include out of hours and
weekend arrangements
Arrangements for the accurate and timely booking in of the medicines to the care home
Safe Storage and Security of Medicines, including Controlled Drugs
Liaising with GPs and other allied healthcare clinicians and staff and communicating
changes to residents’ medication to the pharmacy provider as appropriate and via the
PCS handset as per agreed processes and protocols
Recording and accounting for the medicines administered to residents
Ensuring access and review of all records relating to medicines management
Maintaining a list of all homely remedies used in the home and clearly indicating and
recording the administration to each appropriate resident
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2. The Pro-active Care System and arrangements for pharmaceutical services
This section outlines the procedure for using the electronic medication system called the Pro-active
Care System (PCS) and the agreement in place with Well Pharmacy as the provider of
pharmaceutical services and a partner in the management of medicines at the care home.
The Care Home Manager must ensure that the agreed Service Level Agreement with the
Pharmacy Provider is upheld at all times to support the integrity of the Pharmacy service and to
ensure residents receive their medication when they require it.
2.1. The Pro-active Care System
Woodchurch House will employ the PCS system to manage medicines related activities. This will
ensure the safe, efficient, consistent and accountable management of residents’ medicines at all
times. The medicines related activities to be carried out using the PCS system includes:
 Administration of medicines
 Communication of changes to medicines or therapy
 Ordering of prescriptions
 Receipt of medicines
 Disposal and return of medicines
 Viewing prescriptions (via Invalife)
 Accessing medicines or clinical information (not yet available)
 Stock management and control
2.1.1. Fundamental requirements for using the PCS device
There are a number of fundamental requirements for the use and application of the PCS system
which will ensure high standards of medicines management in the care home. All members of staff
are required to meet these fundamental requirements at ll times:
1. Scan the barcodes on the medication labels of the medicines selected prior to administration.
This policy requires that 100% of medicines which have barcodes on their instruction labels are
scanned prior to administration.
2. “Dock” or “Synchronise” the PCS device before and after every medication round and when
prompted.
This policy requires that the PCS device is “docked” before and after each medicines round.
3. Book in all supplies of medicines received on the PCS device.
This policy requires that 100% of all medicines received in to the care home are booked in
using the PCS device.
4. Carry out a stock take for the prompted medicines.
This policy requires that 100% of all required stock takes are carried out.
5. Take action on the “low stock” medicines prompted.
This policy requires that 100% of “low stock” items are acted up on promptly.
6. Order the Monthly medicines on time.
This policy requires that the Monthly Medicines are ordered on the day that they are prompted
and this is typically day 8 of the monthly cycle and where possible to use the PCS summary
order reports in agreement with your local GP surgeries to ensure accuracy and efficiency of
ordering
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7. Account for all “Missing Entries”.
This policy requires that all 100% of “missing entries” are accounted for at every hand over or
by using the Invalife web portal.
8. Complete the administration plans for “PRNs”, “Emollients”, and “Dressings”.
This policy requires that 100% of administration plans are completed.
9. Ensure the PCS device is charged.
This policy requires that the PCS device is charged 100% of time when not in use and that its
battery charge does not drop below 40%. All members of staff are required to be vigilant and
never allow the PCS device to run out of charge.
10. Ensure that paper MAR charts are only used in exceptional circumstances once all options to
address issues and problems have been explored.
This policy requires that the use of paper MAR charts in the care home is only initiated in
conjunction with your pharmacy provider once Invatech customer services department has
been consulted and all attempts to resolve the situation have been fully explored.
2.2. Support for the PCS device
Each care home will have available as a minimum one member of staff trained on the PCS device
24 hours a day. This will ensure capability of each care home to train agency staff or newly
inducted staff in the use of the PCS device to administer medicines. The names of members of
staff trained and competent in the use of PCS should be recorded by the care home manager and
included as an appendix in the care home medication policy folder.
It is a requirement that all staff involved in the administration of medication to residents must have
successfully completed the appropriate e-learning modules and deemed competent by the Home
Manager as proven by the successful completion of a competency assessment.
All staff involved in the administration of medication will be offered a unique Personal Identification
Number (PIN) for use with the PCS device. Ongoing access to the device will only be authorised
for staff who have completed or refreshed their training according to Well Pharmacy policy
requirements.
Please also note that there will be rare occasions where the PCS device is temporarily rendered
inactive. In this situation, and after contacting your providing Pharmacy for advice, care homes
may record administrations temporarily on paper MARR using the MARR sheets which are
provided to the home via e-mail from Invatech on a daily or weekly basis according to the care
home preference.
2.3. Arrangements for the pharmaceutical service
The care home will use Well Pharmacy as far as is possible to supply all prescriptions for its
residents. This will ensure that all medication details are automatically updated to the PCS device
and that there is the added safety net of barcode validation at the point of administering medicines
to the resident. Any medicines which are obtained from a pharmacy which is not your main
medicines provider must be entered into the PCS device as soon as possible to ensure that the
integrity and accuracy of residents medicines information is up to date at all times.
2.3.1. Dispensing of medicines
All medicines will be dispensed in manufacturer’s original packages or traditional dispensing boxes
and bottles. There will be no routine dispensing of medicines in monitored dosage systems and
halving of tablets will only be carried out by Well Pharmacy with the pharmacists approval.
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All medicines will be dispensed against valid legal prescriptions and will be provided with legally
compliant instruction labels.
All medicines dispensed in manufacturer’s original packages will be provided with patient
information leaflets. In situations where patient information leaflets are not available, the PCS
device can be used to request a “fax back” of the patient information leaflet, or the Invalife web
portal can be used to print the appropriate patient information leaflet.
2.4 Service Level Agreement
All care homes should have a Service Level Agreement in place with their main pharmacy provider
to include details for:
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2.5
Arrangements of the ordering and provision of monthly, interim and same day medication
Daily delivery and cut off times for emergency and interim medication
Details of key contact names at the Pharmacy
Provision for out of hours or weekend and Bank holiday pharmaceutical services or advice
Pharmacist advice / resident medication review visits to the care home
Learning and support resources
Waste management services
Arrangements for controlled drugs delivery and recording
Provision of equipment and consumables for the purposes of medicines management
Escalation and complaints procedures
Customer support and escalation procedures for resolving issues
All enquiries or complaints relating to the provision of pharmaceutical services should be escalated
to your main pharmacy provider in order to resolve any immediate concerns or queries.
The care home will be provided with access to self-help on line files to support the early resolution
of the most common queries and access to a library or resources via Invalife.
Should there be an unresolved technical or medication supply issue, then the care home will raise
this matter directly with your main pharmacy provider in the first instance. If the matter cannot be
resolved by the pharmacy then they will escalate the issue direcvtly to the Invatech support desk.
2.6
Contact Details
The name and contact details for the following persons should be clearly visible in all care home
medication rooms:
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The key contact / Medication PCS lead for the care home and their deputy
The key contact at the main pharmacy provider location to include telephone and fax details
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The name, address and number of the nearest out of hours pharmacy to include telephone
and fax number
The names and contact details for all GP practices in the locality who provide a service to
the care home
Contact details for Invatech Health support desk and ‘out of hours’ procedures
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3
3.1
Supply and Storage of Medicines
Introduction
The over-riding principle is to ensure that the supply and storage of medicines are compliant with
all relevant regulations and that the risk of harm to residents and staff is minimised.
This section of the policy outlines the following:
 Legal classification of medicines
 Requirements for prescriptions and associated instructions
 Requirements for dispensing labels
 Storage requirements for medicines
 Records for the receipt and disposal of medicines in the care home
 Requirements for controlled drugs
 Storage of Oxygen
3.2
Supply of medicines
The supply of medicines to all care homes in the UK is governed by the Medicines Act 1968 which
defines three legal categories of medicines:
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Prescription Only Medicines (POM): May only be obtained upon presentation of a written
prescription, signed by an authorised prescriber. Most medicines in the care home are POMs.
Pharmacy Only (P): May be purchased within a community pharmacy when a pharmacist
supervises the sale.
General Sales List (GSL): May be purchased from any retail outlet.
o e.g. Homely remedies that are bought without a prescription and used as stock
medication in the care home and given to residents when needed.
In addition the Misuse of Drugs Act defines some medicines that are subject to additional controls
because they are liable to abuse – these are “controlled drugs”. In the care home many of the
medicines given to control pain at end of life are controlled drugs.
Please note that it is illegal for a pharmacy to supply a POM without a prescription and it is illegal
for someone to administer such medicines to a resident without a prescription.
This policy provides details of the arrangements for supply of monthly and interim prescriptions.
3.2.1
Dispensing of medicines and label requirements
All medicines will be dispensed in manufacturer’s original packages or traditional dispensing boxes
and bottles. There will be no routine dispensing of medicines in monitored dosage systems or
halving of solid dose forms (tablets) unless agreed with the main pharmacy provider.
All medicines in the care home must have a pharmacy label so that carers know who to administer
the medicines to and how much and how frequently to administer the medicines.
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The pharmacy label should have the following information:
1. Quantity of the medicine dispensed.
2. The name of the medicine, the formulation, and the strength.
3. Directions for use: dosage and frequency. It must be noted that directions such as “use as
directed” are not acceptable. In these situations the instruction for administration must be
clarified with the prescribing doctor and documented in the care plan.
4. Warning labels: e.g. avoid Alcoholic drink, Take with or after food, Take regularly and
complete the course.
5. The resident’s name.
6. The date the medicine was dispensed.
7. The name of the pharmacy and “keep out of the sight and reach of children”.
3.2.2
Prescribed medicines are the property of the resident for whom they are
supplied
Medicines prescribed, labelled and supplied for an individual resident are the property of the
named resident and they may not at any time be used for other residents as though they were
“stock” held by the care home. This principle applies to medicines, dressings, appliances and
nutritional supplements or any other prescribed item.
3.3
Records of medicines, dressings and appliances received
All medicines, dressings and appliances brought into the home from whatever source must be
booked in using the PCS device. This includes all prescribed items, hospital discharge medicines,
medicines brought from another home and medicines brought in by residents’ friends or relatives
(including supplements, homely remedies and herbal medicines, etc.).
The GP and Pharmacist should be consulted prior to any non-prescribed medicine being
administered to ensure there is no incompatibility or risk to current medication or health conditions.
The booking in process with the PCS device simply involves scanning the barcode on the medicine
labels. This will record the receipt of medicines and their quantities.
On admission of a new resident, written confirmation of the current medicines they are on must be
obtained from an authoritative source and this should be either a hospital discharge letter/summary
or a copy of their current repeat medicines list obtained from their surgery. It is not acceptable to
obtain this information from the labels of the medicines brought in by the resident or family to the
care home.
Records of medicines booked in to the care home are available on the PCS chart produced using
the Invalife web portal.
3.3.1 Booking out medicines in periods of absence from the care home
All medicines taken out of the care home for whatever reason must also be booked out using the
PCS device. This includes all prescribed items that residents may take with them to hospital, or for
short periods of absence from the home e.g. day visits or weekend stays with relatives. In such
scenarios it is recommended that the entire supply of medicines required for the duration is taken
with the resident and an up to date and valid paper MAR provided for the purposes and ease of
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recording administration. This will ensure that the medicines are supplied complete in original
packs with labels and the instructions for administration. The Home Manager should be satisfied
that the person taking responsibility for the resident whilst away from the home is fully aware of the
administration requirements and safe keeping of the medication.
If a resident is absent from the care home or in hospital, their status on the PCS device should be
changed accordingly. This will avoid the creation of “missing entries”. On returning to the care
home, the resident’s status must be amended and their medicines booked in following the
processes outlined in the PCS user manual.
3.4
Records of disposal of medicines
A record is required to identify the removal from the home of a resident’s medicines. Only those
medicines appropriate to current therapy should be stored within the care home. All items
prescribed for an individual resident remain their property. Thus if a resident leaves the home then
their medicines should be given to them or a suitable representative unless consent is given for
their safe disposal.
The following are scenarios where medicines may need to be disposed of:
 Medication remaining after a resident has died. These medicines must be kept separately
from all other medication in the home and disposed after a period of 7 days unless
otherwise directed by an enforcement officer.
 Medication that has been stopped by the prescriber must be removed from the resident’s
current medicines immediately and stored separately. These medicines may be disposed of
or returned immediately.
 Refused doses of medication that have been removed from the manufacturer’s original
container, must be placed into a pot or waste bag or pouch labelled “refused medicines”
and recorded appropriately on the PCS device.
 The “refused medicines” containers are available from your main pharmacy provider
 Expired medication identified as part of the checking process that are required prior to
administration of medicines
The PCS device must be used to record the return and disposal of medicines. The device has a
“Returns” functionality which is used to record the items being returned and communicate the need
for collection. The record of returns made using the PCS device is then “faxed back” to the care
home (copies can also be printed off using the Invalife web portal).
The record of disposal must show:
 The date of return
 The name, strength and quantity of the medicine
 The resident for whom medication was prescribed or purchased
 The signature of the member of staff who checked all the items out
3.4.1 Storage and collection of medicines for disposal
All medicines to be disposed must be stored separately to the current residents’ medicines in the
home and a regular routine and frequency for the return of medication should be defined by the home
manager to prevent the accumulation of unwanted medication in the care home.
The medicines to be disposed must be labelled for “disposal or return”.
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The home manager must ensure that waste collection arrangements are in place with the current main
pharmacy provider according the services level agreement.
The regulatory requirements for collection of waste medication from nursing homes will differ to
collection requirements and arrangements from residential homes. The care home manager must be
satisfied that the correct arrangements are in place for the care home.
On collection of the medicines to be disposed: the nurse / carer in charge both need to sign the “faxed
back” returns log. Refer to the PCS user guide for further details. The local pharmacy provider may
wish to make additional or separate arrangements for the recording of returns medicines and the care
home manager must ensure that these arrangements comply with regulatory guidelines.
3.4.2
Disposal of controlled drugs
Controlled drugs are denatured using “denaturing kits” available from your main Pharmacy
provider. Arrangements for CD destruction and return should be agreed within the Service Level
Agreement between the care home and the pharmacy.
Nursing homes must denature any unused or out of date controlled drugs prior to promptly
returning the medication to the pharmacy provider.
Residential homes must make prompt collection arrangements with the pharmacy provider to
return controlled drugs in their original packs or bottles.
When returning controlled drugs an entry is required in the controlled drugs register along with a
second authorised signatory. All items for disposal should be locked in the CD cupboard including
the active denaturing kit until immediately before collection.
3.5
Storage of medicines
It is the responsibility of the care home manager to ensure that there are appropriate facilities to
ensure the safe, secure and appropriate storage of medicines.
There must be a designated medicines room (s) for storing medicines that is secure. Consideration
must be given to the size of the home and the nature of the medicines to be supplied. The room
must be maintained at an appropriate temperature for medicines storage; for most products this is
25°C or below, some products require refrigeration (2 – 8 C).
The required conditions for storage will always be stated on the packaging of the medicines and
this must always be followed. There must be sufficient room to store nutritional supplements,
dressings and appliances (such as incontinence and ostomy products); no medical items should
ever be stored on the floor. All medicines must be stored away from direct sunlight.
For all but very small homes the usual arrangement is to have a designated medication room
containing medicines cupboards. Cupboards for storing medication not contained in the medication
trolleys should be of a suitable size and construction with a robust lock. The security of medicines
should not be compromised by using the lockable cupboard for storage of non-clinical items. There
should be no access to the medicines room via an external door and there should preferably be no
external windows. Where windows are included then arrangements should be considered to fix
metal bars over the windows and any direct vision into the room should be prevented.
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The medicines trolley must have sufficient capacity for all residents medicines to be locked away
during a medicines round whilst a nurse or carer is away from the trolley administering medication
to residents. The trolley must be locked and secured to a fixed wall in a secure area or room when
not in use and preferably in the designated medication room where space permits.
The keys to the medicines storage cupboards, trolleys and controlled drug cabinets must be kept
with an authorised member of staff at all times. The safe custody of spare keys to all medicines
storage areas is the responsibility of the care home manager.
A key control log should be in place at all times for all keys and entries made and updated at each
shift change or appropriate handover. The home manager should check control log compliance on
a regular basis.
3.5.1 Expiry dates
All medicines stored in the care home must have their expiry date checked on a regular basis
according to ……… policy. This date is usually printed on the packaging. Medicines storage areas
should be regularly checked for expired medicines. Some products have a limited life once
opened. In these cases the manufacturer’s expiry dated printed on the packaging only applies if
the product is left unopened and sealed and stored according to manufacturer’s instructions.
Medicines must never be used beyond their expiry date under any circumstances.
Staff must rotate the stock stored in the cupboards, placing the products with the longest expiry at
the back and using the most recent expiry first.
Staff must always check the expiry dates of medicines prior to administration to the resident and
advice should be sought from the supplying pharmacy should any concerns or queries arise as to
the integrity of any medication.
3.5.2 Expiry dates for “in use” medicines
These refer to the length of time from the date of first opening, that these preparations remain
usable before they should be disposed of. The date of opening should be marked on the container
so that these expiry dates can be applied. Always refer to the manufacturer’s labelling or your main
pharmacy provider for advice if in any doubt.
“In use” expiry of certain medicines
Product Type
Eye drops or eye ointment
Oral liquid preparations
External liquids, lotions, etc. and creams and ointments
packed in tubes
Topical preparations in pump packs
Topical preparations in tubs (eg aqueous cream)
Insulin
Tablets or capsules dispensed into amber tablet bottles
Expiry
28 days (in most cases. Always
check label or PIL)
6 months or less*
6 months
6 months or less
4 weeks
4-6 weeks (dependent upon
specific brand)
6 months from date of dispensing
(Unless pharmacy labelling states
otherwise)
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* Some liquid preparations have a shorter usable life once opened. Always refer to the
manufacturer’s labelling or the pharmacy labelling. Reconstituted antibiotics will usually have
a 7 day shelf life from the date of supply.
3.5.3 Items requiring refrigeration
A separate, secure and dedicated fridge should be available in the home to be used exclusively for
the storage of medicines requiring cold storage.
The temperature of the medicines fridge should be monitored and recorded daily when in use,
using a maximum/minimum thermometer or built in facility, ensuring that both the maximum and
minimum temperatures are recorded, and that the thermometer/built in facility is reset after the
readings have been taken.
The normal range for medication fridge items is 2–8°C but it is important to check the product
literature or ask the pharmacist if in any doubt.
If the temperature falls outside this range, the care home manager should be informed. The care
home manager should contact the pharmacist to check the integrity of the medicines and to seek
advice on the repair or replacement of the refrigerator. In the meantime, action should be taken to
store fridge items appropriately whilst the medicines fridge is repaired or replaced. This must not
be in a fridge which is used for the purpose of food storage.
Please note that whilst some medicines need to be kept in the fridge whilst they are being stored,
they do not necessarily need to be in the fridge whilst they are being used. For example some
Insulin types and eye drops, once opened do not need to be kept in the fridge. They will last
around 28 days outside the fridge. In addition because the medicines are not cold when injected or
inserted then they do not cause irritation or pain on administration.
Advice should always be sought from the supplying Pharmacy to confirm storage requirements if
this is not made clear on the packaging or pharmacy label.
3.6
Controlled Drugs (CDs)
Controlled drugs are medicines that require additional legal control on their supply, storage and
administration because they are liable to abuse. These are defined by the Misuse of Drugs Act.
3.6.1 Storage of Controlled Drugs
Controlled drugs for residents who are not self-medicating must be stored in cupboards meeting
the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973.
Only members of staff who are authorised to access the CD cupboard are permitted to hold the
keys. The keys should never be passed to a member of staff who is not authorised to access it.
The controlled drugs cupboard must be used for the storage of controlled drugs only, not jewellery
or money or any other personal belongings.
All CD transactions to include the issue, administration, receipt and destruction should be carried
out by two staff, one of whom is authorised to administer medication, the other as a trained witness
to the transaction. Both members of staff must ensure that their PINs are recorded at each stage
on the PCS device.
Controlled drugs should only be taken out of the controlled drugs cupboard whilst they are being
dispensed or counted for stock purposes.
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If a care home wishes to set up a palliative care service in their care home then they should seek
the advice and guidance of their pharmacy provider, clinical commissioning group / health board
and local NHS pharmaceutical adviser.
The use and application of CD patches e.g. Fentanyl, BuTrans require additional precautions and
procedures (e.g. body maps) to ensure correct and safe administration. Nurses and senior carers
should refer to the pharmacist for advice as appropriate and should refer to the patient information
leaflet for further guidance as required.
3.6.2 Controlled Drugs Register
Strict recording of CDs must be kept in the CD register. It must be a bound book with numbered
pages and the following details must be recorded:
-
The date the drug was received
The signature of the person who received the drug and a witness
The amount received and where from
The form of the drug e.g. Tablet, liquid, ampoule
The name of the resident who the drug is administered to
The date, time and amount administered
The signature of the person who administered the drug and a witness
The date and amount returned/transferred and where to
The signature of the person returning/transferring and a witness
The balance remaining for each item must be recorded and regular balance checks should be
conducted
3.6.3 Controlled Drug Register entries
The entries in the controlled drug register:




Must be clear, neat and legible
Must be in chronological order
Must have a separate page for each drug for each resident
Must be recorded as soon as the drug is administered, received or returned
The register should not be used for other purposes and must never be altered by changing entries
or crossing out entries; a footnote to correct the entry should always be used. Correction fluid
should never be used.
The register must be kept available for three years after last entry and should never be removed
from the home.
3.6.4 Dealing with CD discrepancies
There must be a weekly check as a minimum of all stock balances of controlled drugs. These
should be carried out by two members of staff.
Discrepancies should be notified and investigated by the care home manager. If the discrepancy is
resolved, then an appropriate record should be made, see the examples below.
If the discrepancy is not resolved, then the care home manager needs to take advice from their line
manager in the first instance and then from the pharmacy provider or the central CQC / CSSIW
telephone line and the police as appropriate.
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The following actions must be taken in the event of a discrepancy or incorrect entry with Controlled
Drugs
1. Where a discrepancy is found, it should be reported immediately to the care home manager
who should investigate promptly and escalate to their line manager for advice.
2. If the discrepancy cannot be resolved, the advice of the pharmacist should be sought and
the care home manager should contact the central CQC telephone line 03000 616161 or
CSSIW on 03007900126. If the reason for the discrepancy cannot be determined, and the
CDs appear to have gone missing, then all relevant people mentioned above, including the
police, should be notified.
3. If the discrepancy is found to be an error of calculation of stock balance or other entry
reason, do not change the balance column or use correction fluid. Under the last entry,
write the following:
• The date
• The error in subtraction/addition (indicated with an asterisk)
• The correct balance
• The signature of the nurse/member of staff and the witnessing nurse/member of
staff
4. In care homes providing nursing or residential care where a dose is given, but the
administering nurse or carer fails to complete the CD register at the time of administration
under the last entry, write the following:
• The current day’s date
• “DOSE ADMINISTERED, BUT NOT RECORDED AT THE TIME” followed by the
resident’s details
• The signature of the administering nurse/carer and that of a witness
• The correct balance
Such incidents MUST be reported to the home manager at all times.
Loss of Medicine Keys
The loss of medication room/cupboard/trolley keys must be reported to the Home Manager
without delay by the Nominated Person. The Home Manager is to decide on appropriate
action to ensure public safety. If following an initial investigation, keys are still not found,
this must be reported to the Line Manager or the Emergency on-call Manager. The Home
Manager (or person in charge of the home in his/her absence) must report the loss and
subsequent action to the local relevant regulator at CQC (England), CSSIW (Wales) or
SCSWIS (Scotland).
Theft of Medication
In the event of obvious theft of medication the following action needs to be carried out by
the most senior person in the home:
a)
b)
c)
Do not touch anything
Inform organisational Line Manager or on-call Manager
Inform the local Police
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d)
e)
f)
3.7
Document events clearly
Inform regulatory body verbally and through completion
documentation as requested
Inform local contracting officer if contractually required
of
appropriate
Use of oxygen in care homes
Oxygen cylinders and concentrators must be prescribed by a medical practitioner for a named
resident only and obtained from an authorised supplier. The GP surgery can advise on local supply
arrangements. Prophylactic oxygen (for use for non-named residents on an emergency basis)
should not be kept in the care home.
Oxygen should never be given to a resident for whom it has not been prescribed. A prescription for
oxygen should specify the dosage of oxygen to be given and the amount in litres per minute.
Oxygen must be administered via a mask which fits over the resident’s mouth and nose or via a
nasal cannula which fits into the nostrils.
Some residents may be prescribed oxygen concentrators which acquire oxygen from the air.
A risk assessment must be conducted for both oxygen cylinder and concentrators.
3.7.1 Storage of oxygen
 Cylinders being stored should be under cover, upright, secured to a wall or within a special
secured lockable room or container, and not subject to extreme temperatures
 They should be stored in dry, clean, well-ventilated areas so that they do not become dirty
or rusty
 Cylinders should be away from highly flammable liquids and other combustible materials
and from sources of heat and ignition
 They should be separate from other gases
 They should be preferably be stored on a cylinder stand or chained to the wall, but in any
case in a position where they are unlikely to fall over
 The storage area should allow for segregation of full and empty cylinders
 All rooms where oxygen is in use or stored should display the statutory warning notices:
Compressed Gas. Oxygen: No Smoking, No Naked Lights
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4
4.1
Medicines Administration
Introduction
The over-riding principle is to ensure there are procedures in place that ensure adherence to the
seven rights of medicines administration and to optimise the benefit from medicines for residents.
The Seven Rights are:
1. Right resident. Medicines must be administered to the right resident.
2. The right medicine. The right medicines must be given to the resident.
3. The right dose. The exact amount of the required medicine must be administered.
4. The right time. The medicines must be administered at the right time.
5. Right route. The medicines must be administered via the right route.
6. Right Documents and entries into the PCS device
7. Right of the resident to refuse their medication
In this section the following procedures are described:
• Safe practices and procedures in medicines administration
• The requirements for record keeping and accounting for medicines administrations
• Monitoring the effects of medicines
• Supporting residents in self-administration of their medicines
• Administering Homely Remedies
Who Can Administer Medicines?
In a Care Home with Nursing, medicines may only be administered by a first-level nurse or
a second-level nurse who has undergone appropriate training and assessment of
competence in medicines administration, known as a Registered Nurse (or RN). The RN
may occasionally delegate to a suitably qualified person the administration of oral and
topical medicines, but will at all times be responsible. This RN needs to hold a valid current
registration and PIN check; and may be either an employee or an employee of an approved
agency
or
In residential Care Homes, medicines may only be administered by an Authorised Person
who is generally a senior carer or carer or once dispensed and ready for administration
may delegate to a suitably qualified person the administration of oral and topical medicines,
but will at all times be responsible. The Authorised Person will never give medication to
care staff to administer unless that person has been formally trained in the administration of
medication
or
a)
or
The Resident (only if self-medication has been agreed and risk -assessed
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b)
4.2
Relatives (where agreed and recorded) and other appropriate Healthcare
professionals (where agreed and recorded) e.g. community nurses, GPs
General requirements relating to administration of medicines
The following are general requirements of this policy which relate to the administration of
medicines.

Medicines should be administered to residents only against a written prescription which has
been signed by an appropriate practitioner. If there is no prescription then the supply and
administration is being carried out illegally. The only exception would be homely remedies
administered in accordance with the section on homely remedies.

Medicines that have been prescribed and dispensed for one resident should not, under any
circumstances be given to another resident or used for a purpose which is different to that for
which they were prescribed.

Medication which has been prescribed for use by members of staff by their own GP must be
kept separate to residents medication and should be stored in a lockable personal receptacle
or locker or by prior arrangements with the care home manager to be kept safe elsewhere e.g.
the use of inhalers for asthma. Staff must not at any time use medication which has been
prescribed for a resident.

Medicines should only be administered when there is a proper dosage instruction. The dosage
instruction “use as directed” should not be accepted and a clear and specific instruction
should be agreed with the prescriber.

The medicines must have a pharmacy label with the directions for administration as written on
the prescription. The exception to this principle is when there is documented evidence to show
that a GP has authorised a change to the dosage of a medication which has already been
prescribed and this has been recorded and witnessed if the GP is present in the home or
recorded and witnessed by two people if new instruction is issued via a phone conversation. An
entry should be made in the residents notes and the change processed and witnessed on the
PCS device.

Medicines administration must only be undertaken by nursing and care staff that are trained
and competent to do so.

Medication should never be removed from the original container in which it was supplied until
the time of administration.

Administration of medicines may take place in the dining room, the lounge, or the resident’s
bedroom. At all times it is important to respect the dignity, preferences and wishes of the
resident when administering medicines.

When medicines are transported around the home, transportation must be done in a secure
manner such that they can be quickly and securely locked away in the event of an emergency.
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
The Home Manager must retain an up to date list of staff authorised and competent to
administer medicines. This list can be viewed on the front screen of the PCS device and Home
Managers can also access and amend this list via Invalife.

Each member of staff must log on to the PCS device using their own details and Personal
Identification Number (PIN). This PIN must be kept confidential. The use of another members
details to log on to the device will result in disciplinary action. Agency staff are required to use
their own allocated PIN which can be accessed by request through Invalife to the PCS
administrator. The Home Manager is responsible for ensuring that all agency staff are allocated
their personal PCS PIN. Managers can also determine the duration/expiry of the PIN
depending on the timescales the agency nurse is working at the home.
4.3
Medicines administration procedure
All staff must comply with the following procedure for the administration of medicines.
1. Before you begin you must wash your hands thoroughly. Then assemble all the equipment
required: medicines trolley (if used), the PCS device or medicine record, a sufficient supply
of medicines pots, medicines spoons, oral syringes (if required), tablet cutters, gloves,
water, glasses, paper towels and container for collection of waste materials. Medicines
should be administered to each resident in turn according to the clinical needs /
preferences of residents e.g. residents requiring medication for pain relief should have their
medication administered as a priority.
2. Identify the first resident by asking their name and date of birth and using the PCS device
scan the barcode on the plastic container which is used to store the medicine for that
resident. This will present a photograph of the resident which you are required to confirm is
correct. If this is not practical or possible due to the resident’s lack of capacity or physical
state, then their identity must be verified by another member of staff who is familiar with
them.
3. Obtain the resident’s consent to administer their medication. This may be implied consent
through the resident cooperating with your request to administer. All residents have the
right to refuse their medicines and medicines should not be given without consent unless
this is specifically documented in the care plan and agreed by a multidisciplinary team (see
section for ‘covert medication’)
4. Using the PCS device read the list of medicines presented, and note which medicines have
a red background which indicates that they are due to be given at this time.
5. Select the first medicine due to be given and using the PCS device scan the barcode on the
medicine label. This will confirm the correct medicine by presenting the number of tablets /
capsules to be placed in the pot for administration to the resident.
6. Check this prompted number against the label on the medicine package/container; if there
is a discrepancy a check should be made with the supplying pharmacy or person-in-charge
before giving the medicine to the resident. Having checked that the medicine is correct and
checked its expiry date, remove it from its pack directly and place into a medicines pot
(tablets and capsules).
If the tablet or capsule is in a bottle then it can be gently tipped into the lid before
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transferring to the medicines pot. Tablets and capsules should never be dispensed into
your hand and protective gloves should be used for this purpose.
Bottles of liquid preparations should always be shaken well before measuring a dose. Oral
liquid medicines should be measured using a medicines measure for doses of 5ml or more.
For smaller doses, an oral syringe (obtained from your Pharmacy Provider) should be used
because the medicines measure is not accurate enough.
If the medicine dose requires the tablet to be cut in half, guidance and support should
always be sought from your pharmacy provider as they should provide pre-cut tablets on
request and ensure that the container is labelled with the correct dose.
All medicines, nutritional supplements, patches, medicated dressings and topical medicines
must be administered and recorded using the PCS device. In some situations it is
acceptable to record topical preparations, dressings and nutritional supplements via
individual paper MAR records which must be kept securely in the resident’s room with their
permission. These items and the use of paper MAR records should only be administered by
trained and competent staff. The use of paper MAR records for these items must be
recorded on the PCS device. Stock records must be kept up to date routinely on the PCS
device.
7. On the PCS device select “add to pot”.
8. Select the next medicine that is due for administration and repeat the step in 5.
9. Find any other items to be administered such as creams or eye drops. Offer any “when
required” or “prn” medicines that the resident has been prescribed according to their care
plan.
10. Once all items for the first resident have been potted, they should be taken directly to the
resident and administered via the prescribed route immediately. Medicines should not be
left with the resident to “take later”.
11. Account for all of the medicines immediately after administration by confirming the
administration on the PCS device.
Please note that medicines refused/spat out or not taken should be accounted for by
selecting the appropriate code. Medicines that have been “spat out” or “spilled” can be
placed in the “refused medicines” receptacles/pouches supplied by your supplying
pharmacy. When returning medication, the actual refused medication items should be
reconciled with the returns report to ensure that all refused meds can be accounted for.
After administration, place the pot(s) and measure (if used) in a container for washing up
and cleansing for future use as appropriate; pots and measures should not be re-used for
another resident without washing. Your pharmacy provider can advise if pots can be
washed and re-used.
12. Repeat procedure from step 2 with all other residents.
13. Ensure that the resident has their choice of drink/food (if applicable to the administration of
that medicine) at the time. Oral medication should be taken with sufficient water if the
resident chooses water. If a resident does not wish to take his/her medication at the time of
offering, the Authorised Person must explain that (s)he will return later with it at a time
suitable to the resident and in line with prescribed times, allowing for time for specific
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medications e.g. Medicines to treat Parkinson’s Disease. Medication must be given at the
exact time as stated by the prescriber.
NB Oral medication should not be administered when the resident is lying down. The
resident should be sitting upright or standing.
14. Medication should be directly administered to the resident and not left where another
resident may pick it up
15. Administration should be only from the container labelled with the resident’s name and for
topical medicines the date of opening should be recorded on the tube or container.
16. Medication must never be administered from an unmarked bottle and only medication for a
single resident should be prepared for administration at any one time.
17. At no time must the drugs trolley be left unattended unless it is locked and all medication is
inside and the keys removed. Once the medication round is completed the trolley must be
returned to its place of storage and secured to the wall.
18. Administration of medicines should be avoided (where possible) during residents’
mealtimes unless that particular medication is required to be taken with food or the resident
requests this. The medication trolley should always be stored in a safe and discrete area
when in use.
19. Following the administration of medication all pots and utensils used during the process
must be thoroughly washed, rinsed and dried according to infection control procedures prior
to re-use. All plastic medication measures containing a figure 2 on the base are intended
for single use only and should not be re-used. If in doubt consult with your Pharmacy
provider.
20. The nurse or carer should ensure that all full and appropriate entries are recorded on the
PCS for each resident with a final check made at the end of each medication round to
ensure that there are no missing entries. Any missing entries from previous administration
rounds must be reported by the authorised nurse or senior carer identifying the missing
entry to the Home Manager for investigation without delay and actions recorded to include
entry into the residents care plan as appropriate. It is good practice to ensure that the PCS
device is taken to shift handover meetings so that any outstanding actions can be
discussed and followed up.
21. All calendar packed medicines and blister packs should be used to follow and match the
day of the week correctly where it is printed on the tablet blister and where more than one
pack is provided e.g. 2 x 28 packs of the same medication and strength, then one pack
should be started, marked with a pen on the box (not on the label) and finished before
opening up the second box. The same applies to liquid medicines
e.g Gaviscon Liquid
and boxes containing sachets e.g. Laxido. It is also good practice to write the date of first
use/opening on the pack.
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22. Disposable vinyl unpowered gloves should be used to administer creams, ointments and
other topical medication and should also be used when handling any cytotoxic medications
(Advice on the safe handling of cytotoxic medication should be obtained from the
Pharmacist). Disposable vinyl gloves must also be worn if there is a requirement to handle
solid dose medication e.g. tablets or capsules which are provided loose in brown labelled
bottles or for the purpose of stock counting.
23. If a resident is prescribed a dose of medication to be administered via
the halving of a tablet then appropriate tablet cutters should be used to ensure that an
accurate dose of medication is administered. Care homes should contact their pharmacy
provider should they need advice or support. It is important that the prescriber instructions
are well understood and that the pharmacy label reflects clear instructions with no
ambiguity.
4.3.1 Resident Refusal and Covert Administration of Medication
Resident refusal:
i)
Refusal to take medicines, or omissions, should be recorded on the PCS device,
clearly indicating correct code with reason, and this also recorded within the
resident’s Care Documentation. Residents have the right to challenge and refuse
medication that is prescribed for them and should this occur the consequences
should be explained to the resident where it is appropriate to do so. Consistent or
persistent refusals must be recorded in the Care Documentation and through a risk
assessment process with all involved parties including the GP and other healthcare
professionals as soon as possible and within 48 hours in order to support the
wellbeing of the resident.
ii)
There should be no blank space or entries on the PCS.
Covert medication:
It is Woodchurch House stated position that covert medication should only be
administered in exceptional circumstances and only after following the correct
policy and procedures.
‘Covert’ is the term used when medicines are administered in a disguised format without
the knowledge or consent of the person receiving them, for example, contained in food or in
a drink.
Giving medication by deception is potentially an assault. The covert administration of
medicines should only take place within the context of existing legal and best practice
frameworks to protect the person receiving the medicines and the authorised persons
involved in administering the medicines. This decision should involve a multi-disciplinary
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team assessment, including resident/relative/advocate (where appropriate), the GP,
pharmacist and care home staff. The decision, action taken, names of the parties
concerned should be documented within a risk assessment and all relevant sections of the
care documentation. The Line Manager of the care home manager is to be consulted of
any such decision.
A Mental Capacity Assessment and a Best Interests Decision Plan must also be considered
and further advice can be obtained your regulator or local compliance team.
Advice should be sought from the pharmacist or GP when administering medicines to residents
(including dysphagia) who are unable to take or swallow solid oral forms.
Most tablets and capsules are also available as liquids and the doctor or pharmacist will be able to
advise if liquid medication might be more suitable and is available as an alternative. If this is not
possible the decision needs to be made with the pharmacist and the residents GP the most
suitable form of administering and this must be confirmed in writing by the GP.
If a resident suffers any harm as a direct result of a resident’s medication being crushed or a
capsule opened to make it easier to swallow then the authorised nurse or senior carer could be
held legally liable. Each drug has a product licence which covers its use and places liability with
the manufacturer. By crushing a tablet which is not designed or licensed to be crushed, the drug is
being altered and the manufacturer is no longer responsible.
Whilst Woodchurch House does not condone the process of administering medicines in an
unlicensed manner, the organisation has a duty of care to follow the instruction of the prescriber.
The nurse or senior carer may be requested to crush or disperse tablets or open capsules by the
prescriber. Initially this request should be challenged and the option of other suitable medicines
explored, however if no other suitable medicines are available the decision to administer medicines
in an unlicensed manner must be made with the pharmacy provider (Pharmacist) and a written
instruction must be made by and received from the GP. A care plan must then be formulated on
the basis of the instruction, detailing the medicine prescribed, the reason for the administration in
an unlicensed manner, how the medicine will be administered, the strength and dosage of the
medicine, the frequency of administration, this support plan must be evaluated on a monthly basis
within the home and discussed monthly with the GP to continue in an attempt to find an alternative
medicine which can be used in its licensed form.
Regular attempts should continue to be made to encourage the resident to take their medication
conventionally, and ongoing review must be documented in the care plan
Ensure that antibiotics are given at the prescribed intervals and the full course completed
per GP instructions.
as
Any problems encountered, e.g. difficulty in swallowing, side effects, whether observed or
mentioned by the resident, should be recorded and brought to the immediate attention of the GP.
4.3.2 Administration of controlled drugs
Administrations of controlled drugs must follow the same procedure as above using the PCS
device. However the following additional procedure must be complied with:
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



The person administering the medicines must take the CD from the CD cupboard and
check against the medicine’s record on the PCS device. This must be witnessed by a
second authorised person.
Return remaining stock to CD cupboard and lock it
Administer the medicine according to procedures above. A witness will be required to
confirm the administration on the PCS device by entering their PIN. Please note that this
second person does not need to be accredited for administering medicines, but must be
approved for witnessing medicines administration.
Complete CD register in full ensuring the stock balance is correct. A witness will be
required to check and sign the CD register.
Patches that are used for analgesic purposes e.g. Fentanyl, BuTrans should be
administered as per the Patient Information Leaflet Instructions and patches should be
checked on a daily basis ( this can be done and recorded by care staff when conducting
personal care to residents) to observe that it is secure and confirmation recorded and
checked periodically by qualified staff i.e. nurse or senior carer.
Fentanyl Patches may cause serious or life threatening breathing problems, especially
during the first 72 hours of treatment. The use of this particular patch must be treated with
caution and additional procedures put in place to ensure safe practice of administration and
management as well as recording.
If a controlled drug is wasted or partly used this must be recorded and witnessed and
appropriate entries made on the PCS device and in the CD register.
4.3.3 Injections
a) Injections must be administered to residents only by the Authorised
Person (Registered Nurses only within the scope of this section of the policy), acting in
accordance with the prescription written and signed by a medical practitioner, unless
the resident is self-medicating.
b) RNs, GPs/Community Nurses administering injections in the home must be asked to
sign the Record of Administration (MARR sheet if this is appropriate) or suitable
alternative documentation which is kept in the home. Refusal of this request should be
documented in the resident support plan. Regular care home staff are responsible for
ensuring that the PCS entries are accurate and up to date. Records of administration
held by the visiting healthcare professional must also be held at the home and
accessible by authorised staff for the purposes of monitoring and review. This process
may vary from home to home according to the co-operation of visiting
clinicians/professionals.
c) Injections should never be prepared in advance of their immediate use.
d) Insulin may be administered only by a RN, the resident him/herself or by
a community/district nurse. In exceptional circumstances this may also be by a relative
where this has been mutually agreed by all concerned and clearly documented and
signed on the Care Documentation. Care staff are not permitted to administer insulin
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unless this is an agreed policy within the home. Insulin to be checked and administered
by a Registered Nurse with a 2nd Nominated Person to witness the procedure. Both
persons should then record and confirm administration using appropriate company
documentation and a single confirmation of administration entered on the PCS device.
Community nurses should be requested to complete organisational documentation as
well as their own CCG/HB/NHS documents.
4.3.4
Dressings
a) Care Staff may apply first aid dressings to minor injuries.
b) Socialised dressings, e.g. for leg ulcers or pressure sores, are the responsibility of the
Authorised Person (RNs only within the scope of this section of the policy)/Tissue
Viability Nurse/Community Nurse (Residential Care Home). Under the direction and
regular assessment by a RN/TV Nurse or Community Nurse (Residential Care Home)
this treatment may be continued by an Authorised Person trained and deemed
competent to do so.
4.3.5
Enemas
Enemas must be prescribed by a doctor and administered by a RN/ Community Nurse or
an Authorised Person trained and deemed competent by a recognised authority. A record
of administration must be completed on the resident’s MARR sheet.
4.3.6
Suppositories, Pessaries, Vaginal/Rectal Creams and Ointments
a) These must be administered by a RN (Care Home with
Nursing) or a Community Nurse (care home), or self-administered by a resident
deemed competent to do so.
b) A RN may administer these preparations with the resident’s consent
as long as he/she has received the appropriate training and is deemed competent. The
written consent is to be recorded and maintained with the care records
c) The RN within a Care Home, administering these preparations must
have received suitable training from Community Nurses, Doctors or appropriate health
professionals authorised to administer such training. Evidence of the training must be
held in the training file and in the individual Authorised Person’s personnel file.
d) Disposable vinyl unpowdered gloves must be worn.
e) In all circumstances a record of administration must be maintained
on the PCS device.
4.3.7
Eye drops, ear drops, nasal sprays, inhalers
For administration of eye drops the lower eyelid should be gently pulled downwards and the drops
administered into the pocket between the lower lid and eye ball. One drop is usually sufficient
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unless otherwise directed; most individual’s eye cannot hold more than two drops – any excess
runs out of the eye and is wasted.
Ear drops should be administered with the resident’s head tipped to one side; the head should
remain tipped for a minute or two to ensure the drops run thoroughly inside the ear before drops
are placed in the other ear (if appropriate). The ear may hold at least 3-4 drops, more may be
appropriate in some cases, always follow the prescriber’s instructions
Nasal sprays should be administered by placing the nozzle into one nostril whilst holding the other
one closed, the resident should then be asked to breathe in gently through their nose whilst the
spray is activated.
For standard aerosol inhalers, the resident should exhale deeply; insert the inhaler between their
lips ensuring a good seal then they should inhale deeply and steadily whilst activating the inhaler.
There are a few types of dry power inhalers; these are usually breath activated and then the
contents of the activated dose inhaled.
These preparations may be administered by the resident him/herself or by an Authorised Person
and be recorded on the PCS device.
NB.
Eye drops may in general only be used for only four weeks after opening with date of
opening to be recorded on the label to ensure audit trail. They must be dated when first
opened using the ‘date opened’ labels provided by some pharmacy providers.. Separate
bottles, clearly labelled, must be used for each eye (when prescribed separately).
4.3.8 Creams, Ointments, Gels (Including Medicated Shampoos, Bath Oils)
a) These may be applied by care staff where appropriate training has
been given and the person has been assessed as competent. It is the responsibility of
the authorised nurse or carer even if applied by a care staff member to ensure that
administration is being conducted correctly and recorded correctly by the carer on PCS
device or e.g. T- MARR Administration Plan for Topical Applications
The Authorised person must visually check skin condition at regular intervals as agreed
and recorded in the care documentation. The T-MARR Administration Plan should
remain in the resident’s room for ease of access by authorised staff and the topical
preparation must be marked on the PCS that it is being managed on paper to confirm
that a T-MARR is being used and is located in the residents room.
It is Woodchurch House policy to use T-MARRs for the application of topical
medications and the T-MARRS should be kept in the resident’s room with the care plan
documentation unless by exception there are individual residents for whom this
approach is not desirable and this is agreed by the Home Manager. At the end of the 28
day cycle, the completed and printed T-MARR should be securely attached to the
corresponding paper MARR for that resident for the same month.
For some topical applications, e.g. prescribed for infections or severe bed sores, then it
is likely that the nurse or senior carer will be responsible for administering this
medication and this should be recorded directly on the PCS device or on the T-MARR
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as appropriate and care staff should be informed of the agreed method of
administration and recording in these situations to avoid any doubt or confusion.
b) All staff must be aware that some topical preparations contain potent medication and
they must be applied in accordance with the instructions. Disposable vinyl unperfumed
gloves should be worn by staff for their own protection.
c) Creams, ointments and gels may be stored in the resident’s
bedroom at the discretion of the Authorised Person in agreement with the Home
Manager or an appropriately qualified Nominated Person provided that they can be
locked away. These should be risk-assessed as there is a need to consider the
individual and other residents. Some preparations require storage in the medication
fridge and arrangements must be made at local level to ensure these arrangements are
in place.
d) Prescribed creams, ointments and gels (e.g. E45 cream) must only
be used for named residents only and not applied to any other residents.
4.3.9 Percutaneous Endoscopic Gastrostomy (PEG)
A PEG is a feeding tube which passes through the abdominal wall directly into the stomach, so that
nutrition can be provided without swallowing, or in some cases to supplement ordinary food. The
PEG tube can be connected to a ‘giving set’ to provide feeds continuously or a syringe can be
used to receive feeds at intervals.
PEGs are used in people of all ages, who are unable to swallow or unable to eat enough and need
long term artificial feeding. Common causes include stroke (CVA), head injuries, neurological
diseases such as multiple sclerosis or motor neurone disease, or surgery to the head or neck. In
some cases PEGs are used to give extra nutrition (or supplements) to people who can still eat,
such as patients with cystic fibrosis.
Nutrition given via PEG must be prescribed by an appropriately qualified and authorised
practitioner for a named individual. The nutritional supplements may be delivered by your
pharmacy or another supplier. These nutritional supplements must be treated in the same way as
other medicines and only administered by a trained and competent individual. Therefore they need
to be appropriately booked in, securely stored, their administration and management accounted for
on the PCS device.
Infection control
Minimal handling and an aseptic non-touch technique should be used when administering
water/medication/feed via a PEG tube.
Effective hand hygiene must be carried out prior to handling the tube and/or administration of
feed/medication/water. Hands should be washed thoroughly with liquid soap and water, using a
technique, which will cover all surfaces of the hands. They should be rinsed under running water
and dried well with a disposable paper towel. A detergent skin cleansing wipe can be used.
Alternatively alcohol gel can be used on visibly clean hands i.e. free from dirt and organic material,
using the same technique. Carers who carry out these tasks should be made aware of the
importance of hand hygiene.
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Hand hygiene must be maintained throughout the procedure and carried out prior to a clean procedure
and after any activity or contact that could potentially result in hands becoming contaminated.
Potential infection control risks should be integral to the education of staff at the care home.
Administration of medicines via PEG
The over-riding principle is to ensure residents receive medicines in a form that benefits them without
causing problems. To comply with this principle pharmacists and GPs must be consulted on the
suitability of the form of the medicine to be administered via the PEG. Liquid formulations are
preferable and at all times the PEG tube must be flushed with water before and after administrations.
The following procedure must be followed when administering medicines via a PEG:

Stop the infusion of feed if need arises. (With some drugs, the feed must be stopped in
advance.)
 To prevent blockage, the enteral feeding tube should be flushed before and after feeding
or administrating medicines. Flush the feeding tube with at least 30mls of water. Use
freshly boiled and cooled water.
 Enteral feeding tubes for patients who are immunosuppressed should be flushed with
either cooled boiled water or sterile water from a freshly opened container.
 Administer the dose in an appropriate syringe via the feeding tube.
 Draw up 10mls of water in the same syringe and administer via the tube to flush.
 If more than one medication, flush between each drug with a least 10ml of water then
repeat steps 2-4 (Each medication requires a separate syringe)
 Flush the tube with at least 30ml water following administration of the last drug
PEG administration must only be conducted by suitably qualified, trained and competent staff.
Care of PEG
Ensure the tube is firmly clamped or the end of the tube fully closed. The PEG tube should not
interfere with your normal activities and when clamped and not in use it can be hidden discreetly
beneath your normal clothes.
Mouth care
It is important to look after the teeth and mouth of individuals with PEGs. This may be helped by
using a mouth wash or swabs moistened with water. The doctor or nurse will advise on whether
the individual can suck ice cubes or on other ways to keep the mouth moist.
Replacement of PEG tubes
Several PEG tubes are available and the doctor will decide on the best type and size. Some are
designed to last for a few months, while others may function for one or two years or even longer. If
the tube wears out and PEG feeding needs to be continued the tube can be easily replaced. If
however, swallowing condition improves and PEG feeding is no longer required the PEG tube can
be removed by the hospital. The doctor should always be consulted before this is done.
Below is a list of some possible problems and how to prevent or overcome them.
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Diarrhoea, bloating, constipation, reflux
The dietitian will advise on the correct type of feed and rate of feeding. If constipation is
experienced it may be advised to have a high fibre feed. If reflux or vomiting occurs after feeds it
may help to change position during feeding. The doctor must be informed in abdominal symptoms
occur at any time.
Skin infection
It is important that the skin around the PEG is cared for well. It should be kept clean and, after
washing, bathing etc., should be dried carefully. Ensure that the area under the disc is also
carefully dried. If the skin becomes red, swollen or sore you should contact your doctor or nurse.
Feeding tube problems
The prescriber must give clear instructions on the feeds and medicines that can be given through
the PEG tube. Only specially prepared feeds should be used and medicines should be given in the
form of liquids where ever possible. There are also other issues which must be considered such as
crushing of tablets and covert administration. The tube should be flushed with 30-50ml of cooled,
boiled water before and after each feed or medication. If this is not done, feed or medicines can
solidify in the tube and cause blockages. The care home manager must ensure that staff have
training on what to do if the tube blocks. If the measures fail the doctor or nurse must be contacted
as soon as possible.
If the tube splits or the hub breaks
The tube must be clamped shut close to the retention disc to prevent leakage. Contact the nurse or
doctor as soon as possible. It may be possible to repair the tube otherwise they will arrange for a
replacement to be inserted.
If the tube falls out
The exit hole will not close immediately. If trained appropriately to insert another tube do so as
soon as possible. If not, cover with a dressing to absorb any leakage and get in touch with the
nurse or doctor who will arrange for a replacement to be inserted. If there is any delay the dressing
may need to be replaced so that the skin remains dry.
4.3.10
External Diagnostic Procedures
a. Urine testing may be performed by a competent resident or a trained person using
prescribed diagnostic sticks e.g. Clinstix. following appropriate training. Results must
be monitored by a Registered Nurse within a care home for Nursing or by the GP or
Community Nurse in residential homes.
b. The taking and checking of blood in any form must be done by a Registered Nurse
within a Care Home for Nursing, competent in venepuncture, or the GP or
Community Nurse in residential homes. Results must continue to be monitored by
the Nurse, GP or Community Nurse.
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c. The use of a glucometer (by an authorised person or a competent resident) prior to
the taking of insulin including the frequency must be indicated in the residents care
plan documentation. This must also include indications of other times when the use
of the glucometer is advisable e.g. indications of low blood sugar.
4.3.11
Sub Cutaneous Infusion – For use in nursing homes only
Sub Cutaneous fluids are prescribed and used to support residents who have compromised
hydration. Staff should refer to the appropriate nursing / care policy for full information and
procedures on subcutaneous infusion.
Details of the fluids infusion time and other relevant information should be recorded on a
sub-cutaneous Infusion Record.
Fluids must be obtained through procedures set out and agreed by the GP practice.
The agreed process for administering subcutaneous fluids should be well understood by
nurses and staff must ensure that a local policy is followed in relation to obtaining supplies
( including giving sets and butterfly needles)checking of batch numbers, setting up and
recording. It is important that there is continuity of medication for the resident according to
GP instruction and prescribing requirements.
4.3.12 Syringe Drivers – For use in nursing homes only
Staff should refer to Woodchurch House Nursing Policies for full information and
procedures on the administration of drugs via a syringe driver. Staff should undergo a
competency assessment and received appropriate training before being assessed as
competetent by an approved assessor.
Additional details on the administration of syringe drivers must be recorded on a Syringe
Driver Monitoring Record .This record must be signed by the RN and witnessed by a
competent person who has been assessed by the home manager in order to witness the
setting up of the syringe driver.
All syringe drivers must be serviced on an annual basis and records of
servicing maintained along with PAT service records
4.3.13 Nutritional Supplements
All nutritional supplements must be prescribed for individual named residents and are not
transferable for use with other residents. An administration plan and record of nutritional
supplements form should be completed for all residents who are prescribed nutritional
supplements and these records should be filed in a separate folder and kept on the
medication trolley for completion by care staff. Nurses and senior carers who are
conducting the medication round should ensure that the records are fully completed to
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ensure that all appropriate residents have received their supplements in accordance with
GP/Dietician instructions.
The use of nutritional supplements should be reviewed regularly for each resident to
ascertain ongoing requirements or cessation in order to best meet the needs of the
resident.
4.3.14 The use of Thick and Easy or other fluid thickeners
The use of thickeners as for all prescribed medication must be for named residents only
and not used for other residents who have not been prescribed this by their GP. Details of
usage must be documented in the Nutrition Care or Support Plan (or equivalent) and stock
levels checked on a regular weekly basis or sooner if necessary. Nurses and senior carers
authorised to administer medication should ensure that all care staff involved in the usage
of fluid thickeners are aware of the quantity to be used (usually expressed as the number of
scoops) for individual residents as per the instructions entered in the Nutrition Care or
Support Plan.
4.3.15 Oral Anticoagulant medication
An Anticoagulant medicine is used to prevent or treat the formation of harmful blood clots
within the body by making the blood take longer to clot. Warfarin is the most commonly
used oral anticoagulant which must be monitored regularly, other anticoagulant medicines
may be used and do not require regular INR monitoring e.g. Dabigatran. Each individual
resident must have a risk assessment in place when prescribed anticoagulant medication.
Monitoring Treatment
Whilst the resident is on Warfarin they must have a regular blood test called an INR test
(International Normalised Ratio), these are very important. The results of the blood test will
determine if the dose of the anticoagulant needs to be increased decreased or stay the
same. The anticoagulant clinic or GP surgery should give the resident an information
booklet and an anticoagulant alert card. The residents will need to attend the anticoagulant
clinic, and it is important to contact the GP/Clinic immediately if an appointment is missed.
Alternative arrangements will need to be made for residents who are unable or incapable of
attending the clinics.
The clinic or GP surgery will also issue treatment records (this may be a separate
typewritten form which is sent after each blood test or in a yellow record book which
summarises the recent and current anticoagulant therapy and regime.) that will indicate the
latest blood test result, the dosage of anticoagulant and the date of the next blood test.
The procedure for regular blood testing and the use of the treatment card will need to be
agreed with the resident’s GP and should be included in the residents care plan and also
within the home’s medication policy.
Pharmacists are contractually required to request and review all INR record cards on each
occasion that a prescription for an anticoagulant is received. The care home should fax a
copy of the latest INR card entry to the pharmacy provider or attach a copy of the INR card
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to the prescription prior to collection / receipt of the prescriptions by the supplying
pharmacy. Prior to the prescription being sent to Well Pharmacy the authorized person to
check the prescription against the treatment card to ensure they correspond. Any
discrepancies should be passed onto the GP and or Pharmacist immediately.
Pharmacists will dispense anticoagulant medicines in their original containers or white
dispensing boxes. All Warfarin medication must be administered in accordance with the
INR yellow booklet or equivalent documentation provided by the anticoagulant team. The
PCS device will not prompt with a dose for Warfarin and will refer staff to the INR
documentation as the dosage can be variable from day to day according to the needs of the
resident.
Warfarin is available in various strengths – 500 micrograms, 1mg, 3mg, 5mg - and great
care should be taken to select the correct strength.
Upon receipt of the prescribed medicines the authorised Person must check the medicine,
yellow treatment card and prescription correspond.
All changes to the strength of warfarin must be confirmed in writing by the GP or by a new
prescription. Dosage changes often result as a review visit to the anticoagulant clinic who
may directly inform the care home of any changes to medication strength via fax or letter.
Dose changes should not be made unless authorised or confirmed in writing by the GP or
the clinic.
1. Medicines Administration Records:
a. The dose of Warfarin intended for the resident must be clearly stated on the
residents individual record received from the clinic/GP surgery.
b. The words “as before” must never be used.
c. Warfarin must never be administered before the fax, yellow book and medicines
administration records are cross-referenced for dose clarity or discrepancies.
d. If a hand written MAR sheet is required it is good practice to have the sheet
checked and signed by a second member of staff for accuracy. The PCS device is
not set up for a second witnessing signature and care homes should use their own
documentation for these purposes if this is an agreed policy.
2. Administration:
a. The least number of tablets required to provide the specific dose of Warfarin should
be administered to the resident.
b. Avoiding breaking tablets in half. There is a 500 microgram tablets available.
c. Ensure that all administrations of Warfarin are carried out by using the PCS device
to scan the barcode on the medicines label.
d. Ensure all members of staff are aware of the potential for error surrounding 500
microgram and 5mg tablets.
Pharmacists undertaking ‘Pharmacy Advice Visits’ to the homes will incorporate a check to
ensure the home has written safe procedures for the administration of oral anticoagulants.
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Home Managers should be satisfied that arrangements for the safe administration of
Warfarin are in place and in accordance with the local arrangements as defined by their
local anticoagulant clinic.
4.4
‘When required’ PRN Medicines and variable dosage instructions on regular
medication
When medicines are intended for use ‘when required’ (PRN), the label should state the
minimum interval between doses and indicate reasons for use, e.g. for pain, for nausea. It
should also include the maximum dosage which could be given within a twenty-four-hour
period. This also applies to the PCS instructions. There should not be ambiguity in the
dosage; e.g. ‘1 or 2 tabs to be taken three or four times a day when required’ and every
effort should be made to contact the Pharmacist or GP to avoid the usage of these variable
doses and a specific administration instruction obtained. The avoidance of variable
administration instructions for regular medication as well as PRN medication must also be
avoided and clarity sought from the GP or Pharmacist.
When PRN medicines are prescribed it is recommended that a clinical note is added
against the medicines on the PCS. The note should state:
a) The maximum frequency
b) The maximum number of doses in 24 hours
c) The reason for treatment (e.g. for nausea)
If PRN medicine is not administered, the MAR record should not be left blank for that
medication and should be identified as not required. This will prevent any blank entries on
the MAR record .
PRN medicine should not normally be administered as routine. All residents who are
prescribed PRN medication must undergo an administration assessment plan for PRN
medicines before administration. If a PRN medicine is being given on a regular basis, a
discussion with the prescribing GP should take place with a view to it becoming a regular
medication. A copy of the PRN administration plan should be kept available at all times for
purposes of cross reference with the PCS record and the plan should be reviewed with the
GP on a regular basis.
If PRNs are not being administered routinely then the dose reminder should be switched
off. A summary of the key notes on the PRN assessment plan should also be entered into
the appropriate notes section of the PCS.
PRN medication for sedative and tranquillising medication is not considered good practice
and should be avoided or discouraged wherever possible. Where it is prescribed there
must be a clear record of reasons and it must be reviewed on a monthly basis with the GP.
The administration plan should also include confirmation of structured or unstructured
administration:
4.4.1 “Structured PRNs”
Medicines classed as “Structured PRN” are those with a “when required” dosage that must be
offered at every medicines administration time. These would typically be medicines prescribed for
pain relief or a condition that the resident is likely to experience on a regular basis. See below for
an example PRN care plan:
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Resident Name
Mr A. N. Other
Name, Strength and Form
of medicine
Paracetamol 500mg Tablets
Prescribed Dosage
Take ONE to Two four times a day When Required
What is the medicine
prescribed for?
For general pain and osteoarthritis
When to give the
medicine?
Offer the medicine to the resident up to four times a day and record if
the resident refuses or does not require the medicine.
Assessment Criteria and
signs to look for
If resident is rubbing knee joints or grimacing on getting up or
complaining of pain
How many to give?
Offer two tablets for maximum relief, remember to record the number of
tablets administered and the time of administration
Maximum quantity and
dosage interval
Maximum of Two tablets at any one time, at least four hours interval
between dosages
Extra Notes and
instructions
Contact GP if pain relief is not achieved, or if the medicine is requested
regularly as this will indicate the need for a review
Signature of author of the
plan
A senior nurse
Date: 01.01.212
4.4.2 “Non-Structured PRNs”
Medicines classed as “Non-Structured PRN” are those with a “when required” dosage that must be
used / offered on the rare occasion that a resident experiences a condition. These would typically
be medicines prescribed for specific conditions for example to control behaviour or for relief of
diarrhoea, constipation and dry skin. See below for an example PRN care plan and Appendix 5.
Resident Name
Mr A. N. Other
Name, Strength
and Form of
medicine
Haloperidol 500mcg
Prescribed Dosage
Give 1-2 capsules when required for agitation
What is the
medicine
prescribed for?
To reduce agitation and restlessness
When to give the
medicine?
When the resident is in an extremely agitated state that is likely to result in
harm to the resident or others and when the methods below have been tried without
any success:
 Re-directing their attention to something interesting
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Providing intensive one-to-one direct care
Letting the resident have time alone
Talking to the resident about what is bothering them
Removing the resident to a different area in the nursing home
Leaving the resident and returning at a later time
Assessment
Criteria and signs
to look for
If the resident attempts to strike out at another resident or staff member. If the
resident attempts to harm themselves for example throwing themselves out of bed.
How many to give?
Offer one capsule to start and then an additional capsule 6-8 hours later if still
needed. Remember to record the number of capsules administered and the time of
administration
Maximum quantity
and dosage
interval
Maximum of one capsule at any one time, and no more than 2 capsules in 24
hours.
Call the GP if there is a need to give the medicine for more than 48 hours.
Extra Notes and
instructions
Make sure that you have explored what the underlying cause of the agitation and
restlessness is and try and resolve this if you can. Try all other methods of
calming the resident before giving the medicine. Document all the signs and
symptoms in the care plan.
Signature of author
of the plan
A senior nurse
Date: 01.01.212
Any PRN medications which are being administered on a regular every day basis
should be referred for review by the GP as should any PRN medications where there
has not been an ongoing requirement for administration to the resident.
4.5
Prescribed Regular Medicines
4.5.1
Specific Times for Administration
Medicines intended to be given regularly shall be given every day at the times specified by
the prescriber or pharmacist until the prescription is cancelled or instructions are given to
the contrary. Careful consideration should be given to ensuring the resident receives their
medication at appropriate intervals so as to ensure a safe therapeutic level is achieved
especially when considering the resident’s routine. Medicines which are deemed to be time
critical e.g. for Parkinsons disease, must be given at the time stated on the
prescription/PCS and staff should ensure that any prescribed analgesic medication is
administered at the right times to meet the needs of the resident e.g. early and near to
rising if a resident suffers with joint pain when getting up or dressed and to allow a sufficient
period of time between doses e.g. a minimum of four hours is required between doses of
Paracetamol up to a maximum dose per day.
Managers should ensure that every effort is made to complete medication rounds within a
reasonable time period each day with particular emphasis on the main morning round
wherever possible being completed each day by 10.15am.
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4.5.2 Hand written MAR records
A hand-written MARR sheet should only be completed in an emergency situation and
where the PCS device is unusable. A printed MAR sheet can be requested directly from the
PCS device for an individual or for the whole home, the Invalife web portal allows paper
MAR charts to be generated and printed.
4.5.3
Discontinued Treatment
When the treatment is to be discontinued, the PCS system should be used to discontinue
the drug.
4.5.4 Change of Dosage – If a GP authorises a change of dosage to an existing medicine
then this must be witnessed on the PCS device by a second authorised person and a note/reason
of the changes also made in the notes section on the PCS device and care documentation.
4.5.5
Telephone/Verbal Instructions from GPs
GPs retain the right not to attend a patient. On occasions where a GP refuses to attend a
resident, this must be fully recorded within the resident’s Care Documentation.
In an emergency a Nominated/Authorised Person may accept a verbal instruction from a
GP for a change to instructions for existing medication as long as the GP then reiterates the
instructions to a second Authorised Person or nominated person who fully understands the
process. Each then writes down the instructions, compares, and confirms, dates and signs
records in the care plan sheet. This should be followed up as appropriate with the GP if
practical and a signature obtained from the GP and the pharmacist informed of any
changes for future medication supply e.g. via a pharmacy servicer user update form (copies
available from your local supplying pharmacy) or directly via the PCS device.
4.5.6 Urgent prescriptions obtained out of hours from late night Pharmacies
Urgent prescriptions can be obtained from local late night or out of town Pharmacies.
Arrangements should be made to contact the Pharmacist in the first instance to establish
that the medication is available and the prescription should be taken or faxed to the
Pharmacy and arrangements for delivery or collection agreed. The nurse or senior carer on
duty is responsible for ensuring that a photocopy of the prescription is taken and kept at the
home and on delivery / receipt of the medication, an entry for the medications is made onto
the PCS device and a check made to ensure that the correct medication for the resident
with correct dosage has been supplied and recorded and a second signatory obtained for
the PCS entry.
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4.6
Records of medicines administered using PCS
It is a requirement to keep records of all medicines administered to a resident including prescribed
and non - prescribed medicines. The care home records of medicines administered will be kept on
the PCS device and downloaded on to a central database. The historical records of medicines
administered over the previous three years will be made available to the care home on request to
the Invalife support desk. These MARR records must be printed by the care home at the end of
each complete cycle or PDF versions sent to the home on a regular basis should be kept so that a
full paper record of all residents medication is kept and stored securely as archived information and
to show CQC/HB / Local Authority inspectors or compliance teams on request.
The records will contain the following information:
 Name and date of birth of the resident, and their room number if appropriate.
 Details of any allergies that the resident may have.
 Name, strength and route of all medicines.
 Frequency and times of administration.
 Any special instructions such as “before food”
 Codes to explain reasons for omission.
 As required medication should have information on maximum dosage and frequency –
PCS does not capture this detail for all PRN medication and where this information is
absent, the care home must ensure that details are correct and assistance sought from
the pharmacy provider if required.
Please note that in addition to the medicines administration records described above, care homes
can access a detailed record for every transaction via Invalife relating to a resident’s specific
medicine. This detailed record must be requested in scenarios where inspectors or others wish to
carry out a detailed investigation or for the purposes of audit or clinical reviews with GPs or
pharmacists.
To ensure accurate records are maintained on the PCS device the following requirements must be
observed by all staff:





Always ensure that the most up to date information is on the device by “docking” the
device before and after each medication round.
Always scan the barcode on the medicine label prior to administering the medicines.
This gives you an extra level of safety.
Use the device to account for the administrations. Complete one resident’s transaction
and then move on to another resident. .
Account for all medicines which are due for administration. These are indicated by
being displayed against a red background. There should be no “red” unaccounted
medicines at the end of each residents medication episode or the completed medication
round even if a medicine has been potted / not potted and not administered
The administration of topical preparations and nutritional supplements must always be
accounted for on the PCS device.
The administration of emollients and/or barrier creams which are applied by carers who
do not have access to the PCS device, need not be recorded on the PCS device. For
these preparations a suitable paper topical MAR record Emollients” can be used.
Dressings should be accounted for on the resident’s care plan.
If paper MAR records are used in place of direct PCS entry then it is imperative that this
is coded and referenced on the PCS device. Nurses and senior carers must conduct
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
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



random checks to ensure that paper MAR entries completed by trained carers are
correct and complete.
If a medicine is not given then the reason must always be clearly stated. The PCS
device provides a list of reasons for why medicines are not administered.
The administration of homely remedies must always be recorded on the PCS device in
addition to the use of a stock administration / management record
Ensure there are PRN assessment plans completed for all individual “when required”
medicines. This ensures a consistent approach to offering to administer medicines
which may be needed regularly and those medicines which may only be needed when
the resident experiences a specific condition. Please note that PRN plans should also
be recorded in the resident’s care documentation.
The actual quantity of medicines given must always be recorded for variable doses e.g.
1 or 2 tablets three to four times a day
If a dose is changed following advice from the resident’s GP, then update this
information via the PCS system with a second signatory. Then “dock” the device to
ensure the new information is updated on the device and to the central database.
Controlled drugs administrations are recorded on the device as well as the CD register.
To ensure there is full adherence to CD requirements, the PCS device will require a
second member of staff to witness administration of controlled drugs.
Account for all “missing entries” at the end of each medication round. At hand over
meetings the PCS device should not be accepted unless all “missing entries” have been
accounted for. The Invalife web portal can also be used to account for “missing entries”.
4.6.1
Audit of Medication Administration Records and medicines related activities
through the Invalife Web portal
All records of administration, medicines received, copies of original prescriptions, and medicines
orders are available via the online system.
It is a requirement that all care home managers access the Invalife web portal reports to audit and
monitor administration records as well as all other medicines related activities. The information on
Invalife web portal can be used for the following purposes:

To investigate interim orders placed (being developed)

To review copies of original prescriptions for residents

To investigate medicines received

To review recent dosage changes

To print drug information

To review administration times for each resident

To print paper MAR charts in an emergency and only when initiated by Invatech or the
supplying pharmacy.
Managers should ensure that Invalife Web portal is accessed at least on a monthly basis to review
the following:

Number of missed doses for residents.

The reasons for missed doses

Percentage of medicines administered using barcode validation.

Performance of individual staff in terms of medicines administrations

Progress of the care home in terms of the medicines management cycle.
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Managers should review the management information reports available on the Invalife Web portal
to ensure that the fundamental requirements for the use of PCS are being maintained.
The fundamentals include:
1. 100% of medicines which have barcodes on their labels are scanned prior to administration.
2. The PCS device is “docked” or synchronised before and after each medicines round.
3. 100% of all medicines received in to the care home are booked in using the PCS device.
4. 100% of all required stock takes are carried out.
5. 100% of “low stock” items are acted up on promptly.
6. The Monthly Medicines are ordered on the day that they are prompted.
7. 100% of “Missing Entries” are accounted for.
8. 100% of administration plans for emollient creams and “PRNs” are completed.
9. The charge on the battery of the PCS never runs out.
10. The use of paper MAR charts is reserved for occasions when all options for resolving PCS
issues have been fully explored and in consultation with Invatech or your providing Pharmacy.
Care home managers are required to report the actions following their internal medication/PCS
audits to their allocated Quality Assurance Manager (or equivalent).
The Quality Assurance Managers (or equivalent) are also required to monitor the performance of
each home and take appropriate action.
Care home organisations should consider the use of their own internal medication audits to assess
performance and compliance in addition to the medication audits provided by local compliance
teams and the regular pharmacy provider.
Monitoring the use of medicines
Staff members who administer medicines are required to monitor and report on the wellness of
residents after taking medicines. These observations of residents are essential and can be
recorded as PCS notes as well as entered into the relevant section of the residents care
documentation.
The observations will help the resident’s GP to decide if side effects are being experienced as a
result of the new medicines or if the resident is allergic or intolerant to that particular medicine.
These observations may also help the GP in considering alternative treatments or medicines.
Nurses and senior carers are able to report all incidents where residents have experienced side
effects or intolerance to medication to the GP immediately and via the yellow card reporting
procedure at yellowcard.mhra.gov.uk
4.6.2 Clinical readings and monitoring tests
Requirements for clinical readings e.g. pulse, and monitoring tests e.g. INR result must be
observed by all members of staff who administer medicines. The recording and taking of pulses or
other readings should only be conducted by nursing staff. In residential homes this should be
conducted by visiting community nurses.
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The PCS device will prompt to record the pulse readings associated with the administration of
Digoxin only. Care homes must add in prompts for other medicines via the PCS notes facility
according to the care home medication policy.
Members of staff must be vigilant and ensure that residents attend any appointments for
monitoring tests requested by GPs or clinics to include anticoagulants, dentist, chiropodists
opticians and any other appropriate healthcare professionals or clinicians.
4.6.3 Access to Medicines Information
Staff members must have access to medicines information to help monitor the use of medicines
and report on potential side effects.
Patient information leaflets are available in the packaging of the medicines supplied..
The following resources are recommended as a source of medicine information via the Invalife
Web Portal:
 The British National Formulary (BNF) which provides detailed information about
prescription only medicines (www.bnf.org )
 Patient information leaflets (PILs) available in the medicines original packs or from the
pharmacy. These usually list what the medicine is for, common side effects and how the
medicines should be stored (www.emc.medicines.org).
 You may also contact your supplying pharmacy and speak to one of the pharmacists
It is the responsibility of the care home manger to ensure that staff members know how to access
this information.
4.7 Self-administration of medicines
Self-administration of medicines by residents is good practice and should be the route of choice in
order to promote independence, offer dignity and respect and encourage residents to have greater
control of their own care. The right of a resident to take responsibility for his or her own medication
must be observed at all times. New residents to the care home must always be offered the choice
of self-administration of some or all of their medicines.
Self-administration or self-medication is not an “all or nothing” scenario. Some residents may wish
to self-medicate eye drops, inhalers or creams but allow the home to take care of their tablets.
There may be situations where a resident wishes to retain custody of all their medicines but needs
some help at the time of administration. Safely enabling any degree of self-medication is always
considered good practice and residents who wish to self-medicate should be encouraged to do so.
In general, the care home takes full responsibility for the re-ordering of medication and making
sure that a resident has full access to all of their medication at all times.
Should a resident wish to self-administer any medication then an individual assessment must be
made to confirm that self- medication is suitable and safe for the resident.
This assessment should be reviewed after an appropriate period of time.
A record must be kept of the medicines given to residents for the purposes of self-medication.
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Effort should be made to monitor compliance by the resident and issues should be reported and
acted on and a new assessment conducted as appropriate.
Residents who self-medicate must be provided with a lockable drawer or cupboard for the storage
of their medicines. There must be adequate procedures in place to ensure residents understand
that medicines must be locked away and the care home must ensure that this happens.
The PCS device should be used for the re-ordering of medication along with all other medication
orders for the care home.
4.8 Homely Remedies
A homely remedy is a medicine that can be obtained without a prescription that is used for treating
minor self-limiting ailments e.g. diarrhoea, headaches, cough and dry skin.
Homely Remedies are usually purchased from a pharmacy and held by the care home as stock;
they should be stored in a lockable medicine cupboard and separate from all prescribed medicines
and clearly marked as “Homely Remedies”.
The person-in-charge, the pharmacist and the GPs should approve a list of medicines that are to
be made available as Homely Remedies, and a letter should be sent to GPs for approval of homely
remedies for residents. Only those medicines on the approved list may be used. The situations
under which staff can administer Homely Remedies are detailed below.
The directions on the box or bottle should be followed carefully and generally they should only be
administered for a maximum of two days without the pharmacist or GP being consulted. This will
be dependent upon your care home’s policy and the wishes of the individual GPs.
The administration of all Homely Remedies must always be recorded on the PCS device.
If there is any doubt as to whether a Homely Remedy is suitable for a particular resident, for
example interaction with current regular medication, then the pharmacist or GP should be
consulted.
Expiry dates of Homely Remedies should be checked regularly by the care home and a record
kept of these checks.
Medicines brought in by a resident or friend or relative must be reviewed against the list of
approved homely remedies to be used for that resident. If they are not on the approved list, they
should be removed and not administered to the resident. If the medicines are on the approved
homely remedy list then they should only be used for that resident. The care home manager and
GP should be consulted where a resident or relative is insistent on providing non-prescribed
medication for a resident.
Dressings and items for first-aid, etc. are NOT classed as homely remedies.
The list of homely remedies must be communicated to your pharmacy who will ensure that the
PCS device carries this information for that resident. This information can also be processed by the
home via the PCS device.
All homely remedies must be purchased by the home and clearly labelled ‘Homely remedies’. They
are to be stored in a safe and secure area in the medication room
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This policy sets out a range of conditions or symptoms considered appropriate for this type of
medication:
 Indigestion
 Mild Pain
 Coughs
 Constipation
 Mild diarrhoea
 Mild skin conditions
Remedies should only be administered to residents at the discretion of the senior person on duty.
They should be administered to the resident according to the criteria and instructions given.
Homely remedies should only be administered to a resident for a maximum of two days. If it is
considered that there is a need for continued treatment, the doctor should be contacted and the
appropriate medicine prescribed.
Recommended conditions and Homely Remedies to be used
Constipation and Recommended Laxatives:
 Senna Tablets: 1 – 3 Tablets at bedtime. Start with a low dose on the first day,
increasing very gradually (if necessary, only half a tablet) at the same time on the
following day or
 Senokot Syrup: 2 – 4 x 5ml spoonfuls at bedtime. Note: Syrups are unsuitable for
Diabetics
 Most people do not need regular doses of any laxative. Constipation may be corrected
by increasing the amount of fibre and possibly fluids, in the diet.
Side effects:
 If the dosage adjustments are too large, tummy griping and diahorrea may
result. Small dosage adjustments avoid this problem.
 The correct dose is reached when a soft, well-formed bowel motion is produced.
 Senna may colour the urine yellow/ red – this is a normal and harmless effect.
 IF CONSTIPATION PERSISTS, CONSULT A MEDICAL PRACTITIONER
Cough:
 Simple Linctus ( Unsuitable for diabetics): Dose 2 x 5ml spoonfuls up to three
times daily and at night
 Cough mixtures may be used occasionally when the cough is troublesome. They
are rarely effective but people have come to believe in them.
 CAUTION: BE AWARE OF THE EFFECT OF SYRUPS TAKEN BY DIABETICS
AS NOT ALL SYRUPS ARE SUITABLE.
Indigestion
 Magnesium Trisilicate mixture: Dose 10 – 20 mls up to 4 times daily, in between
meals and at bedtime if required
 Side effects: Too much can cause loose motions/ diarrhoea
 Precautions: Indigestion is likely to be brought on by heavy and/ or fatty meals,
eating too quickly, smoking, and drinking alcohol. Do not give indigestion
remedies to residents who are prescribed drugs for acid conditions of the
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stomach such as H2 inhibitors (Zantac) and PPI’s (Omeprazole/ Losec). Discard
after 4 weeks of opening.
Mild Diarrhoea
 Dioralyte sachets: Dose: the contents of one sachet to be mixed with 200ml of
water and taken slowly. Up to 4 sachets may be used a day.
 Precautions: If diarrhoea persists for more than 48 hours contact the doctor.
Pain (Mild, e.g. Headache, toothache)
 Paracetamol Tablets 500mg, Soluble Paracetamol Tablets: Dose Adults – 2 tablets (1
gram) up to 4 times daily. No more than 8 tablets in 24 hours) for occasional pain.
 Precautions: For any persistent pain, painful movement or pain which is not controlled
by paracetamol, consult a doctor. Records need to be kept with regard to dose,
frequency, maximum daily dose, indications for the drugs use, and the time of day
administered. Ensure that the maximum dose is not exceeded by other drugs already
prescribed which contain hidden paracetamol, e.g. Co- proxamol, Co-dydramol.
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5
Ordering and receiving medicines in to the care home
5.1
Introduction
The over-riding principles of this section of the policy are to ensure that the ordering and receipt of
medicines is carried out in a timely manner so that residents do not run out of medicines and
hence go without taking important medicines. Equally important is to ensure that there is not an
excessive amount of stock of medicines which could expire and become a high wastage cost to the
NHS.
This section describes the processes that must be followed in the ordering of prescriptions, their
collection, delivery, booking in to the care home and checking the details of prescriptions.
5.2
Determining which medicines are needed
Staff members must be specific about which medicines are necessary to be re-ordered. Below is a
list of specific requirements that must be complied with:





Ordering medicines that are taken regularly by residents and ordered via repeat
prescriptions. These medicines are usually ordered on a monthly basis. These are referred
to as “Monthly medicines”.
Order those medicines which have a supply of less than 9 days remaining and which are
likely to run out before the next delivery is made. These are referred to as “Interim
medicines”.
Orders for prescriptions must be made in good time. It is recommended that medicines are
ordered at least 9 days before they are due to run out.
Do not order medicines which are used infrequently and whose stock are going to last for a
number of weeks e.g. PRN medication
Take care to consider carefully the quantities needed for medicines whose quantities are
difficult to predict to last four weeks e.g. Creams and ointment. It is important not to over
order or stockpile. Equally, it is essential that you do not run out of stock and are able to
maintain ongoing administration of all medicines
Please note the PCS device has a facility that keeps a running total of stocks of medicines and
prompts you to order medicines that are running low. It is a requirement of this policy that these
stock prompts are acted on immediately. In addition the PCS device will prompt items that need to
have a stock take. It is a requirement of this policy that these stock take prompts are acted on
immediately. Failure to comply with this guidance can result in residents not being given their
appropriate medication and this may lead to disciplinary action if staff have not been compliant with
the above processes.
Accounting for dressings and appliances
The PCS device will not prompt the application of dressings or the use of appliances. This is
because the uses of these items are not predictable and they are often applied by other personnel
(e.g. district nurses) outside the normal medicines administration rounds. The PCS device,
however, must be used to place orders for these items if required.
Dressings and appliances must be accounted for on paper Administration Plans
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The Dressing and Appliance administration plans are to be kept securely in the resident’s room, or
the treatment room together with the dressings and appliances to comply with security and
confidentiality requirements. Dressings which are used regularly may be kept in the residents room
and stored in a secure place to ensure dignity for the resident at all times.
5.3
The prescription ordering process
The ordering of all prescriptions must be processed using the PCS device. This will ensure that the
supplying pharmacy know when to collect the authorised prescriptions and that there is information
on the status of the order. There will be variations in the prescription ordering process which is
dependent on the preference of the GP surgery. The process involves the following:
1. Sending a written request to the resident’s GP for the required medicines with the
appropriate details including resident’s name and date of birth, medicine name strength and
form, dosage instruction and quantity needed.
2.
 As a preference, care homes should print off the monthly / interim medicines
order summary report and seek the permission of all supplying surgeries to
accept this mode of re-ordering which will save valuable nurse and carer time.
 Note some surgeries insist on the use of the right hand side copy of
prescriptions (or a paper copy of the most recent PCS records) which have a list
of resident’s active medicines as the written request. These are known as
“repeat slips”.
It is imperative that the correct agreed method of sending requests for prescriptions to GPs
is used.
3. The prescription clerk / receptionist at the medical surgery will print off a prescription for the
items, if appropriate.
 Note some medicines may not be able to be issued by the prescription clerk as
these may need to be reviewed by the GP. This can cause a delay in issuing of the
prescription and the receipt of the supply of the medicines.
4. The GP then signs the printed prescriptions and thus authorises the supply.
5. The prescriptions are now ready to be collected from the surgery for dispensing and supply.
Your SLA with your Pharmacy should confirm collection arrangements.
6. The status of the prescription orders placed can be checked on the PCS device. This is
categorised by “Monthly” and “Interim” prescription orders. From this functionality all images
of prescriptions can be viewed and printed if required using the “Fax back” option.
7. Any discrepancies between the prescription orders placed and prescriptions issued are
highlighted on the PCS device. For example prescriptions not issued, mismatch of
quantities and prescriptions for which there are no active orders. The images of the
prescriptions relating to these discrepancies can be viewed on the Invalife web portal .
8. Appropriate members of care home staff are required to review both the status of the
orders and to actively resolve the discrepancies with the surgery. In this way the risk of
non-availability of medicines for monthly and interim medicines is reduced and
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requirements for checking of prescriptions is adhered to (See section 5.7). Your pharmacy
provider must be updated with the details of the issues resolved.
Please note that most practices state that requests for prescriptions take at least 48 hours to
process providing that there are no further problems or clarifications required. In practice 48 hours
is too short a time and this is the reason why this policy states that medicines are ordered at least
9 days before they are due to run out.
5.4
The prescription collection, dispensing and delivery process
Once the prescriptions have been authorised by the GP, they are ready for collection and
dispensing.
Your supplying pharmacy will collect the vast majority of authorised prescriptions. This process
involves the following:
1. Pharmacy collects authorised prescriptions from surgeries in the mornings
 Please note: sometimes the authorised prescriptions are not ready at the time that the
Pharmacy visits the surgery. This can further delay the supply to the care home.
 Please note: sometimes not all of the requested medicines are issued at the same time,
especially in the case of monthly medicines and the pharmacy may need to make more
than one visit to the surgery. This can further delay the supply to the care home.
2. Prescriptions are taken back to the Pharmacy for dispensing
 Medicines sometimes need to be ordered. This can further delay the supply to the care
home.
3. Medicines are dispensed
4. Deliveries of the dispensed medicines are made to the care home in the morning and on an
agreed day (unless there are urgent items) as confirmed in the Service Level Agreement
(SLA).
Each of the processes above can potentially delay the medicine reaching the care home. This is
why it is important to order medicines in plenty of time.
For Interim medicines, this policy states that medicines are ordered at least 9 days before they are
due to run out. Monthly medicines are ordered on or before day 8 of the current medicine cycle.
5.5. Interim prescriptions
Interim medicines are defined as those medicines that are outside of the monthly medicines supply
process. For example there may be times when a resident may be running low on their “PRN”
medication or stock is in short supply due to a resident regularly refusing their medication which
has already been potted.
When making requests for these medicines from the surgeries it is a requirement that all relevant
information be provided to the surgery so that there is an understanding as to why the extra
request is being made and how quickly it is needed.
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The order for the interim orders must be placed on the PCS device. This involves selecting the
specific medicine that is required from the resident’s record and then selecting the “Order Interim”
option..
The status of the interim order can also be viewed on the device so that its progress can be
determined. Stock should then be ordered promptly and directly from the GP in accordance with
the local agreement with your GP practice
5.5.1 Urgent prescription left at the care home
A GP visits the resident and leaves a prescription at the home which needs to be administered the
same day. In this scenario the following actions must be taken:


Fax the prescription immediately to your Pharmacy.
If the faxed prescription is received by the pharmacy before the agreed cut off time, the
supply will be delivered the same day, subject to the item being in stock.
 If the prescription is issued after your agreed cut off time, please ring your Pharmacy
after faxing the prescription to see if the supply can be made on the same day.
o If this is not possible for delivery the same day, the delivery will be made the
following day.
 If it is important that the resident has the medicine on the same day and if the
Pharmacy cannot deliver, then you will have to arrange to have the medicine dispensed
at another pharmacy.
o If new medicines are obtained from another pharmacy, please ensure that you
update the resident’s records via the PCS device.
o
Urgent prescription left at the GP surgery.
A GP visits the resident and informs you that he/she will write an urgent prescription when they get
back to the surgery.
 You MUST as a matter of urgency inform your Pharmacy via the phone that there is an
urgent prescription at the surgery for the resident.
 The Pharmacy will then contact the surgery, explain that the prescription is urgent and ask
the surgery to fax the prescription to the Pharmacy for same day delivery.
 Please note that the surgery may refuse to fax prescriptions, in which case you will have to
arrange for the prescription to be collected and brought to the home for faxing to the
Pharmacy.
 Also note that there will be occasions when the prescription is issued after the locally
agreed cut off time which means that you may have to take the prescription to another
pharmacy for dispensing.
o If new medicines are obtained from another pharmacy, please ensure that you
update the resident’s records using the PCS device.
Urgent prescriptions for controlled drugs
The Pharmacy cannot legally dispense controlled drugs without the original copy of the
prescription. For this reason the Service Level agreement must state the procedures that must be
adopted to ensure:


There is no delay to the administration of medication to the resident
All legal and regulatory requirements for controlled drugs are complied with
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5.5.2. Receiving an interim supply of medicines
There are several key actions to perform on receipt of interim supplies of medicines:
 Any prescriptions that have been faxed to the pharmacy must be handed over to the driver
at the time of delivery before the supply can be made.
 Check and sign the driver’s delivery sheet. Note in the case of controlled drugs the person
in charge should receive the delivery and do an actual count of the number of CD
medicines received.
 Controlled drugs should also be booked into the Controlled Drugs register and witnessed
by a second authorised person.
 Book in stock using the PCS device by selecting the “Book In Stock” functionality and
simply scan the barcode on the dispensing label of the items.
5.6. Monthly medication cycle – further information
5.6.1. General Requirements
Resident’s regular medicines are usually prescribed on a monthly basis. These regular medicines
are referred to “Monthly” medicines. Their ordering, delivery and administration follows a four week
cycle.
The following are key requirements for the management of the monthly medicines cycle:
 Ensure that the records of the medicines for each resident at the care home are an exact
match of the records held on the PCS device and therefore at your Pharmacy.
 Ensure the timely ordering of requests for prescriptions.
 Ensure that all items requested have been issued by the surgery and if they have not what
the reasons are. This requires close liaison with the Pharmacy who collect prescriptions on
behalf of the care home.
 Ensure the proper procedures for receipt and booking in of the medicines.
 Ensure there is the ability to check issued prescriptions by using the Invalife web portal and
if necessary print copies of prescriptions.
 Ensure there is the ability to present a full audit trail of all activities involved in the monthly
medication cycle in the event that something goes wrong.
The first day of administering the new supply of the monthly medicines is defined as day 1, of
Week 1 of the new cycle. There are 4 weeks/28 days in the Monthly Medication Cycle.
The section below describes the monthly process that is to be followed using the PCS device.
5.6.2. Monthly process using the PCS device
The following steps must be acted up on in a timely manner to ensure the monthly process is
efficient.
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Step 1 Placing orders on PCS
The first step is the initiation of the order process. The PCS device will prompt that the monthly
order is due in Week 2 of the current medication cycle. The device will continue to prompt this
message until the order is sent. It is imperative that these prompts are dealt with immediately.
The PCS device will highlight all medicines that should be accounted for and you are simply
required to confirm if an individual medicine is “required” or “not required”. . It is essential that the
stock levels are correct otherwise you will be supplied with too much or too little stock for a
particular resident.
There are items that the PCS device cannot calculate an order quantity. For these items you are
also required to manually input the required order quantity. These items include:
 Dressings or medicines being self- administered
 Medicines that have unclear dosages (e.g. Use as directed)
 Medicines that do not have specific unit of measure (e.g. creams, drops and gels)
To place the monthly order follow the steps below on the PCS device:
1. Before you place your monthly order; make sure all outstanding stock takes are done; Make
sure all PCS Alerts are answered and dealt with
2. Now go into the “Manage orders screen and the Monthly orders tab”
3. Go through the items that need manual ordering and order these if needed.
4. When the order is ready, select “complete order” and synchronise the device
5. A copy of the order you have just placed will be emailed to your home. It can also be
downloaded on the Invalife web portal.
Step 2 Ordering the monthly prescriptions
The process of ordering of monthly prescriptions is dependent on the repeat prescription request
process at the surgery. Some surgeries will give consent to using the monthly summary order
reports information transmitted from the PCS device in Step 1. If this is the case then no further
action is needed.
Other surgeries insist on the use of the right hand side copy of the prescription often referred to as
“Repeat slips”. In this case you are required to complete the “Repeat slips” by using the copy of
the order that you have placed on the PCS device (faxed to you after transmission) and ensuring
that the same items are ordered on the “Repeat Slips”. The “Repeat slips” need to be sent to the
surgery.
Step 3 Collecting your monthly prescriptions and reconciliation against PCS order
In the majority of cases the Pharmacy will collect the monthly prescriptions on behalf of the care
home. At this stage it is important for you to have the ability to check the prescriptions to ensure
that what you have ordered on the PCS device has been received by the Pharmacy. The image of
every prescription collected on your behalf is available for viewing on the PCS device and printing
using the “Fax back” option.
If your care home collects your own prescriptions then it is important that they are available to be
collected from your home ASAP and according to the Service Level Agreement with your
Pharmacy. Any delay in collection of your prescriptions could delay the supply of monthly
medicines for the residents and this could lead to medicines not being administered.
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Please note that monthly medication prescriptions must be collected from the care home and
should not be faxed to the Pharmacy, unless agreed otherwise with your GP surgery and
Pharmacy.
Step 4 Checking of missing prescriptions and discrepancies
In this step the Pharmacy compares the collected prescriptions with the medicines ordered on the
PCS device. The PCS device provides a day 18 and day 21 report which staff can use to check
progress on obtaining residents prescriptions and allowing sufficient time for any discrepancies to
be resolved prior to the start of the new cycle.
Note that there will always be prescription requests that will take longer to resolve with the surgery
e.g. due to clinical checks with the GP, out of stocks or discontinued items. This is the reason why
sometimes deliveries for these “late resolved” medicines are made separate to the rest of the
monthly medicines.
Step 5 Dispensing, packaging and delivery
Once the vast majority of the prescriptions for the care home have been received by the pharmacy,
the dispensing process is initiated.
Deliveries are made to the home on a pre-arranged day before the new supply has to be initiated.
Although it is preferable that the supply of monthly medication is made as a single delivery, it is
accepted that late prescriptions and “owings” will be delivered as they are made available.
Step 6 Booking in your monthly medication supply with the PCS device
The monthly medication supply must be delivered in sealed boxes.
The supply for each unit within the home will be packed separately.
Controlled drugs will be supplied separately. Fridge Items and specials will be clearly identified and
supplied separately.
You will be required to sign the driver’s paper delivery sheet or electronic device.
The PCS device will book in each item and check it against the monthly order by simply scanning
the dispensing barcode.
To book in your medication;
1. Synchronise PCS before you start booking in medication
2. From the main menu screen select “manage stockand the Book in tab”
3. Pick up the item you wish to book in
4. Barcode scan the dispensing label and check the quantity is correct
5. Repeat this process until all items have been booked in and the screen is clear
6. Put the stock away into the relevant places
Any items that have not been received or are outstanding can be seen on the screen.
Controlled Drugs must be entered into the CD register as well as being booked into PCS.
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If there is a discrepancy or an item is damaged or has the wrong quantity in the box, you must
report this to the Pharmacy at the time of booking in.
Step 7 New medication cycle
Transfer the medicines received in to the appropriate storage compartments in the medicines
trolley or store any excess or bulky items in the medicines cupboards. The new medication cycle
can now begin on day 1.
5.7. Checking of authorized prescriptions via Invalife web portal Invalife web portal
Only members of staff who have the correct permissions have the ability to check authorized
prescriptions. There are several reasons for this including:
1. The prescription is the legal document that authorizes the supply and administration of the
medicines to residents. The medicines have to be administered according to the directions
on the prescription. If the prescription has a direction different to the one being
administered then technically the administration is illegal. It is therefore very important for
the directions on the prescription to match exactly the administration of medicines to the
residents.
2. Supplied quantities must match the prescribed quantities. In some situations you may find
that you have not received enough medicines to last the whole monthly medication cycle. In
these situations you should check the prescribed quantity to see if this was the quantity that
was supplied. On occasions, your Pharmacy may be required to owe you items which are
in short supply or out of stock.
3. There will be situations where you did not receive the medicine that you were expecting. In
these situations you should check the prescriptions to see if the medicine was issued or
not.
4. Wrong medicines dispensed. In some situations you may find that you have received a
different medicine or strength to what was expected. This may be due to a dispensing error
and by checking the copy of the prescription you will be able to determine this.
5. Viewing of prescriptions is also important to ensure that the Pharmacy has made a supply
or accounted for every prescription collected from the GP surgery.
. The images of prescriptions can be viewed against specific orders placed by the care home and
categorized as interim or monthly prescription requests.
These systems therefore allow all the checks to be made whilst ensuring that there are no delays
in the medicines supply process.
The Pharmacy should be contacted promptly if there is a perceived discrepancy in the supply or
administration instructions of medicines.
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5.7.1
The Invalife Web Portal
All members of staff must first register with the Invalife web portal. On Invalife they can access elearning and be given permission to administer medicines and view patient information if
appropriate. Invalife web portal
The care home manager will usually have administration rights for determining roles and access of
different members of staff.
The internet address https://www.invalife.com will take you to the Invalife web portal. Users are
required to register and indicate which organization they want to be linked to. They are then
provided with a verification email confirming their login details. The care home manager then
enables the user access to the following list of information and facilities detailed below if
appropriate:





Records of resident’s medicines which can be checked and any discrepancies can be
communicated to the Pharmacy
Tracking dispensing progress to determine if an item has been dispensed and is on its way
to you
To print a summary of the resident’s medicines in the case of emergency admission in to
hospital, or an urgent visit by an out of hours GP, or on discharge from the care home.
Print a Quality Assessment Report and Medication Audit (QARMA): This report provides a
wealth of information about the performance of the Care Home and the Pharmacy. It also
performs a full medicines review for each individual resident in your home and offers
recommendations you can give to your GPs
Advanced features including:
o Viewing of Monthly and Interim orders (also available on the PCS device)
o Viewing of items returned
o Clinical Management Reports (CMR) which provides a thorough review of the
resident’s medication therapy including items administered.(being developed)
o Current and Previous Month’s administration records (MAR)
o Daily report of how medicines have been managed
Care Home Managers should ensure that Invalife Web Portal is accessed at least every week to
review the following:

Number of missed doses for residents.

The reasons for missed doses

Percentage of medicines administered using barcode validation.

Performance of staff by exception in terms of medicines administrations

Progress of the care home in terms of the medicines management cycle.

Report any issues to the allocated Quality Assurance Manager (or equivalent)
<<Insert Company Name>> Quality Assurance Manager (or equivalent)s are required to also
monitor the performance of each care home using the Invalife web portal and to act appropriately
to improve medicines management in the care home.
5.8. Communicating with the Pharmacy
All changes to a resident’s therapy must be communicated to the Pharmacy preferably using the
PCS device or by telephone or other agreed process with your Pharmacy. This will ensure that the
medicine records at the Pharmacy are correct and accurate at all times.
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5.8.1.
New Resident Registration requirements
When new residents come in to the home their details must be inputted directly on to the PCS
device.
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6. Special considerations
6.1
Introduction
In this section a number of policies relating to specific medicines management issues are detailed.
These include:
•
•
•
•
Promoting independence, informed consent and freedom of choice
Data protection and confidentiality
Evidencing and demonstrating quality of Medicines management to inspectors
Reducing the risks of medicines management in care homes and overcoming common
issues
6.2
Promoting Independence
Care homes are to be regarded as the place of residence for people where they can carry out all
activities independently in a supportive environment. This philosophy should also apply to their
medicines and residents should be encouraged to take responsibility for some or all of their
medicines.
All residents will be given the choice to act independently and take responsibility for some or all of
their medicines. There will be an assessment of the appropriateness to self-administer and the
level of support required.
6.3
Informed consent and freedom of choice
Every resident has the right to know and understand the treatment that they are being given and
the right to choose to take the medicine and treatment. The resident’s GP should deal with the
issue of consent to treat. However there will be occasions when the resident may ask for more
information on medicines.
All members of staff at the care home should have access to the Invalife web portal where a
number of resources for information on medicines is provided including patient information leaflets
and the electronic British National Formulary. This is in addition to the patient information leaflets
provided by manufacturers in the medicines supplied.
6.4
Confidentiality and data protection
Confidentiality is an important aspect of care in any organisation. This policy states that only staff
members who are trained and or appropriately qualified in administering medicines can have
access to resident’s personal and medicines records. This information can also be shared with
other care providers such as your Pharmacy , GPs and social workers if appropriate. Resident’s
issues and details should not be shared with anyone who is not directly involved in the care of that
resident.
The Data Protection Act requires that resident’s details are secure. Therefore the PCS device and
all paper administration plans and management information reports must be locked away when not
being used.
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6.5
Care home inspections and medicines – see section 1.3 (page7) for further guidance
For Care Homes in England
The Care Quality Commission refers to Regulation 12 of the HSCA 2008. This lists the
expectations of care homes in relation to medicines management. Care homes should also be
aware of the new inspection process introduced from October 2014 involving the new Key Lines of
Enquiry model. Further information can be obtained directly from the CQC website – ‘How we
inspect and regulate’.
For Care Homes in Wales
The Care and Social Services Inspectorate Wales has published Standard 17 on minimum
standards for medication in care homes
6.6
Residents Medication Reviews by GPs or Pharmacists
All residents should have their medication reviewed by their GP or Pharmacist at least every twelve
months or sooner if required and in accordance with their care plan requirements. Care home staff
should seek the advice of the GP for more frequent reviews if it is deemed to be in the best interest
of the resident.
The PCS device and the Invalife web portal Invalife web portal can help care home staff and
Pharmacists to identify residents who can benefit most from medication reviews and also to
provide a list of issues to be considered.
The Invalife web portal can be used to print out a clinical summary of all the potential medication
related issues that the resident’s GP should consider.(In development)
The Invalife web portal also ranks the residents in terms of their need for a medication review.(In
development)
If adverse effects of medication are observed this shall be an issue documented in a care plan,
written in the resident’s notes and the prescribing doctor contacted immediately to review the
medication. If the prescribing doctor is not available then another doctor shall be contacted.
It is the responsibility of the staff in charge of the unit/ home to document adverse effects of
medication and to contact the doctor to report adverse effects.
If chronic adverse effects are observed then the medication should not be given until the situation
is discussed at length with a doctor.
It is the ultimate responsibility of the Home manager to ensure that a resident’s medication regime
is reviewed in full at least every six months.
It is essential that any dosage changes are inputted directly on the PCS device in the normal way
to ensure that the PCS device is updated.
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7. Procedure for dealing with medication errors and drug alerts
7.1. Medication errors
Medication errors are almost never the result of a single, isolated human error. Instead, they result
from multiple small breakdowns in the systems for managing medication. For this reason this policy
makes a requirement for all medication errors to be investigated by the care home manager. The
learning from these errors must be communicated to all appropriate members of staff.
If a medication administration error occurs the following steps must be carried out:
 The incident must be reported to the care home manager immediately for prompt and urgent
investigation and action and the safety, best interests and wellbeing of the resident remaining
paramount at all times
 The medication error should be documented on a medication incident form and a copy should
be stored with the resident’s care plan.
 The care home manager should seek the advice of a pharmacist from the supplying Pharmacy
or the care home Quality Assurance Manager (or equivalent) as to the seriousness of the
medication error and the effect on the resident.
 The resident’s GP should be informed promptly and the actions recommended must be
implemented and documented.
 The need to report the error to CQC/CSSIW should be discussed with the care home
managers line manager and where necessary it should be reported to the CQC/ CSSIW
central telephone line and local compliance team as per local contractual arrangements.
 If the medication error is suspected to be a result of a dispensing error or a failure in service
delivery, this should be immediately reported to the issuing Pharmacy. The Pharmacy will carry
out an internal investigation and respond to the care home manager within the agreed
timescales contained in the SLA of receiving news of the incident. Attempting to conceal any
error within the care home may result in a disciplinary action against individuals.
The following are strategies that care home managers should implement to reduce the risk of
occurrence of medication errors:

Ensure that staff administer medicines using the PCS device to scan the barcode on the
medicine label

Lighting in medication dispensing areas must be adequate

Members of staff who administer medicines must be protected from interruptions and
distractions

Ensure room temperature in medication storage areas and the refrigerator are kept within
safe guidelines

Ensure medicines are arranged in a manner that fosters efficient workflow

Ensure all handwritten prescriptions are legible

Ensure the PCS device contains the correct information by synchronising the device
regularly

Ensure all changes to medication therapy are communicated to the Pharmacy

Ensure wherever possible that residents are aware of all medicines they are prescribed,
and the rationale for their prescription

Ensure all medications and the PCS device and the Invalife web portal are checked on a
daily, weekly and monthly basis.

Ensure that every medication error is individually analysed by the Home Manager to
determine the root cause of the error, regardless of the outcome.

Ensure that medication rooms are tidy, clean and well organised with minimal overstocks.
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8.0 Staff Training for medicines administration and assessment of competence
All members of staff who administer medicines must have completed the medicines courses
available as follows prior to using the PCS device for the administration of medicines to residents:





Getting started with PCS ( e-learning)
Medicines handling and management ( e-learning) – accredited by the Royal
Pharmaceutical Society
Keeping records up to date (e-learning)
Stock management (e-learning)
Handling management information / resident reports (e-learning)
The above courses take the form of multiple topics with quiz questions at the end of the course
with a requirement for a set pass mark.
All care homes are expected to appoint a medication lead person called the ‘PCS lead’ for the
purposes of acting as an ambassador for medication management and as a lead in supporting and
coaching nurses and carers in their ongoing personal development in medication management and
administration as well as inducting and training new or existing staff to medicines management.
The PCS device can be set up to not allow access to any nurses or carers who have not
completed the necessary training or have not undergone the periodic refresher training. (In
development)
All staff must have a refresher training every 2 years to ensure they are aware of any new
regulations or practices or procedures.
Despite the requirement for all staff to receive regular training regarding the administration of
medicines, <<Insert Company Name>> recognises the issue that staff may not necessarily
become competent after attending the course.
All staff who are responsible for administering medication shall be required to undertake a
competency check at least once a year by the Home Manager or designated senior member of
staff. Care home managers may also request competencies to be re-assessed following
incidences and concerns about performance.
Under no circumstances are members of staff to administer medication unless they have received
suitable training and have successfully completed the required competencies.
All completed competency forms are to be kept within the individual’s personnel file for inspection
by Regulatory bodies or by the Company.
Please note for the receipt of a certificate of course completion ,the e-learning courses must be
successfully completed.
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MEDICATION POLICY USING PROACTIVE CARE SYSTEM (PCS)
9.0 DAMAGED MEDICINES
Anyone becoming aware of a damaged medical product (e.g. damaged/broken in transit)
shall contact the supplying pharmacy as soon as possible. Such medicines must be stored
separately and safely while awaiting further instructions. Prompt actions should be taken to
ensure continuity of medication for the resident. Examples of damaged medicines are:
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10.0
Split capsule
Damaged bottle
Broken tablets
Pierced container/Seal broken
REPORTING ADVERSE DRUG REACTIONS / PROTOCOL FOR MEDICATION RECALL
ALERTS
Serious or unusual reactions, which may be due to the prescribed medication, must be
recorded and reported to the GP. This will be done initially verbally, but following discussion
with the GP or home manager may result in submitting one of the yellow cards at the back
of the BNF or on line via www.yellowcard.gov.uk. An extreme adverse reaction may
require reporting as a serious/ critical incident.
If a medication recall is issued, notification will be given to the home, these must be
actioned immediately.
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The person in charge should check if it affects any of the medication within the home
They should remove any affected medication from the medication trolleys and stock
cupboard
It should be stored in the returns cupboard, and entered onto a new page of the returns
book.
Pharmacist to be contacted for collection
When talking to the Pharmacist they will advise as to how to obtain replacement or
alternative medication
Pharmacist will need to be informed which residents are affected
Person in charge to inform the GP’s of affected residents
Person in charge to document in the affected residents care plans
Home Manager to be informed and action to be taken to inform all other relevant staff
as a matter of priority
N.B. Information will be circulated by the MHRA. When drug alerts are received, all
Authorised Persons must sign to say they have read and understood them. The alerts must
then be kept on file at the home.
All care homes must be registered on line for receiving drug and device safety alerts from the
MHRA.
The care home manager is required to keep records of the receipt of all safety alerts and actions
taken as a result of the alerts.
POLICY NO: P-47
Kettlewell House
Reviewed: 23/12/16
Issue No. 1
Page 63 of 65
MEDICATION POLICY USING PROACTIVE CARE SYSTEM (PCS)
11.0
DAY CARE & RESPITE SERVICE USERS
a)
These service users accessing day care will normally be responsible for the care
and administration of their own medicines. The PCS device should not be used for
day service users. Procedures are those set within a local protocol and may include
the self-administration of medicines if applicable under a risk assessment process.
The best interests of the residents should be taken at all times and appropriate
discussions held with family members and the GP if appropriate.
b)
Where it is agreed that suitable trained and competent staff take responsibility for
the administration of medicines, then this Medication Policy applies. This includes
ensuring the administration is recorded on MARR sheets and the medicines stored
securely and full compliance in line with this Medication policy for completion of
MARR sheets must be adhered to. If medication is brought into the home in
unsuitable containers with illegible instructions then again in accordance with policy,
staff must check with the appropriate GP prior to administration.
c)
When residents in the home are regularly attending other day centres or day
hospitals, the help of the pharmacist or doctor should be sought to obtain suitably
packed medicines.
d) When residents attend other day centres, the administration of medication at that time
becomes the responsibility of the other day centre staff.
e) It is recommended that residents receiving short term residential respite care at the
home should use a paper based MAR system in place of PCS if the duration of stay is
for less than seven days.
12.0
UNPLANNED OUTINGS
Where medication is needed for a resident for administration later in the day and who is
leaving the home temporarily, the original pack (s) should be taken from the home with the
individual and a ‘Short Term Leave’ document completed and retained at the home and the
appropriate code recorded on the PCS device. The Home Manager or authorised person
must ensure that suitable arrangements are in place for the safe storage and correct
administration of the medication to the resident whilst the resident is away from the home.
This may include the use of a paper MAR produced from the on line service and given to
the resident or carer and checked and filed safely on the return of the resident to ensure
there has been full compliance of medication administration.
13.0
HOLIDAYS AND PLANNED OUTINGS FOR RESIDENTS
When a resident has a planned holiday, arrangements must be made by the Authorised
Person or an appropriately qualified Nominated Person and the pharmacist, ensuring the
safest means of administration for the resident. The home manager must ensure that a
POLICY NO: P-47
Kettlewell House
Reviewed: 23/12/16
Issue No. 1
Page 64 of 65
MEDICATION POLICY USING PROACTIVE CARE SYSTEM (PCS)
suitably trained and competetent person in medication management accompanies the
residents on any arranged outing. This trained person must also ensure that arrangements
are made for the safekeeping of the medication and the suitable administration and
recording of medication to residents whilst away from the home. The PCS device must
have the correct entry code to acknowledge the absence of the resident whilst away from
the home.
The original packs provided by the pharmacy should accompany the resident.
A short term leave document or equivalent should be completed, with one copy given to the
resident and another retained in the resident’s file
When staff are accompanying residents on holiday, they should take the current original
medication packs and a paper copy of the most recent MARR sheet with them but can only
administer the medication if they are suitably trained and compete tent to do so. The Home
Manager must be satisfied that appropriate arrangements are in place for the safe keeping
and administration of medication to the resident whilst they are away from the home
including the determination of competence of any relatives or friends involved in caring for
the resident.
The care home must also conduct a stocktake of medication when the resident leaves the
home and a further stock take of medication on their return.
14.0
MEDICINE FOR RESIDENTS WHO LEAVE THE HOME
When the resident leaves the home, arrangements are to be made with the resident and
pharmacist for medication that has been prescribed to be taken with the resident and /or for
the resident to be given their repeat prescription in order to obtain future medication and t
ensure continuity of supply.
When to Retain Medicines after Discharge
Medicines are to remain in the home for at least seven days and stored separately when a
resident is:
a) Admitted into hospital as an emergency.
b) Admitted into hospital as a planned admission (unless the hospital
requests the medications to accompany the resident).
c) In the event of death.
Hospital Admission
A copy of the current up to date MARR sheet, obtained from Invalife or via PCS fax back,
must accompany the resident for all hospital admissions. This includes appointments and
emergency admissions. Some hospitals are asking on occasion for the medicines to be
brought into them even if not a planned admission; NB This should be on request only and
not regular practice and the Home Manager or authorised person must determine if
medication is required to be sent along with the resident or retained at the home. The PCS
device must have the appropriate code entered to acknowledge the absence of the resident
POLICY NO: P-47
Kettlewell House
Reviewed: 23/12/16
Issue No. 1
Page 65 of 65
MEDICATION POLICY USING PROACTIVE CARE SYSTEM (PCS)
15.0
REPEAT PRESCRIPTIONS / SPECIALS MEDICATION
Repeat prescriptions should be ordered in accordance with the agreed service level
agreement with Boots and to ensure that all prescription requests are submitted on time to
the GP surgery using duplicate MARR sheets or the prescription repeat slips and made
available to Boots within the agreed timescales in order to ensure timely delivery of the
monthly medication prior to the start of the new medication cycle.
The GP may on occasions prescribe a medication which has to be manufactured
specifically for a resident. This type of medication is called a ‘Special’ and will typically take
longer to be obtained than standard medication. Authorised staff must check the availability
and delivery times of this type of medication with the Pharmacy Provider to ensure there is
continuity of medication for the resident and that the wellbeing of the resident is not
compromised.
16.0
EMERGENCY EVACUATION OF THE HOME
If the home is evacuated for a short period of time, then authorised staff must make every
effort to ensure that all medication trolleys are locked and medication rooms left secure as
long as these actions do not compromise the safety of staff or residents. Medication rounds
should be resumed when the fire officer or other authorised person deems it safe to return
to the building.
For longer periods of time and where access to residents medication is compromised, the
Home Manager should in the first instance contact the appropriate GP surgeries to inform
them of the situation and to then contact the local main Pharmacy provider to request
urgent MARR sheets for all residents and arrangements then made for the surgery to
produce emergency prescriptions for these residents. Arrangements should then be agreed
with the Pharmacy provider as to the best means of supplying this medication to residents
as promptly as possible. In some situations, and where the return to the home is indefinite,
this may require the co-ordination of deliveries of medication to residents across a number
of temporary sites. The Care Home Emergency plan must include arrangements to meet all
of these scenarios along with contact details of the GP and main Pharmacy Provider.
17.0
FAILURE TO COMPLY WITH MEDICATION POLICY
Non-compliance with Woodchurch House Medication Policy could result in abuse or neglect
for the residents in the home. Any failure to comply could result in disciplinary action and
dismissal and will be dealt with accordingly.