Download Medication Procedure for Home Care Services

Guidance for Medicines
Management Services provided
to people in their own homes.
Produced Date
June 2013
Approved Herefordshire Clinical Commissioning Medicines Optimisation Group 25.06.13
Review Date
June 2015
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CONTENTS:
1. Introduction
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2. Legislation and statutory requirements
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3. Aims and objectives of this guidance
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4. Rights, Roles and Responsibilities
4.1 Service User
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4.2 Families or Carers
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4.3 Domiciliary Care Agency
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4.4 Paid Care Workers (Social Care Services & Independent Sector Care Workers) 7
4.5 Community and Hospital based Pharmacists
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4.6 Service Managers and Corporate Responsibility
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4.7 Healthcare Professional Responsibilities GPs
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4.8 Nursing Personnel
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5. Care Planning and Individual Risk Assessment
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6. Children as Home Care Service Users
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7. Education and Training Requirements of Home Care commissioned staff
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8. Principles of Safe Medication
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9. Recording of Medicines Administration
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10. Categories of Medicines Tasks Level 1
Level 2
Level 2 (extended)
Level 3
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11. Monitored Dosage Systems
12. Administering Medication on an Emergency Basis
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13. Controlled Drugs Medication
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14. Over the Counter Medication
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15. Disposal of medicines
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15. Medication errors
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16. Monitoring Of Service Delivery
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APPENDIX 1 Procedure for administering medication
APPENDIX 2 Sources of advice on Medicines related queries
APPENDIX 3 Guidance on Homely Remedies
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AUTHORS AND CONTACTS FOR FURTHER INFORMATION
Alison Rogers
Governance Pharmacist Herefordshire Clinical Commissioning Group
All queries should be directed to [email protected]
Victoria Dixon
Admissions and Interface Pharmacist Wye Valley NHS Trust
Sue Vaughan
Lead Clinical Pharmacist Wye Valley NHS Trust
Sharon Mayglothling Service Delivery Manager Neighbourhood Teams/Community Zones.
Professional Head of District Nursing Care Closer to Home Service Unit
Hayley Williams
Registered Manager Adult Social Care, Care Closer to Home Service Unit
Barbara Lloyd
Adult Social Care (Commissioning), People’s Service Herefordshire Council
Marie Bromage
Children’s Community Nurse Wye Valley NHS Trust
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1. INTRODUCTION
This guidance has been developed to ensure that commissioned services involving medicines enable
service users and their informal carers to
live independently within their own home environment,
have choice and control over the support they receive, and
promote independence while helping people to achieve positive outcomes in all aspects of their
life.
This document will be referenced within contractual arrangements of NHS Herefordshire Clinical
Commissioning Group (CCG) so is applicable to commissioned care agencies and other parties which
these agencies employ or contract with. It also integrates social and health care medicines management
issues to ensure seamless care for service users and will be referenced in quality assurance
undertakings of Herefordshire Clinical Commissioning Group.
It should be noted that Herefordshire Council People’s Directorate and Herefordshire Clinical
Commissioning Group are partners in commissioning services which involve assistance with medication
from for example, domiciliary care agencies. Currently some of the services directly provided by
Herefordshire Wye Valley Trust are regulated by Care Quality Commission (CQC) in the same way as
other domiciliary care agencies. NHS Hereford Wye Valley Trust also purchases domiciliary care and
therefore this guidance outlines expectations and responsibilities from all services currently provided
throughout Herefordshire.
The detail within this guidance should mirror any other independent service providers’ medication
policies, to ensure home care service users achieve their personal outcomes through a suitable level of
support and assistance in their medication regimes.
The document is written in order to be adopted as a protocol for the management of medicines in home
care setting for those staff directly employed by Wye Valley NHS Trust designated as a sub document to
the Wye Valley Trust Medicines Code but does not alter or replace the principles or detail within this
Code.
It is not possible to describe every possible situation when administering medication or supporting selfmedication. When a situation arises that has not occurred before, it is important that actions are based on
sound principles. Commissioners will have responsibility for safe services and provider’s responsibilities
should remain the same regardless of how the care package is determined for an individual.
All home care organisations and their staff must therefore read and comply with this best practice
guidance for assistance with medication.
2. LEGISLATION AND STATUTORY REQUIREMENTS
All transactions involving medicines are regulated by the Medicines Act 1968 and subsidiary regulations
made under that Act. Relevant policy and guidelines for Wye Valley NHS Trust embody the principles of
the following legislation and guidance:
Medicines Act 1968 and subsequent amendments
NHS and Community Care Act 1990
Health & Social Care Act 2008
Royal Pharmaceutical Society (RPSGB) guidance “The Handling of Medicines in Social Care”
2007
Care Quality Commission (CQC) Professional Guidance, including “The administration of
medicines in domiciliary care”
National Service Framework for Older People 2001
Mental Capacity Act 2005
Pharmaceutical Services Regulations (England) 2012
3. AIMS AND OBJECTIVES
This guidance aims to ensure that service users:
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receive appropriate help and encouragement to manage their own medication as independently
as possible when assessed that this is needed
are safeguarded by systems put in place regarding access to medication, storage, administration,
recording and disposal of medication.
4. RIGHTS, ROLES AND RESPONSIBILITIES
4.1 Service User - DIGNITY IN CARE / CHOICE AND CONTROL
All service users will be encouraged to take as much responsibility for their own medication as possible in
order to promote their independence and wellbeing. If the service user’s ability to manage their own
medicines deteriorates to the extent that they need assistance from the appropriately trained staff, it will
be necessary to gain written consent from the service user or their relative / carer to do so and for the GP
/ Consultant / Nurse Practitioner to be consulted.
When a service user is considered incapable of giving consent, or where the wishes of a service user
appear contrary to the interests of that person, instructions should be sought from the leading GP.
Medication will only be administered to service users when clearly identified on the support plan, as per
assessment of needs. The level of support given will be the absolute minimum deemed necessary to
maintain the person’s independence and should be recorded on the individual’s medication / support
plan.
All service users should be given the choice to take or refuse medication and their dignity and
independence should be maintained at all times. Medicines are used to treat and prevent disease or to
relieve symptoms and not to punish or control behaviour.
Administration of medication will be delivered in a way that respects dignity, privacy, independence and
cultural and religious beliefs of the customer. Service user’s personal and confidential information will be
kept secure. All service users will receive the equal quality care regardless of their condition, e.g. an
unconscious person should receive the same or higher level of care as though they were conscious.
When needing assistance with medication service users retain the same decision making rights and
responsibilities as any patient. A Medication Risk Assessment tool will identify the level of support in line
with the aims of this Guidance. Service users must provide workers governed by this Guidance, with
access to the prescription, medicines and other relevant information to be able to assist with medication.
Informed consent must be given by the service user before each treatment is given and the service user’s
right to refuse must be respected. Informed consent applies when a person can be said to have given
consent based on a clear appreciation and understanding of the facts, and the implications and
consequences of an action. Consent can either be explicit (specific consent to carry out a specific action)
or implied (not expressly given by a patient, but inferred from their actions, the facts and circumstances of
a particular situation, and sometimes a patient’s silence or inaction.) Generally, there is no legal
requirement to obtain written consent but it may be advisable in some circumstances.
If a service user lacks capacity to make a decision about assistance with medication, they are unable to
give valid consent. The Guidance requires assistance with medication to be provided in a way that meets
the requirements of the Mental Capacity Act (2005) (MCA) which is designed specifically to empower and
protect an individual who is unable to make a decision because of the way their mind or brain works.
The MCA describes the circumstances when someone else may make decisions when a person is
unable to make a particular decision. This could be a friend, a relative, an informal carer, a professional
carer, a doctor, a social worker or a nurse, for example. See 7 below- Health Professional.
This Guidance requires Lasting Power of Attorney (LPA) or an advance decision to be respected (see
MCA).
Service users have the right to expect that any assistance offered is carried out in a professional manner
by properly trained staff.
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4.2 Families or Carers
When responsibilities for assistance with medication are shared between family/carers and a
commissioned service e.g. domiciliary care agency, the domiciliary care agency will only be able to assist
with prescription medication provided and contained within the original pharmacy produced and labelled
packaging. Medication must be administered in line with this Guidance and recorded on a Medication
Administration Record.
4.3 Domiciliary Care Agency (DCA)
It is the responsibility of the DCA to ensure that this Guidance is implemented in their service. The Home
Care provider should ensure:
The agreed level of assistance within the care plan is provided to the service user on a
day to day basis by competent home care staff who have received appropriate training in
medicines which can be demonstrated by comprehensive training records.
That when medication is administered by staff from the original pharmacy filled container
that this is recorded on a Medicines Administration Record (MAR) by trained and
competent staff
The service is monitored and reviewed and any significant changes that may trigger the
need for a review is highlighted to relevant Commissioners
Incidents and ‘near-misses’ are recorded appropriately, regulatory safeguarding and
contracts teams are appropriately informed and information is used as a learning tool to
improve the service
Feedback on this Guidance is provided to aid its evaluation and review
An assessment of medicines in the home is made upon initial assessment in order to
assist with appropriate disposal of unwanted/ out of date medicines to the community
pharmacy is made that only appropriate re-ordering of medication is undertaken.
A current list of medicines that the service user takes should be available for the purposes
of assessment and kept in the service user’s file at the home and kept up to date by the
DCA when/if medicines change.
High levels or overstocking of medicines in the service user’s home should be brought to
the attention of the GP practice with a view to amending requests for further medicines
whilst existing stocks are used up.
4.4 Paid Care Workers (Social Care Services and Independent Sector Care Workers)
It is the responsibility of domiciliary care workers to follow the support plan and administer/record
medication in line with this guidance using a MAR chart. Domiciliary care workers should report any
concerns to their line manager. It should be noted for consistency of communication and care that if
domiciliary care workers are required as part of their duties to present prescriptions for dispensing they
should try to use the pharmacy normally used by the service user so that appropriate checks can be
made by the pharmacist used to dispensing other medicines for that individual service user. In other
words service users are encouraged to receive all their medicines from the same pharmacy where
possible.
4.5 Community and Hospital based Pharmacists
All pharmacists have a professional responsibility to supply medication prescribed by GPs and other
recognised prescribers. The medication must be of a suitable quality and comply with legal and ethical
requirements for the packaging and labelling.
Additionally, pharmacists have a responsibility to ensure that a service user or carer receives appropriate
information and advice to support them in gaining best effect from any medicines supplied.
There are various options for assistance with medicines related queries. If service users obtain their
medicines from a community pharmacy then community pharmacists can very often assist in the first
instance. If service users obtain their medicines from a dispensing practice then the query can be placed
to the prescribing doctor. Where to find assistance with medicines related queries can be found in
Appendix 2.
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4.6 Service Managers and Corporate Responsibility
Where problems arise which cannot be resolved, these must be referred to appropriate national bodies.
Beyond this, further appropriate specialist support must be sought. In this way a body of knowledge can
be generated about problematic issues relating to medication. It is a corporate responsibility to collate
and communicate these issues consistently to all relevant personnel.
4.7 Healthcare Professionals Responsibilities GPs
General Practitioners (GPs) have a duty of care for all of their listed patients to provide general health
and medical care or refer for specialist health care or social care. In looking after an individual’s health
and wellbeing, the GP or other nonmedical prescriber will prescribe medication to their patient to prevent,
treat or relieve medical conditions. It should be noted that individual service users might also receive
medication prescribed by specialists that might have been supplied to them in hospital. Within primary
care, other professionals may be involved in prescribing for service users – suitably qualified nurses or
pharmacists are able to prescribe.
4.8 Nursing Personnel
They will provide nursing and clinical care to individual service users, e.g. planning the care for wounds,
pressure sores, invasive procedure such as injections and bladder irrigations and matters relating to
feeding tubes. During such provision, they will also monitor the health status of the individual and report
any change in circumstances e.g. pain control to the GP. Stoma nurses, palliative care nurses or
continence advisors will similarly provide nursing and clinical care to individual service users and support
to their family. These specialist nurses will support and educate the service user and carers in coping
with their particular condition and assist them in dealing with equipment or the drug treatment or therapy
necessary to the condition. Registered nurses should not work beyond their level of competence
according to their professional Nursing and Midwifery Code of Medicines.
5. CARE PLANNING - INDIVIDUAL CAPACITY AND RISK ASSESSMENT
The result of a comprehensive risk assessment, including details of any medication and support required,
must be recorded on the service user’s medication / support plan. The plan will identify tasks relating to
medicines through general support or assistance with administration allowable, which the service user or
an appointed person has consented to. The plan must be signed by the service user or their
representative (if appropriate). Ensure the consent/refusal of the service user or their representative is
properly recorded in the care plan.
The health professional in charge of the treatment makes the decisions about whether the individual can
give consent. That professional should discuss any issues with others involved in the patient’s care and
with the patient’s family and close friends. If it is decided that the patient lacks the capacity needed to
give consent, the treatment can be given if it is deemed to be in the person’s best interests. The Mental
Capacity Act 2005 does not contain a definition of the term “best interests” but does set out a checklist of
issues that should be considered by anyone taking an action or decision on behalf of someone else.
Note: certain major treatments cannot be given without approval from the Court of Protection.
Where a person cannot give informed consent, the care plan in respect of medication must include a
statement from a health professional in charge of the treatment that they believe the treatment to be in
the best interests of the service user and confirming that they have consulted with that person’s carer or
significant other in reaching that decision. In the case of the latter the statement must include the
person(s) consulted and the date(s) and nature of the consultation.
The GP surgery should be informed of the assistance required.
Care staff MUST NOT deviate from this care plan (except for allowable variations agreed with the GP). If
the service user requests any additional assistance, or does not accept the assistance, the care worker
MUST record the incident appropriately and refer the matter to the provider manager. If any request for
different or additional support appears to be the result of a significant change in the condition of the
service user, the care worker should immediately inform their manager, or consider whether emergency
medical care is required.
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A comprehensive risk assessment that covers all aspects of care and includes the medication regime
must be undertaken to ensure the right decision is made regarding the most appropriate method of
assistance with service user’s medication routine. All such assessments will be carried out in conjunction
with a relevant health professional and the assessor will record any agreed interventions or assistance
necessary in the care plan noting where administration of an individual’s medicines is unlicensed.
This document also provides a governance framework in which both professionally registered healthcare
professionals and unregistered persons who are involved in supporting safe medicines administration for
service users understand the increase in liability for actions and omissions when medicines are
administered in an unlicensed way e.g. crushing tablets prior to administration via a PEG tube.
Health and Safety risk assessments and close supervision will be undertaken for any medication that is
unsafe to handle e.g. cytotoxic preparations (medication for cancer treatments). To ensure safe handling
of this type of medication advice on the medicine label, Patient Information Leaflets and advice from the
pharmacy must be followed.
6. CHILDREN AS HOME CARE SERVICE USERS
Parents or guardians will normally be expected to be responsible for a child’s medication. The home care
worker may provide assistance with medication, as a result of a request from the health care in charge of
treatment, or prompt the parent or guardian to give medication to the child.
Assistance with medication routine should preferably be done by direct observation but when appropriate
also by questioning the child, parent or carer. The administration record should be initialled and ‘service
user self-administration’ documented.
With any shared undertaking or responsibility over medicines there is the potential for inadvertent
omission of doses or administration of extra doses unless there is clear communication and
documentation.
Parents or informal carers can be encouraged to administer to their children in whatever setting when this
is appropriate to the clinical condition of the child and when the leading GP has assessed that the parent
or carer is competent to do so.
Assistance with medication administration to a child in their own home or at respite requires strict
governance and assurance of competency of the care worker. In the case of Wye Valley NHS Trust the
care worker will receive training and will be assessed as competent by completion of “Wye Valley NHS
Trust competency workbook for Medicines Administration” (currently in development at the time of writing
being specifically written for support workers administering medicines to children within the community
setting) plus direct observation of medicines administration by a Children’s Community Nurse or
equivalent registered nurse. This will ensure care workers have the necessary skills to administer and
document accurately medicines as well as knowledge of when to seek advice.
7. EDUCATION & TRAINING REQUIREMENTS OF HOME CARE STAFF
The requirements for training in England are explicit. New training requirements were applied in England
from 1st October 2010, as provisions of the Health and Social Care Act 2008 (Regulated Activity)
Regulations 2010 (the Regulations) and Guidance about compliance: Essential Standards of Quality and
Safety came into effect. These replaced the training requirements in the Domiciliary Care National
Minimum Standards (2002).
Guidance about compliance: Essential Standards of Quality and Safety (which includes the Health
and Social Care Act 2008 (Regulated Activity) Regulations 2010)
Guidance about Compliance: Judgement Framework (the guidance CQC inspectors use)
Outcome 14 (Supporting workers), Outcome 24 (Requirements relating to registered managers),
Outcome 25 (Registered person: training), parts of Outcomes 12 (Requirements relating to workers) and
Outcome 13 (Staffing), of the Essential Standards of Quality and Safety place obligations on employers
to recruit effectively, have sufficient staff and ensure they are trained, supervised and appraised,
establish individual learning and development plans and a workforce plan, and ensure registered
managers and registered persons are qualified and experienced.
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Staff must undertake induction to Skills for Care Common Induction Standards and training and
qualifications to meet requirements advised by workforce body Skills for Care. These are listed according
to job role, with a timescale for completion and links to additional information on Skill's for Care's
qualification and training web page (as revised from time to time).
In domiciliary care services, all medication, (except those for self-administration) should be administered
by designated and appropriately trained staff. Medication training must be carried out by trainers that are
knowledgeable in the subject and have relevant current experience in handling medication. Competency
assessments should be carried out by registered health care professionals or those with a qualification
enabling this to be undertaken. The domiciliary care provider must establish a formal means to assess
whether the care worker is sufficiently competent in medication administration before being allowed to
give medicine and this process must be recorded in the care worker’s training file. Care staff must have
received adequate training and be assessed as competent against the elements set down in the Skills for
Care Knowledge Set for Medication. The training must comply with the National Minimum Standards for
Domiciliary Care.
The training for care staff must include:
Basic knowledge of how medicines are used and how to recognise and deal with problems in use;
The principles behind all aspects of this Guidance on medicine handling and
Records; and,
Care workers may, with the consent of the service user, administer prescribed medication, so long
as this is in accordance with the prescriber’s directions.
All home care staff must be aware of this document and where to access information held in this
document when needed. All staff who administer medication must have completed an approved
medication training course and must attend a refresher medication course every two years or earlier if
necessary. Staff must be fully supported in order that they feel confident and competent to carry out the
required medication tasks with annual competency assessments undertaken. Care workers should
contact their supervisor if faced with administration procedure that is not as directed in the Support Plan.
The essential elements of administration training should include:
Obtaining informed consent and giving assistance in a way compliant with the Mental Capacity
Act 2005
How to prepare the correct dose of medication
How to document and confirm the patient’s allergy status
How to administer medication that is not given by invasive techniques, to include tablets,
capsules, and liquid medicines given by mouth; ear, eye, and nasal drops; inhalers; and external
applications
The responsibility of the care staff to ensure that medicines are only given in the right (prescribed)
dose, at the right time by the right method or route
Checking that the medication ‘use by’ date has not expired
Checking that the service user has not already been given the medication by anyone else, e.g. a
different care assistant or a family member
Documenting the administration event appropriately
Recognising and reporting possible side effects
Reporting refusals and medication errors
Understanding the Guidance for record keeping
Home Care staff - responsibility to:
Obtain informed consent and give assistance in a way compliant with the Mental Capacity Act
2005
Ensure that medication is presented in clearly labelled and appropriate containers with a
pharmacist label including specific dosage instructions “take as directed” is not acceptable without
additional instructions.
Complete the MAR sheet accurately
Record any incidence of non-compliance and report to their manager
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Concentrate on the important task of administering medication to the exclusion of all other duties
and distractions
Report to their managers the build-up of medication in service users homes who will then liaise
with GP prescribing practice
Report any incidence of medication errors to their manager
Assist their manager with the completion of a medication incident report form in the event of an
incident occurring
Discuss their medication training needs during their supervision
Managers have a responsibility to:
Ensure that staff receive appropriate medication training and/or refresher training as appropriate
Ensure that home care staff feel confident about their role and responsibilities and feel that their
manager will reinforce the importance with service users and informal carers
Ensure that medication Policies/Procedures and forms are audited regularly and
processes/systems reviewed for trends and practices that might contribute to errors
Maintain an awareness of the quantities of medication in service user’s homes and inform GP
prescribing practice of over stocking of medicines.
Ensure that all incidents/ errors are reported and acted upon. Failure to do so could result in
serious consequences for the service user and for individual care workers in criminal law.
Ensure social care staff are actively encouraged to report any situation where things have, or
could have gone wrong.
Ensure that care workers who report errors are supported and that individual as well as
organisational learning is shared following any incidents involving medicines.
If it is found from the investigation the home care staff have not followed guidelines and safe practice or
have acted illegally, maliciously, negligently or recklessly in line with their duty of care, an investigation
interview should be undertaken in line with the organisation’s disciplinary procedures.
8. PRINCIPLES OF SAFE MEDICATION
Supply and storage of medication
Wherever possible, medication should be obtained by the service user or family member / appointed
person. Prescription requests would usually be completed by the service user or a member of the family
or an authorised member of the health care team.
All medication should be examined for information about storage conditions and these conditions must be
adhered to. Medicines must be out of the reach and sight of children and should be kept away from heat,
humidity, and sources of light. It is also necessary to provide separate storage for internal and external
use only medicines. Medications which require storage in a fridge (e.g. antibiotic suspensions, Insulin)
must be clearly labelled and placed in a safe area away from other contents of the fridge.
Where a service user is supported with medication and there is a risk of misuse, their medication needs
to be kept in a secure place out of their sight and reach where it is only accessible to family, care workers
and other healthcare professionals. This should be agreed and noted in the support plan.
All medicines retained for each service user must be stored in the original manufacturers’ or other
packaging / containers as dispensed by the pharmacist or doctor with a record of:
The name of the person
The name of the medicine
The prescribed dosage
The frequency of the administration
The strength, quantity or volume of the medicine
The date of dispensing
Date of opening for eye drops / insulins and medicines where there is a time limited validity
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Pharmacists must supply all oral solid dose and liquid dispensed medicines in child resistant packaging;
however at times, when a child is recognised as the sole or main carer, the medication must be
accessible to them as necessary, following the undertaking of a risk assessment.
Medication Theft Prevention
There are many ways the provider can assist the service user in securing medications to prevent theft,
e.g. by obtaining a lock box (a tool box or similar box with a pad lock or combination lock) or a lockable
medicine cupboard. Prescribed medicines are the property of the person to whom they have been
prescribed and dispensed and must not be used by or given to any other person.
Medicines Administration
The following basic principles of medication administration must be applied where the service user
requires assistance:
RIGHT SERVICE USER - The identity of the service user must be confirmed and checked with
the name on the service user’s Medication Administration Record (MAR), the pharmacy label on
the medication and by addressing the service user by name.
RIGHT DRUG - The name, form and strength of the medication must be checked during the
administration process i.e. the pharmacy label on the medication should be compared with the
MAR sheet when, before it is placed with the service user and before documenting and signing on
the MAR sheet.
RIGHT TIME - Medication should be given at the time indicated on the MAR sheet. If medication
is administered more than one hour either side of the time stated, advice may need to be sought
from the home care manager/GP before the medication is administered.
RIGHT DOSE - The dose of medication must be administered in accordance with the prescriber’s
instructions. Again, reference must be made between the MAR sheet and the pharmacy label to
ensure this. If there is any discrepancy between the dose on the MAR sheet and that stated on
the label, advice must be obtained from the home care supervisor/GP before the medication is
given.
RIGHT ROUTE - Each medication must be administered in its prescribed form i.e. tablet, capsule,
patch, inhaler etc. and by the prescribed route i.e. oral, sublingual, topical etc.
RIGHT DOCUMENTATION - The documentation for the medication should clearly reflect the
service user’s name, the name of the ordered medication, date, time, dose, route and frequency
of administration. Each medication sheet must be signed immediately after administration of the
drug.
Staff need to be aware that medicines can have two names, the generic name based on the medicine’s
main ingredient, e.g. paracetamol and its proprietary/trade name like Panadol. It is important to
administer the correct dose of the correct medicine.
Care workers will administer medication only from the Manufacturer’s Original Pack or a Monitored
Dosage System dispensed by the pharmacist/dispensing GP practice and prescribed to the individual
service user. Care workers are not authorised to administer medication from family filled compliance aids
as it may lead to a medication error and are not permitted to fill compliance aids themselves.
Under no circumstance will home care staff secondary dispense medicines, i.e. taking them out of their
original package or container and put into another container for someone else or the service user
themselves to administer at a later stage.
Medicines labelling
Medication must be administered in accordance with the prescriber’s instructions, as printed on the
pharmacy label. If a medication is labelled “Take as directed”, the service user’s GP should be contacted
for full instructions and a written authorisation of dose requested. It is not acceptable to administer from a
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container without full dosage instructions. In particular, doses of insulins, oral anticoagulants, cytotoxics
should be specifically recorded and detailed advice for application of topical products should be available
in the care plan
The label on the container provided by the pharmacist must not be altered under any circumstances. If
the label becomes detached from the container, is illegible or cannot be read, the care staff should
contact the supplying pharmacist immediately.
Timing of medicines administration
The times of administering medication are essential and there are often set times. It is important to know
if the medication is ordered to be taken a specified number of hours apart, as taking some medications
too closely together can result in toxicity. Medication errors related to time given often occur during shift
changes, it is important to document clearly that medications have been given. No double doses should
ever be given e.g. if a service user refuses one dose do not give two doses the next time round. This
should be recorded on the MAR chart.
Medicines incidents
Should care workers miss, omit or in any way incorrectly administer a dose; the error should be reported
to the line manager and the relevant health professional consulted. If following consultation with a health
professional there is a belief that the error could have led to harm and injury, then CQC and the service
user’s carer must be informed in writing. The error must be recorded on the MAR sheet and recorded on
the service user’s file. Errors should also be reported as incidents under the provider agency
accident/incident reporting system. It is a requirement that incidents involving Controlled Drugs (CDs) are
reported in writing and brought to the attention of the Accountable Officer for Controlled Drugs – all
providers of home care services employed by WVT should ensure that errors involving Controlled Drugs
are brought to the attention of the WVT Chief Pharmacist.
Response to medicines use
Care staff administering medication should monitor the response to treatment and be able to inform the
team caring for the patient of any changes in the patient’s condition. They should know about potential
interactions with food, liquid or other medication, and what action to take when adverse effects occur.
(this means the care staff will know why each medication is given and should be able to recognise
common side effects from medication e.g. confusion, sedation, nausea, agitation, constipation, diarrhoea
rash and report accordingly)
Blood glucose monitoring - the care worker is only responsible for the recording of the value and
reporting back to the health professional if necessary when the service user undertakes their own blood
tests.
Eye drops may be administered by care workers following medication training.
Surgical stockings - Care workers may assist with surgical stockings if the stockings have been
prescribed correctly fitted and instructions for use are available.
Common side effects from medicines
All medicines can potentially cause side effects or adverse reactions and these can vary from person to
person. Side effects may be minor or extreme enough to be life threatening.
Common side effects include: rashes; stiffness; breathing difficulties; shaking; swelling; headaches;
nausea; drowsiness; vomiting; constipation; diarrhoea; weight gain - this list is not exhaustive.
Side effects can either present as one symptom or as a combination of symptoms. Home care staff must
be aware of the common side effects of most drugs and record any adverse reactions in the Service
User’s care/support plan. In such cases, the service user’s GP must also be contacted and the
medication stopped until staff are informed otherwise.
All medication in Manufacturer’s Original Packs should come with a Patient Information Leaflet, which
lists possible side effects. These should be retained for future reference. If medication for the service user
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comes in MDS packs the pharmacist should be contacted for information on all medication dispensed in
this manner.
Off license use of medication - Crushing or dissolving medication
NHS Herefordshire and Wye Valley NHS Trust do not consider crushing medication as a good practice.
In exceptional circumstances, an instruction to crush or dissolve medicines may be given, which does not
agree with the manufacturer’s instructions. Such an instruction should be printed on the medication label
produced by a pharmacist. The activity has to be documented in the service user’s medication plan, and
agreed with the service user’s GP. Not all medications are suitable for crushing or dissolving. If in doubt,
confirm new instructions with the prescriber or pharmacist
Disguising medication
NHS Herefordshire and Wye Valley NHS Trust do not consider disguising medication as a good practice.
As a general principle, by disguising medication in food or drink, the service user is being led to believe
they are not receiving medication, when in fact they are.
Only in exceptional circumstances and after confirming with service user’s pharmacist and/or GP, will the
medication be disguised. The following principles must be observed:
a written permission must be obtained for the administration of medicines in food or drink to
service users who are able to give consent after all alternative avenues have been explored
that the treatment is necessary
if the decision is ultimately taken to administer in a food or drink, the decision is reached by a
multidisciplinary team, including permission in writing granted by the prescribing GP
need to ensure the medicine is administered in food or drink which has no deleterious effect on
the efficiency of the medicine and does not cause an interaction
clear records to be kept of:
- the reason why the medicine is refused
- if the service user is unable to swallow
- if the medicine is available in a different form e.g., capsule or liquid, or be changed to a similar
medicine
- if the medicine can be sprinkled on food
8. RECORDING OF MEDICINES ADMINISTRATION
For all medication prompting and administration a record must be made on the service user’s contact
sheet / on the Medication Administration Record including:
Date & Time
Medication – name, form, strength, dose
Appropriate codes used for refusal, absence, sleeping and other reasons such as medication
unavailable, spillage, dropped tablets etc.
Where a service user chooses not to take their medication or a dose is omitted for any reason an
appropriate entry on the service user’s MAR sheet must be made and must be signed by the care worker
involved. The service provider manager must be informed. They will make a judgement about whether to
seek further advice from the Pharmacist/GP.
If it transpires that details have been put in the wrong box, the error must be annotated and initialled, and
the details entered in the correct box with a correction note made at the header/ footer of the MAR chart.
Under no circumstances must correction fluid be used or signatures be crossed out since this does not
enable a full audit trail to be followed.
An up-to-date sample signature and initials list should be kept for those staff eligible to undertake
medication administration in the service user’s file. A copy should also be maintained by the service
provider manager. All Medication Administration Records must be retained for a minimum of 7 yrs.
All administered medication at Level 2 (see page 16) must be recorded on the Medication Administration
Record (MAR) chart, completed for that individual person. This serves two purposes: the first being a
record of medication prescribed to the particular person and the second, a ‘check list’ for unneeded
14
medication to be returned. Where possible a computer generated MAR chart should be requested from
the pharmacy at the point of dispensing the medicines for the service user.
The MAR chart should be kept in the service user‘s files. All medicine records should be kept together in
one place so that all visiting health professionals e.g. consultants or Out of Hours Service are able to
reference the information to medicines easily.
- The MAR chart is individual to the person and should reflect the items which are still being
currently prescribed and administered to them
- The MAR chart should be clear, up to date and contain date and time of administration, name of
the medication, strength, dose frequency, quantity and any additional information required
- The MAR chart needs to be regularly signed and dated indicating who has dealt with each
medication task
- If the medicine label does not agree with the MAR chart advice should be sought initially from the
home care manager before administration unless a change of frequency has been recorded,
signed and dated on the MAR chart and the label annotated to this effect.
- The pharmacist should use their professional judgement and liaise with the care service to include
the appropriate times of administration for each medicine on the MAR chart
- A MAR chart must be completed following each task, listing the activity undertaken, and any
incidents such as failure to take medication by the service user
- Where there is an option of “when required” medicines these should be clearly documented as to
the time of administration on the MAR chart
- Where there is a potential for a variable dose to be taken by the service user e.g. 1-2 tablets then
the MAR chart should clearly identify the number of tablets taken
It is advisable that the quantities of medicines are monitored by completion of the quantity of
medicines boxes on charts and updated following new supplies.
Changes to MAR charts:
When a medicine dose is changed or a new prescription is issued mid-cycle for a long term medicine,
ideally a new chart will be produced and the product included in subsequent MAR charts when the next
cycle commences. There must be liaison with the care service to ensure that the directions on the in-use
MAR chart are cancelled. Errors might occur when discontinued medicines are included in a MAR chart
and the service has not disposed of the medicine previously supplied. It will be the responsibility of the
service provider manager to ensure that changes to MAR charts are undertaken accurately and fully.
The home carer must not accept the word of the service user, family member or pharmacist, that the
label on the bottle is the correct dose if the GP’s orders say something different.
Changes to MAR Charts mid cycle should be the responsibility of the home care providers authorised
staff member. Regular monitoring would take place by them through spot checks on care workers in
service users’ homes. Care should be taken through handwritten amendments by prescribers who should
put a line through any discontinued medicines, initialling and dating at that time plus make a new entry
which is clear for care personnel. A note to the same effect should be made in the care plan of the
patient. Any existing medicine which can be used up should be used up by annotating the label of the
prepared medicine to indicate that a change of frequency has been made but the supply can be used up
before the next dispensing falls due. Again it will be the responsibility of the home care supervisor to
ensure that this is completed accurately.
9. CATEGORIES OF MEDICINES TASKS
The type of support with medication tasks has been divided into the following categories:
Level 1 Level 2 Level 2 Extended –
Level 3 -
Induction/ General Support / Assisting
Administering Medication
Administering Medication following Extended Level Training
Administering medication by specialised techniques
Level 1: Induction/ General Support/Assisting
15
Level 1 forms part of induction training. The importance of this level is that it should raise awareness of
the management of medicines. It should also identify what the domiciliary care worker is not able to do
before completing Level 2 training.
General support is given when the adult service user takes responsibility for their own medication. The
nature of the general support should be identified on the service proposal and service user’s support
plan; this may include:
An occasional reminder or verbal prompt from care workers for a service user to take their
medication. For all level 1 medication prompting a record must be made on the service user’s
contact sheet detailing the date, time and medication that was prompted. This must be signed by
the care worker that undertook the prompt.
A persistent or increasing need for a reminder may indicate that a service user does not have the
ability to take responsibility for their own medicine and should prompt an urgent review of the
service user’s support plan. The Home Care manager should be informed at all times.
Requesting repeat prescriptions from the GP or community pharmacy via a managed repeat
dispensing system
Collecting medicines from the pharmacy - all staff must comply with their responsibilities reference
the Data Protection Act, other relevant legislation and professional/NHS guidance and assurances
such as the NHS Information Governance Toolkit with regard to person’s data displayed on a
prescription. When taking or collecting a prescription from the pharmacy, care should be taken to
protect confidential service user information from view.
Returning unwanted medicines to the supplying pharmacy/dispensing GP practice when
requested by the service user
Opening of a container under the direction of the service user who has capacity, for example,
opening a bottle of liquid medication or popping tablets out of a manufacturer’s blister pack on to
e.g. a saucer. In the case of monitored dosage systems these should only be in place where the
service user is able to access them and can use them safely.
When appropriate, the service user may be referred to a Pharmacy/dispensing GP practice to undertake
a Disability Discrimination Act assessment, to establish whether a pharmacy-prepared MDS would
support the Service User to self-medicate. Care staff must not dispense into a daily dosette/ compliance
aid container as this carries high risk of errors or prompt medicines from a family filled dosette container.
An individual's ability to self-administer their medication should be regularly monitored. A persistent or
increasing need for reminders may indicate that a person does not have the ability to take responsibility
for their own medicine routines and a review of the medication plan must be undertaken. The care worker
must immediately advise their line manager who must ensure that appropriate (urgent) contact is made
with the services user’s GP and the commissioning body. In these circumstances ongoing assistance
(administration) with medication must only be then provided by a suitably skilled worker.
Level 2: Administering Medication
Level 2 may be described as basic training and should be carried out by a suitably qualified person. This
should provide the domiciliary care worker with knowledge and practical skills to safely select, prepare
and give different types of medicines, a process that is referred to as ‘medicine administration’. A senior
worker should always mentor a care worker until he/she is both confident in giving medicines and
competent to do so correctly.
Relevant for service users assessed as unable to take adequate responsibility for taking their medication.
This could be due to impaired cognitive awareness, sensory disability or through physical disability.
However, many service users with some impairment may still be able to instruct the care worker and
where this is the case, the care worker will still be required to ask for the permission of the service user to
administer their medicines. Support and knowledge required will include all of the following:
Establishing from the service records which medicines are prescribed for a service user at a
specific time in the day
Selecting medicines for immediate administration, including selection from the Manufacturer’s
Original Pack (MOP) or from a monitored dosage system as supplied by the dispensing practice
or community pharmacy
Selecting and measuring a dose of liquid medication for the service user to take
16
Applying a prescribed medicated cream/ ointment; inserting drops to ear, nose or eye;
administering inhaled medication by an inhaler - see level 2 extended for nebulisers, oxygen
therapy
Presenting the tablets / medication only to the service user and assisting service user to swallow
any medicines correctly by providing a full glass of water
Recording that a service user has had the medicine or the reason for not administering it
What to do if a service user refuses medicine that the care worker offers
Who to inform if a medication error occurs
Who to inform if the service user becomes unwell after taking his/her medicines
How to dispose of unwanted medication
It is part of the contractual requirement that a MAR chart will be used to record any medication
administered under Level 2. Preferred practice would be to use pharmacy-prepared computer-generated
MAR chart.
Please refer to APPENDIX 1 – PROCEDURE FOR ADMINISTERING MEDICATION
Level 2 extended role: Administering medication by specialised techniques requiring extended
knowledge
Level 2 extended allow for extended practice which requires specific training requirements plus
competency assessments before these tasks can be performed with annual competency updates.
Level 2 medication administration should only be provided in accordance with a service user-specific
Support Plan drawn up by Social Care & Support Workers, Health partners and the Provider. The
administration of medication under a Level 2 extended role will be permitted only when failure to do so
would jeopardise the health of the service user.
Examples of administration by specialised techniques include:
Rectal administration e.g. suppositories, enemas, diazepam (for epileptic seizure)
Vaginal administration e.g. pessaries
Administration through a Percutaneous Endoscopic Gastrostomy (PEG) or other feeding tube
Oxygen via cylinder or concentrator
Supportive skin care management in relation to stoma care service users
Supportive pressure area care under supervision of registered health care professional
documented in the care plan
Application of transdermal patches (special consideration to be given to analgesic opiate patches
and the requirement to monitor and report pain control).
Application of heel pads
Level 3: Administering Medication by Specialised Techniques by registered healthcare
professionals only
Level 3 relates to those circumstances when a registered healthcare professional is asked to administer
medication by a specialist technique. Level 3 tasks should only be undertaken by a trained health care
professional with skills, competencies required described in the Medicines Code at WVT.
An assessment of an individual’s medicines requirements should be documented in the care plan and if
a registered health care professional delegates any aspect of care then there should be appropriate
safeguards, education and training and competency assessments against national professional
standards recorded with accountability and responsibility remaining with the registered professional.
Any procedure which requires staff to make a medical judgement
Invasive administration, e.g. injections, insulin pen devices, medicines administered by
suppository or vaginal pessary
Administration of s/c insulin following specific training within the WVT Medicines Code
Nasogastric administration
Planning of wound management care. Delegation to appropriately trained and competent workers
working at extended Level 2 is possible.
17
Injectable drugs administered through sc syringe driver systems or im administration
Compression therapy
Registered Health Professionals will be mindful of the medicines standards within the Nursing
Midwifery Code (NMC) in addition to employer policies in relation to medicines administration.
DELEGATION OF CARE
Delegation of care can be defined as the entrusting of a task to another ‘person’ and can support
successful team working. However some points need to be considered before delegating care to non –
registered members of staff. When registered nurses and midwives are considering which tasks and
activities to delegate they should consider the following:
• the needs of the people in their care
• the stability of the people being cared for
• the complexity of the task being delegated
• the expected outcome of the delegated task and the availability of resources to meet those needs.
A registered nurse always retains accountability and responsibility for care delegated and has the
responsibility to note that unregistered staff are accountable for their actions and are responsible for the
tasks that they undertake, they should be competent and maintain competency for a given task that
complies with this Guidance and they should not work beyond their level of competence and cannot
further delegate care to another member of staff. When a nurse is delegating they must be assured that
the person to whom they have delegated (the delegatee) fully understands the nature of the delegated
task particularly in relation to what is expected of them. The delegatee should know their limitations and
when to seek advice from the appropriate professional in the event that circumstances change. Therefore
a record should be made in the service user’s care plan the detail of a registered healthcare professional
decision of what specifically is being delegated to whom and over what time period.
If these conditions have been met and an aspect of care is delegated, the delegatee also becomes
accountable for their actions and decisions. However, the nurse remains accountable for the overall
management of the person in their care.
10. MONITORED DOSAGE SYSTEMS (MDS)
Non-adherence with medication has considerable health, economic and social implications. Several
factors have been implicated, which provision of MDS can potentially address; resulting in improved
adherence to prescribed medication where service users have difficulties:
Difficulty accessing medication from packaging due to manipulation problems
Sight impairment with difficulty reading labelled directions, warnings / distinguishing between
medicines or difficulty accessing medication from packaging
Confusion / forgetfulness
Complexity of treatment regimen
A wide range of both disposable and reusable Monitored Dosage Systems (MDS) is available. Their use
is intended to support patients who are unable, or experience difficulty managing their medication
independently and is thereby an aid to maintaining their independence. However, supply of MDS in
home care is considered to be a business agreement between the pharmacy and the service user
supplied. An MDS and appropriate support from the local community pharmacist may be all that is
needed to help services users take their medicines more effectively on their own and remain their
independence for longer. MDS systems do not offer a guarantee of appropriate medication use and
disadvantages of MDS include:
Possibility of errors due to secondary dispensing
Wastage when treatment changes necessitates complete re-dispensing
Not all medicines can be packed in MDS, due to various stability problems
MDS preparation is very labour intensive
Failure to communicate a treatment change to dispenser could result in patient continuing to
receive unintended treatment
Lack of patient information leaflets (which are included in Manufacturer’s Original Packs)
Potential waste of medicines if service user is admitted to hospital , other care settings
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Potential deskilling of carers
Only support self-administration if the patient is orientated in time and space
Further information should be sought from a document entitled “Monitored Dosage Systems Guidance for
Health and Social Care Professionals in Herefordshire” March 2010, produced by NHS Herefordshire and
Herefordshire Council. For more information about services offered by community pharmacies refer to
APPENDIX 2
Routine use of MDS for the convenience of care staff is NOT supported. Following individual
assessment by dispensing practice or community pharmacist some service users may be eligible
for NHS supply of MDS systems to support independent management of their medicines (Level 1)
but MDS systems cannot be requested on behalf of patients for the benefits of supporting carer
administration.
11. ADMINISTERING MEDICATION ON AN EMERGENCY BASIS
There are cases when any delay in not receiving medication on time would significantly impact on the
service user’s health and well-being.
Only medication in its original container, labelled with the date and service user’s name; and with an
exact dosage will be administered. Care workers may administer medication only if previously authorised
in writing by the service user / their representative and the provider service manager staff member.
Home care staff should be notified of any allergies to medications or antibiotics being taken.
12. CONTROLLED DRUGS MEDICATION
Controlled drugs (CDs) are usually used to treat severe pain or treat drug dependence and they have
additional safety precautions and requirements. They are prescription medicines containing drugs
controlled under the Misuse of Drugs Legislation and are classified (by law) based on their benefit when
used in medical treatment and their harm if misused and therefore should only be used in accordance
with the prescriber’s direction.
There are 5 Schedules of Controlled Drugs with different levels of regulations governing them, for
example, morphine (Zomorph®), fentanyl (Matrifen®), temazepam, midazolam. GPs, pharmacists and
other health professionals, residential and nursing homes have strict rules as to how they must be
managed. However for service users in their own homes, these drugs should be managed in the same
way as other medicines. The carer should be careful about ordering, collecting, administering, recording
and disposing of in order to ensure that both they and the service user are safeguarded.
There are special legal requirements for CD prescriptions and a prescription that does not comply with
these requirements may have to be sent back to the prescriber for altering before it can be dispensed. If
home carers collect CDs from a pharmacy on behalf of someone else they may be asked to provide
identification. CDs should be returned to the pharmacist or dispensing doctor at the earliest opportunity
for safe disposal. When CDs are returned for disposal, a record of the return should be made using a
returns sheet and ask the pharmacist or dispensing doctor for a signature to note their return.
13. OVER THE COUNTER MEDICATION
Service users and their families are requested to inform the home care team, of any non-prescribed
medicines that are purchased or that a service user wishes to take including e.g. vitamins, minerals and
supplements, painkillers, cough syrups, cold and ‘flu remedies etc. that have not been prescribed. These
are known as “homely remedies”, a term that describes “conventional / proprietary medicines” which are
registered legally as medicines to help treat short, self-limiting conditions. Example conditions which may
be treated using a homely remedy include indigestion, mild pain, constipation and diarrhoea.
Please refer to APPENDIX 3 – HOMELY REMEDIES for a guidance list for the use of homely remedies
A service user may have a pre-agreed list of homely remedies which can be given to the service user for
a limited agreed time. Treatment with a homely remedy should not continue for more than 2 days without
19
medical assessment. A procedure for the administration and recording of homely remedies must be in
place. Most medication administration records include a section for recording the administration of
homely remedies or this feature should be included if appropriate. If a service user does not have any
routinely prescribed medicines but requires a Homely Remedy then the Homely Remedy list can be used
as a guide in discussions with a community pharmacist to confirm suitability of products. Service users
should be encouraged to discuss any requirements for medicines with either their community pharmacist
or dispensing GP before making any purchases of medicines. Care staff should not offer advice to a
service user about or purchase on their behalf over-the-counter (OTC) medication or complementary
treatments.
Vitamins, minerals, homeopathic medicines and other proprietary preparations including those
used externally
Vitamins, minerals and other supplements, homeopathic, herbal medicines, creams, lotions, muscle rubs,
glucosamine etc. are not usually legally registered as medicines. These types of supplements can
seriously interact with conventional prescribed medicines and so a written agreement does need to be
clear how these have been considered and are to be managed for individual service users. Service Users
should be encouraged to discuss any requirements for these preparations with either their community
pharmacist or dispensing GP before making any purchases of medicines from pharmacies or other retail
establishments.
14. DISPOSAL OF MEDICINES
To comply with The Environment Protection Act 1990, all unwanted medicines must be returned to the
supplier or a local pharmacist/dispensing GP practice for safe disposal. Medication can be disposed of
when:
The expiry date is reached
The supplying pharmacist or prescriber says so i.e. when treatment is no longer required
A course of treatment is completed or stopped
The service user dies or leaves the service. In case of the death, the medicines should be
retained for seven days in case they are required by the Coroner’s office
When medicines become soiled
Medication identified above should be disposed of within a maximum of two weeks, by returning them to
a pharmacy (or dispensing general practice).
No medicines should be thrown in the bin or down a W.C. Any sharp objects (e.g. needles) or other
clinical waste should be disposed of into designated bags/containers if these have been made available.
If there is no local procedure in place, the designated full bin should be returned according to local
arrangements for sharps disposal – not through community pharmacists.
No out of date medicines or discontinued medicines are to be kept. Out of date medicines for disposal
must be kept separate from medicines in use. For any medication that requires disposal a record should
be kept with details of the name of the medication, quantity, date and reason for return. The form should
be signed and dated by the service user and their care worker. The pharmacist receiving the medication
should sign and date the form. The form should be kept in the service user’s file.
15. MEDICATION ERRORS
While in the vast majority of cases medicines are prescribed and used safely, service users may be
harmed by unwanted effects, or errors might occur as a result of poor medication handling practice. It is
common for a number of people to be on multiple medications, some in excess of 20 or even 30 different
prescriptions. If not maintained appropriately, this can be confusing both for the Service User and the
care staff.
Medication errors may be related to inadequate labelling, wrong dosage, lack of staff experience, illness,
personal or works stress and distractions but must also be distinguished from side effects of medication.
20
If a mistake occurs, staff must IMMEDIATELY report this to their line manager so as to prevent any harm
to the customer. If the line manager is not available, the on-call emergency contact staff must be
contacted to notify the manager of the medication error.
If mistake is made advice must be sought immediately from GP, pharmacist or a nurse, particularly if
medication is missed or a double dose is accidentally given. Family carers or other appointed
representatives must also be informed as soon as possible.
At the time that the error is discovered, the care worker should stay with the service user and the service
provider’s authorised staff should seek medical advice. If an incident occurs out of office hours,
emergency assistance should be accessed such as ‘NHS Direct’ phone line emergency services or the
emergency contact at the local GP surgery.
All staff involved in the medication error should submit a written statement immediately as to their
understanding of the incident. All errors must be recorded by the provider’s branch authorised staff and
filed in the provider’s branch office alongside the Regulation 28 documentation that will be forwarded to
the Care Quality Commission (CQC). A copy should also be maintained on the Service User’s file in the
office.
Home care staff should be instructed and encouraged to report any medication errors in a blame free
culture. Such instances should be dealt with in a constructive manner that addresses the underlying
reason for the incident and prevents recurrence.
Under no circumstances should the home care staff ignore the error or handle the error on their
own.
16. MONITORING
The provider’s branch authorised staff member will undertake regular audit of all Service User’s
Medication Administration Record sheets alongside a service user feedback form.
The audit will include the following topics using a Medication Audit Checklist:
Medication Administration Record signatures
Loose medication counts
Labelling of creams / ointments
Date of opening of eye drops / liquid medications
Date check of all medication (including PRN)
All forms – Risk Assessment, PRN, Confirmation of Current Medication, Medication Error Report
form.
Staff competence
Medication training of staff team
Any discrepancies / errors should be fully investigated immediately using a Medication Error Report form.
For all home care services observational supervision will be undertaken periodically by the provider’s
branch authorised staff member to all care workers involved in the regular administration of medication
(level 2) to customers who should receive an annual update in terms of assurance of continued
competency around medicines management.
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APPENDIX 1 – PROCEDURE FOR ADMINISTERING MEDICATION
1. Wash and thoroughly dry hands and any utensil that may be required e.g. medicine spoon,
measure, glass, tablet cutter
2. Where a clinical tasks protocol is in place, undertake such preparations and infection control
procedures as required.
3. Check the service user’s identity, and allergy status
4. Check against the medication administration record (MAR), care plan and risk assessment
that the medication has not been changed and confirm which medicines are due.
5. Check the physical state of the medicines, including the expiry date and labelling and that it
has been suitably stored. If the Medicines label and MAR chart do not appear to match then
advice should be sought before administration from the service manager.
6. Check the required dose and any special instructions on the dispensing label (e.g. not to be
given with milk or antacids or to be taken with food etc.) and take appropriate action.
7. Contact the home care manager if there are concerns that the dose has already been given
by somebody else.
8. Measure with the supplied liquid measure or count the dose and give it to the service user, if it
is not in a compliance aid.
9. Ensure that the service user is either in a standing position or sitting upright. A home carer
should not attempt to assist with medication for someone who is in a prone position.
Medicines should be swallowed with plenty of water e.g. 100-150ml of water or at least half a
glass.
10. Check that the medication has been taken.
11. For applications of creams and ointments disposable powder free gloves must be worn.
12. Before commencing administration of medication, hands must be washed with liquid soap to
prevent contamination. This should be repeated if gloves have been worn.
13. Record on the medication administration record that the medicine has been given or that it
has been offered and refused (in the case of the latter a protocol should have been agreed
regarding notification of other agencies/appropriate professional).
14. Return the medicines to a safe storage place as identified on the risk assessment.
15. Return the medication administration record sheet to the service user’s notes.
16. Wash hands.
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APPENDIX 2 – SOURCES OF ADVICE ON MEDICINES RELATED QUERIES.
Wye Valley Trust Medicines Information
There are various options for assistance with medicines related queries. If service users obtain their
medicines from a community pharmacy then community pharmacists can very often assist in the first
instance. If service users obtain their medicines from a dispensing practice then the query can be placed
to the prescribing doctor.
Alternatively Medicines Information Service at Wye Valley NHS Trust is a pharmacist-led information
service on medicines available for health professionals as well as service users or carers. They can be
contacted Monday to Friday during working hours on:
Medicines Information
The County Hospital
Union Walk
HEREFORD HR1 2ER
Tel: 01432 364017, Fax: 01432 364055, E-mail: [email protected]
Community Pharmacy Services
A "Medicines Use Review" is an appointment with a community pharmacist to focus on how people are
getting on with their medicines. It usually takes place in the local pharmacy (chemist). It is a free NHS
service and usually completed once a year. The service is designed to:
Help Service Users and Carers to find out more about the medicines they are taking
Pick up any problems with the medicines being taken
Improve the effectiveness of medicines – there may be easier ways to take them or Service Users
may find they need fewer medicines than before
Get better value for the NHS – making sure that medicines are right for an individual helps prevent
unnecessary waste. Pharmacists have completed further training in order to provide this service so
ask the regular pharmacist you obtain medicines from for further information.
Community Pharmacy New Medicine Service
The New Medicine Service is a free NHS service, offered through the community pharmacy (chemist), to
help understand conditions and get the most out of any newly prescribed medicines. The service is for
people who have received their first prescription for a medicine to treat any of the following conditions:
Asthma, Lung conditions such as chronic bronchitis and emphysema, Type 2 diabetes, High blood
pressure, Conditions where you take a medicine to control the way your blood clots.
Between 30% and 50% of prescribed medicines are not taken as recommended. This means that a lot of
medicines are wasted or are not as effective as they could be. The New Medicine Service can help
provide better value for Service Users and the NHS by making sure that medicines are right for Service
Users.
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APPENDIX 3 - HOMELY REMEDY GUIDANCE LIST
This list contains the medicines that can be provided to adult Service Users who require symptom relief for the listed indications for up to 48 hours. The medicines can
be provided without calling out the GP but the receipt, administration and disposal of these medicines must be recorded.
External preparations have been excluded, as they should be ordered specifically for an individual to avoid cross contamination.
INDICATION
FREQUENCY
MAXIMUM DOSE
1or 2 tablets
Every four to six hours as
required
Not more than 2 tablets at any one
time. Not more than 8 tablets (4g)
in 24 hours.
Do not give in conjunction with
any other medicines that contain
paracetamol.
Paracetamol susp
250 mg / 5 ml (Sugar-free)
10 – 20 mls
Every four to six hours
as required
Not more than 20 ml at any one
time. Not more than 80 ml (4g) in
24 hours.
Ensure suspension is sugar-free if
Service User is diabetic.
2. Indigestion
Simple indigestion mixture e.g.
Magnesium trisilicate mixture / simple
indigestion tabs- consult pharmacist
for suitable product
10 - 20 mls
Three times a day
Maximum.
Not to be given at the same time as
other drugs as they impair
absorption
3. Constipation
Senna tablets 7.5 mg
2 tablets
At night
4. Diarrhoea
Monitor carefully for signs of
dehydration.
1. Mild to
moderate pain,
pyrexia (fever)
MEDICATION
Paracetamol 500 mg tablets
DOSE
OR
Consider electrolyte replacement sachet.
Dissolve 1 sachet in 200
ml fresh drinking water
and give after each loose
motion.
ADDITIONAL INFORMATION
Not if laxative is already prescribed.
Contact GP if not improved after 24
hours.
Consider Loperamide 2 mg caps/tabs
following instructions. * Do not supply
if service user has had a previous
diagnosis or present infection of
C.Diff (clostridium difficile).
Persistent diarrhoea will necessitate
a stool sample diagnosis.
If symptoms worsen or if you have any concerns, contact the GP. Refer to GP if symptoms persist after 48 hours.
If required for regular treatment, a prescription must be obtained from GP. Check that current treatment is not causing the problem and seek advice from community
pharmacist/GP at dispensing practice if necessary. Ensure any warnings and directions from the manufacturer are available and strictly followed. Provide Patient
Information Leaflet if available.
Name of Service User:
Address:
Signed on the basis of information provided at the time in relation to other concurrent medicines and health related conditions
Name of person providing
authorisation:
Mr / Mrs ……………………………………………….. (Pharmacist) or
Date of authorisation ………………………..
Dr …………………………………………………….... (On behalf of GP Practice)
Reauthorisation due …………………….. ….
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