service area: communities directorate adult · pdf fileappendix 5 medication administration...

SERVICE AREA: COMMUNITIES DIRECTORATE

ADULT SOCIAL CARE

TITLE MEDICATION POLICY & PROCEDURE FOR OLDER PEOPLE’S RESIDENTIAL AND DAY SERVICES.

STATUS: POLICY

REF. NO. POL – 4010 / 2008 DATE ISSUED: DECEMBER 2006 REVIEW DATE: DECEMBER 2007 EQUALITY IMPACT ASSESSMENT: STATUS

WRITTEN BY: APPROVED BY: HEAD OF SERVICE BRIEF DESCRIPTION: This document sets out the policy and procedure which Lincolnshire County Council expects will be followed to ensure the safe handling of medicines within the County Council’s Care Homes for Older People. FURTHER REFERENCE DOCUMENTS: Reference Number Description: Date Issued:

RELATED FORMS: Form No: Description: Date Issued: Appendix 1 Staff Authorisation for medication December 2006 Appendix 2 Self Medication Letter December 2006

Appendix 3 Record of Approved Staff December 2006 Appendix 4 Receipt of Medication December 2006 Appendix 5 Medication Administration Record December 2006 Appendix 5a Carers Medication Notes December 2006 Appendix 7 Non-Prescribed/Home Remedies Check

List December 2006

SS1/2 Client Contact Sheet December 2006 SS1/4 Supplementary Information February 1996 Appendix 10 Unidentified Medicines List December 2006 Appendix 13 Controlled Drugs Audit December 2006 Appendix 14 Medication Competence Assessment December 2006

ADULT SOCIAL CARE

MEDICATION POLICY & PROCEDURE

FOR

OLDER PEOPLE’S RESIDENTIAL

AND

DAY SERVICES

Date: December 2006

Review Date: December 2007

Contents

Page

1. INTRODUCTION 1

1.1 Current Legislation 1

1.2 Practice Statement 1 - 2

1.3 General Principles 2 - 3

2. THE ROLE OF THE PHARMACIST 4 - 5

3. ASSESSMENT OF NEED 6 - 7

3.1 Risk Assessments and Management 7

4. CONSENT 8

5. POLICIES AND PROCEDURES 9

6. RECORD KEEPING 10

6.1 Receipt of Medicines 10 - 12

6.2 Administration of Medicines 12

6.3 Self-administration by Service User (Self Administration) 12

6.4 Administration by Staff 13

6.5 Medication Administration Records (MAR sheets) 14

6.6 Disposal of Medicines 14

6.7 Pharmacy Record 15

7. MEDICINES SUPPLY 16

7.1 Presentation of Medicines 17

7.2 Labelling of Medicines 17 - 18

7.3 NHS Prescriptions 18 - 19

7.4 Bulk Prescribing 19

7.5 Monitored Dosage Systems 19

6 Compliance Devices 19

7.7 Verbal Orders 20

7.8 Facsimile Transmission of Prescriptions 20

7.9 Purchase of Non-Prescription Medicines 20 - 21

8. STORAGE OF MEDICINES

8.1 Medicine Security 22 - 23

8.2 Cold Storage 23

9. ADMINISTRATION OF MEDICINES

9.1 Service Users taking their own Medication 24 - 25

9.2 Medicine Administration by Care Staff 25 - 26

9.3 Refused Administration 26 - 27

9.4 Procedure for Medicine Administration 27 - 29

9.5 Time of Medication 29

9.6 Use of Monitored Dosage System (MDS) 29

9.7 Administration of Medicines away from the home 30

9.8 Day Care 30

9.9 Day Care Services outside the Home 30

9.10 In House Day Care Services 30 - 31

9.11 Incorrect Administration of Drugs 31 - 32

10. BOOKING OUT OF MEDICINES 33

11. DISPOSAL OF MEDICINES 34

12 OXYGEN

12.1 Storage of oxygen 35

13. CONTROLLED DRUGS 36

13.1 Obtaining Controlled Drugs 36

2 Storage of Controlled Drugs 36

13.3 Administration of Controlled Drugs 36 - 37

13.4 Records of Controlled Drugs 37

13.5 Booking out Controlled Drugs 38

13.6 Disposal of Controlled Drugs 38

13.7 Dealing with Discrepancies 39 - 40

13.8 Temazepam 40

13.9 Oramorph 40

14. MEDICINE INFORMATION AND PHARMACEUTICAL ADVICE

IN CARE HOMES 41

14.1 Hazard Notification and Drug Alerts 41

14.2 Adverse Drug Reaction Reporting 42

15. MEDICINES TRAIL 43

16. TRAINING OF CARE STAFF 44

17. REGULATION OF CARE HOMES 45

18. INVESTIGATION PROCEDURE 46

19. APPENDICES 47 - 63

20. GLOSSARY 64 - 65

21. BIBLIOGRAPHY 66


SECTION 1

INTRODUCTION

1.1 CURRENT LEGISLATION 1.2 PRACTICE STATEMENT 1.3 GENERAL PRINCIPLES

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1. INTRODUCTION The Management of Medication is one of the most important responsibilities staff will perform. This document sets out the procedures which LCC expects will be followed to ensure the safe handling of medicines within the Council’s Care Homes for Older People. All staff have a duty of care within our establishments that requires medication to be handled safely so that people who are cared for in our homes are supported to take their medicines safely.

1.1 Current Legislation The Care Standards Act 2000 provided the setting up of the following body: The Commission for Social Care Inspection (CSCI). The regulatory body is accountable to the Secretary of State for Health in England. The following is a list of legislation that has a direct impact upon the handling of medication within a registered care home. The Medicines Act 1968 The Misuse of Drugs Act 1971 The Misuse of Drugs (safe custody) Regulations 1973 SI 1973 No 798 as amended by the Misuse of Drugs Regulations 2001 The Health and Social Care Act 2001

1.2 Practice Statement The majority of Service Users will take responsibility for administering their own medication. This procedure is designed to cover situations where Service Users are unable to take responsibility for administrating their own medication and require assistance. This procedure has been developed to meet all the requirements of the National Minimum Standards for Residential, Respite and Day Care. It aims to provide guidance to staff on the safe handling of medication.

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Medication must not be administered without the consent of the Service User according to their needs as assessed by the appropriate assessment team. Written agreement must be obtained from the Service User or another person authorised to act on behalf of the Service User before staff administer medication to a Service User. The Principles and Aims are:

• To maintain dignity and independence

• To allow choice where possible

• To ensure accessibility of service

• To ensure no discrimination and that all services reflect agreed values

• To ensure continuous and comprehensive service to maintain people in their own homes

• To be responsive to the needs of the community

• To provide service in a cost effective way

1.3 General Principles All medicines are potentially harmful if not used correctly, and care must be taken in their storage, administration, control and safe disposal. The Service User or their representative must give consent in writing before staff may assist with the administration of medicines. It is the responsibility of the assessor to obtain consent where it is considered that the Service User will require assistance with their medicines. Consent will be noted on the Service User’s care plan. Where the Service User has responsibility for their own medicines, and the staff are concerned about the Service User’s ability to continue to manage their own treatment, the staff should request another assessment from the appropriate assessor. Appropriately qualified staff who have the necessary knowledge and skills must carry out any invasive clinical procedure, i.e. District Nurses etc.

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Services Users have the right to expect that any assistance offered be carried out in a professional manner by properly trained and competent staff. The following documents give guidance to staff so as to ensure that any assistance given with medication is carried out in a professional manner, within the knowledge and competence of staff, and meets the aims of the service. It is essential that staff observe the guidelines set out in this document. The Council would wish to assure staff that providing they do follow the guidance given, any legal claim made against staff acting in the course of their duties would be referred to the Council’s insurers for consideration under the appropriate policy insurance, and the employee will receive the full support of the authority.


SECTION 2

THE ROLE OF THE PHARMACIST

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2. THE ROLE OF THE PHARMACIST Pharmacists are responsible for the supply of medicines and appliances prescribed by a Doctor, Dentist or non-medical prescriber. Please see Appendix 6 for your local arrangements. Pharmacists provide advice to patients and carers on the proper use, storage and disposal of medicines. Service Users may be using medicine and appliances supplied by a hospital pharmacy, emergency medical service, or dispensing doctor. Pharmacists keep computerised records of the medication that their regular Service Users receive on prescription. These records provide useful information and can indicate potential drug interactions. Pharmacists will advise on the use of alternative containers/auxiliary aids for medicines. Monitored Dosage Systems may enable a Service User to retain responsibility for their own medication, requiring staff only to remind them to take their medication. Monitored Dosage systems are not available free on the NHS. Staff should support the Service User if they consider that they may benefit from a Monitored Dose System or other compliance aid. Under the Disability Discrimination Act (DDA) pharmacists are required to make “reasonable adjustments” to their services to enable disabled people to access them. With regard to the supply of medicines this means that if a person falls within the scope of the Act they may need extra help to take their medicines- such as non-child-resistant-container tops, large print labels and Medicine Administration Record (MAR) charts. The provision of monitored dosage systems within the DDA is still in debate and at this time it cannot be assumed that the provision of such auxiliary aids are classed as “reasonable adjustments” and will be made by pharmacists free of charge. It is important that the needs of the client are addressed and the most suitable reasonable adjustment to meet these needs are made.

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Doctors and Dentists may issue private as well as NHS prescriptions. Currently the term “non-medical prescriber” includes other groups of professional staff such as certain nurses, and pharmacists. This group is likely to expand. Unit Managers should find it useful to introduce themselves to local Pharmacists. Pharmacists offer advice on many aspects of the use of medicines. However some services offered by pharmacists e.g. collection of prescriptions from GP surgeries and delivery of dispensed medicines, are not funded under the NHS and are thus undertaken on a goodwill basis.


SECTION 3

ASSESSMENT OF NEED

3.1 RISK ASSESSMENTS AND MANAGEMENT

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3. ASSESSMENT OF NEED This is a key to the whole process to identify what, if any, assistance is required. It will also highlight Service Users whose medications needs are beyond the knowledge and competence of staff. When making the assessment, particular care should be taken if one or more of the following high risk factors apply:

• Health would deteriorate rapidly without medication

• Language difficulties

• Long term conditions e.g. diabetes, epilepsy

• Service Users who have memory impairment

• Service Users who have impaired vision

• Any other presenting factor Appropriate fieldwork staff will be able to carry out this assessment in conjunction with the individual, their carers where appropriate, and the guidance of this procedure. Advice and assistance on the individual assessment can be obtained from Pharmacists, District Nurses, GPs and Health and Safety Officers where required. The result of the assessment will be one of the following:

• Ability to self medicate without assistance

• Ability to self medicate with prompts or with the use of administration aids

• Full assistance required

• Complex clinical/invasive procedures required The results of the assessment must be recorded and made available to all staff that will be involved in the care of the Service User. The assessment will need to be reviewed to take into account any changes in the medication needs of the individual.

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Details of sources of advice must be recorded on the Carer’s Medication Notes on the Service Users MAR sheet. The sources to be identified are as follows:

• Pharmacist

• Doctor/Nurse

• Family/Next of Kin

3.1 Risk Assessments and Management There is a wide range of risks inherent in everyday life, and older people present as an especially vulnerable group. The process of self-administering medicines may identify risks that may cause potential harm. This should be balanced against the benefits and the likelihood of their occurrence and in a stated time scale. It is important to address potential benefits to help maintain the Service User’s independence. Central to this approach is an attempt to reach an acceptable balance between the right of the Service User for protection from harm and his/her need to develop, exercise choice and empowerment.

• Staff should always place the Service User and his/her best interests at the centre of all decisions.

• Risk Assessment and Risk Management are part of a continuous process.

• It is the duty of staff, once the risk has been identified, that they attempt to reduce the likelihood of the event occurring.

The key components for the associated risks of medicines for Service Users and staff are:

1. Identify the need for a Risk Assessment 2. Planning and Assessing Risk 3. Risk management 4. Risk Decision 5. Monitoring and Reviewing


SECTION 4

CONSENT

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4. CONSENT It is the responsibility of the assessor to determine if help is required with medication and to obtain consent from the Service User. Written consent for the administration of the medication must be obtained from the Service User before staff may assist with the administration of medicines, (Appendix 1). Details of consent must be kept on the Service User’s file and consent must be reviewed at every admission. Where consent cannot be obtained from the Service User due to incapacity, a judgement will be taken by the assessor about the potential risk, and the individual’s ability to consent. Where a Service User is unable to give consent because of the nature of their condition, consent should be obtained from an authorised person acting on behalf of the Service User, i.e. guardian, power of attorney etc. Where consent is refused, staff must not administer medication. Where the assessor considers refusal to consent to assistance with medication will place the Service User at risk, the refusal should be reported to the Service User’s doctor or other member of the GP practice team. Where it is felt that refusal of consent by a Service User is not made of their own free will, it may be appropriate to refer to the Protection of Vulnerable Adults Policy and guidelines. The Unit Manager must then take appropriate action in such circumstances. Staff should make the Unit manager aware in the event of a Service User who has previously given consent, refusing to take prescribed medication.


SECTION 5

POLICIES AND PROCEDURES

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5. POLICIES AND PROCEDURES There is a requirement for each care home to provide policies and procedures. These policies are to promote the safety, independence and well being of the Service User and also the safe practices of all staff. The ethos of the homes, which should be reflected within the policy, is how best to support the Service Users in the safe administration of medicines. All staff should be made aware of the policies during supervision and all staff should be working with them at all times. The Unit Manager may appoint another member of the staff team to be the designated person/s to look after the medicines when a Service User is unable to manage their own medication. Designated persons and members of staff involved with medicines should be appropriately trained and deemed as competent persons by the Unit Manager to undertake this role (Appendix 14). The doctor and Pharmacist should know, and be known by, the Unit Manager and the designated person/s. They should also have a good awareness of our policies and procedure.


SECTION 6

RECORD KEEPING

6.1 RECEIPT OF MEDICINES 6.2 ADMINISRATION OF MEDICINES 6.3 SELF-ADMINISTRATION BY

SERVICE USER 6.4 ADMINISTRATION BY STAFF 6.5 MEDICATION ADMINISTRATION SHEETS (MAR SHEETS) 6.6 DISPOSAL OF MEDICINES 6.7 PHARMACY RECORD

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6. RECORD KEEPING The Registered Manager will have overall responsibility for the Care Home. There is a statutory requirement for recording all medicines in the home. The Registered Manager must be responsible for ensuring the appropriate maintenance of records and the manner in which records will be kept. The standard of record keeping should ensure that records are properly completed, legible and current, providing a complete audit trail of medication. All medication records should be referenced back to the original prescription and not the previous MAR sheet. Each home must retain an up to date reference of current medication prescribed for each Service User. All records should be made in black ink.

6.1 Receipt of Medicines All medicines brought into the home from whatever source must be recorded. This includes discharge from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular on going basis or those brought from another home. Care should be taken to include medicines brought from the Service User’s own home or those brought in by friends/relatives. At any given time the home must be able to identify the medicines prescribed for each individual Service User. On admission, written confirmation of the medicine a Service User is taking should be obtained from an authoritative source such as the Service User’s own GP or from hospital. The home should record requests for prescriptions on behalf of a Service User. This ensures that all items ordered have been received and that no inadvertent changes to medication have been made.

� The dispensing Pharmacist may deliver the medicines. If so the date delivered, medication delivered, scripts collected, deliverer’s signature and signature of the staff receiving it must be recorded, (Appendix 3).

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• On arrival ensure Service User’s medication is handed to the designated person on shift. If this is not possible then medicines should be stored securely until that staff member is ready to book them in.

• Confirm identity of Service User and ensure that the medication is for that individual.

• A senior member of staff plus one staff member books the medication in.

• Medication must be in its original container with instructions.

• Expiry dates must be checked, especially eye drops which have a life span of 28 days from being opened. If there is no date, then it must be assumed that the life span has elapsed and the medication must be disposed of. Ensure there is a replacement if appropriate.

• Medication containers must have clear instructions. If the label states “as directed” it must be referred back immediately following receipt to the prescriber and dispenser so that this can be changed.

• Some medicines have different names, generic and brand. If there are any concerns about medical names the dispensing pharmacy should be contacted. The MAR chart should reflect the name on the medication container.

• If there is no patient name on containers of medication do not use. Medication must be returned to the pharmacy/surgery and then re-ordered if this occurs.

Records must show:

• Date of receipt

• Name, strength and dosage of medication

• Route of taking

• Quantity received

• Service User for whom the medication is prescribed or purchased

• Signature of staff members receiving the medicines

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• All prescribed medication to be recorded on a MAR sheet. A separate MAR sheet for each individual Service User.

• Check times of dosage and record clearly. Record the number of dose units to be given, e.g. ‘one tablet or ‘two tablets’. If the medication is liquid state, the amount to be given in a single dose, e.g. ‘5ml’ or ‘10ml’ as stated on the pharmacy label.

• Information must follow a regular pattern. Times of the day must appear in the correct position within the 24-hour window. Any other information appropriate to the medicines being administered can be written by hand on the MAR sheet ideally being checked by the dispensing pharmacy i.e. patch removal.

• The two members of staff booking the medication in must both sign the MAR sheet.

• Controlled drugs need to be recorded on the MAR sheet and also recorded in the Controlled Drugs Book.

• If the Service User has any allergies, this is to be documented on the MAR sheet.

6.2 Administration of Medicines Each home should hold a current record of the name, role, initials and signature of those staff that have been suitably trained and deemed competent to carry out the safe administration of medicines, (Appendix 3).

6.3 Administration by Service User (Self-administration) Self-Administration by Service Users must be recorded clearly on their care plan by endorsing the words “self-administered”. The Service User or their representative should read and sign, (Appendix 2). A self-administering Service User does not need to record on a MAR sheet.

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6.4 Administration by Staff If a Service User requires support with the administration of their medication, then they or their representative must read and sign Appendix 1. This then confirms that the Service User authorises staff to administer their prescribed medication. The MAR sheet is the working document which is signed to record administrations of medicines. The MAR sheet includes all prescribed medicines. It may also be used to record other medicines administered e.g. non-prescription medicines. The signature of the person administering the medication must be linked to a specific medicine. This is to facilitate audits at a later date and to ensure that the records are clear. Although it is not part of a GP’s contract to sign the MAR sheet, it would be considered an element of good practice, particularly for changes to doses or discontinuation of medicines. In the case of hand-written MAR sheets not signed by the GP, a second member of staff should sign these and refer back to the original prescription. There is no legal barrier to our care home constructing a hand written MAR sheet but there is the potential for error when charts are regularly re-written by staff. It is good practice to obtain printed MAR charts from the dispensing pharmacy. DO NOT COPY INFORMATION FROM MAR SHEET. INFORMATION MUST ONLY BE TAKEN FROM THE LABELLED BOXES OF MEDICATION. The record of medicines taken, including homely remedies, should always be made available to the GP when he/she visits the individual Service User. It is a legal requirement for care home records to be retained within the home even when the Service User has left. It is recommended that these records be retained for a period of 3 years from the date of the last entry, and should be retrievable if needed.

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6.5 Printed Medicine Administration Record (MAR) Sheets

The Community Pharmacist may supply the home with printed MAR sheets; this can be negotiated with them. Pharmacists have a duty to ensure that the information on the MAR sheet they produce is correct. Staff should always make sure that the printed information is correct. Refer back to the Pharmacist if there is an error. If the community Pharmacist does not supply the home with printed MAR sheets, then information should be recorded on MAR sheet (Appendix 5).

6.6 Disposal of Medicines To provide a full audit trail of medicines, a record is required to identify the disposal from the home of a Service User’s medicines. This information should be recorded on the record of Disposal of Medicines/Drugs book. This record must include the following:

• Date of disposal/return to pharmacy

• Quantity removed

• Name and strength of medicine

• Method of disposal

• Service User for whom the medication was prescribed or purchased and their signature to agree the disposal.

• Signature of the member of staff who arranges disposal of the medicines.

• Signature of witness.

• Signature of disposal agency

• Controlled drugs to be clearly marked “CD” in red ink. This record is also necessary when medication is transferred to another care provider, including an NHS hospital.

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6.7 Pharmacy Record The dispensing Pharmacist may keep Patient Medication Records (PMR’s) for Service Users on long-term medication. The records are not a duplication of the Service User’s medical records but contain items dispensed from the pharmacy and, in some instances, medicines purchased by the Service User.


SECTION 7

MEDICINES SUPPLY

7.1 PRESENTATION OF MEDICINES 7.2 LABELLING OF MEDICINES 7.3 NHS PRESCRIPTIONS 7.4 BULK PRESCRIBING 7.5 MONITORED DOSAGE SYSTEMS 7.6 COMPLIANCE DEVICES 7.7 VERBAL ORDERS 7.8 FACSIMILE TRANSMISSION OF PRESCRIPTIONS 7.9 PURCHASE OF NON-

PRESCRIPTION MEDICINES

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7. MEDICINES SUPPLY Medicines supplied for individual Service Users are the property of the named Service User. The Medicines Act clearly defines that medicines must only be administered to the person for whom they have been prescribed, labelled and supplied. It therefore follows that prescribed medicines obtained in this manner may not at any time be used for other Service Users as though they were ‘stock’ held by the care home. Each Unit must devise a set of procedures that show the process of ordering, collection and delivery of medicines for their local area (Appendix 6). The principle of named patient dispensed medicines being the property of the named Service User should be applied to dressings, surgical sundries, nutritional supplements etc. in that they should only be used for the Service User for whom they are supplied. At all times, medication must be kept in original containers in which they were dispensed. Pharmaceutical preparations must not be decanted from one container to another for the purposes of storage. This applies to medications that remain from the current supply when the new supply is received; the original supply should be finished first. Each Care Home must take precautions that stock levels of medication for each Service User are kept at an appropriate level dependent upon need. It is accepted by the Royal Pharmaceutical Society of Great Britain that Service Users in Care Homes may have to accept a certain restriction of freedom of choice as to where their prescriptions are dispensed. The Unit Manager should select one pharmacy where the home obtains medicines on behalf of its Long Term Service Users in order to ensure a timely and responsive service and continuity of care.

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7.1 Presentation of Medicines Under the Royal Pharmaceutical Society of Great Britain Code of Ethics, Pharmacists must supply all oral solid dose medicines in child resistant packaging. This also applies to all dispensed liquid medicines. Under this code, all solid dose preparations must be dispensed in either a re-closable child resistant container or in unit packaging of strip or blister type, unless:

• The type of original pack is such as to make this inadvisable

• The Service User is likely to experience difficulty in opening a child resistant container- reference section 2 Role of the Pharmacist-DDA.

• A specific request by the Service User or the staff is made for the product not to be dispensed in a child resistant container

Where the medicines for a Service User differ unexpectedly from those received for the same Service User in the past, the home should check with the Pharmacist or dispensing doctor before administering medicine.

7.2 Labelling of Medicines For a care home member of staff to administer a medicine it must have a printed label containing the following information:

• Service Users name

• Date of dispensing

• Name and strength of medicine

• Dose and frequency of medicine In the case of multiple containers, each container should be labelled. For medications which have an inner container and an outer box (e.g. eye drop bottles, cream and ointment tubes) the label should be applied to the item instead of, or as well as, the outer container. This may be discussed with your local pharmacy. In the case of monitored dosage systems, a new label should be affixed to each supply.

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If the label becomes detached from a container, or is unreadable, the prompt advice of the person who made the supply must be sought. Until then, the original container should not be used. Cautionary and advisory labels for dispensed medicines provide additional information to Service Users and staff, which can improve understanding and compliance. A guide to these labels is published in the British National Formulary (BNF). Pharmacists should include this information on labels of dispensed medicines, where appropriate. Staff must never alter labels on dispensed medicines. A patient information leaflet (PIL) must be supplied with each medicine (including those supplied in monitored dosage systems) and these should be made available to the Service User.

7.3 NHS Prescriptions Medicines are individually prescribed for each Service User and are the property of the Service User. Staff should ask the prescriber to write full and precise instructions on the prescription. Prescribers should avoid the use of instructions such as ‘as before’ or ‘as directed’. It is important that the written prescription includes the dose and frequency of administration to ensure that the correct treatment is administered and to reduce the risk of errors. When the route is other than oral, it is important for the route to be clearly stated. The indication for use of an ‘as required’ medication should be presented clearly and include the dose, frequency and dosage interval, including the maximum daily dose. The medication of each permanent Service User should be reviewed every six months. Service Users needs are continually changing and these should be taken into account at the time of the review. (Reference National Service Framework (NSF) for older people, England). It is recommended that the home keeps a record of prescriptions issued and dispensed for each Service User e.g. photocopies, fax sheet.

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7.4 Bulk Prescribing From April 2005 bulk prescribing is no longer allowed. Hence all medicines must be prescribed on an individual basis on a prescription for a named patient.

7.5 Monitored Dosage Systems (MDS) Where the Unit takes responsibility for the administration of medicines to Service Users, at the outset the Unit should decide whether there is a need to use a MDS for the administration of medicines to its permanent Service Users. In order to make this decision the community Pharmacist, in conjunction with the designated person within the home should assess the overall needs of the care home and its Service Users. Issues to be taken into account are:

• Working relationship with the surgery

• Wastage of medicines within the home

• Competency and training of staff to administer medicines from normal containers

These systems are only suitable for some medicines. There are several types of these systems available and the Pharmacist should assess the needs of the Service User and Unit before supplying medicines in such systems.

7.6 Compliance Devices Compliance devices are designed to promote the safe self-administration of medicines by Service Users.

• A compliance aid cannot be accepted into the Care Home unless it has been filled and labelled by a Pharmacist/dispensing practice. This is when the Service User has support from staff.

• Medicines should then be entered by writing on the MAR sheet and recorded appropriately.

• PRN medication should not be used with compliance aids as this could lead to wastage.

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7.7 Verbal Orders Due to legal restrictions, the home cannot action a verbal instruction to initiate treatments with a Prescription Only Medicine. Written confirmation of the change should be requested by fax.

7.8 Facsimile Transmission of Prescriptions A fax of a prescription does not fall within the definition of a legally valid prescription. A fax can however confirm that, at the time of receipt, a valid prescription exists.

7.9 Purchase of Non-Prescribed Medicines Non-prescription medicine is another name for homely or household remedies, which refer to medicines available over the counter. If a Service User is able to choose and wishes to buy their own remedies for minor ailments, they should be supported in the decision and encouraged to speak to a Pharmacist. The use of complementary /alternative treatment should only be undertaken with the express agreement of the Service User or person who is authorised to speak on the Service User’s behalf. Advice must always be sought from the Pharmacist about any potential interactions between the non-prescribed medicine and the Service User’s regular medication. There is a recognised duty of care by staff to be able to make an appropriate response to symptoms of a minor nature, e.g. toothache. The Service User may not be able to fully participate in the decision. This decision may be taken by staff without the express consent of the Service User and without necessarily consulting with the Service User’s GP.

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Although the opportunity exists for a Registered Manager to purchase a wide range of medicines for use in the home as homely remedies, this must be subject to careful control. An agreed list should be compiled in conjunction with the Service User’s GP, the Pharmacist and the home. Care should be taken to check whether the medicine would interact with the Service User’s regular medication, (Appendix 8). The locally agreed list of homely remedies should only include those that can be bought over the counter from a community pharmacy, preferably from the one usually used by the home to obtain pharmaceutical advice.


SECTION 8

STORAGE OF MEDICINES

8.1 MEDICINE SECURITY 8.2 COLD STORAGE

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8. STORAGE OF MEDICINES

8.1 Medicine Security

• All medicines must at all times be kept secure wherever stored.

• Service Users responsible for their own medicines should be provided with a personal lockable drawer or cupboard. Staff should have access to such a drawer or cupboard, with the permission of the Service User.

• Using the cupboard for non-clinical purposes, for example housing electrical equipment, should not compromise the security of the medicines.

• The positioning of medicine cupboards should be determined by considering easy access of the medicines when needed and maximum security.

• The designated place must be maintained at a temperature appropriate for medicine storage.

• There must be sufficient room to store nutritional supplements, prescribed dressings and ostomy products if the Service Users in the Unit need these types of products. Care must be taken to ensure that medicinal items are stored off the floor at all times.

• If the decision is to use a medicines trolley, its construction should be of a suitable material and of a size appropriate to the home. It must be fit for purpose and keep the medicines of each Service User separate.

• The trolley must have sufficient capacity for all medicines to be locked away in an emergency during the medicines administration round.

• If a mobile trolley is used to store medicines, it must be locked and fixed to the wall when not used for medicines administration or secured in the locked designated place.

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• The keys for the medicine area or cupboard should not be part of the master system for the home. Key security is integral to security of the medicines; therefore access should be restricted to authorised members of staff only.

• Monitored Dosage Systems will need special consideration with regard to storage. Adequate lockable storage must be provided at all times.

• Subject to Home Office direction, the storage of Controlled Drugs where administration is undertaken by staff should be accordance with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended.

• If Controlled Drugs are incorporated into a Monitored Dosage System then the whole box is subject to Misuse of Drugs (Safe Custody) Regulations.

• Guidance should be sought from the supplier of medicines.

• A COSHH Regulations risk assessment should be undertaken of those medicines that must be “handled”. The purpose of such assessments is to provide staff with an understandable statement of personal risk, safe practice to be followed to minimise personal risk, and what to do should staff come into direct contact with the product.

8.2 Cold Storage

• A separate, secure and dedicated refrigerator should be available in the home to be used exclusively for the storage of medicines requiring cold storage.

• The temperature of the medicines refrigerator should be monitored daily when in use, using a maximum/minimum thermometer and recorded.

• Staff should have a clear understanding of the action to be taken if the temperature is outside the normal range.

• The normal range is usually between 2 and 8 degrees centigrade but the patient information leaflet and product should be checked for confirmation.

• The refrigerator should be cleaned and defrosted monthly.


SECTION 9

ADMINISTRATION OF MEDICINES

9.1 SERVICE USERS TAKING THEIR OWN

MEDICATION 9.2 MEDICINE ADMINISTRATION BY CARE

STAFF 9.3 REFUSED ADMINISTRATION 9.4 PROCEDURE FOR MEDICINE

ADMINISTRATION 9.5 TIME OF MEDICATION 9.6 USE OF MONITORED DOSAGE SYSTEM

(MDS) 9.7 ADMINISTRATION OF MEDICINES

AWAY FROM THE HOME 9.8 DAY CARE 9.9 DAY CARE SERVICES OUTSIDE THE

HOME 9.10 IN HOUSE DAY CARE SERVICES 9.11 INCORRECT ADMINISTRATION OF

DRUGS

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9. ADMINISTRATION OF MEDICINES

9.1 Service Users Taking Their Own Medication The National Minimum Standards for Older People place great emphasis on the right of a Service User to take responsibility for his/her medication where possible. This will preserve independence and prepare those in short term care for their return to the community, where they will need to look after their own medicines. It is important to recognise that the prescribed medicines are the property of the Service User for whom they are prescribed and staff should not assume that these can automatically be removed from the Service User. It is the senior staff’s responsibility to carry out a risk assessment of each situation. There are situations when a Service User is able to take complete control of his/her medicines. Self-administration of medicines is not an ‘all or nothing’ scenario. If the Service User has the capacity to collect their own prescription and take it to the pharmacy for dispensing, they have the right to choose where the prescription is dispensed. If a Service User cannot present their own prescription at the pharmacy because of a disability this does not mean that they will be incapable of exercising control over their medicines. A Service User can exercise control over his/her medicines provided that the staff can assist the Service User in taking them for example:

• A Service User who has suffered a stroke and is unable to manipulate containers may choose to retain custody of medicines and ask staff to assist at the time he/she chooses to take the medication.

• A Service User may be able to safely manage the application of external creams but may elect to have staff administer tablets and other prescribed medicine.

• A Service User with limited understanding and awareness may be given prescribed medicines for 24 hours in a compliance aid.

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• The responsibility of the staff for each Service User should be clearly defined in the Service User’s care plan and risk assessment.

The Service User’s appropriateness to self-administer their medicines should be subject to a risk assessment. It is the responsibility of the staff to ensure that the Service User understands that medicines must be locked away and to ensure that this happens.

If homely remedies are to be used by a Service User, because of the risks of interactions between prescribed medicines and those purchased over the counter (including herbal and homeopathic remedies) a Service User or relative who purchases medicines for self-medication should be encouraged to inform the staff that the Service User is taking a particular remedy. It is the responsibility of the senior staff to confirm the administration of the over the counter medicines are appropriate to be taken alongside prescribed medicines for a Service User. This can be done by contacting the Community Pharmacist/GP.

The home only needs to keep a record when they have an involvement in obtaining the medicines on behalf of the Service User.

There may be differing levels of monitoring that are required of the staff in respect of the Service User. This would be part of the on going risk assessment. However, it may be considered an invasion of privacy for staff to check at each administration time that the medicine has been taken.

9.2 Medicine Administration by Appropriately Trained Staff

Medicines that have been prescribed and dispensed for one Service User must not, under any circumstances, be given to another Service User or used for a purpose that is different from that which they were prescribed for.

The Medicines Act defines that medicines may be administered by a third party to the person that they were intended for when this is strictly in accordance with the directions that the prescriber has determined. Therefore, medicines should be administered strictly in accordance with the prescriber’s instruction; they should not be given for any other purpose or to any other Service User.

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Medicine administration may only be undertaken by staff that are trained to do so.

9.3 Refused Administration

• It is an individual’s right to refuse medicines.

• Staff should record the reason for refusal of the dose on the MAR sheet so that this can be appropriately discussed with the GP and/or the Pharmacist.

• When a Service User is considered incapable of giving consent to treatment, or where the wishes of a mentally impaired Service User appear contrary to the interests of the person, the GP responsible for treatment should be consulted. The GP should then contact relatives/carers and other members of the multi-disciplinary team on any action to be taken, and should respect any previous instructions given by the Service User.

• Refer to Service User’s GP if Service User refuses to take medication. A risk assessment and guidelines should be implemented for an individual in this situation.

� A risk assessment may be necessary to identify risks to the

individual and how to implement a risk reduction strategy.

• Under the Regulation of Care (Scotland) Act 2001 details of any instance in which medication is administered to a Service User without the consent of the Service User or a person duly authorised to consent on their behalf must be notified to the Commission for Social Care Inspection.

SPECIALIST AND INVASIVE TECHNIQUES SUCH AS:

Sub-cutaneous injection of insulin. Medicines administered by the rectal or vaginal route.

Giving oxygen. Giving medicines through a Percutaneous Endoscopic

Gastrostomy (PEG) tube. Administration via a syringe driver

MUST NOT BE ADMINISTERED BY STAFF

27

• To help the Service User take their medication, alternative formulations of the medicine that may be more acceptable, should be considered e.g. liquid preparation.

• A medicine should only be crushed when it has been shown not to alter the pharmaceutical properties of the medicine. Refer to the local pharmacist for advice.

• Any decision must be reached after assessing the care needs of the individual Service User and the decision recorded in the care plan for the Service User, with a date for reviewing the decision.

9.4 Procedure for Medicine Administration Medication should never be removed from the original container in which a pharmacist or dispensing doctor supplied it until the time of administration. The best way to administer medicines to a Service User is directly from the dispensed container; medication can be placed in a small pot after removing it from the dispensed container as a way of hygienically handing it to the Service User. Medication should never be secondary dispensed for someone else to administer to the Service User at a later time or date. Administration of medicines may occur by the Service User coming into the clinic room, by accessing the medicines from a cabinet in the Service User’s room or by the medicine being transported to the Service User around the home. When medicines are transported around the home, it must be done so in a secure manner, but whichever method of transporting the medicines in the home setting is used, care must be taken that they can be quickly and securely locked away in the event of an emergency. Staff administering medicines should always:

• Check Appendix 1 has been sign accordingly.

• Check the identity of the Service User.

• Have an agreement made with regards to consent with the Service User having their photograph placed in front of the Service User’s MAR sheet. This should ensure that the right medication is administered to the correct individual.

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• Look at the Service User’s MAR sheet for their name and dosage instructions. Note any recent changes. Follow times and dosage. Be aware of specific instructions e.g. before food.

• Identify the appropriate original medicine container(s) checking that the label(s) match the record.

• Place the required dose(s) in a suitable container, e.g. medicine cup.

• Staff must only take medication to one Service User at a time.

• Administer the dose(s). Ensure with dignity and respect that the medication has been given, especially when giving eye drops, or supporting with inhalers. The administration of these may not be suitable to be administered at meal times i.e. when the Service User is sat at the dining room table.

• When there is a Service User choice of dosage e.g. 1-2 tablets, the number of tablets administered is recorded. It is vital that it is clear on the MAR sheet how many tablets can be given within a 24-hour period and that this is not exceeded.

• Do not leave the medication unattended if the Service User is not ready to have it. Medication should never be secondary dispensed for someone else to administer to the Service User at a later time or date.

• If the medication is not administered, staff must record the reasons why; this should be recorded on the carer’s Medication Notes on the back of the MAR sheet (Appendix 5a).

• Use a suitable code to indicate when a medicine is not taken, e.g. ‘A’ refused, ‘B’ nausea or vomiting, ‘C’ hospitalised, ‘D’ social leave, ‘E’ refused and disposed of and ‘F’ other. Record further information on Carer’s Medication Notes on the back of MAR sheet.

• On administration of the medication the member of staff must initial the MAR sheet, paying particular attention to signing it

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in the correct place and that the date of administration is correct. Every dose administered to a Service User by staff must be individually recorded at the time it is given.

• The signature/initials of the staff member administering the medication must be linked to a specific medicine.

• During the medication round, if you have to leave the trolley unattended make sure that it is secure and locked.

The home must retain a list of staff members authorised to give medicines, which includes a record of their approved initials, (Appendix 3). It is recommended that a MAR sheet be used to record information about the date that a supply of medicines was given to a self-administrating Service User. It is not necessary that the Service User sign the MAR sheet.

9.5 Time of Medication Most homes will identify specific times of day when the medicine ‘round’ will be undertaken and this may follow the pattern of meal times. However, the time of administration must be carefully considered and respond to Service User’s needs. This should allow for special provisions such as when medicines are required in advance of food and medicines with specific dosage regimes. The administration of products such as eye drops, and inhalers may not be suitable at mealtimes. It is essential that the Service User’s right to privacy be carefully considered.

9.6 Use of Monitored Dosage Systems (MDS)

Medicines may be provided in original containers or one of the recognised monitored dosage systems. These systems can only be used for some solid oral dose medicines. It is important to remember that medicines provided in other dosage forms (e.g. liquids) must be supplied in traditional containers. Therefore, by necessity, the home that utilises MDS will be using two differing systems of medicine administration: MDS and traditional containers.

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9.7 Administration of Medicines away from the home

Normally the Service User will be given the dispensed containers of medicines when going on leave e.g. on holiday. However there may be occasions when an additional supply of medicines is organised for that leave. Secondary dispensing of medicines or use of unsuitable containers, such as envelopes is not permitted and must not happen. Appropriate entries on the Service Users MAR sheet should indicate the absence of Service Users and the details of the medicines the Service User has taken out of the home.

9.8 Day Care

The purpose of day services is to provide Service Users with skills to help them maintain their independence. Therefore, Service Users should have the opportunity to take custody of their own medication if they are capable of doing so.

9.9 Day Care Services outside the Home

Steps should be taken by the home to ensure the continuity of supply of medicines to a Service User where the person spends time in two or more places e.g. outside the home in day care or with relatives/friends. Where a Service User goes out of the home regularly (e.g. every lunchtime) and requires medication whilst away from home, the pharmacist and/or GP should be asked to assess the individual’s situation. If it is established that the medicine is taken whilst the Service User is absent from the home, a separate container of medicine should be requested by liaising with the pharmacist/GP as appropriate.

9.10 In House Day Care Services

• Service Users should not be required to surrender their medicines to staff unless it is the Service User’s wish to.

• If it is necessary for staff to take custody of and/or administer medicines then the same guidelines apply as Medicine Administration by appropriately trained staff.

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• Medicines bought in by the Service User must be in their original containers.

• Medicines bought in by a Service User need to be booked in on a daily basis.

• When recording on the MAR sheet, enter the date only when the Service User attends the day centre.

• Out of date medication must be returned to the carer.

9.11 Incorrect Administration of Drugs

• Ensure Service User is observed indirectly for any adverse effects whilst informing their GP.

• If you are unable to contact the community pharmacist or Service User’s doctor ring the on call GP or the NHS help

line for advice: 0845 46 47

• Explain what the error was and record in writing the response and advice on a SS1/4, (Appendix 9).

• Inform Unit Manager and/or Team Leader if a Service User has been over or under dosed.

• Record on the Service User’s MAR sheet on the “Carer’s Medication Notes” (Appendix 5a).

• Record the date, time, your initials, medication, dose, reason, result, time and your initials again.

• Record on the Service User’s contact sheet (Appendix 8) that an error in medication has occurred. Refer to SS1/4 (Appendix 9) for further information about incident.

• Record that “care staff are to sensitively observe, over the next 24 hours, the individual for any side effects”. All staff to record findings.

• Record on the SS1/4 (Appendix 9) any side effects and the advice and guidance from the pharmacist or GP.

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• Record in the daily diary, highlighting with an *, the Service User’s name and ‘see contact sheet and SS1/4’; initial the entry.

• Inform the Service User and/or the person acting on their behalf if an error has occurred.

• If the medication that was given in error was another Service User’s, then this must be recorded on their MAR sheet Carer’s Medication Notes, identifying why there is less medication. Also record on the Service User’s contact sheet SS1/2.

• Ensure during handover that all staff are aware of the incident so that safe monitoring of the Service User takes place.

• Staff to record on PO3 and inform The Commission for Social Care on a Regulation 37 if the above adversely affects the well being of the Service User.


SECTION 10

BOOKING OUT OF MEDICINES

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10. BOOKING OUT OF MEDICINES Appropriate entries on the Service User’s MAR sheet should indicate the discharge of the Service User and the details of the medicines the individual has taken out of the home.

• There should always be two authorised persons booking out the medicines.

• The medicines for booking out should be checked and counted against the Service User’s MAR sheet and checked for quantity left against instructions on label on the medicines original container.

• All medicines being booked out should be recorded on the Service Users MAR sheet and signed and dated by each authorised person.

• The Service User or their representative should sign to say that they have taken the medicines out of the home.

• Medicines for a self-administering Service User do not have to be booked out.


SECTION 11

DISPOSAL OF MEDICINES

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11. DISPOSAL OF MEDICINES The medicines that are held in the home at any given time should be appropriate to the current therapy of the Service Users. Any surplus or unwanted medicines should be disposed of in the appropriate manner. When the Service User leaves the home, the medicines should be returned to the Service User, unless the Service User has positively consented to their safe disposal. Where:

• Medication is discontinued by a GP (It is good practice to get the GP to sign this.)

• The course of treatment is completed

• The medicines have expired

• The Service User dies (following the death of a Service User, the medicines should be retained for seven days, in case the Coroner’s Office or courts require them).

This must be recorded on the ‘carer’s medication notes’ with the reason why the disposal of medication is necessary. If medication is found and cannot be identified, this is to be recorded on The Unidentified Medicines List, (Appendix 10). This information will then be collated and documented on the record of disposal of medicines/drugs book and returned with the medication to be disposed of to the appropriate pharmacy.

This process should ensure that all medication can be tracked in terms of date, time, medication, dose, reason and result.


SECTION 12

OXYGEN

12.1 STORAGE OF OXYGEN

35

12. OXYGEN If a Service User is assessed to need oxygen then the patient’s doctor will arrange with the client/carer for the service to be provided direct to the patient’s home from the supplier for that area.

12.1 Storage of Oxygen Oxygen can be kept in the individual Service User’s room, taking into account relevant safety advice and displaying the appropriate safety notices. (Appendices 11 and 12). In an emergency the Emergency Services should be told about the oxygen and where it is kept. All rooms/areas where oxygen is in use should display the statutory warning notices:

Compressed Gas. Oxygen: No Smoking, No Naked Lights.


SECTION 13

CONTROLLED DRUGS 13.1 OBTAINING CONTROLLED DRUGS 13.2 STORAGE OF CONTROLLED

DRUGS 13.3 ADMINISTRATION OF

CONTROLLED DRUGS 13.4 RECORDS OF CONTROLLED

DRUGS 13.5 BOOKING OUT CONTROLLED

DRUGS 13.6 DISPOSAL OF CONTROLLED

DRUGS 13.7 DEALING WITH DISCREPANCIES 13.8 TEMAZEPAM 13.9 ORAMORPH

36

13. CONTROLLED DRUGS The National Minimum Standards for Older People and Adults (18-65) incorporate additional standards for the storage, administration and recording of controlled drugs. The Misuse of Drugs Act 1971 is the legislation governing Controlled Drugs and the National Minimum Standards recommend that these regulations be followed.

13.1 Obtaining Controlled Drugs

Care homes should only keep controlled drugs prescribed for individual Service Users. Stock controlled drugs are not permitted with in the Unit.

13.2 Storage of Controlled Drugs

Controlled drugs for Service Users must be stored in cupboards meeting the requirements of the Misuse of Drugs (Safe Custody) Regulation 1973 as amended, this specifies the quality, construction, method of fixing and lock and key for the cupboard. The security of the location also needs careful consideration. For safe practice the controlled drug cupboards should only be used for the storage of controlled drugs. Items such as jewellery or money should not be placed here. Only those with authorised access should hold keys to the controlled drug cupboard. When a Service User is self-medicating they can hold their own individually dispensed supply of controlled drugs in their personal lockable cupboard.

13.3 Administration of Controlled Drugs In addition to the procedures relating to the administration and recording of other medicines, the following procedures must be carried out when administering controlled drugs.

• The administration of a Controlled Drug must be witnessed by a second member of staff i.e. senior care worker or care worker. A care worker should only be asked to witness the administration of a Controlled Drug if there is no other senior member of the team available.

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• An entry must also be made in the Home’s Controlled Drugs Register, including:

1. Date and time of Administration 2. Name of Service User 3. Dose Administered 4. Signatures in full of staff member who has

administered the medicines and the witness 5. Remaining balance of stock should be checked on

returning the stock to the cupboard.

• Any medicines prepared and not used, or only partly used, must be appropriately packaged in the presence of a second member of staff and the procedures outlined in section 13.6 must be followed.

• An entry must be made in the Controlled Drugs Register and signed by both authorised staff member and staff witness.

• Any discrepancies must be brought to the notice of the Registered Manager.

13.4 Records of Controlled Drugs

In addition to the records described earlier in this guidance, care homes must keep a separate record of controlled drugs receipt, administration and disposal. These records must be kept in a bound book or register with numbered pages. The bound book will include the balance remaining for each product with a separate record page maintained for each Service User. The balance of controlled drugs must be checked at each administration.

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13.5 Booking out Controlled Drugs Appropriate entries MUST BE RECORDED in the homes controlled drugs register. Records should indicate the date of discharge of the Service User and the details of the medicines the individual has taken out of the home.

• There should always be two authorised persons booking out the medicines.

• The controlled drugs for booking out should be checked and counted against the Service User’s MAR sheet and checked for quantity left against instructions on label on the medicines original container.

• The balance of controlled drugs being booked out must be recorded in the controlled drugs register and signed and dated by each authorised person.

• The Service User or their representative should sign to say that they have taken the medicines out of the home.

• Medicines for a self-administering Service User do not have to be booked out; this includes controlled drugs.

• Any discrepancies must be brought to the notice of the Registered Manager.

13.6 Disposal of Controlled Drugs

• When Controlled Drugs have passed their expiry date, the need for prescription has ceased, or the Service User has died, the Controlled Drugs should be referred to the relevant pharmacist or dispensing doctor at the earliest opportunity for appropriate destruction. Even when still in date, such drugs should not be reused for other Service Users.

• The Unit should record the forms and quantities of Controlled Drugs they are returning, and the pharmacist/dispensing doctor should sign for them on receipt. If pharmacy staff collects the Controlled Drugs they should sign for the receipt of them in the ‘register’ at the time of collection.

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• Relevant details of any such transfer for disposal should be entered into the ‘register’ and signed by the authorised member of staff, returning the drug.

Appropriate records should also show:

1. Date 2. Controlled drug name and strength 3. Number or volume of tablets, liquid or patches 4. Signature of authorised staff member 5. Signature of witness

13.7 Dealing with Discrepancies

• Routine checks of all Controlled Drugs held, and the recorded running balances, should be carried out by two authorised members of staff, each month, and a record kept. (Appendix 13)

• Where a discrepancy is found, it should be reported immediately to the registered manager who must investigate immediately.

• If the discrepancy cannot be resolved the advice of the local pharmacist must be sought, and Commission for Social Care Inspection informed.

• If the discrepancy is found to be an error of subtraction or addition in the calculation of stock balance, the following procedure must be followed:

Do not change the balance column or use correction fluid. Under the last entry, details of the following should be made:

1. The date 2. The error in subtraction/addition (indicated with an asterisk) 3. The correct balance 4. The signature of the member of staff and the witnessing

member of staff Where a dose is given but the administering staff member fails to complete the register at the time of administration, the following procedure must be followed:

40

Under the last entry, details of the following must be made:

1. The current days’ date 2. ‘Dose administered but not recorded at the time’ followed by

the patient details 3. The signature of the administering member of staff and that

of a witness the correct balance If neither of the above discrepancies can be identified, the pharmacist who is providing a service to the home should be contacted to establish whether there were any unrecorded returns of Controlled Drugs. If confirmed by the pharmacist, full details of such returns should be entered into the Controlled ‘register’ together with the signature of the person who returned the drugs and that of the pharmacist who received them. The correct date and the words ‘entered in retrospect’ should be added. If the reason for discrepancy cannot be found, and the Controlled Drugs appear to have gone missing, then all relevant people, including the police, should be notified. 13.8 Temazepam must be stored in the Controlled Drug Cupboard and treated as a controlled drug within our units.

Although it is not a legal requirement to maintain full records through the Controlled Drugs Register, it is a requirement within this procedure that full records are maintained at all times when supporting Service Users with the administration of Temazepam. 13.10 Oramorph must be stored in the Controlled Drug Cupboard and treated as a controlled drug within our units.

Although it is not a legal requirement to maintain full records through the Controlled Drugs Register, it is a requirement within this procedure full records are maintained at all times when supporting Service Users with the administration of Oramorph.


SECTION 14

MEDICINE

INFORMATION AND PHARMACEUTICAL ADVICE IN CARE

HOMES

14.1 HAZARD NOTIFICATION AND DRUG ALERTS

14.2 ADVERSE DRUG REACTION REPORTING

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14. MEDICINE INFORMATION AND PHARMACEUTICAL ADVICE IN CARE HOMES

The provision of advice is important if medicines, dressings and appliances are to be supplied, administered and stored appropriately. The National Minimum Standards for Care Homes for Older People recommend that the Registered Manager should seek advice from a pharmacist. Information that carers and Service Users need about medicines is different. Carers need access to information about the safe handling of medicines whereas the Service User will need more detailed information about the properties and the expected actions and side effects of the medicine. Carers should have access to appropriate information about medicines. Staff should also be encouraged to contact the community pharmacist when additional information is required. In addition, the staff should be encouraged to make use of other appropriate medicines information sources. Care should be taken over the quality of reference sources (especially the Internet). In case of doubt, advice should be sought from a pharmacist.

14.1 Hazard Notification and Drug Alerts In the event of a medicine being recalled, the supplier will be able to provide the home with further information.

• Upon receipt the designated person will take responsibility of the Hazard Notification and/or Drug Alert.

• It must be then brought to attention of all relevant staff.

• Recommended remedial action must be implemented within the time scale specified.

• In some cases no action will be necessary or the bulletin will not apply.

• All senior care staff must sign to say that they have seen the Alert.

If the bulletin does apply then action must be taken.

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The action taken must be recorded and attached to the Alert and signed by the designated person/s. In all cases the Registered Manager will have to confirm “Action to be Taken” by e-mailing the appropriate person. Further information can be obtained through the Department of Health, MHRA Document “Reporting Adverse Incidents and Disseminating Medical Device Alerts”. (January 2005).

14.2 Adverse Drug Reaction Reporting Any adverse drug reaction (ADR) or suspected ADR should be reported to the GP and/or supplying pharmacist for that individual Service User and discussed before further administration of the drug in question.


SECTION 15

MEDICINES TRAIL

43

15. MEDICINES TRAIL The Registered Manager must ensure that there is a complete trail from receipt through to administration and/or disposal of all medicines. It is recommended that Managers audit this process on a regular basis.


SECTION 16

TRAINING OF CARE STAFF

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16. TRAINING OF CARE STAFF Particular care should be taken to ensure that the appropriate staff members are suitably trained in the use of the medication.

• New members of staff should have medication training before they begin to handle and administer medicines, (Appendix 14).

• For existing staff members, a refresher course should be given at least every two years.

• The National Minimum Standards set out requirements for training of care staff in homes for Older People and Adults (18-65). The standards require that such training is accredited and must include basic knowledge of how medicines are used and how to recognise and deal with problems in use.

• It is the responsibility of the Registered Person to access training that meets these basic requirements.

• All staff training should be documented.

• Review and evaluation of the training of care staff is essential.


SECTION 17

REGULATION OF CARE HOMES

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17. REGULATION OF CARE HOMES The Commission for Social Care Inspection incorporates medication handling within the registration and inspection process. The National Minimum Care Standards provide the basis for the inspection process. Pharmacists may be willing to offer an opinion as to how the care home can meet the requirements of registration and inspection. The Commission for Social Care may elect to request a specialist pharmaceutical inspection by one of its pharmacists. A pharmacist inspector is authorised under the Care Standards Act 2000, and the Pharmacy Adviser under the Regulation of Care (Scotland) Act 2001, to have access to any registered service provider and to request records relating to medication handling within that care home. Every place within the home where medicines are stored will normally be inspected regularly by the CSCI. It is recommended that changes in storage arrangements and procedures be discussed with the inspecting officer prior to a change being made.


SECTION 18

INVESTIGATION PROCEDURE

46

18. INVESTIGATION PROCEDURE 18.1 The practice for the Administration of Medication outlined in

this procedure provides safeguards for staff and Service Users to ensure that medication is administered correctly, safely and in compliance with CSCI Standards and the Royal Pharmaceutical Society Recommendations for the Administration and Control of Medicines in Care Homes and Children’s Services.

18.2 As stated in the staff training section of this policy, all staff

will receive training before administering medication. 18.3 The Unit Manager of the Registered Home will, in the first

instance, investigate any diversion or failure to comply with this policy when administering medication. This may lead to implementing the Lincolnshire County Council’s capability or conduct procedure and/or ultimately the Disciplinary procedure.

Examples that will initiate an investigation would include:-

• Administering medication to a Service User that has been prescribed for someone else

• Giving the wrong dosage to a resident or Service User

• Failure to administer medication to a Service User

• Not signing MAR sheets

• Not following correct procedure This list is not exhaustive.


SECTION 19

APPENDICES

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I ……………………………………………………. (Name) will be staying at …………………………………… as a *Permanent/Temporary Service User. This gives the Senior Staff at …………………………………… authorisation to administer the prescribed medication as per my Medication Administration Record. Signed ……………………………………………….. Date ……………………… (Service User)

Signed ……………………………………………….. Date …………………….. (Team Leader/Senior Care Worker)

* Please delete as appropriate

APPENDIX 1

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APPENDIX 2

I ...................................................................................................... (Name) will be staying at ………………………………………. as a Permanent/Temporary Service User. I wish to exercise personal control and custody of my own medication and therefore will not hold Lincolnshire County Council responsible for maladministration of any drugs. I understand that I will be provided with a lockable facility and arrangements will be made for the safe keeping of the keys. I am fully aware that I am responsible for the safe custody of my medication and should not leave it unattended when in use. I understand that I must not give my medication to any other person at the home. I will be responsible for re-ordering my own medication or I will liaise with staff to ensure that arrangements are made for the re-ordering of my medication if necessary (Delete which part does not apply) I will report any missing medication to the Unit Manager immediately. If I purchase home remedies, I will check with the Pharmacist/G.P. that they are compatible with any medication I may be taking and/or liaise with a senior staff member within the Unit. I agree to the above and fully understand the implications. Signed ................................................................... Date .............................. (Service User) Signed ................................................................... Date .............................. (Team Leader/Senior Care Worker)

* Please delete as appropriate

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APPENDIX 3

RECORD OF SIGNATURES OF STAFF SUITABLY TRAINED TO ADMINISTER MEDICATION

Name

(Please print) Signature Date and Details of Training

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APPENDIX 4

RECEIPT OF MEDICATION

Date

Delivered Medication Delivered

Scripts Collected

Deliverer’s Signature

Medication Received Staff Signature

APPENDIX 5 MEDICATION ADMINISTRATION RECORD / OF /

Name

Date of Birth

Address

Room No

Allergies

Doctor Start Date End Date Start Day

Time Week Week

Current Medication

Com Route

G.P. Sign

Date Received Sign on Receipt

Quantity Check sign

Date_______Quantity rec’d______Signatures________Total C/Fwd_____


Returned/Destroyed

Quantity______By_____________

Current Medication

Com Route

G.P. Sign


Quantity Check sign



Returned/Destroyed

Quantity______By_____________

Current Medication

Com Route

G.P. Sign


Quantity Check sign



Returned/Destroyed

Quantity______By_____________

MEDICATION RETURNED ON DISCHARGE DATE_____________________________________

SERVICE USER / CARER SIGN____________________________________________________ Ret/des = Returned/Destroyed; A = Refused; B = nausea or vomiting; C = hospitalised; D = social leave; E = refused &

destroyed; F = other (define) 51

APPENDIX 5a CARERS MEDICATION NOTES

DATE TIME MEDICATION DOSE

REASON INITIALS

52

53

APPENDIX 6

PLEASE INSERT

PROCEDURES FOR ORDERING, COLLECTION AND DELIVERY OF MEDICINES FOR YOUR UNIT

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APPENDIX 7 NON-PRESCRIBED / HOME REMEDIES CHECK LIST

Unit

S.U. Name

G.P.Name

It is recommended that the following remedies are suitable for use, according to the manufacturers instructions

GP Signature

Date

Review Date

Dosage

For dry coughs:

Simple Linctus (Sugar Free)

10 mls 3 times a day

For nasal

congestion:

Karvol capsules

As required

For sore throats:

Lozenges – Strepsils

As required but no more than 8 in 24 hours

For indigestion: Magnesium Trisilicate mixture Aluminium Hydroxide tablets

10 mls 3 times a day 1 or 2 tablets chewed 4 times a day

For pain: Paracetamol tablets 500 mg

No more than 2 tablets in 4 – 6 hours. A maximum of 8 tablets in a 24 hour period. Under no circumstances to be given to service user if already taking prescribed medication containing Paracetamol, e.g. Co-Codamol,

Co-Dydramol

Others – Please state

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APPENDIX 8

Form SS1/2

Sheet No. _____________________________

CLIENT CONTACT SHEET All contacts with, or concerning a Client, to be recorded and signed

Date Details of Contact Signed

Continued overleaf

56

Date Details of Contact Signed

APPENDIX 9

Form SS1/4 (Revised February ’96)

Name Social Worker Tick appropriate box Supplementary information accompanying application for service or Note of interviews, visits, etc. including reviews other than CIC. All entries to be signed

Date Notes

57

Date

Notes

58

THE UNIDENTIFIED M

EDICINES LIST

Date

Tim

e

Initials

Description of Medication

(Cap

su

le, ta

ble

t, c

olo

ur

sh

ap

e, etc

) How

many

Where it was found

Result

Tim

e

Initials

APPENDIX 10

59

60

APPENDIX 11

OXYGEN IN THE HOME

Having a ready supply of oxygen at home will make all the difference in the world to your daily life. But as with many other good things - your domestic gas or electricity, for example - you need to observe a few simple precautions. One of the properties of oxygen is that it makes things burn better.So ...

• DO NOT SMOKE

• DO NOT USE IT NEAR A FIRE OR A NAKED FLAME

• DO NOT HANG CLOTHES OR DUSTERS ON CYLINDERS

• DO NOT STORE CYLINDERS IN THE SAME PLACE AS FLAMMABLE LIQUIDS LIKE PETROL AND PARAFFIN

Another thing about it is that it can combine with other materials in a chemical reaction. This is particularly true of oil and grease in contact with oxygen under pressure. So ...

• DO NOT USE OIL OR GREASE ON THE CYLINDER VALVE OR EQUIPMENT

Oxygen is a life giver provided it is kept under control. So ...

• DO NOT LET A CONCENTRATION OF IT BUILD UP IN A CONFINED SPACE

• MAKE SURE YOU CLOSE CYLINDER VALVES FIRMLY WHEN NOT IN USE

• DO NOT LET CHILDREN OR UNTRAINED PERSONS TAMPER WITH THE EQUIPMENT

If you need any further help or advice, just contact your supplier

LINCOLNSHIRE COUNTY COUNCIL

OXYGEN IN THE ROOM

61

APPENDIX 12

OXYGEN IN THE HOME

(This label to be secured to the cylinder at all times when in use)

Do not – smoke in the vicinity of this equipment Do not – use this equipment near a fire or naked flame Do not – use oil or grease on the cylinder valve or equipment Do not – let children or untrained persons tamper with this equipment Do not – store cylinders in the same place as paint, petrol, paraffin, heating gas cylinders or other flammable materials Do not – hang clothes or dusters on cylinders Do not – let a concentration of oxygen build up in a confined space When the cylinder is not in use:

• Close the cylinder valve fully as above. To remove regulator from cylinder:

• Release the pressure in the system by turning the flow selector on the regulator to the highest flow.

• When the flow stops re-select the OFF position.

• The regulator can then be removed by unscrewing the inlet connector in an anti-clockwise direction.

• It is important that the cylinder valve protector cap be replaced to prevent moisture entering the cylinder.

PLEASE ARRANGE FOR ALL EMPTY CYLINDERS

TO BE RETURNED TO YOUR PHARMACIST

APPENDIX 13

CONTROLLED DRUGS AUDIT

Controlled Drugs Register and Controlled Drugs m

edication to be checked every two weeks by a m

ember of Management. The balance in

stock for any particular service user must be the same as the amount of Controlled Drugs in storage for that person. All service users who

are prescribed Controlled Drugs m

ust be audited.

Date of Audit

Time of Audit

Service

User’s

Name

Drug

Dosage

Balance in Stock

– as recorded in

CD Register

Actual Amount

of Drug in

Storage

Correct

Signed

(Member of

Management

carrying out

audit)

Comments

Yes

No

62

63

APPENDIX 14

MEDICATION COMPETENCE ASSESSMENT

Staff Name

Unit

All criteria must be achieved to constitute competent. Complete the boxes for each criteria

v = Competent/Achieved x = Not yet Competent/Achieved n/a = Not applicable

Knowledge Criteria - determined by verbal questioning

1. Awareness of all medication, including Controlled Drugs

2. Correct timing for giving regular medication (in relation to food)

3. Awareness of the main side effects of each medication

4. Instructions and warnings related to each medication

5. The procedure for non-administration as prescribed

6. The procedure for administration of medication

7. The guidelines for administration of medication taken as required

8. The procedure for administration of non-prescribed medication

9. The procedure for administration of Controlled Drugs

15 Skills Criteria – direct observation of staff administering medication to service users

1. Informs service user that medication is due

2. Washes hands

3. Preparation of appropriate equipment

4. Details on medication chart checked:

a. Name of service user

b. Allergies

c. Name of medication

d. Timing of administration

e. Check appropriate box to ensure absence of signature

5. Details on medication container checked:

a. Name of service user

b. Name of medication

c. Method of administration

d. Strength

e. Dosage

f. Expiry date/date for use of monitored dose cassette

6. Correct quantity of medication is measured

7. Medication is returned to safe storage

8. Name/identity of service user is checked

9. Observes hygiene requirements during administration

10. Checks the service user has taken the medication

11. Medication chart is completed and signed

12. Service user is given appropriate advice with reference to medication

13. Independence is encouraged whenever possible

Outcome: Competent Not yet competent

SIGNATURES

Date Staff Member

Assessor Designation


SECTION 20

GLOSSARY

64

GLOSSARY

Assessor Social Worker, Community Care Office, Social Care Co-ordinator, Nurse Co-ordinator

Audit Trail A system whereby all transactions with regards to medicines can be traced from the act of purchase to the point of use or disposal

Care Home One of the in house Lincolnshire County Council’s Older Persons Units

Carers Medication Notes Used to give further information about medication administration – used in conjunction with the MAR sheet

Community Pharmacy A retail pharmacy i.e. not attached to an NHS hospital

Competent Person Staff who are appropriately trained and are deemed competent by the Registered Manager in the use of medication

Compliance Device These devices help service users with reduced strength and manual dexterity to access their medicine and also provide a visual aid memoir to remind them which medicine to take and when. There are two types of manufactured medicine compliance devices; The Daily Dose Reminder (DDR) and Monitored Dose System (MDS)

Controlled Drugs Controlled Drugs (CDs) are classified in various schedules depending on their usefulness and potential for harm. Each schedule has different requirements in relation to storage, handling and record keeping. The classifications are set out in the current Misuse of Drugs Regulations.

CSCI

Commission for Social Care Inspection are the regulatory body for Lincolnshire County Councils in-house Units.

Designated person Person appointed by the Registered Manager who has the responsibility as the competent person to deal with medication issues.

Field Work Staff Social Worker, Community Care Officer

65

GLOSSARY

MAR Sheet Medication Administration Sheets used for recording of Medicines

Medicine Medicines or groups of medicines as defined in the Medicines Act

Non-Prescribed Medicines Could be described as “homely” or “household” remedies. These can be obtained without a prescription

Pharmacist Person who is qualified to prepare and dispense drugs

Registered Manager Manager of the Unit who has been through CSCI registration process

Registered Person Usually Head of Services for Lincs. County Council

Senior Member of Staff Senior Care Worker, Night Care Worker, Team Leader, Unit Manager

Service User Person using the Service

Staff Senior Care Worker, Night Care Worker, Team Leader, Unit Manager


SECTION 21

BIBLIOGRAPHY

66

Bibliography

Royal Pharmaceutical Society of Great Britain (2005) The Safe and Secure Handling of Medicines Royal Pharmaceutical Society of Great Britain (2003) The Administration and Control of medicines in Care Homes and Children’s Services Care Standards Act 2000 Department of Health National Minimum Standards for Social Care Services MDA/2004/001 – Reporting Adverse Incidents and disseminating Medical Device Alerts Lincolnshire County Council Social Services Directorate Medication Policy and Good Practice Guide for Homecare Workers operating in a Service User’s Home.

If you would like a copy of this policy/procedure in a different format or another

language, please contact your Unit Manager

service area: communities directorate adult · pdf fileappendix 5 medication administration...

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