Risk Assessment for
Medicines Management in the Domiciliary Setting (Adult Services)
DOCUMENT NO: / DN195
Lead author/initiator(s):
(enter job titles) / Ann Darvill, Principal Pharmacist
Pippa Scrimshaw, Specialist Pharmacy Technician
Developed by:
(enter Team/Group etc.) / Lead authors in consultation with the Unplanned Care Managers and Lead Extra Care Sheltered Housing/Day Care
Approved by:
(enter management group/committee) / Clinical Medicines Team
Approval date: / 26th September 2014
Review date: / September 2016
Version no: / 2.1
For office use only:
Ratified by:
(enter Board of Directors or Sub-committee of BoD)
Date ratified:
Version Control And Revisions:
1 / First published / Enter date that document was first published
Version / Page/Para No. / Description of change / Date approved
2.1 / Pages 3-8 / Formatting change / 26-09-2014
Q4 / Additional question / 26-09-2014
Q19 / Addition of “process set up for disposal” / 26-09-2014
Q26 / Wording changed for clarity / 26-09-2014
Appendix 2 / Addition of service user’s details / 26-09-2014
THIS IS A CONTROLLED DOCUMENT
Whilst this document may be printed, the electronic version maintained on the CCS NHS Trust Intranet is the controlled copy. Any printed copies of this document are not controlled.
© Cambridgeshire Community Services NHS Trust. Not to be reproduced without written permission.

Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Peterborough, Luton and Suffolk

26th September 2014 version: 2.1Page 1 of 10

Risk Assessment for

Medicines Management in the Domiciliary Setting

Name of service user:…………………………….Address…………………………………………….Date of Birth…………….NHS No………………………

……………………………………………

Assessed by……………………………… ………Date:……………...... Must be reviewed annually or sooner if health or medication alters

DOCUMENT CONTROL SHEET

Purpose and Scope of document: / To serve as a tool for identifying and assessing the risks associated with assisting adults with medicines in the domiciliary setting.
This Risk Assessment is for implementation by Registered nurses (RN), pharmacy staff, doctors, designated unregistered staffassessing risks associated with medicines when assistance is to be provided by unregistered staff in the domiciliary setting.
It should be used when Trust staff who are not registered health professionals are required to provide such assistance.
This is not intended for use by registered health professionals who administer medicines such as injections as part of their professional role.
Dissemination: / Business Managers Care at Home Division; Cambridgeshire County Council training and contracts departments; Medicines Management Team; Assistant Manager Workforce Development.
Accessibility: / CCS NHS Trust intranet
CCS NHS Trust public-facing website:
Implementation: / For implementation by Registered nurses (RN), pharmacy staff, doctors, designated unregistered staffassessing risks associated with medicines when assistance is to be provided by unregistered staff in the domiciliary setting.
Review: / September 2016
This document supports (enter Standards and Legislation): / CQC Guidance about compliance, Essential standards of quality and safety Outcome 9
Department of Health 2006, Our Health, Our Care, Our Say: A New Direction For Community Services
Key related documents: / CCS NHS Trust Policy: Assisting people with prescribed medication in the domiciliary setting

DN195 Risk Assessment for Medicines Management in the Domiciliary Setting (Adult Services) V2.1

Review Date: September 2016Page 1 of 10

Risk Assessment for

Medicines Management in the Domiciliary Setting

Name of service user:…………………………….Address…………………………………………….Date of Birth…………….NHS No………………………

……………………………………………

Assessed by……………………………… ………Date:……………...... Must be reviewed annually or sooner if health or medication alters

Risk Assessment for

Medicines Management in the Domiciliary Setting

Name of service user:…………………………….Address…………………………………………….Date of Birth…………….NHS No………………………

……………………………………………

Assessed by……………………………… ………Date:……………...... Must be reviewed annually or sooner if health or medication alters

Part 1 – If the answer to any question is NO, action is required

If NO what action is required? / Date action taken / Changes made& action completed? / Further actions or comments? / Date complete
Yes
() / No
(x) / N/A / Yes
() / No
(x) / date
1 / Is there a current medication list on record for the service user?
2 / Are all medicines clearly labelled?
3 / Do the labels correspond with the current medication list?
4 / If service user has a dosett box or blister pack can they open it themselves? (self administration only)
5 / If the family is involved in ordering or assisting with medication, is this still appropriate?
6 / Are all non-fridge medicines kept in a cool, dry place in their original containers, including creams etc?
7 / Are medicines requiring low temperature storage kept in the refrigerator?
8 / Are any aerosol medicines/ pressurised containers kept away from heat sources?
9 / Are all medicines within their expiry dates?
10 / Has expired and unwanted medication been removed from the premises?
11 / Is it safe for the service user to have access to their medications? E.g. to reduce the risk of overdose etc
12 / If relevant, is the service user aware of the risks associated with use of large quantities of liquid or white soft paraffin products? (N.B. fire hazard if dressings come into contact with heat source)
13 / Are the necessary precautions in place if oxygen in the home? (N.B. fire hazard if people smoke in the room, open fires etc)
14 / Is any tubing tucked safely away?
15 / If any medicines are left out for the service user to take themselves at a later time, are appropriate arrangements in place? (i.e. risks considered, care plan, staff and family awareness etc)

Potential Hazard

/ If NO what action is required? / Date action taken / Changes made &action completed? / Further actions or comments? / Date complete
Yes
() / No
(x) / N/A / Yes
() / No
(x) / date
16 / As-required medicines – Are there clear instructions regarding when they are to be used, the correct dose and maximum daily dose or minimum frequency?
17 / Do all medicines have the same dose at the same time every day?
(e.g. for weekly or monthly doses, reducing or otherwise changing doses answer “No” )
18 / Warfarin – is the yellow book or latest blood test result and dosage instruction always available?
19 / Patches – Are there clear instructions regarding
- How to apply them
- How often to change them
- Where on the body to place them
- Whether this needs to be moved around the body
- Do staff have a clear method of recording when the previous patch was removed
- process set up for disposal
20 / Methotrexate
- Are the tablets 2.5mg strength?
- Is the dose clear in terms of number of tablets?
- Is it clear that the dose should be taken once a week?
- Is it clear which day of the week it should be taken?
21 / Insulin
- If delegated to care staff, is the relevant training and support in place? (on an individual service user basis)
-Is the type and dose clear for each time of day when due?
-Is the dose stable and unchanging from day to day?
22 / Injectables
– Is the relevant support from healthcare professionals in place?
23 / Are there proper facilities (sharps boxes) for the disposal of syringes for those clients who inject?
24 / Liquid medicines, sachets, granules
– is the most appropriate measure available for use, i.e. 5ml spoon or oral syringe of the nearest size to the dose to be given?
25 / Are all medications presented as tablets to be swallowed whole?
Answer “No”for sublingual tablets, sprays, patches, melts, orodispersible tablets, buccal tablets.

Part 2 If the answer to any question is YES, action is required

Potential Hazard

/ Yes
() / No
(x) / If YES what action is needed? / Date action taken / Changes made
& action
completed? / Further actions or comments? / Date complete
Yes
() / No
(x) / date
26 / Are there any of the hazardous medicines listed in Appendix 1? These should be managed carefully and should not be administered by pregnant women
27 / Other hazard? Please specify.
(e.g. security risk)
28 / Level 3 task required, e.g.
Suppository, pessary, oxygen, medicines via PEG, Insulin – please specify.

DN195 Risk Assessment for Medicines Management in the Domiciliary Setting (Adult Services) V2.1

Review Date: September 2016Page 1 of 10

Appendix 1

Aldesleukin / Alemtuzumab / Alitretinoin
Altretamine / Amsacrine / Anastrozole
Arsenic trioxide / Asparaginase / Azacitidine
Azathioprine / Bacillus Calmette-Guerin / Bexarotene
Bicalutamide / Bleomycin / Busulfan
Capecitabine / Carboplatin / Carmustine
Cetrorelix acetate / Chlorambucil / Chloramphenicol
Choriogonadotropin alfa / Cidofovir / Cisplatin
Cladribine / Colchicine / Cyclophosphamide
Cytarabine / Ciclosporin / Dacarbazine
Dactinomycin / Daunorubicin HCl / Denileukin
Dienestrol / Diethylstilbestrol / Dinoprostone
Docetaxel / Doxorubicin / Dutasteride
Epirubicin / Ergonovine/methylergonovine / Estradiol
Estramustine phosphate sodium combinations / Estrogenprogestin / Estrogens, conjugated
Estrogens, esterified / Estrone / Estropipate
Etoposide / Exemestane / Finasteride
Floxuridine / Fludarabine / Fluorouracil
Fluoxymesterone / Flutamide / Fulvestrant
Ganciclovir / Ganirelix acetate / Gemcitabine
Gemtuzumab ozogamicin / Gonadotropin chorionic / Goserelin
Hydroxyurea / Ibritumomab tiuxetan / Idarubicin
Ifosfamide / Imatinib mesilate / Interferon alfa-2a
Interferon alfa-2b / Interferon alfa-n1 / Interferon alfa-n3
Irinotecan HCl / Leflunomide / Letrozole
Leuprolide acetate / Lomustine / Mechlorethamine
Megestrol / Melphalan / Menotropins
Mercaptopurine / Methotrexate / Methyltestosterone
Mifepristone / Mitomycin / Mitotane
Mitoxantrone HCl / Mycophenolate mofetil / Nafarelin
Nilutamide / Oxaliplatin / Oxytocin
Paclitaxel / Pegaspargase / Pentamidine isethionate
Pentostatin / Perphosphamide / Pipobroman
Piritrexim / Pethionate / Podoflilox
Plicamycin / Prednimustine / Podophyllum resin
Procarbazine / Progesterone / Progestins
Raloxifene / Raltitrexed / Ribavirin
Streptozocin / Tacrolimus / Tamoxifen
Temozolomide / Teniposide / Testolactone
Testosterone / Thalidomide / Thioguanine
Thiotepa / Topotecan / Toremifene citrate
Tositumomab / Tretinoin / Trifluridine
Trimexate glucuronate / Triptorelin / Valganciclovir
Uracil mustard / Valrubicin / Vidarabine
Vinblastine sulfate / Vincristine sulphate / Vindesine
Vinorelbine tartrate / Zidovudine

Potentially hazardous medication

Caution should be taken when handling any of the medications listed below. Names in bold denote they are more likely to be found in the community. Please handle these tablets with caution and wear gloves if needing to assist a service user.

NB: This list contains various hormonal preparations including Hormone Replacement Therapy (HRT)

DN195 Risk Assessment for Medicines Management in the Domiciliary Setting (Adult Services) V2.1

Review Date: September 2016Page 1 of 10

Appendix 2

Name of service user:…………………………….Address…………………………………………….

Date of Birth…………….…. NHS No…………………..……………

Please print, sign and date when you have read and understood what is in the medication risk assessment.

Print name / Signature / Date

DN195 Risk Assessment for Medicines Management in the Domiciliary Setting (Adult Services) V2.1

Review Date: September 2016Page 1 of 10