Administration of Medication

1.0Introduction:

The appropriate administration of medicines/tablets is generally crucial to the well being of the Service user.

2.0Objective:

To ensure that Carers and others shall be aware of their duties or otherwise regarding the administration of medication

The National Minimum Standards for Domiciliary Cars Agencies, (Standard 10) states:-

“ The Agency’s policy and procedures on medication and health related activities protect service users and assist them to maintain responsibility for their own medication and to remain in their own home, even if they are unable to administer their medication themselves”

Regulation 14 of the Domiciliary Care Agencies Regulations 2002, require the Registered person to :-

Assess how much help a service user will need to take prescribed medication and to provide care workers with written procedures for the administration of medication (14(6(b)

Make arrangements for the safe handling of medicines in the course of providing personal care to service users(14(7))

Provide domiciliary care workers with training to ensure safe systems of working and to prevent harm (14(8),(9))

Prepare a written plan that meets the needs of the service user, and is subject to review (14(20,(3),(4)) Care Plan F/103

3Roles and Responsibilities of Briarcare Ltd

Registered Manager

It is the responsibility of the registered manager to ensure a care plan and assessment is carried out on the individual service user.

It is then therefore their responsibility to ensure that the level of assistance required is appropriate and that all staff receive the appropriate training.

It is the registered manager’s responsibility to ensure all appropriate documentation is recorded and upto date.

Care Worker:

Carers have a responsibility to assist and enable a service user to live independently in the community. A carer has a variety of responsibilities that includes assisting with personal care, housework, shopping etc.

Carers have a responsibility to ensure a service user takes their medication in accordance with the care plan. Carers have a responsibility to follow the care plan and NOT to do anything that is not written down.

Care Assessor:

The care assessor is responsible for carrying out a detailed and thorough assessment of the individual service user needs.

The care assessor is responsible for liaising with the registered manager the level of assistance required and the appropriate level of training for the care staff.

The care assessor is responsible for updating and reviewing care plans at least every 12 months or sooner if required.

Roles and Responsibilities of Health Care Professionals:

General Practitioner (GP)

A GP has responsibility to ensure all their patients receive the appropriate health care they require. A GP is responsible for prescribing medication for an individual service user to treat, prevent or alleviate medical conditions.

It is the GP’s responsibility to communicate to the registered manager any changes within medication immediately. It is also expected that a GP will write on the service users care plan any changes regarding medication.

Care workers need to be aware that a service user may also be prescribed medication from another healthcare professional such as a dentist, specialist nurse or specialist hospital staff. It is vital this information is written on theCare Plan F/103; if no instructions are written or communicated to the registered manager the care worker MUST NOT assist/administer the medication and report this immediately to the office.

Pharmacists:

A pharmacist has responsibility to ensure all medications are supplied in accordance with the prescription. Pharmacist can only supply prescription only medication in receipt of a prescription.

A pharmacist will arrange with the service user collection instructions as well as providing detailed information regarding the prescription.

The pharmacist has a responsibility to label all medication, and by law the label should contain the five following features…

The name of the individual for whom the medicine was prescribed

Directions for use

Date of supply

Name and address of supplier

The wording ‘Keep out of reach of children’

Other important information that may be found on a prescription is…

Use by date

Special instructions, such as take with food, on an empty stomach etc

Warnings or cautions – Make cause drowsiness, do not drive etc

District Nurses:

District nurses are registered nurses who have received specialist training to enable them to meet the large variety of community care requirements. District nurse perform a variety of tasks within the community. This may include…

Assisting with assessments

Education and advice

Health promotion

Identifying needs

Support

Administer invasive techniques

Apply dressings and bandages

District nurses play an important role in community care as they offer support and advice on issues such as Pressure area care, continence, Diabetes, Parkinson’s etc.

Care workers should note that some nurses have received specialist training which enables them to prescribe certain medication.

Working within the community care staff will work along side a variety of specialist nurses such as, stoma nurses, palliative care nurses etc.

Supply of Medicines:

  • All medication will be supplied by the GP or local pharmacy.
  • Care workers can ONLY collect routine medicines from the pharmacy if identified and stated on the care plan to do so.
  • Care workers can only collect a repeat prescription is identified and stated on the care plan.
  • If medication is collected by a care worker this must be recorded on the care plan and the care worker must record the time and date of collection.
  • Care workers must return medicines immediately once collected.
  • Care workers must NOT store medication outside the service users home i.e. in the car, or carers house overnight

Storage of medicines:

  • The care plan F/103 must detail to the care worker where the medication is stored in the service users home.
  • The care plan F/103 must be made accessible to all care workers when they arrive in a service user’s home.
  • The care assessor must risk assess the area where medication is to be stored. Ensuring medicines are in easy reach, stored at correct temperature, stored away from chemicals, away from light sources and away from children and pets.
  • The care assessor must ensure that the medicines are either in an approved monitored dosage system/compliance aid or in the original packaging from the dispensing pharmacy.
  • If medication is unlabelled or stored differently to the care plan, care workers MUST NOT assist and must contact the office immediately and speak to the registered manager.
  • Medicines must not be hidden from the service user unless in exceptional circumstances where it is in the best interests of the service users health and safety and clear documentation is in place.
  • Where medication is hidden the care plan must be drawn up in consultation with the care assessor, registered manager, family members and health care professionals.
  • In an emergency if a care worker feels the service user’s health and safety is at risk then the care worker may hide medication on a temporary basis. This must however, be discussed with the registered manager immediately (no later than the end of their run). The manager will then inform the necessary carers and review the care plan immediately in consultation with family members and health care professionals.
  • Medication must only be in the original packaging or monitored dosage systems/compliance aids.

Care workers are not permitted to administer medication out of compliance aid/monitored dosage system if this has not been filled by a pharmacist or the dispensing surgery

Medication must only be in the original packaging or monitored dosage systems/compliance aids.

  • Care workers are not permitted to administer medication out of compliance aid/monitored dosage system if this has not been filled by a pharmacist or the dispensing surgery.
  • In circumstances where relatives fill compliance aid/monitored dosage system, the care assessor must identify the risks and record this on the care plan after consultation with the registered manager.
  • Care workers can only administer medication out of a compliance aid/monitored dosage system filled by a family member if clearly stated on the care plan. If the aid has been filled by a family member and this is not stated on the care plan, the care worker MUST NOT administer the medication and MUST contact the office immediately and speak to the manager.
  • Care workers MUST NOT fill compliance aids/monitored dosage systems under any circumstances.

The removal of tablets from original packaging from pharmacists and the dispensing GP surgery (secondary decanting) should be discouraged. In exceptional circumstances where the registered manager and healthcare professionals have agreed this to happen, a detailed risk assessment must be carried out. In addition to this the care workers involved must receive in-depth training and must be assessed in the administration of this medication by the care assessor. Only when the care worker is deemed competent and the assessmentis recorded on file then the carer may administer medication from original packaging.

Carer intervention:

  • The care plan F/103 must clearly state what intervention is required by a care worker.
  • The care worker must receive the appropriate training to enable them to assist and administer medication. This training must be documented in the care workers training file.
  • The care worker must be assessed administrating medication by the care assessor or manager and must be deemed as competent to do so. A record of this assessment must be recorded in the care workers training and development file as well as their personnel file.
  • Where appropriate and possible the service user should be encouraged to take their own medication.
  • Care workers may be required to administer oral medication such as, tablets, capsules, liquids, powders and lozenges. Care workers must adhere to the instructions on the compliance aid and ensure the correct dosage is given at the correct time. Staff to ensure disposable gloves and aprons is worn at all times.

Care workers may administer skin treatments in accordance with the instructions if recorded on the care plan. Staff must ensure disposable gloves are worn at all times in the application of lotions, creams, skin patches and scalp applications

The use of compliance aids may be helpful in the administrating of eye, nose, ear preparations and inhalers. The care assessor should encourage the service user to administer this type of medication themselves, with or without the help of compliance aids.

  • In the circumstances where a care worker may be required to assist a service user to take their inhaler, the care worker must receive further training from a healthcare professional. This may be a district nurse or a qualified nurse in a controlled training environment. The care worker must then be assessed and deemed as competent before administration is allowed. This must then be recorded in staff personnel and training files.

In the case of eye preparations staff must receive further training from a healthcare professional. This may be a district nurse or a qualified nurse in a controlled training environment. The care worker must then be assessed and deemed as competent before administration is allowed. This must then be recorded in staff personnel and training files.

  • In the case of ear preparations staff must receive further training from a healthcare professional. This may be a district nurse or a qualified nurse in a controlled training environment. The care worker must then be assessed and deemed as competent before administration is allowed. This must then be recorded in staff personnel and training files. (There are no compliance aids to assist a service users to self medicate).
  • In the case of nose preparations, although rare, staff must receive further training from a healthcare professional. This may be a district nurse or a qualified nurse in a controlled training environment. The carer must then be assessed and deemed as competent before administration is allowed. This must then be recorded in staff personnel and training files.
  • In the case of eye, ear and nose preparations, the date of opening must be written on the label by the person starting the new container/packet. This medication must be used up within 28 days of opening. In the event this is not used up the medication must be returned to the pharmacy or dispensing surgery.

Full records of any administration or assistance shall be securely maintained and retained F/103, ( page 21 Medication Record )

There are three levels of medication assistance.

  1. General Support
  2. Administering medication

3. Administrating Medication by Specialist Techniques

1: General Support

General support is when the service user takes responsibility for their own medication. The types of intervention required by the carer will depend on the service user’s capabilities and abilities.

The support given may include some or all of the following:

Requesting repeat prescriptions from the GP

Collecting medicines from the community pharmacy/dispensing GP surgery

Disposing of unwanted medicines safely by return to the supplying pharmacy/dispensing GP practice (when requested by the service user).

An occasional reminder or prompt from the care workers to an adult to take their medicines. (A persistent need for reminders may indicate that a service user does not have the ability to take responsibility for their own medicines and should prompt review of the service user plan).

Reading the label to remind the service user of the correct dose for their medication. This must be recorded on the daily task sheet (comment sheet) and reported to the manager.

General support needs should be identified in the care plan/service user plan. On-going records will also be required in the continuation notes when care needs are reviewed.

Adults can retain independence with medication from the assistance of a compliance aid. These should be considered when a service use finds opening packs and lids off bottles difficult. These can also be useful when a service user has difficulty remembering is they have taken their medication.

Compliance aids and monitored dosage systems are usually filled by the pharmacist or dispensing GP. This service is sometimes available free of charge if the service user meets the criteria under the Disability Discrimination Act.

If the compliance aid/monitored dosage system is filled by anybody other than the pharmacist or dispensing GP, an assessment will be carried out and if assessed as safe this will be recorded on the care plan in consultation with the manager and healthcare professionals.

2: Administering Medication

The assessment carried out by the care assessor may identify that the service user is unable to take responsibility for their own medication and therefore needs assistance. This can be a result of impaired cognitive awareness but can also result from a physical disability.

Care workers may administer prescribed medication (including controlled drugs) to a service user with consent, so long as this is in accordance with the prescriber’s directions. (The Medicines Act 1968).

If medication is to be given in invasive techniques the care worker will need specialist training as detailed in level 3, administrating medication by specialist techniques.

The service user must agree to have the care worker administer medication and consent should be documented in the service user plan. If the service user is unable to communicate informed consent, the prescriber must indicate formally that the treatment is in the best interest of the individual. This must also be recorded in the service user care plan. (Reference Department of Health documentation ‘Seeking consent: working with people with learning difficulties’).

Administration of medication may include some or all of the following:

When the care worker selects and prepares medicines for immediate administration, including selection from a monitored dosage system or compliance aid

When the care worker selects and measures a dose of liquid medication for the service user to take.

When the care worker applies a medicated cream/ointment; inserts drops to ear, nose or eye; and administers inhaled medication.

When the care worker pus out medication for the service user to take themselves at a later (prescribed) time to enable their independence.

Care workers must only administer medication that has been prescribed. Care workers should only administer medication from its original container complete with label from the pharmacist or dispensing GP Surgery. This includes compliance aids and monitored dosage systems.

Service users discharged from hospital may have medication that differs from those retained in the home prior to admission. Briarcare will provide additional support for this and a care assessor will carry out an immediate review.

Only care workers that has been trained and assessed as competent can administer medication.

3: Administrating medication by Specialist techniques:

Following a detailed assessment carried out by a healthcare professional; in exceptional circumstances a care worker may be asked to administer medication by a specialist technique. Specialist techniques may include the following…

Insulin by injection

Rectal administration, e.g. diazepam (epileptic seizures), suppositories, etc.

Administration through a Percutaneous Endoscopic Gastrostomy (PEG)

This also includes nebulising machines and feeds, such as PEG feeds.

In the event this task is delegated to the care worker, the healthcare professional must train the care worker and be satisfied that they are competent and safe to administer this type of specialist medication. This must then be recorded on the care workers personnel and training file.

The care worker has the right whether trained or untrained to refuse to assist with the administration of medication by specialist techniques if they do not feel comfortable or competent to do so.