MEDICATION MANAGEMENT OLDER – OLDER PERSONS DAY CARE 06/09 – WEB V2.
MEDICATION MANAGEMENT PRACTICE GUIDELINES
OLDER PERSONS DAY CARE
IMPORTANT NOTE
The medication management practice guidelines for Older Persons Day Care require some revision which is currently in progress. This revision is necessary to fully reflect the key changes to the main Medication Management policy document.
However the guidelines continue to detail the safe operating procedures for managers and staff working in Older Persons Day Care services.
Managers must ensure that all staff working in Older Persons Day Care are aware of, and comply with the current practice guidelines which must be used in conjunction with the main Medication Management Policy. Managers should also ensure that all practice guidance documents printed include this 'caution' page.
Every practice guide has this front cover directing staff to refer to the key areas of the revised medication management policy relevant to their service. Managers are responsible for ensuring staff are aware of these changes and the implications for their service.
REFER TO MAIN MEDICATION MANAGEMENT POLICY:
The main changes contained within the medication management policy that will replace those contained within the practice guidelines for Older Persons Day Care are:
Medication Management Policy Section 5:
- Medication Consent and capacity
OLDER PERSONS DAY CARE
CONTENTS
PART ONE
General information
1. How to use these guidelines
2. Responsibility of the staff
3. Resources
4. Levels of support
5. Liability
6. Consent and capacity
PART TWO
Approved procedures and practices for staff in
older persons day care
1. Principles
2. Record keeping
3. Receiving medication
4. Storage of medication
5. Disposal of medication
6. Administration of medication
7. Refusal of medication
8. Disguising medication
9. Use of the medication administration record
10. When required or prn medication
11. Types of medication and methods of administration
12. Diagnostic testing and monitoring
13. Administration of rectal diazepam
14. Administration of buccal Midazolam
15. Administration of adrenaline for anaphylaxis
16. Medication incidents
17. References
Hampshire County Council
Practice Guidelines for Older Persons Day Care
PART ONE
General information
1. How to use these guidelines
These guidelines, together with the Medication Policy, describe how service users may be supported by staff, within a day care unit, to use their medication effectively. They are intended to provide a comprehensive guide to clarify the scope of the medication policy for staff working in Hampshire County Council Older Persons’ Day Care. Other services have specific procedural guidance and these day care guidelines must never be applied to other care services.
2. Responsibility of the staff
The Manager
· Is responsible, with the support of the service manager, for ensuring that all staff are aware of the systems for the control and administration of medication and how these are implemented
· Must ensure that all medication is stored appropriately while in the unit
· Must ensure that all medication, including controlled drugs are administered only by designated staff.
· Must ensure that all residents have a current care plan and associated risk assessments
The Designated Staff
· Must know the limitations of the their role in relation to medication
· Must follow the policies and procedures within the unit
· Must have undergone suitable training for their role
· Must immediately report any discrepancies in the records, errors with medication or changes in a service user’s condition, to the duty manager
· Carers must not administer intrusive medication unless they have had specific training from an appropriately qualified professional, and are competent to do so.
3. Resources
All staff must have access to the current medication policy and guidelines for the Older Persons’ day care Service
Each unit must have a copy of ‘Handling Medication in Social Care’ from the Royal Pharmaceutical Society of Great Britain’.
online here. Additional information can be found in: Managing medicines in care homes (National Institute for Health and Care Excellence)
4. Levels of support
The levels of support available to service users are defined in the medication policy as:
Prompt: to remind a service user verbally or, where appropriate, physically, to take their medication.
Assist: to support the service user to access their medication so they can administer it themselves by the prescribed route.
Administer: to give the service user medication via the prescribed route.
A service user’s needs may change and it is essential that these needs are monitored and assessed regularly and an on-going risk assessment is in place..
Risk assessment
A risk assessment must be carried out for all new service users on entering the day service, to establish the level of support they require. For those service users who self-medicate, there must be an ongoing assessment of their continuing ability to do so.
5. Liability
The following statement has been agreed by Hampshire County Council and it’s insurers. It intends to clarify the position of staff in relation to their role when supporting service users to manage their medication needs as part of a care package or programme of care.
‘Providing that staff act in accordance with the policy and guidelines, they will be covered by the organisation’s insurance policy in the event of any complaint or action resulting in legal liability arising from duties associated with medication. Where staff act outside their contract of employment or authorised duties, or where there is fraud, dishonesty, criminal or unlawful acts, there will be no such cover’.
6. Consent and capacity
All staff have a clear responsibility to ensure they understand their role in relation to situations where an individual service user exercises their right to refuse to take medication. Where a service user is assessed not to have mental capacity to make decisions in relation to medication, staff must also be clear about their responsibility to refer this to the multi-disciplinary team.
Section 5 of the medication policy sets out the responsibilities of all staff in relation to issues of consent and capacity. If there is any need for further clarification the service manager must be involved immediately.
General principles for all staff to be aware of:
· Service users who are capable of giving or withholding consent can refuse to take medication at any time. In these circumstances staff must not attempt to administer medication
· Giving and obtaining of consent is a process not an isolated event, service users may change their minds and withdraw consent at any time. Consequently, consent must be sought before any administration
· Capacity to consent may fluctuate and must therefore be assessed continually
· Covert administration of medication for service users who are capable of giving or withholding consent is NOT permitted under any circumstances
· People who have a mental disorder must be assessed to determine their capacity to make decisions. It must never automatically be assumed that they are not able to give or withhold consent to take medication.
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PART TWO
Approved procedures and practices for staff in day care
1. Principles of Day Care
Before attending a day care centre, service users must have a medication review, to assess the continuing need of their current medication, and if possible reduce any doses which may have to be given whilst in the day care centre. This will reduce the risk of errors and incidents occurring during transport, storage and administration. Service users must also be assessed for their level of need while they are in the day care centre, the level of need will include a full risk assessment of self medication if the service user wishes to undertake this.
Before an individual is admitted for day care, the following information must be obtained:
· A list of current medication, with explicit instructions for administration, from the individual’s prescriber and main carer
· ‘When required’ medication must have details of dose, frequency and the conditions under which the medication may be given
· Consent to administer un-prescribed medication which the individual has been taking at home must be obtained from the individual’s main prescriber before the medication can be administered. An assessment of the support required by the individual whilst in the home
· Sufficient medication must be provided for the planned duration of the visit
· All medication must be in original containers provided by the pharmacy
· Useful contact details e.g. the prescriber, dispensing pharmacy
· If possible, the dispensing pharmacy should be asked to provide a printed medication s administration record sheet for use specifically in the day centre
Where it is not possible to obtain a pharmacy printed MAR sheet, it will be necessary to transcribe information onto a Medication Administration Record. The detail must be transcribed accurately, in black ink and must be signed and witnessed by the two designated staff who received the medication. It must include and must include:
· The individual’s full name, date of birth, GP, allergies
· Medication details, name, strength, form (e.g. tablets) quantity, dose, frequency and any other instructions e.g. ‘after food’
· Recorded doses, those taken or refused, quantity, time.
While a service user is at the day care centre, the daily medication routine must be as close as possible to the normal pattern for the individual. This is particularly important for the timing of doses. The following principles will apply :-
· An individual’s medication is their property. There must be procedures in place for an audit trail for the receipt, storage and administration of the medication, and on leaving the centre the service user’s or their carer must also record their receipt of the medication.
· Details of any prompting, assisting or administration support required must be clearly recorded in the care plan.
· It is the managers responsibility to ensure that designated staff are aware of the support to be given, have the appropriate training, and understand their limitations.
· Care staff must not administer medication to service users in day care unless they fully understand their role, and feel confident to do so.
2. Record keeping
There is a service requirement for recording of all medication in care homes. The Registered Manager is responsible for ensuring the appropriate maintenance of records. There must be a complete audit trail of medication within the home. The audit trail starts with the receipt of medication into the home.
Day Care centres where records are stored electronically, must comply with the Data Protection Act 1998. All medication records must be kept in accordance with the Hampshire County Council retention schedule.
Whenever a health professional is contacted for advice or information, a record must be kept of the:
· Date
· Query
· Advice given
· Action taken as a result
· The name and role of the person giving the information
· Their place of work.
· The name, role and signature of the person receiving the information
3. Receiving medication
All medication entering the centre must be recorded in accordance with procedure. All prescribed medication received into the centre is the property of the service user, and must not be given to anyone else. Records must be kept which include:
· The name of the service user
· The name of the medication
· The form, strength and quantity and route of administration of the medication.
The records can be kept on the medication administration record.
Controlled drugs must be entered in the controlled drugs register. It is good practice to enter morphine sulphate solution 10mg/5mls in the controlled drugs register, although this is not a legal requirement for this drug. This must be treated as a controlled drug within the day centre as a matter of good practice. Storage of controlled drugs within the centre must comply with the guidance in ‘The Handling of Medication in Social Care’.
All records relating to controlled drugs must be recorded in black ink for clarity.
Medication must be checked carefully against the details provided by a service user’s carer or prescriber. Any discrepancies must be sorted out immediately, with either the dispensing pharmacist or the prescriber. The manager will ensure that records are kept up to date, but will only be responsible for the medication brought in by the service user on that day.
4. Storage of medication
· A risk assessment must be carried out and recorded in the care plan, to asses the way in which the service user manages their medication. The assessment must specify if the service user’s wishes, and is capably of retaining medication in their possession whilst in the centre.
· Medication not kept in a service user’s possession must be stored in a locked cupboard.
· The registered manager must ensure that the keys to all cupboards in which medications are stored, are kept securely and are only accessible to nominated staff. An individual unit policy must detail the arrangements for key security and staff responsibility for maintaining the security
· All nominated staff must ensure that the keys are available to the succeeding designated person at the end of each shift
· Medication which must be stored between 2-8oC must be stored in a locked refrigerator kept for the purpose. The temperature must be recorded daily, and if it exceeds the limits, the pharmacist must be contacted to see if the medication are suitable for use
· External medication must be stored separately from oral medication
5. Return and Disposal of medication
· Where a service user is not independent and the day service has been responsible for holding their medication during the day, when a service user ends their session at the centre, any medication must be given to them or the person collecting them. They, or the person collecting them who must be asked to sign for the receipt of the medication.
· The details in the record must be the same as those taken when receiving the medication into the day care centre.
· A separate sheet for each service user must be used and the details recorded in black ink
· When a dose has been contaminated or not taken, it must be placed in the medication disposal box, prior to return to the pharmacy for disposal.
· All day centres must have a medication disposal (green) box,.