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9.1.8 Control Storage, Disposal, Recording and Administration of Medicines

SCOPE OF THIS CHAPTER

This chapter is for implementation within the following resource centres:

  • Craven Vale;
  • Ireland Lodge;
  • Knoll House;
  • Wayfield Avenue.


Contents

  1. Introduction
  2. Training of Care Staff
  3. Admissions from Community or Hospital
  4. Recording Medication on Arrival
  5. Administration of Medication
  6. Medicines not Normally Administered
  7. Homely Remedies
  8. Changes in Medication Dosage/Time of Administration
  9. Ordering Medication
  10. Security and Storage of Medication
  11. Disposal of Medication
  12. Monitoring and Quality Assurance
  13. Assessment Checklist


1. Introduction

The medication policy has been drawn up to provide staff with clear instructions on the correct way to handle medication. The policy must be used to train staff appropriately and be followed by all staff responsible for medication within our service. The policy has been set out into separate sections to include all areas where medication is handled. It is important to say that although we have included as much information for staff as possible, it is impossible to provide written instructions on all eventualities. Therefore, in any situation where staff find themselves unsure of what to do, advice must be sought before handling medication. This will avoid any unnecessary errors occurring.


2. Training of Care Staff

Staff will attend in-house training in order for them to understand clearly the medication policy. This training is usually delivered within the resource centre by a designated Senior Care Officer/Operations Manager. Following completion of in-house training and medication 'workbook', you will be issued with an accredited certificate.

Staff will be required to complete the 'administering medication' workbook with supervision/guidance from their line manager. This includes existing staff.

Staff will be required to undertake a yearly test with their line manager to assess competency in handling medication. A copy of each person's signature and initials will need to be kept in the establishment.


3. Admissions from Community or Hospital

It should be remembered that medication is the property of the person for whom it is prescribed. It is their right to keep and administer their medication if they wish to do so.

On admission an individual risk assessment is carried out to determine whether a service user has the ability to administer their own medication safely. If the outcome of the assessment indicates that the service user has the ability to self medicate, staff must continue to monitor medication in accordance with the assessment tool.

Where the risk assessment indicates they are unable to self administer their own medication, it must be recorded that the establishment will take responsibility and restrictive practice guidelines followed.

If a service user generally self-medicates at home, then they should be encouraged and supported by staff to continue this practice during their stay.

The service user is provided with a lockable cupboard within their room to store medication.

For planned admissions, service users must be asked to bring sufficient medication to cover the period of their stay.


4. Recording Medication on Arrival

If controlled drugs are delivered to the establishment from the pharmacist, staff will be asked to sign that they have received them.

It is essential that medication is kept in a secure environment - i.e. a locked medication cupboard or room - as soon as it arrives in the establishment, and not left in the Duty Office or any other place where it may become misplaced, taken in error or stolen.

Upon admission, a MED 1, MAR chart and PRN criteria (if necessary) are completed in accordance with the exact instructions printed on the pharmacist label.

label


All controlled drugs received into the home must be recorded in a controlled drugs register as well as on a MAR chart.

Where medicine containers state "as directed by your G.P" confirmation must be sought from the G.P on the correct dosage before administration.

If a service user is being admitted from hospital, staff should check that the medication they have brought with them corresponds with the hospital discharge summary.

In addition, the following must be recorded:

  • Date of receipt of incoming medication;
  • Name of the service user;
  • Quantity received.

Staff should also follow the above for re-ordered or newly prescribed medication.

The accuracy of this information must be checked and signed by two staff; a Senior Care Officer will check the accuracy within 24 hours.

A photograph should be taken of service users on admission. The photo will then be attached or kept with the service user's MAR chart to ensure that medicines are administered to the correct person. If a service user refuses to have their photograph taken this must be documented on their file.

If a service user has PRN medication, staff must check that there are clear instructions on when to administer. Unclear instructions must be confirmed by the G.P. before administering.

When you have received the correct information you must then write clearly the instructions on the MAR chart and the container.

If this is a cream or eye drops etc, the information should contain i.e. which leg, eye to apply and when to do so. In the case of topical creams, a body map should be completed to show exactly where they should be applied.

If a service user has their medication organised in a blister pack then a record of all medication must be recorded in the same way. The list of medication is printed on the blister pack. The difference with blister packs is that staff will not be able to identify the tablets in the blister pack.

Click here for Example Med 1

Click here for Mar Chart

Click here for Med Check on Arrival


5. Administration of Medication

While you are administering medication, avoid any distractions or situations that might lessen your concentration.

Staff can only administer medicines and treatments that are prescribed for an individual service user.

Administration of medication flowchart

Administration of medication may only be carried out by trained staff.

Administration of warfarin and Digoxin must be administered and signed by two staff - one to administer; the other to act as a witness. The witness must watch the whole process and sign the MAR chart.

Warfarin doses are often altered after a service user visits the warfarin or anti-coagulation clinic. Do not make any changes on the Mar chart or MED 1 until you have received confirmation from the clinic.

Be aware that warfarin tablets come in different doses. Instructions are written in milligrams (mgs) and not per tablet. If in doubt check it out before administration.

When the establishment takes responsibility for administering controlled drugs, this must be administered and signed for by two staff and recorded in the 'controlled drugs register'. A list of medicines classed as controlled drugs must be available within the establishment for staff to refer to.

When administering medication, staff must always check the following:

  • The name on the label matches the MAR chart and resident;
  • The name and strength of the medicine and dosage instructions on the container are the same as on the MAR chart.

If there are any discrepancies between the two sets of information, then no medication should be given until this has been clarified with either the G.P or pharmacist, and the correct details have been accurately recorded on the MAR chart.

Staff should NEVER leave medication out assuming that a service user will take it later. The wrong person could take it or it could be forgotten.

When initialling or signing a MAR chart, staff are recording that they have witnessed a service user accepting and taking a medication. NEVER sign the MAR chart until the service user has taken the medication.

Always check previous signatures for any gaps and report immediately so that this can be followed through.

Staff must refer to the PRN criteria when offering PRN medication. If PRN medication is required by a service user on a regular basis, consider asking the G.P to review the PRN status.

Clear instructions are required before staff can apply applying creams, ointments, lotions, gels etc.

Please complete a body map form to illustrate where the above medications are to be applied on the body.


6. Medicines not Normally Administered

There are some medicines that care staff would not normally be allowed to administer. They include:

  • Injections;
  • Suppositories;
  • Pessaries;
  • Medication through PEG tubes;
  • Oxygen.

There is a process that allows care workers to carry out these specialist tasks. According to the CQC, training must be provided by a health-care professional to a member of care staff, who then demonstrates their competency back to the health care professional who documents this.


7. Homely Remedies

There may be occasions where service users experience a headache, indigestion or develop a cold and have no access to medicines. In order to prevent service users being left in unnecessary discomfort, some homely remedies can be stored within the establishment for such times. Some examples of homely remedies include:

  • Senna (for constipation);
  • Simple linctus (a cough syrup);
  • Paracetamol (A painkiller);
  • Gaviscon (indigestion).

However, it is very important to remember that some medicines can interact with each other.

Staff will not have the in depth medical knowledge on the types of medicines that can adversely interact with each other. By administering the above types of homely remedies without consultation from a medical professional, this could have the potential to put service users at risk. Before any medication is provided, staff must contact a medical professional to seek advice. At night, staff can get advice from a chemist (if before 10.00pm), the out of hours district nurses, NHS 111, and IC24 Roving GPs (Knoll House and Craven Vale only) numbers should be available within the resource centres.

If advice is sought and the administration of a homely remedy is agreed, then this must be administered for a period of 2 days only. Homely remedies must be added to the MAR chart in the same way that all other medication is recorded on the MAR chart and MED 1.

Should symptoms persist for any longer than 2 days, then the service users GP must be contacted.


8. Changes in Medication Dosage/Time of Administration

Where a medication either changes dosage or is stopped by the G.P, staff must ensure the previous medication is removed from the current stock and stored in the returns cupboard.

When a medicine has been stopped, cross through the original item on the MAR chart (with a diagonal line) in a way that makes it clear it has been discontinued, but leaves the original entry still visible. The cancellation should be signed and dated. Where possible, ask the G.P to sign the amendment on the MAR chart. Ensure you record on the Med 1 the date the medication was stopped.

When the dosage has been changed, the item should then be re-added to the MAR chart on a separate line with the new directions. Remember to alter the pharmacy label on the packaging if the dosage/time of administration changes.

If a service user has blister packs, staff will not be able to identify tablets, so removing tablets is not permitted. Any changes will need to be carried out by a pharmacist. In circumstances where the G.P wants the medication changes to be immediate, then the blister pack can be taken to the chemist for the pharmacist to make the necessary changes. If the G.P is able to give staff the correct instructions on identifying medication, then changes can be completed within the resource centre.


9. Ordering Medication

Ordering medication should be complete by filling out the appropriate order form. These order forms may differ within each establishment. Make sure you are aware of the appropriate form to use.

Check that before you order medication, a member of staff has not already done this. A record should be recorded in the service users diary sheets or a copy of the order form will be on their file.

Staff must re-order medication when they notice that a service user is running low. Remember that most pharmacists will ask for at least 48 hours notice. Lack of available medication is a serious as any other error. Forgetting to order is a common reason for medication omissions.

Establishments with long-term service users will order medication on a monthly cycle.

When medication has been delivered, it is very important that you check the medication is either re-ordered medication or has been newly prescribed. Any newly prescribed medication will need to be added on to the MED 1 and MAR chart. There have been occasions where staff have assumed the delivery was re-ordered and the medication was put with a service users existing medication and never recorded on the MED 1 or MAR chart. This resulted in the service user not having this medication administered.


10. Security and Storage of Medication

It is a legal requirement that all medication held within a resource centre must be locked away. This can be in a lockable trolley, cabinet, cupboard or safe. The type of lockable facility will vary within establishments. Some medication needs to be stored in a locked refrigerator e.g. eye drops, insulin and certain creams.

Service users who self medicate must keep their medication locked away at all times. If you notice medication left out on display, this must be locked away immediately and the service user reminded about our policy.

Controlled drugs that service users self medicate can be kept in their room in a locked drawer/cupboard.


11. Disposal of Medication

Medication should be disposed of when:

  • The expiry date is reached or on the advice of the supplying pharmacist;
  • A course of treatment is finished or discontinued;
  • The service user is discharged from the Resource Centre and they do not need to take certain medications with them;
  • In the case of a death of a service user, all medication pertaining to that service user must be retained for seven days in case they required by the Coroner's Office.

Prescribed medication is the property of the service user, even when the administration and management of the medication is undertaken by staff. Staff should obtain the consent of the service user for disposal whenever possible.

All medicines for disposal should be returned to the pharmacy. A record must be retained within the Resource Centre containing the names and quantities of medication returned.

Controlled drugs should be disposed of in the same way as all other medicines but placed in a separate bag from all other medication being returned.

In circumstances when a dose of medication is refused by a service user this must be put in an envelope and placed in the returns cupboard.

Where oxygen is used, cylinders and headsets should be returned to Allied Respiratory in East Grinstead when empty or no longer required. The contact number will be held in the establishment.

Where syringes and needles are used these should be placed in "sharps" boxes after use.

MEDICATION, SYRINGES AND NEEDLES MUST NEVER BE DISPOSED OF IN REFUSE CONTAINERS.


12. Monitoring and Quality Assurance

MAR charts are checked for accuracy of signatures at least daily or as per the establishment protocol and recorded.

The accuracy of MAR charts against instructions on medication containers is checked and recorded weekly.

Any medication errors are reported and recorded on an incident form. This is then investigated by a manager.

Medication records are inspected as part of the council’s in-house Quality Assurance visits, undertaken by the Care Standards Officer.

Manager's quality assurance systems will inspect medication records every three months.


13. Assessment Checklist

Click here for the Assessment Checklist

End