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9.6.2 Storage, Administration and Disposal of Medication

SCOPE OF THIS CHAPTER

This policy applies to Tower House, Craven Vale, Ireland Lodge and Wayfield Ave Day Centres and not Day Centres for people with a learning disability.

This chapter was added to the manual in December 2011.


Contents

  1. Introduction
  2. Aims and Objectives
  3. General Principles of Safe & Appropriate Handling of Medicines
  4. Storage of Medication
  5. Administering of Medication
  6. PRN (As Required) Medication
  7. Over the Counter / Homely Medicines
  8. Medication not Normally Administered by Care Staff
  9. Disposal of Medication
  10. Manager’s Responsibility / Quality Assurance / Audit


1. Introduction

  • These guideline are intended to provide all staff concerned with the delivery of day services to members with a set of practice standards relating to the administration of medication.


2. Aims and Objectives

  • Embody the principles of the NHS and Community Care Act 1990, the Health & Social Care Act 2008, the NHS Plan 2000, the National Framework for Older People 2001 and guidance from The Royal Pharmaceutical Society and applies to all employees of Brighton and Hove City Council;
  • To ensure that all staff are aware of the procedures, systems and arrangements that must be in place regarding the storage, administering and disposing of medication;
  • That all staff receive the appropriate training to enable them to become competent in the administration of medication;
  • Aim to ensure that members receive appropriate help and support to manage their own medication wherever possible;
  • Aims to ensure where a risk assessment identifies that a member is unable to manage or administer their own medication, they, receive the appropriate support and assistance;
  • Define the principles of good practice which are to be applied to the administration of all medication.


3. General Principles of Safe & Appropriate Handling of Medicines

  • As part of the assessment for Day Services, staff should have discussions with the member and where appropriate informal carers to determine whether the member will need to take medication whilst attending day services;
  • If a member generally self medicates at home, then they should be encouraged and supported by staff to continue this practice when attending day services, unless there are issues around misadministration due to increased vulnerability;
  • Staff should complete a risk assessment to determine the level of support a member will require to ensure they receive the correct medication;
  • Members that self medicate must be supported to ensure their medication is kept secure. A risk assessment should be completed to highlight any risk to members holding their own medication;
  • Accurate records must be kept for each member within the service that gives a full account of medicines administered by staff;
  • Members and carers to inform staff of any medication changes, key workers to check for updates monthly. If a risk assessment high lights that the member may not be able to give accurate information Key worker will contact carer/care agency or GP monthly to check prescription;
  • It is important that the member give their consent and their view must be respected. Any refusal to take medication should be recorded and appropriate advice sought;
  • Administration of medication will be delivered in a way which respects the dignity, privacy, personal and cultural preferences of the member;
  • Staff must report any errors that occur when administering medication and ensure they access appropriate advice from a G.P, pharmacist or Medical Practitioner to determine further action needed. Staff must complete incident reports following any errors and inform managers.


4. Storage of Medication

  • It is a legal requirement that all medication held for staff to administer within the day service must be kept in a secure (locked) cabinet, cupboard or safe. The type of lockable facility will vary within establishments. Some medication needs to be stored in a refrigerator e.g. eye drops, insulin and certain creams. There should be a designated lockable box kept within the refrigerator for this purpose;
  • Staff should complete a risk assessment where members choose to hold their own medication to ensure there is no risk that another member could take it;
  • Staff must be mindful to keep medication safe and not leave it unattended when escorting members using the service’s transport.


5. Administering of Medication

  • Each Day Service should have a Medication Folder which is kept in a locked cabinet which contains:
    • Copy of this policy;
    • List of Control Drugs;
    • List of Staff Names with their initials;
    • Med 1’s for members with photographs if permitted;
    • All MAR Charts, PRN Criteria and any other information relevant to the administration of medication.
  • Before staff can administer any medication, A Med 1, Mar Chart and PRN Criteria Form (if required) must be completed in accordance with the exact instructions as printed on the pharmacy label. A second member of staff should check and sign that the information is accurate;
  • A Photograph of the member should be placed with the Med 1;
  • Staff must only administer medicines and treatments that are prescribed for an individual member;
  • Staff should only administer medication from the original pharmacy packaging i.e. blister pack, bottles or boxes with a clear pharmacy label;
  • Where medicine containers state “as directed by your G.P.” confirmation must be sought from the G.P. on the correct dosage before administration;
  • When medication is received that is not clearly labelled, staff will not be able to administer medication and the GP and next of kin will need to be contacted. This should be explained to the member;
  • All Controlled Drugs must be recorded in a Control Drug Book as well as Med 1 and Mar Chart;
  • Administration of Warfarin, Digoxin and Controlled Drugs 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. (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);
  • Staff should avoid any distractions or situations that might lessen concentration whilst administering medication;
  • When administering medication, staff must always check the following:
    • The name on the label matches the MAR chart and member;
    • The name and strength of the medicine and dosage instructions on the container are the same as on the MAR chart.
  • When initialling and signing a MAR chart, staff are recording that they have witnessed a member accepting and taking a medication. NEVER sign the MAR chart until the member has taken the medication;
  • If a member declines to take their medication this should be recorded on the MAR Chart and recording sheet. Where the member has informal carers / relatives they should be informed where necessary;
  • Staff should never leave medication out or unattended assuming that the member will take it later (the wrong person could take it, or it could be forgotten);
  • Gloves to be worn to administer eye drops, ear drops and creams.


6. PRN (As Required) Medication

  • A PRN Criteria Form must be completed for any medicines that members take ‘as required’ such as pain relief or inhalers. If instructions are unclear about the amount or how often this medication can be given, advice should be sought from G.P, Pharmacist or other medical practitioner before staff administer it. Staff need to ensure they inform informal carers/relatives if a person has taken such medication on their return home to prevent an overdose situation.


7. Over the Counter / Homely Medicines

  • Staff are not permitted to purchase over the counter / homely medicines for members such as pain relief or cough linctus;
  • If staff are required to administer such medicines, they should only do so from original packages and after receiving a written request from the next of kin/carer or if the member signs a consent form. The staff member must ensure that clear written instruction has been received (i.e. how much and how often) and record and sign for once administered. If the service is responsible for administering any other medication, staff should consult a G.P, Pharmacist or other medical practitioner to ensure that it is safe for the member to take the OTC medicine. (Remember some medicines interact badly with each other and there may be a reason why the G.P. has not prescribed it).


8. Medication not Normally Administered by Care Staff

  • There are some medicines that Care Staff would not normally be allowed to administer. These include:
    • Injections;
    • Suppositories;
    • Pessaries;
    • Medication through PEG tubes;
    • Oxygen.
  • Staff would need to receive individual training from a Health Care Professional who would agree that the Care Worker was competent to complete the task.


9. Disposal of Medication

  • If a member declines to take their prescribed medication, this should be placed in an envelope with their name and details of the medication. This should be placed safety in the medication storage facility / cupboard for return to a pharmacy each month;
  • If a member leaves the service where medication is being held for them, this should be returned to them or sent to a pharmacy. Details of the medication and quantity should be recorded and placed in the member’s file.


10. Manager’s Responsibility / Quality Assurance / Audit

  • It is the responsibility of the manager of the service to ensure:
    • That there is always appropriately trained staff available to administer medication;
    • That risk assessments are completed with any member who needs to take medication whilst using the service;
    • That risk assessments are reviewed at least every six months or as necessary if concerns are raised;
    • That members have been made aware of the basic principles staff have to follow when administering medication i.e. the need for medicines brought into the service being in their original packages with a pharmacy label;
    • That staff follow the correct procedures when administering medication and that appropriate records are kept within the service.
  • The Manager of the service should check individual MED 1’s and MAR Charts for accuracy of information and signatures at least monthly;
  • The Manager will investigate any medication errors to ensure the staff member is competent to administer medication.

End